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epilepsy
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{{redirect2|Epilepsia|Epileptic|the journal|Epilepsia (journal)|the novel|Epileptic (graphic novel)}}{{pp-protected|reason=Persistent ()|small=yes}}{{good article}}{{Use dmy dates|date=February 2017}}







factoids
Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures.JOURNAL, Chang BS, Lowenstein DH, Epilepsy, The New England Journal of Medicine, 349, 13, 1257–66, September 2003, 14507951, 10.1056/NEJMra022308, JOURNAL, Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshé SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S, ILAE official report: a practical clinical definition of epilepsy, Epilepsia, 55, 4, 475–82, April 2014, 24730690, 10.1111/epi.12550,weblinkweblink" title="web.archive.org/web/20140609024638weblink">weblink dmy-all, dead, 9 June 2014, Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking. These episodes can result in physical injuries, including occasionally broken bones. In epilepsy, seizures have a tendency to recur and, as a rule, have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to their condition.The cause of most cases of epilepsy is unknown. Some cases occur as the result of brain injury, stroke, brain tumors, infections of the brain, or birth defects through a process known as epileptogenesis. Known genetic mutations are directly linked to a small proportion of cases.JOURNAL, Pandolfo, M., Genetics of epilepsy., Seminars in Neurology, 31, 5, 506–18, Nov 2011, 10.1055/s-0031-1299789, 22266888, Epileptic seizures are the result of excessive and abnormal neuronal activity in the cortex of the brain.JOURNAL, Fisher R, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J, Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE), Epilepsia, 46, 4, 470–2, 2005, 15816939, 10.1111/j.0013-9580.2005.66104.x, The diagnosis involves ruling out other conditions that might cause similar symptoms, such as fainting, and determining if another cause of seizures is present, such as alcohol withdrawal or electrolyte problems. This may be partly done by imaging the brain and performing blood tests. Epilepsy can often be confirmed with an electroencephalogram (EEG), but a normal test does not rule out the condition.BOOK, Longo, Dan L, vanc, Harrison's principles of internal medicine, 2012, McGraw-Hill, 978-0-07-174887-2, 3258, 18th, 369 Seizures and Epilepsy, Epilepsy that occurs as a result of other issues may be preventable. Seizures are controllable with medication in about 70% of cases;JOURNAL, Eadie MJ, Shortcomings in the current treatment of epilepsy, Expert Review of Neurotherapeutics, 12, 12, 1419–27, December 2012, 23237349, 10.1586/ern.12.129, inexpensive anti-seizure medications are often available. In those whose seizures do not respond to medication, surgery, neurostimulation or dietary changes may then be considered.JOURNAL, Bergey GK, Neurostimulation in the treatment of epilepsy, Experimental Neurology, 244, 87–95, June 2013, 23583414, 10.1016/j.expneurol.2013.04.004, JOURNAL, Martin K, Jackson CF, Levy RG, Cooper PN, Ketogenic diet and other dietary treatments for epilepsy, The Cochrane Database of Systematic Reviews, 2, CD001903, February 2016, 26859528, 10.1002/14651858.CD001903.pub3, {{Update inline|reason=Updated versionweblink|date = December 2018}} Not all cases of epilepsy are lifelong, and many people improve to the point that treatment is no longer needed.{{as of|2015}}, about 39 million people have epilepsy.JOURNAL, Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 388, 10053, 1545–1602, October 2016, 27733282, 5055577, 10.1016/S0140-6736(16)31678-6, Vos, Theo, Allen, Christine, Arora, Megha, Barber, Ryan M., Bhutta, Zulfiqar A., Brown, Alexandria, Carter, Austin, Casey, Daniel C., Charlson, Fiona J., Chen, Alan Z., Coggeshall, Megan, Cornaby, Leslie, Dandona, Lalit, Dicker, Daniel J., Dilegge, Tina, Erskine, Holly E., Ferrari, Alize J., Fitzmaurice, Christina, Fleming, Tom, Forouzanfar, Mohammad H., Fullman, Nancy, Gething, Peter W., Goldberg, Ellen M., Graetz, Nicholas, Haagsma, Juanita A., Hay, Simon I., Johnson, Catherine O., Kassebaum, Nicholas J., Kawashima, Toana, Kemmer, Laura, 29, Nearly 80% of cases occur in the developing world.WEB, Epilepsy Fact sheet,weblink WHO, 4 March 2016, February 2016, live,weblink" title="web.archive.org/web/20160311001129weblink">weblink 11 March 2016, dmy-all, In 2015, it resulted in 125,000 deaths, an increase from 112,000 in 1990.JOURNAL, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 388, 10053, 1459–1544, October 2016, 27733281, 5388903, 10.1016/s0140-6736(16)31012-1, Wang, Haidong, Naghavi, Mohsen, Allen, Christine, Barber, Ryan M., Bhutta, Zulfiqar A., Carter, Austin, Casey, Daniel C., Charlson, Fiona J., Chen, Alan Zian, Coates, Matthew M., Coggeshall, Megan, Dandona, Lalit, Dicker, Daniel J., Erskine, Holly E., Ferrari, Alize J., Fitzmaurice, Christina, Foreman, Kyle, Forouzanfar, Mohammad H., Fraser, Maya S., Fullman, Nancy, Gething, Peter W., Goldberg, Ellen M., Graetz, Nicholas, Haagsma, Juanita A., Hay, Simon I., Huynh, Chantal, Johnson, Catherine O., Kassebaum, Nicholas J., Kinfu, Yohannes, Kulikoff, Xie Rachel, 29, JOURNAL, Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet, 385, 9963, 117–71, January 2015, 25530442, 4340604, 10.1016/S0140-6736(14)61682-2,weblink GBD 2013 Mortality Causes of Death Collaborators, Epilepsy is more common in older people.JOURNAL, Brodie MJ, Elder AT, Kwan P, Epilepsy in later life, The Lancet. Neurology, 8, 11, 1019–30, November 2009, 19800848, 10.1016/S1474-4422(09)70240-6, BOOK, Holmes, Thomas R., Browne, Gregory L., vanc, Handbook of epilepsy, 2008, Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-7397-3, 4th, 7,weblink In the developed world, onset of new cases occurs most frequently in babies and the elderly.BOOK, Wyllie's treatment of epilepsy : principles and practice., 2010, Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, 978-1-58255-937-7, 5th,weblink live,weblink 24 June 2016, dmy-all, In the developing world, onset is more common in older children and young adults due to differences in the frequency of the underlying causes.JOURNAL, Newton CR, Garcia HH, Epilepsy in poor regions of the world, Lancet, 380, 9848, 1193–201, September 2012, 23021288, 10.1016/S0140-6736(12)61381-6, About 5–10% of people will have an unprovoked seizure by the age of 80,JOURNAL, Wilden JA, Cohen-Gadol AA, Evaluation of first nonfebrile seizures, American Family Physician, 86, 4, 334–40, August 2012, 22963022, and the chance of experiencing a second seizure is between 40 and 50%.JOURNAL, Berg AT, Risk of recurrence after a first unprovoked seizure, Epilepsia, 49 Suppl 1, 13–8, 2008, 18184149, 10.1111/j.1528-1167.2008.01444.x, In many areas of the world, those with epilepsy either have restrictions placed on their ability to drive or are not permitted to drive until they are free of seizures for a specific length of time.JOURNAL, L Devlin A, Odell M, L Charlton J, Koppel S, Epilepsy and driving: current status of research, Epilepsy Research, 102, 3, 135–52, December 2012, 22981339, 10.1016/j.eplepsyres.2012.08.003, The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, "to seize, possess, or afflict".JOURNAL, Magiorkinis E, Sidiropoulou K, Diamantis A, Hallmarks in the history of epilepsy: epilepsy in antiquity, Epilepsy & Behavior, 17, 1, 103–8, January 2010, 19963440, 10.1016/j.yebeh.2009.10.023, {{TOC limit}}

Signs and symptoms

(File:Attaque; Periode Epileptoide. Planche XVII. Wellcome L0074938.jpg|thumb|upright=1.4|A still image of a generalized seizure)(File:Bittentongue.JPG|thumb|upright=1.4|A bite to the tip of the tongue due to a seizure)Epilepsy is characterized by a long-term risk of recurrent seizures.JOURNAL, Duncan JS, Sander JW, Sisodiya SM, Walker MC, Adult epilepsy, Lancet, 367, 9516, 1087–1100, April 2006, 16581409, 10.1016/S0140-6736(06)68477-8,weblinkweblink" title="web.archive.org/web/20130324031646weblink">weblink dmy-all, live, 24 March 2013, These seizures may present in several ways depending on the part of the brain involved and the person's age.BOOK, The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care, National Clinical Guideline Centre, National Institute for Health and Clinical Excellence,weblink January 2012, 21–28, live,weblink" title="web.archive.org/web/20131216151008weblink">weblink 16 December 2013, dmy-all,

Seizures

The most common type (60%) of seizures are convulsive. Of these, one-third begin as generalized seizures from the start, affecting both hemispheres of the brain. Two-thirds begin as focal seizures (which affect one hemisphere of the brain) which may then progress to generalized seizures. The remaining 40% of seizures are non-convulsive. An example of this type is the absence seizure, which presents as a decreased level of consciousness and usually lasts about 10 seconds.BOOK, Hammer, Gary D., McPhee, Stephen J., vanc, Pathophysiology of disease : an introduction to clinical medicine, 2010, McGraw-Hill Medical, New York, 978-0-07-162167-0, 6th, 7, JOURNAL, Hughes, JR, Absence seizures: a review of recent reports with new concepts., Epilepsy & Behavior, August 2009, 15, 4, 404–12, 19632158, 10.1016/j.yebeh.2009.06.007, Focal seizures are often preceded by certain experiences, known as auras. They include sensory (visual, hearing, or smell), psychic, autonomic, and motor phenomena. Jerking activity may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a Jacksonian march.BOOK, Bradley, Walter G., vanc, Bradley's neurology in clinical practice., 2012, Elsevier/Saunders, Philadelphia, PA, 978-1-4377-0434-1, 6th, 67, Automatisms may occur, which are non-consciously-generated activities and mostly simple repetitive movements like smacking of the lips or more complex activities such as attempts to pick up something.There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence and atonic seizures.BOOK, The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care, National Clinical Guideline Centre, National Institute for Health and Clinical Excellence,weblink January 2012, 119–129, live,weblink" title="web.archive.org/web/20131216151008weblink">weblink 16 December 2013, dmy-all, They all involve loss of consciousness and typically happen without warning.Tonic-clonic seizures occur with a contraction of the limbs followed by their extension along with arching of the back which lasts 10–30 seconds (the tonic phase). A cry may be heard due to contraction of the chest muscles, followed by a shaking of the limbs in unison (clonic phase). Tonic seizures produce constant contractions of the muscles. A person often turns blue as breathing is stopped. In clonic seizures there is shaking of the limbs in unison. After the shaking has stopped it may take 10–30 minutes for the person to return to normal; this period is called the "postictal state" or "postictal phase." Loss of bowel or bladder control may occur during a seizure.WEB,weblink Epilepsy, Fact Sheets, October 2012, 24 January 2013, World Health Organization, The tongue may be bitten at either the tip or on the sides during a seizure. In tonic-clonic seizure, bites to the sides are more common.BOOK, Engel, Jerome, vanc, Epilepsy : a comprehensive textbook, 2008, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-5777-5, 2797,weblink 2nd, live,weblink 20 May 2016, dmy-all, Tongue bites are also relatively common in psychogenic non-epileptic seizures.Myoclonic seizures involve spasms of muscles in either a few areas or all over. Absence seizures can be subtle with only a slight turn of the head or eye blinking. The person does not fall over and returns to normal right after it ends. Atonic seizures involve the loss of muscle activity for greater than one second. This typically occurs on both sides of the body.About 6% of those with epilepsy have seizures that are often triggered by specific events and are known as reflex seizures.BOOK, Behavioral aspects of epilepsy : principles and practice, 2008, Demos, New York, 978-1-933864-04-4, 125,weblink [Online-Ausg.]., Steven C. Schachter, vanc, Those with reflex epilepsy have seizures that are only triggered by specific stimuli.JOURNAL, Xue LY, Ritaccio AL, Reflex seizures and reflex epilepsy, American Journal of Electroneurodiagnostic Technology, 46, 1, 39–48, March 2006, 16605171, 10.1080/1086508X.2006.11079556, Common triggers include flashing lights and sudden noises. In certain types of epilepsy, seizures happen more often during sleep,JOURNAL, Malow BA, Sleep and epilepsy, Neurologic Clinics, 23, 4, 1127–47, November 2005, 16243619, 10.1016/j.ncl.2005.07.002, and in other types they occur almost only when sleeping.JOURNAL, Tinuper P, Provini F, Bisulli F, Vignatelli L, Plazzi G, Vetrugno R, Montagna P, Lugaresi E, Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep, Sleep Medicine Reviews, 11, 4, 255–67, August 2007, 17379548, 10.1016/j.smrv.2007.01.001,

Post-ictal

After the active portion of a seizure (the ictal state) there is typically a period of recovery during which there is confusion, referred to as the postictal period before a normal level of consciousness returns. It usually lasts 3 to 15 minutesBOOK, Holmes, Thomas R., vanc, Handbook of epilepsy, 2008, Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-7397-3, 34,weblink 4th, but may last for hours. Other common symptoms include feeling tired, headache, difficulty speaking, and abnormal behavior.BOOK, Panayiotopoulos CP, A clinical guide to epileptic syndromes and their treatment based on the ILAE classifications and practice parameter guidelines, 2010, Springer, London, 978-1-84628-644-5, 445,weblink Rev. 2nd, Psychosis after a seizure is relatively common, occurring in 6–10% of people.BOOK, Advanced therapy in epilepsy, 2009, People's Medical Pub. House, Shelton, Conn., 978-1-60795-004-2, 443,weblink Wheless JW, Often people do not remember what happened during this time. Localized weakness, known as Todd's paralysis, may also occur after a focal seizure. When it occurs it typically lasts for seconds to minutes but may rarely last for a day or two.BOOK, Larner, Andrew J., vanc, A dictionary of neurological signs, Springer, New York, 978-1-4419-7095-4, 348,weblink 3rd, 2010,

Psychosocial

Epilepsy can have adverse effects on social and psychological well-being. These effects may include social isolation, stigmatization, or disability. They may result in lower educational achievement and worse employment outcomes. Learning disabilities are common in those with the condition, and especially among children with epilepsy. The stigma of epilepsy can also affect the families of those with the disorder.Certain disorders occur more often in people with epilepsy, depending partly on the epilepsy syndrome present. These include depression, anxiety, obsessive–compulsive disorder (OCD),JOURNAL, Kaplan PW, Obsessive-compulsive disorder in chronic epilepsy, Epilepsy & Behavior, 22, 3, 428–32, November 2011, 21889913, 10.1016/j.yebeh.2011.07.029,weblink and migraine.BOOK, Stefan, Hermann, vanc, Epilepsy Part I: Basic Principles and Diagnosis E-Book: Handbook of Clinical Neurology, 2012, Newnes, 978-0-444-53505-4, 471,weblink Volume 107 of Handbook of Clinical Neurology, Attention deficit hyperactivity disorder affects three to five times more children with epilepsy than children without the condition.JOURNAL, Plioplys S, Dunn DW, Caplan R, 10-year research update review: psychiatric problems in children with epilepsy, Journal of the American Academy of Child and Adolescent Psychiatry, 46, 11, 1389–402, November 2007, 18049289, 10.1097/chi.0b013e31815597fc, ADHD and epilepsy have significant consequences on a child's behavioral, learning, and social development.JOURNAL, Reilly CJ, Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy, Research in Developmental Disabilities, 32, 3, 883–93, May–June 2011, 21310586, 10.1016/j.ridd.2011.01.019, Epilepsy is also more common in children with autism.JOURNAL, Levisohn PM, The autism-epilepsy connection, Epilepsia, 48 Suppl 9, Suppl 9, 33–5, 2007, 18047599, 10.1111/j.1528-1167.2007.01399.x,

Causes

{{See also|Causes of seizures}}Epilepsy can have both genetic and acquired causes, with interaction of these factors in many cases. Established acquired causes include serious brain trauma, stroke, tumours and problems in the brain as a result of a previous infection.JOURNAL, Trends in Neurosciences, 2006, 29, 7, 391–7, Human epilepsies: interaction of genetic and acquired factors, Berkovic SF, Mulley JC, Scheffer IE, Petrou S, 16769131, 10.1016/j.tins.2006.05.009, In about 60% of cases the cause is unknown. Epilepsies caused by genetic, congenital, or developmental conditions are more common among younger people, while brain tumors and strokes are more likely in older people.Seizures may also occur as a consequence of other health problems; if they occur right around a specific cause, such as a stroke, head injury, toxic ingestion or metabolic problem, they are known as acute symptomatic seizures and are in the broader classification of seizure-related disorders rather than epilepsy itself.JOURNAL, Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D, Hesdorffer DC, Hauser WA, Kazis L, Kobau R, Kroner B, Labiner D, Liow K, Logroscino G, Medina MT, Newton CR, Parko K, Paschal A, Preux PM, Sander JW, Selassie A, Theodore W, Tomson T, Wiebe S, ((ILAE Commission on Epidemiology)), Standards for epidemiologic studies and surveillance of epilepsy., Epilepsia, September 2011, 52 Suppl 7, 2–26, 21899536, 10.1111/j.1528-1167.2011.03121.x,

Genetics

Genetics is believed to be involved in the majority of cases, either directly or indirectly. Some epilepsies are due to a single gene defect (1–2%); most are due to the interaction of multiple genes and environmental factors. Each of the single gene defects is rare, with more than 200 in all described.BOOK, Genomics and clinical medicine, 2008, Oxford University Press, Oxford, 978-0-19-972005-7, 279,weblink Dhavendra Kumar, live,weblink 21 May 2016, dmy-all, Most genes involved affect ion channels, either directly or indirectly. These include genes for ion channels themselves, enzymes, GABA, and G protein-coupled receptors.BOOK, Simon, David A., Greenberg, Michael J., Aminoff, Roger P., vanc, Clinical neurology, 2012, McGraw-Hill Medical, New York, 978-0-07-175905-2, 8th, 12, In identical twins, if one is affected there is a 50–60% chance that the other will also be affected. In non-identical twins the risk is 15%. These risks are greater in those with generalized rather than focal seizures. If both twins are affected, most of the time they have the same epileptic syndrome (70–90%). Other close relatives of a person with epilepsy have a risk five times that of the general population.JOURNAL, Bhalla D, Godet B, Druet-Cabanac M, Preux PM, Etiologies of epilepsy: a comprehensive review, Expert Review of Neurotherapeutics, 11, 6, 861–76, June 2011, 21651333, 10.1586/ern.11.51, Between 1 and 10% of those with Down syndrome and 90% of those with Angelman syndrome have epilepsy.

Acquired

Epilepsy may occur as a result of a number of other conditions including tumors, strokes, head trauma, previous infections of the central nervous system, genetic abnormalities, and as a result of brain damage around the time of birth. Of those with brain tumors, almost 30% have epilepsy, making them the cause of about 4% of cases. The risk is greatest for tumors in the temporal lobe and those that grow slowly. Other mass lesions such as cerebral cavernous malformations and arteriovenous malformations have risks as high as 4060%. Of those who have had a stroke, 2–4% develop epilepsy. In the United Kingdom strokes account for 15% of cases and it is believed to be the cause in 30% of the elderly. Between 6 and 20% of epilepsy is believed to be due to head trauma. Mild brain injury increases the risk about two-fold while severe brain injury increases the risk seven-fold. In those who have experienced a high-powered gunshot wound to the head, the risk is about 50%.Some evidence links epilepsy and celiac disease and non-celiac gluten sensitivity, while other evidence does not. There appears to be a specific syndrome which includes coeliac disease, epilepsy and calcifications in the brain.JOURNAL, Grossman G, Neurological complications of coeliac disease: what is the evidence?, Practical Neurology, 8, 2, 77–89, April 2008, 18344378, 10.1136/jnnp.2007.139717, A 2012 review estimates that between 1% and 6% of people with epilepsy have coeliac disease while 1% of the general population has the condition.JOURNAL, Jackson JR, Eaton WW, Cascella NG, Fasano A, Kelly DL, Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity, The Psychiatric Quarterly, 83, 1, 91–102, March 2012, 21877216, 3641836, 10.1007/s11126-011-9186-y, The risk of epilepsy following meningitis is less than 10%; that disease more commonly causes seizures during the infection itself. In herpes simplex encephalitis the risk of a seizure is around 50% with a high risk of epilepsy following (up to 25%).BOOK, The Causes of Epilepsy: Common and Uncommon Causes in Adults and Children, 2011, Cambridge University Press, 978-1-139-49578-3, 467,weblink Simon D., Shorvon, vanc, JOURNAL, Sellner J, Trinka E, Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management, Journal of Neurology, 259, 10, 2019–30, October 2012, 22527234, 10.1007/s00415-012-6494-6, A form of an infection with the pork tapeworm (cysticercosis), in the brain, is known as neurocysticercosis, and is the cause of up to half of epilepsy cases in areas of the world where the parasite is common. Epilepsy may also occur after other brain infections such as cerebral malaria, toxoplasmosis, and toxocariasis. Chronic alcohol use increases the risk of epilepsy: those who drink six units of alcohol per day have a 2.5-fold increase in risk. Other risks include Alzheimer's disease, multiple sclerosis, tuberous sclerosis, and autoimmune encephalitis. Getting vaccinated does not increase the risk of epilepsy. Malnutrition is a risk factor seen mostly in the developing world, although it is unclear however if it is a direct cause or an association. People with cerebral palsy have an increased risk of epilepsy, with half of people with spastic quadriplegia and spastic hemiplegia having the disease.JOURNAL, Hadjipanayis A, Hadjichristodoulou C, Youroukos S, Epilepsy in patients with cerebral palsy, Developmental Medicine and Child Neurology, 39, 10, 659–63, October 1997, 9352726, 10.1111/j.1469-8749.1997.tb07359.x,

Mechanism

Normally brain electrical activity is non-synchronous, as neurons do not normally fire in sync with each other, but rather fire in order as signals travel throughout the brain. Its activity is regulated by various factors both within the neuron and the cellular environment. Factors within the neuron include the type, number and distribution of ion channels, changes to receptors and changes of gene expression. Factors around the neuron include ion concentrations, synaptic plasticity and regulation of transmitter breakdown by glial cells.BOOK, An Introduction to Epilepsy, American Epilepsy Society, 2006, Bromfield EB,weblink JOURNAL, Blumenfeld H, Cellular and network mechanisms of spike-wave seizures, Epilepsia, 46 Suppl 9, Suppl.9, 21–33, 2005, 16302873, 10.1111/j.1528-1167.2005.00311.x, Chronic inflammation also appears to play a role.JOURNAL, Rana A, Musto AE, The role of inflammation in the development of epilepsy, En, Journal of Neuroinflammation, 15, 1, 144, May 2018, 29764485, 5952578, 10.1186/s12974-018-1192-7,

Epilepsy

The exact mechanism of epilepsy is unknown,BOOK, Jeffrey L., Noebels, Massimo, Avoli, vanc, Jasper's Basic Mechanisms of the Epilepsies,weblink Oxford University Press, 2012-06-29, 9780199746545, 466, 470, 2014-10-16, but a little is known about its cellular and network mechanisms. However, it is unknown under which circumstances the brain shifts into the activity of a seizure with its excessive synchronization.JOURNAL, Le Van Quyen M, Navarro V, Martinerie J, Baulac M, Varela FJ, Toward a neurodynamical understanding of ictogenesis, Epilepsia, 44 Suppl 12, Suppl.12, 30–43, 2003, 14641559, 10.1111/j.0013-9580.2003.12007.x, JOURNAL, Lopes da Silva F, Blanes W, Kalitzin SN, Parra J, Suffczynski P, Velis DN, Epilepsies as dynamical diseases of brain systems: basic models of the transition between normal and epileptic activity, Epilepsia, 44 Suppl 12, Suppl.12, 72–83, 2003, 14641563, 10.1111/j.0013-9580.2003.12005.x, In epilepsy, the resistance of excitatory neurons to fire during this period is decreased. This may occur due to changes in ion channels or inhibitory neurons not functioning properly. This then results in a specific area from which seizures may develop, known as a "seizure focus". Another mechanism of epilepsy may be the up-regulation of excitatory circuits or down-regulation of inhibitory circuits following an injury to the brain. These secondary epilepsies occur through processes known as epileptogenesis.JOURNAL, Goldberg EM, Coulter DA, Mechanisms of epileptogenesis: a convergence on neural circuit dysfunction, Nature Reviews. Neuroscience, 14, 5, 337–49, May 2013, 23595016, 3982383, 10.1038/nrn3482, Failure of the blood–brain barrier may also be a causal mechanism as it would allow substances in the blood to enter the brain.JOURNAL, Oby E, Janigro D, The blood-brain barrier and epilepsy, Epilepsia, 47, 11, 1761–74, November 2006, 17116015, 10.1111/j.1528-1167.2006.00817.x,

Seizures

There is evidence that epileptic seizures are usually not a random event. Seizures are often brought on by factors such as stress, alcohol abuse, flickering light, or a lack of sleep, among others. The term seizure threshold is used to indicate the amount of stimulus necessary to bring about a seizure. Seizure threshold is lowered in epilepsy.In epileptic seizures a group of neurons begin firing in an abnormal, excessive, and synchronized manner. This results in a wave of depolarization known as a paroxysmal depolarizing shift.BOOK, Somjen, George G., vanc, Ions in the Brain Normal Function, Seizures, and Stroke., 2004, Oxford University Press, New York, 978-0-19-803459-9, 167,weblink Normally, after an excitatory neuron fires it becomes more resistant to firing for a period of time. This is due in part to the effect of inhibitory neurons, electrical changes within the excitatory neuron, and the negative effects of adenosine.Focal seizures begin in one hemisphere of the brain while generalized seizures begin in both hemispheres. Some types of seizures may change brain structure, while others appear to have little effect.BOOK, Epilepsy : a comprehensive textbook, 2008, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-5777-5, 483,weblink 2nd, Engel J, Pedley TA, Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.

Diagnosis

File:EEG Recording Cap.jpg|thumb|upright=1.4|An EEG can aid in locating the focus of the epileptic seizure.]]The diagnosis of epilepsy is typically made based on observation of the seizure onset and the underlying cause. An electroencephalogram (EEG) to look for abnormal patterns of brain waves and neuroimaging (CT scan or MRI) to look at the structure of the brain are also usually part of the workup. While figuring out a specific epileptic syndrome is often attempted, it is not always possible. Video and EEG monitoring may be useful in difficult cases.BOOK, The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care, National Clinical Guideline Centre, National Institute for Health and Clinical Excellence,weblink January 2012, 57–83, live,weblink" title="web.archive.org/web/20131216151008weblink">weblink 16 December 2013, dmy-all,

Definition

Epilepsy is a disorder of the brain defined by any of the following conditions:
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  1. At least two unprovoked (or reflex) seizures occurring more than 24 hours apart
  2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
  3. Diagnosis of an epilepsy syndrome
Furthermore, epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past that age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.This 2014 definition of the International League Against Epilepsy is a clarification of the ILAE 2005 conceptual definition, according to which epilepsy is "a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure."JOURNAL, Panayiotopoulos, CP, The new ILAE report on terminology and concepts for organization of epileptic seizures: a clinician's critical view and contribution., Epilepsia, December 2011, 52, 12, 2155–60, 22004554, 10.1111/j.1528-1167.2011.03288.x, It is, therefore, possible to outgrow epilepsy or to undergo treatment that causes epilepsy to be resolved, but with no guarantee that it will not return. In the definition, epilepsy is now called a disease, rather than a disorder. This was a decision of the executive committee of the ILAE, taken because the word "disorder," while perhaps having less stigma than does "disease," also does not express the degree of seriousness that epilepsy deserves.The definition is practical in nature and is designed for clinical use. In particular, it aims to clarify when an "enduring predisposition" according to the 2005 conceptual definition is present. Researchers, statistically-minded epidemiologists, and other specialized groups may choose to use the older definition or a definition of their own devising. The ILAE considers doing so is perfectly allowable, so long as it is clear what definition is being used.

Classification

In contrast to the classification of seizures which focuses on what happens during a seizure, the classification of epilepsies focuses on the underlying causes. When a person is admitted to hospital after an epileptic seizure the diagnostic workup results preferably in the seizure itself being classified (e.g. tonic-clonic) and in the underlying disease being identified (e.g. hippocampal sclerosis). The name of the diagnosis finally made depends on the available diagnostic results and the applied definitions and classifications (of seizures and epilepsies) and its respective terminology.The International League Against Epilepsy (ILAE) provided a classification of the epilepsies and epileptic syndromes in 1989 as follows:JOURNAL, Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy, Epilepsia, 30, 4, 389–99, 1989, 2502382, 10.1111/j.1528-1157.1989.tb05316.x,
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  1. Localization-related epilepsies and syndromes
  2. Generalized
    • Unknown cause (e.g. childhood absence epilepsy)
    • Cryptogenic or symptomatic (e.g. Lennox-Gastaut syndrome)
    • Symptomatic (e.g. early infantile epileptic encephalopathy with burst suppression)
  3. Epilepsies and syndromes undetermined whether focal or generalized
    • With both generalized and focal seizures (e.g. epilepsy with continuous spike-waves during slow wave sleep)
  4. Special syndromes (with situation-related seizures)
This classification was widely accepted but has also been criticized mainly because the underlying causes of epilepsy (which are a major determinant of clinical course and prognosis) were not covered in detail.JOURNAL, Engel J, ILAE classification of epilepsy syndromes, Epilepsy Research, 70 Suppl 1, Suppl 1, S5–10, August 2006, 16822650, 10.1016/j.eplepsyres.2005.11.014, In 2010 the ILAE Commission for Classification of the Epilepsies addressed this issue and divided epilepsies into three categories (genetic, structural/metabolic, unknown cause)JOURNAL, Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, Engel J, French J, Glauser TA, Mathern GW, Moshé SL, Nordli D, Plouin P, Scheffer IE, Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009, Epilepsia, 51, 4, 676–85, April 2010, 20196795, 10.1111/j.1528-1167.2010.02522.x, that were refined in their 2011 recommendation into four categories and a number of subcategories reflecting recent technologic and scientific advances.JOURNAL, Shorvon SD, The etiologic classification of epilepsy, Epilepsia, 52, 6, 1052–7, June 2011, 21449936, 10.1111/j.1528-1167.2011.03041.x,
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  1. Unknown cause (mostly genetic or presumed genetic origin)
    • Pure epilepsies due to single gene disorders
    • Pure epilepsies with complex inheritance
  2. Symptomatic (associated with gross anatomic or pathologic abnormalities)
    • Mostly genetic or developmental causation
      • Childhood epilepsy syndromes
      • Progressive myoclonic epilepsies
      • Neurocutaneous syndromes
      • Other neurologic single gene disorders
      • Disorders of chromosome function
      • Developmental anomalies of cerebral structure
    • Mostly acquired causes
      • Hippocampal sclerosis
      • Perinatal and infantile causes
      • Cerebral trauma, tumor or infection
      • Cerebrovascular disorders
      • Cerebral immunologic disorders
      • Degenerative and other neurologic conditions
  3. Provoked (a specific systemic or environmental factor is the predominant cause of the seizures)
    • Provoking factors
    • Reflex epilepsies
  4. Cryptogenic (presumed symptomatic nature in which the cause has not been identified)

Syndromes

Cases of epilepsy may be organized into epilepsy syndromes by the specific features that are present. These features include the age that seizure begin, the seizure types, EEG findings, among others. Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as what anti-seizure medication should be tried.The ability to categorize a case of epilepsy into a specific syndrome occurs more often with children since the onset of seizures is commonly early. Less serious examples are benign rolandic epilepsy (2.8 per 100,000), childhood absence epilepsy (0.8 per 100,000) and juvenile myoclonic epilepsy (0.7 per 100,000). Severe syndromes with diffuse brain dysfunction caused, at least partly, by some aspect of epilepsy, are also referred to as epileptic encephalopathies. These are associated with frequent seizures that are resistant to treatment and severe cognitive dysfunction, for instance Lennox–Gastaut syndrome and West syndrome.JOURNAL, Nordli DR, Epileptic encephalopathies in infants and children, Journal of Clinical Neurophysiology, 29, 5, 420–4, October 2012, 23027099, 10.1097/WNP.0b013e31826bd961, Genetics is believed to play an important role in epilepsies by a number of mechanisms. Simple and complex modes of inheritance have been identified for some of them. However, extensive screening have failed to identify many single gene variants of large effect.JOURNAL, Heinzen EL, Depondt C, Cavalleri GL, Ruzzo EK, Walley NM, Need AC, Ge D, He M, Cirulli ET, Zhao Q, Cronin KD, Gumbs CE, Campbell CR, Hong LK, Maia JM, Shianna KV, McCormack M, Radtke RA, O'Conner GD, Mikati MA, Gallentine WB, Husain AM, Sinha SR, Chinthapalli K, Puranam RS, McNamara JO, Ottman R, Sisodiya SM, Delanty N, Goldstein DB, 6, Exome sequencing followed by large-scale genotyping fails to identify single rare variants of large effect in idiopathic generalized epilepsy, American Journal of Human Genetics, 91, 2, 293–302, August 2012, 22863189, 3415540, 10.1016/j.ajhg.2012.06.016, More recent exome and genome sequencing studies have begun to reveal a number of de novo gene mutations that are responsible for some epileptic encephalopathies, including CHD2 and SYNGAP1JOURNAL, Carvill GL, Heavin SB, Yendle SC, McMahon JM, O'Roak BJ, Cook J, Khan A, Dorschner MO, Weaver M, Calvert S, Malone S, Wallace G, Stanley T, Bye AM, Bleasel A, Howell KB, Kivity S, Mackay MT, Rodriguez-Casero V, Webster R, Korczyn A, Afawi Z, Zelnick N, Lerman-Sagie T, Lev D, Møller RS, Gill D, Andrade DM, Freeman JL, Sadleir LG, Shendure J, Berkovic SF, Scheffer IE, Mefford HC, 6, Targeted resequencing in epileptic encephalopathies identifies de novo mutations in CHD2 and SYNGAP1, Nature Genetics, 45, 7, 825–30, July 2013, 23708187, 3704157, 10.1038/ng.2646, JOURNAL, Chénier S, Yoon G, Argiropoulos B, Lauzon J, Laframboise R, Ahn JW, Ogilvie CM, Lionel AC, Marshall CR, Vaags AK, Hashemi B, Boisvert K, Mathonnet G, Tihy F, So J, Scherer SW, Lemyre E, Stavropoulos DJ, 6, CHD2 haploinsufficiency is associated with developmental delay, intellectual disability, epilepsy and neurobehavioural problems, Journal of Neurodevelopmental Disorders, 6, 1, 9, 2014, 24834135, 4022362, 10.1186/1866-1955-6-9, JOURNAL, Suls A, Jaehn JA, Kecskés A, Weber Y, Weckhuysen S, Craiu DC, Siekierska A, Djémié T, Afrikanova T, Gormley P, von Spiczak S, Kluger G, Iliescu CM, Talvik T, Talvik I, Meral C, Caglayan HS, Giraldez BG, Serratosa J, Lemke JR, Hoffman-Zacharska D, Szczepanik E, Barisic N, Komarek V, Hjalgrim H, Møller RS, Linnankivi T, Dimova P, Striano P, Zara F, Marini C, Guerrini R, Depienne C, Baulac S, Kuhlenbäumer G, Crawford AD, Lehesjoki AE, de Witte PA, Palotie A, Lerche H, Esguerra CV, De Jonghe P, Helbig I, 6, De novo loss-of-function mutations in CHD2 cause a fever-sensitive myoclonic epileptic encephalopathy sharing features with Dravet syndrome, American Journal of Human Genetics, 93, 5, 967–75, November 2013, 24207121, 3824114, 10.1016/j.ajhg.2013.09.017, and DNM1, GABBR2, FASN and RYR3.JOURNAL, EuroEPINOMICS-RES Consortium, De novo mutations in synaptic transmission genes including DNM1 cause epileptic encephalopathies, American Journal of Human Genetics, 95, 4, 360–70, October 2014, 25262651, 4185114, 10.1016/j.ajhg.2014.08.013, Syndromes in which causes are not clearly identified are difficult to match with categories of the current classification of epilepsy. Categorization for these cases was made somewhat arbitrarily. The idiopathic (unknown cause) category of the 2011 classification includes syndromes in which the general clinical features and/or age specificity strongly point to a presumed genetic cause. Some childhood epilepsy syndromes are included in the unknown cause category in which the cause is presumed genetic, for instance benign rolandic epilepsy. Others are included in symptomatic despite a presumed genetic cause (in at least in some cases), for instance Lennox-Gastaut syndrome. Clinical syndromes in which epilepsy is not the main feature (e.g. Angelman syndrome) were categorized symptomatic but it was argued to include these within the category idiopathic. Classification of epilepsies and particularly of epilepsy syndromes will change with advances in research.

Tests

An electroencephalogram (EEG) can assist in showing brain activity suggestive of an increased risk of seizures. It is only recommended for those who are likely to have had an epileptic seizure on the basis of symptoms. In the diagnosis of epilepsy, electroencephalography may help distinguish the type of seizure or syndrome present. In children it is typically only needed after a second seizure. It cannot be used to rule out the diagnosis and may be falsely positive in those without the disease. In certain situations it may be useful to perform the EEG while the affected individual is sleeping or sleep deprived.Diagnostic imaging by CT scan and MRI is recommended after a first non-febrile seizure to detect structural problems in and around the brain. MRI is generally a better imaging test except when bleeding is suspected, for which CT is more sensitive and more easily available. If someone attends the emergency room with a seizure but returns to normal quickly, imaging tests may be done at a later point. If a person has a previous diagnosis of epilepsy with previous imaging, repeating the imaging is usually not needed even if there are subsequent seizures.For adults, the testing of electrolyte, blood glucose and calcium levels is important to rule out problems with these as causes. An electrocardiogram can rule out problems with the rhythm of the heart. A lumbar puncture may be useful to diagnose a central nervous system infection but is not routinely needed. In children additional tests may be required such as urine biochemistry and blood testing looking for metabolic disorders.BOOK, Wallace, Sheila J., Farrell, Kevin, vanc, Epilepsy in children, 2004, Arnold, London, 978-0-340-80814-6, 354,weblink 2nd, A high blood prolactin level within the first 20 minutes following a seizure may be useful to help confirm an epileptic seizure as opposed to psychogenic non-epileptic seizure.JOURNAL, Luef, G, Hormonal alterations following seizures., Epilepsy & Behavior, October 2010, 19, 2, 131–3, 20696621, 10.1016/j.yebeh.2010.06.026, JOURNAL, Ahmad S, Beckett MW, Value of serum prolactin in the management of syncope, Emergency Medicine Journal, 21, 2, 3e–3, 2004, 14988379, 1726305, 10.1136/emj.2003.008870, Serum prolactin level is less useful for detecting focal seizures.JOURNAL, Shukla G, Bhatia M, Vivekanandhan S, etal, Serum prolactin levels for differentiation of nonepileptic versus true seizures: limited utility, Epilepsy & Behavior, 5, 4, 517–21, 2004, 15256189, 10.1016/j.yebeh.2004.03.004, If it is normal an epileptic seizure is still possible and a serum prolactin does not separate epileptic seizures from syncope.JOURNAL, Chen DK, So YT, Fisher RS, Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, Neurology, 65, 5, 668–75, 2005, 16157897, 10.1212/01.wnl.0000178391.96957.d0, It is not recommended as a routine part of the diagnosis of epilepsy.

Differential diagnosis

Diagnosis of epilepsy can be difficult. A number of other conditions may present very similar signs and symptoms to seizures, including syncope, hyperventilation, migraines, narcolepsy, panic attacks and psychogenic non-epileptic seizures (PNES).JOURNAL, Brodtkorb E, Common imitators of epilepsy, Acta Neurologica Scandinavica. Supplementum, 127, 196, 5–10, 2013, 23190285, 10.1111/ane.12043, In particular a syncope can be accompanied by a short episode of convulsions.JOURNAL, Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick AP, Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause, Journal of the American College of Cardiology, 36, 1, 181–4, July 2000, 10898432, 10.1016/S0735-1097(00)00700-2, Nocturnal frontal lobe epilepsy, often misdiagnosed as nightmares, was considered to be a parasomnia but later identified to be an epilepsy syndrome.JOURNAL, Bisulli F, Vignatelli L, Provini F, Leta C, Lugaresi E, Tinuper P, Parasomnias and nocturnal frontal lobe epilepsy (NFLE): lights and shadows--controversial points in the differential diagnosis, Sleep Medicine, 12 Suppl 2, Suppl2, S27–32, December 2011, 22136895, 10.1016/j.sleep.2011.10.008, Attacks of the movement disorder paroxysmal dyskinesia may be taken for epileptic seizures.JOURNAL, Zhou JQ, Zhou LM, Fang ZY, Wang Q, Chen ZY, Yang LB, Chen SD, Cai XD, Analyzing clinical and electrophysiological characteristics of Paroxysmal Dyskinesia, Journal of Research in Medical Sciences, 16, 1, 110–4, January 2011, 21448393, 3063430, The cause of a drop attack can be, among many others, an atonic seizure.Children may have behaviors that are easily mistaken for epileptic seizures but are not. These include breath-holding spells, bed wetting, night terrors, tics and shudder attacks. Gastroesophageal reflux may cause arching of the back and twisting of the head to the side in infants, which may be mistaken for tonic-clonic seizures.BOOK, Rosen's emergency medicine : concepts and clinical practice, 2010, Mosby/Elsevier, Philadelphia, 978-0-323-05472-0, 2228,weblink 7th, John A., Marx, vanc, Misdiagnosis is frequent (occurring in about 5 to 30% of cases). Different studies showed that in many cases seizure-like attacks in apparent treatment-resistant epilepsy have a cardiovascular cause.JOURNAL, Akhtar MJ, All seizures are not epilepsy: many have a cardiovascular cause, JPMA. The Journal of the Pakistan Medical Association, 52, 3, 116–20, March 2002, 12071066, Approximately 20% of the people seen at epilepsy clinics have PNES and of those who have PNES about 10% also have epilepsy;BOOK, Jerome, Engel, vanc, Seizures and epilepsy, Oxford University Press, New York, 9780195328547, 462, 2013,weblink 2nd, separating the two based on the seizure episode alone without further testing is often difficult.

Prevention

While many cases are not preventable, efforts to reduce head injuries, provide good care around the time of birth, and reduce environmental parasites such as the pork tapeworm may be effective. Efforts in one part of Central America to decrease rates of pork tapeworm resulted in a 50% decrease in new cases of epilepsy.

Management

File:Epilepsy Medical Alert Wrist Bracelets 2018.jpg|thumb|upright=1.4|WristbandWristbandEpilepsy is usually treated with daily medication once a second seizure has occurred, while medication may be started after the first seizure in those at high risk for subsequent seizures. Supporting people's self management of their condition may be useful.JOURNAL, Helmers SL, Kobau R, Sajatovic M, Jobst BC, Privitera M, Devinsky O, Labiner D, Escoffery C, Begley CE, Shegog R, Pandey D, Fraser RT, Johnson EK, Thompson NJ, Horvath KJ, Self-management in epilepsy: Why and how you should incorporate self-management in your practice, Epilepsy & Behavior, 68, 220–224, March 2017, 28202408, 5381244, 10.1016/j.yebeh.2016.11.015, In drug-resistant cases different management options may be looked at including a special diet, the implantation of a neurostimulator, or neurosurgery.

First aid

Rolling a person with an active tonic-clonic seizure onto their side and into the recovery position helps prevent fluids from getting into the lungs.JOURNAL, Michael GE, O'Connor RE, The diagnosis and management of seizures and status epilepticus in the prehospital setting, Emergency Medicine Clinics of North America, 29, 1, 29–39, February 2011, 21109100, 10.1016/j.emc.2010.08.003, Putting fingers, a bite block or tongue depressor in the mouth is not recommended as it might make the person vomit or result in the rescuer being bitten. Efforts should be taken to prevent further self-injury.WEB, Shearer, Peter, vanc, Seizures and Status Epilepticus: Diagnosis and Management in the Emergency Department,weblink Emergency Medicine Practice, live,weblink 30 December 2010, dmy-all, Spinal precautions are generally not needed.If a seizure lasts longer than 5 minutes or if there are more than two seizures in an hour without a return to a normal level of consciousness between them, it is considered a medical emergency known as status epilepticus.BOOK, Advanced therapy in epilepsy, 2009, People's Medical Pub. House, Shelton, Conn., 9781607950042, 144,weblink James W., Wheless, James, Willmore, Roger A., Brumback, vanc, This may require medical help to keep the airway open and protected; a nasopharyngeal airway may be useful for this. At home the recommended initial medication for seizure of a long duration is midazolam placed in the mouth.BOOK, The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care, National Clinical Guideline Centre, National Institute for Health and Clinical Excellence,weblink January 2012, live,weblink" title="web.archive.org/web/20131216151008weblink">weblink 16 December 2013, dmy-all, Diazepam may also be used rectally. In hospital, intravenous lorazepam is preferred. If two doses of benzodiazepines are not effective, other medications such as phenytoin are recommended. Convulsive status epilepticus that does not respond to initial treatment typically requires admission to the intensive care unit and treatment with stronger agents such as thiopentone or propofol.

Medications

(File:Anticonvulsants.jpg|thumb|upright=1.4|Anticonvulsants)The mainstay treatment of epilepsy is anticonvulsant medications, possibly for the person's entire life. The choice of anticonvulsant is based on seizure type, epilepsy syndrome, other medications used, other health problems, and the person's age and lifestyle. A single medication is recommended initially;BOOK, Wyllie's Treatment of Epilepsy: Principles and Practice, 2012, Lippincott Williams & Wilkins, 978-1-4511-5348-4, 187,weblink Elaine, Wyllie, vanc, if this is not effective, switching to a single other medication is recommended. Two medications at once is recommended only if a single medication does not work. In about half, the first agent is effective; a second single agent helps in about 13% and a third or two agents at the same time may help an additional 4%.BOOK, Medical aspects of disability; a handbook for the rehabilitation professional, 2010, Springer, New York, 978-0-8261-2784-6, 182,weblink 4th, Flanagan SR, Zaretsky H, Moroz A, About 30% of people continue to have seizures despite anticonvulsant treatment.There are a number of medications available including phenytoin, carbamazepine and valproate. Evidence suggests that phenytoin, carbamazepine, and valproate may be equally effective in both focal and generalized seizures.JOURNAL, Nevitt, SJ, Marson, AG, Tudur Smith, C, Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review., The Cochrane Database of Systematic Reviews, 18 July 2019, 7, CD001911, 10.1002/14651858.CD001911.pub4, 31318037, 6637502, JOURNAL, Nevitt, SJ, Marson, AG, Weston, J, Tudur Smith, C, Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review., The Cochrane Database of Systematic Reviews, 9 August 2018, 8, CD001769, 10.1002/14651858.CD001769.pub4, 30091458, 6513104, Controlled release carbamazepine appears to work as well as immediate release carbamazepine, and may have fewer side effects.JOURNAL, Powell G, Saunders M, Rigby A, Marson AG, Immediate-release versus controlled-release carbamazepine in the treatment of epilepsy, The Cochrane Database of Systematic Reviews, 12, CD007124, December 2016, 27933615, 6463840, 10.1002/14651858.CD007124.pub5, In the United Kingdom, carbamazepine or lamotrigine are recommended as first-line treatment for focal seizures, with levetiracetam and valproate as second-line due to issues of cost and side effects. Valproate is recommended first-line for generalized seizures with lamotrigine being second-line. In those with absence seizures, ethosuximide or valproate are recommended; valproate is particularly effective in myoclonic seizures and tonic or atonic seizures. If seizures are well-controlled on a particular treatment, it is not usually necessary to routinely check the medication levels in the blood.The least expensive anticonvulsant is phenobarbital at around US$5 a year. The World Health Organization gives it a first-line recommendation in the developing world and it is commonly used there.JOURNAL, Ilangaratne NB, Mannakkara NN, Bell GS, Sander JW, Phenobarbital: missing in action, Bulletin of the World Health Organization, 90, 12, 871–871A, December 2012, 23284189, 3524964, 10.2471/BLT.12.113183, BOOK, Shorvon, Simon, Perucca, Emilio, Engel Jr., Jerome, vanc, The treatment of epilepsy, 2009, Wiley-Blackwell, Chichester, UK, 9781444316674, 587,weblink 3rd, live,weblink 21 May 2016, dmy-all, Access however may be difficult as some countries label it as a controlled drug.Adverse effects from medications are reported in 10 to 90% of people, depending on how and from whom the data is collected. Most adverse effects are dose-related and mild. Some examples include mood changes, sleepiness, or an unsteadiness in gait. Certain medications have side effects that are not related to dose such as rashes, liver toxicity, or suppression of the bone marrow. Up to a quarter of people stop treatment due to adverse effects. Some medications are associated with birth defects when used in pregnancy. Many of the common used medications, such as valproate, phenytoin, carbamazepine, phenobarbitol, and gabapentin have been reported to cause increased risk of birth defects,JOURNAL, Weston J, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J, Hounsome J, McKay AJ, Tudur Smith C, Marson AG, Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child, The Cochrane Database of Systematic Reviews, 11, CD010224, November 2016, 27819746, 6465055, 10.1002/14651858.CD010224.pub2, especially when used during the first trimester. Despite this, treatment is often continued once effective, because the risk of untreated epilepsy is believed to be greater than the risk of the medications.JOURNAL, Kamyar M, Varner M, Epilepsy in pregnancy, Clinical Obstetrics and Gynecology, 56, 2, 330–41, June 2013, 23563876, 10.1097/GRF.0b013e31828f2436, Among the antiepileptic medications, levetiracetam and lamotrigine seem to carry the lowest risk of causing birth defects.Slowly stopping medications may be reasonable in some people who do not have a seizure for two to four years; however, around a third of people have a recurrence, most often during the first six months.BOOK, Adolescent health care : a practical guide, 2008, Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-9256-1, 335,weblink 5th, Lawrence S. Neinstein, Stopping is possible in about 70% of children and 60% of adults. Measuring medication levels is not generally needed in those whose seizures are well controlled.WEB, American Epilepsy Society Choosing Wisely,weblink www.choosingwisely.org, 30 August 2018,

Surgery

Epilepsy surgery may be an option for people with focal seizures that remain a problem despite other treatments.JOURNAL, Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ, Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review, Epilepsia, 58, 12, 2133–2142, December 2017, 28994113, 5716856, 10.1111/epi.13920, JOURNAL, Duncan JS, Sander JW, Sisodiya SM, Walker MC, Adult epilepsy, Lancet, 367, 9516, 1087–1100, April 2006, 16581409, 10.1016/S0140-6736(06)68477-8, These other treatments include at least a trial of two or three medications. The goal of surgery is total control of seizuresJOURNAL, Birbeck GL, Hays RD, Cui X, Vickrey BG, Seizure reduction and quality of life improvements in people with epilepsy, Epilepsia, 43, 5, 535–8, May 2002, 12027916, 10.1046/j.1528-1157.2002.32201.x, and this may be achieved in 60–70% of cases.JOURNAL, Duncan JS, Epilepsy surgery, Clinical Medicine, 7, 2, 137–42, April 2007, 17491501, 4951827, 10.7861/clinmedicine.7-2-137, Common procedures include cutting out the hippocampus via an anterior temporal lobe resection, removal of tumors, and removing parts of the neocortex. Some procedures such as a corpus callosotomy are attempted in an effort to decrease the number of seizures rather than cure the condition. Following surgery, medications may be slowly withdrawn in many cases.Neurostimulation may be another option in those who are not candidates for surgery. Three types have been used in those who do not respond to medications: vagus nerve stimulation, anterior thalamic stimulation, and closed-loop responsive stimulation.JOURNAL, Edwards CA, Kouzani A, Lee KH, Ross EK, Neurostimulation Devices for the Treatment of Neurologic Disorders, Mayo Clinic Proceedings, 92, 9, 1427–1444, September 2017, 28870357, 10.1016/j.mayocp.2017.05.005, {{open access}}JOURNAL, Panebianco M, Rigby A, Weston J, Marson AG, Vagus nerve stimulation for partial seizures, The Cochrane Database of Systematic Reviews, 4, CD002896, April 2015, 25835947, 10.1002/14651858.CD002896.pub2, {{open access}}

Diet

There is tentative evidence that a ketogenic diet (high-fat, low-carbohydrate, adequate-protein) decreases the number of seizures and eliminate seizures in some; however, further research is necessary. It is a reasonable option in those who have epilepsy that is not improved with medications and for whom surgery is not an option. About 10% stay on the diet for a few years due to issues of effectiveness and tolerability. Side effects include stomach and intestinal problems in 30%, and there are long-term concerns about heart disease. Less radical diets are easier to tolerate and may be effective. It is unclear why this diet works.BOOK, Maria, Bernard L., vanc, Current management in child neurology, 2009, BC Decker, Hamilton, Ont., 978-1-60795-000-4, 180,weblink 4th, live,weblink 24 June 2016, dmy-all, In people with coeliac disease or non-celiac gluten sensitivity and occipital calcifications, a gluten-free diet may decrease the frequency of seizures.

Other

Avoidance therapy consists of minimizing or eliminating triggers. For example, those who are sensitive to light may have success with using a small television, avoiding video games, or wearing dark glasses.JOURNAL, Verrotti A, Tocco AM, Salladini C, Latini G, Chiarelli F, Human photosensitivity: from pathophysiology to treatment, European Journal of Neurology, 12, 11, 828–41, November 2005, 16241971, 10.1111/j.1468-1331.2005.01085.x, Operant-based biofeedback based on the EEG waves has some support in those who do not respond to medications.JOURNAL, Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA, Meta-analysis of EEG biofeedback in treating epilepsy, Clinical EEG and Neuroscience, 40, 3, 173–9, July 2009, 19715180, 10.1177/155005940904000310, Psychological methods should not, however, be used to replace medications.Exercise has been proposed as possibly useful for preventing seizures,JOURNAL, Arida RM, Scorza FA, Scorza CA, Cavalheiro EA, Is physical activity beneficial for recovery in temporal lobe epilepsy? Evidences from animal studies, Neuroscience and Biobehavioral Reviews, 33, 3, 422–31, March 2009, 19059282, 10.1016/j.neubiorev.2008.11.002, with some data to support this claim.JOURNAL, Arida RM, Cavalheiro EA, da Silva AC, Scorza FA, Physical activity and epilepsy: proven and predicted benefits, Sports Medicine, 38, 7, 607–15, 2008, 18557661, 10.2165/00007256-200838070-00006, Some dogs, commonly referred to as seizure dogs, may help during or after a seizure.JOURNAL, Di Vito L, Naldi I, Mostacci B, Licchetta L, Bisulli F, Tinuper P, A seizure response dog: video recording of reacting behaviour during repetitive prolonged seizures, Epileptic Disorders, 12, 2, 142–5, June 2010, 20472528, 10.1684/epd.2010.0313,weblinkweblink" title="web.archive.org/web/20141006083557weblink">weblink dmy-all, live, 6 October 2014, JOURNAL, Kirton A, Winter A, Wirrell E, Snead OC, Seizure response dogs: evaluation of a formal training program, Epilepsy & Behavior, 13, 3, 499–504, October 2008, 18595778, 10.1016/j.yebeh.2008.05.011, It is not clear if dogs have the ability to predict seizures before they occur.JOURNAL, Doherty MJ, Haltiner AM, Wag the dog: skepticism on seizure alert canines, Neurology, 68, 4, 309, January 2007, 17242343, 10.1212/01.wnl.0000252369.82956.a3, 10.1.1.1003.1543, There is moderate-quality evidence supporting the use of psychological interventions along with other treatments in epilepsy. This can improve quality of life, enhance emotional wellbeing, and reduce fatigue in adults and adolescents.JOURNAL, Michaelis R, Tang V, Wagner JL, Modi AC, LaFrance Jr WC, Goldstein LH, Lundgren T, Reuber M, Psychological treatments for people with epilepsy, Cochrane Database of Systematic Reviews, 10, 10, CD012081, October 2017, 10.1002/14651858.CD012081.pub2, 29078005, 6485515, Psychological interventions may also improve seizure control for some individuals by promoting self-management and adherence.As an add-on therapy in those who are not well controlled with other medications, cannabidiol appears to be useful in some children.JOURNAL, Stockings E, Zagic D, Campbell G, Weier M, Hall WD, Nielsen S, Herkes GK, Farrell M, Degenhardt L, Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence, Journal of Neurology, Neurosurgery, and Psychiatry, 89, 7, 741–753, July 2018, 29511052, 10.1136/jnnp-2017-317168, In 2018 the FDA approved this product for Lennox–Gastaut syndrome and Dravet syndrome.WEB, Press Announcements - FDA approves first drug {{sic, comprised, y, of, an active ingredient derived from marijuana to treat rare, severe forms of epilepsy |url=https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm |website=www.fda.gov |access-date=4 October 2018 |language=en |date=25 June 2018}}

Alternative medicine

Alternative medicine, including acupuncture,JOURNAL, Cheuk DK, Wong V, Acupuncture for epilepsy, The Cochrane Database of Systematic Reviews, 5, 5, CD005062, May 2014, 24801225, 10.1002/14651858.CD005062.pub4, routine vitamins,JOURNAL, Ranganathan LN, Ramaratnam S, Vitamins for epilepsy, The Cochrane Database of Systematic Reviews, 2, CD004304, April 2005, 15846704, 10.1002/14651858.CD004304.pub2, and yoga,JOURNAL, Panebianco M, Sridharan K, Ramaratnam S, Yoga for epilepsy, The Cochrane Database of Systematic Reviews, 10, CD001524, October 2017, 28982217, 10.1002/14651858.CD001524.pub3, 6485327, have no reliable evidence to support their use in epilepsy. Melatonin, {{as of|2016|lc=y}}, is insufficiently supported by evidence.JOURNAL, Brigo F, Igwe SC, Del Felice A, Melatonin as add-on treatment for epilepsy, The Cochrane Database of Systematic Reviews, 8, CD006967, August 2016, 27513702, 10.1002/14651858.CD006967.pub4, The trials were of poor methodological quality and it was not possible to draw any definitive conclusions.

Prognosis

(File:Epilepsy world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.4|Deaths due to epilepsy per million persons in 2012 {{legend|#ffff20|0–7}}{{legend|#ffe820|8–10}}{{legend|#ffd820|11–13}}{{legend|#ffc020|14–17}}{{legend|#ffa020|18–21}}{{legend|#ff9a20|22–28}}{{legend|#f08015|29–37}}{{legend|#e06815|38–67}}{{legend|#d85010|68–100}}{{legend|#d02010|101–232}})Epilepsy cannot usually be cured, but medication can control seizures effectively in about 70% of cases. Of those with generalized seizures, more than 80% can be well controlled with medications while this is true in only 50% of people with focal seizures. One predictor of long-term outcome is the number of seizures that occur in the first six months. Other factors increasing the risk of a poor outcome include little response to the initial treatment, generalized seizures, a family history of epilepsy, psychiatric problems, and waves on the EEG representing generalized epileptiform activity.BOOK, Kwan, Patrick, vanc, Fast facts : epilepsy, 2012, Health Press, Abingdon, Oxford, UK, 978-1-908541-12-3, 10, 5th, In the developing world, 75% of people are either untreated or not appropriately treated. In Africa, 90% do not get treatment. This is partly related to appropriate medications not being available or being too expensive.

Mortality

People with epilepsy are at an increased risk of death. This increase is between 1.6 and 4.1 fold greater than that of the general population.BOOK, Shorvon, Simon, Perucca, Emilio, Engel, Jerome, vanc, The treatment of epilepsy, 2009, Wiley-Blackwell, Chichester, UK, 978-1-4443-1667-4, 28,weblink 3rd, live,weblink 10 June 2016, dmy-all, The greatest increase in mortality from epilepsy is among the elderly. Those with epilepsy due to an unknown cause have little increased risk.Mortality is often related to: the underlying cause of the seizures, status epilepticus, suicide, trauma, and sudden unexpected death in epilepsy (SUDEP).JOURNAL, Hitiris N, Mohanraj R, Norrie J, Brodie MJ, Mortality in epilepsy, Epilepsy & Behavior, 10, 3, 363–76, May 2007, 17337248, 10.1016/j.yebeh.2007.01.005, Death from status epilepticus is primarily due to an underlying problem rather than missing doses of medications. The risk of suicide is between 2 and 6 times higher in those with epilepsy;JOURNAL, Bagary M, Epilepsy, antiepileptic drugs and suicidality, Current Opinion in Neurology, 24, 2, 177–82, April 2011, 21293270, 10.1097/WCO.0b013e328344533e, JOURNAL, Mula M, Sander JW, Suicide risk in people with epilepsy taking antiepileptic drugs, Bipolar Disorders, 15, 5, 622–7, August 2013, 23755740, 10.1111/bdi.12091, the cause of this is unclear. SUDEP appears to be partly related to the frequency of generalized tonic-clonic seizuresJOURNAL, Ryvlin P, Nashef L, Tomson T, Prevention of sudden unexpected death in epilepsy: a realistic goal?, Epilepsia, 54 Suppl 2, 23–8, May 2013, 23646967, 10.1111/epi.12180, and accounts for about 15% of epilepsy-related deaths; it is unclear how to decrease its risk.In the United Kingdom, it is estimated that 40–60% of deaths are possibly preventable. In the developing world, many deaths are due to untreated epilepsy leading to falls or status epilepticus.

Epidemiology

Epilepsy is one of the most common serious neurological disordersJOURNAL, Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R, How common are the "common" neurologic disorders?, Neurology, 68, 5, 326–37, January 2007, 17261678, 10.1212/01.wnl.0000252807.38124.a3, affecting about 39 million people {{as of|2015|lc=y}}. It affects 1% of the population by age 20 and 3% of the population by age 75. It is more common in males than females with the overall difference being small. Most of those with the disorder (80%) are in the developing world.The estimated prevalence of active epilepsy ({{as of|2012|lc=y}}) is in the range 3–10 per 1,000, with active epilepsy defined as someone with epilepsy who has had a least one unprovoked seizure in the last five years. Epilepsy begins each year in 40–70 per 100,000 in developed countries and 80–140 per 100,000 in developing countries. Poverty is a risk and includes both being from a poor country and being poor relative to others within one's country. In the developed world epilepsy most commonly starts either in the young or in the old. In the developing world its onset is more common in older children and young adults due to the higher rates of trauma and infectious diseases. In developed countries the number of cases a year has decreased in children and increased among the elderly between the 1970s and 2003.JOURNAL, Sander JW, The epidemiology of epilepsy revisited, Current Opinion in Neurology, 16, 2, 165–70, April 2003, 12644744, 10.1097/00019052-200304000-00008, This has been attributed partly to better survival following strokes in the elderly.

History

{{See also|On the Sacred Disease}}File:Hippocrates rubens.jpg|thumb|upright=1.4|Hippocrates, 17th century engraving by Peter Paul RubensPeter Paul RubensThe oldest medical records show that epilepsy has been affecting people at least since the beginning of recorded history.BOOK, Saraceno B, Avanzini G, Lee P, Atlas: Epilepsy Care in the World, World Health Organization, 2005,weblink 978-92-4-156303-1, 20 December 2013, Throughout ancient history, the disease was thought to be a spiritual condition. The world's oldest description of an epileptic seizure comes from a text in Akkadian (a language used in ancient Mesopotamia) and was written around 2000 BC. The person described in the text was diagnosed as being under the influence of a moon god, and underwent an exorcism. Epileptic seizures are listed in the Code of Hammurabi (c. 1790 BC) as reason for which a purchased slave may be returned for a refund, and the Edwin Smith Papyrus (c. 1700 BC) describes cases of individuals with epileptic convulsions.The oldest known detailed record of the disease itself is in the Sakikku, a Babylonian cuneiform medical text from 10671046 BC. This text gives signs and symptoms, details treatment and likely outcomes, and describes many features of the different seizure types. As the Babylonians had no biomedical understanding of the nature of disease, they attributed the seizures to possession by evil spirits and called for treating the condition through spiritual means. Around 900 BC, Punarvasu Atreya described epilepsy as loss of consciousness;BOOK, Mervyn J., Eadie, Peter F., Bladin, vanc, A Disease Once Sacred: A History of the Medical Understanding of Epilepsy,weblink 2001, John Libbey Eurotext, 978-0-86196-607-3, this definition was carried forward into the Ayurvedic text of Charaka Samhita (about 400 BC).WEB, Epilepsy: An historical overview,weblink World Health Organization, 27 December 2013, Feb 2001, dead,weblink" title="web.archive.org/web/20131030115816weblink">weblink 30 October 2013, The ancient Greeks had contradictory views of the disease. They thought of epilepsy as a form of spiritual possession, but also associated the condition with genius and the divine. One of the names they gave to it was the sacred disease (ἠ ἱερὰ νόσος).WEB,weblink Epilepsy: historical overview, World Health Organization, 2011-03-20, live,weblink" title="web.archive.org/web/20110120101205weblink">weblink 20 January 2011, dmy-all, Epilepsy appears within Greek mythology: it is associated with the Moon goddesses Selene and Artemis, who afflicted those who upset them. The Greeks thought that important figures such as Julius Caesar and Hercules had the disease. The notable exception to this divine and spiritual view was that of the school of Hippocrates. In the fifth century BC, Hippocrates rejected the idea that the disease was caused by spirits. In his landmark work On the Sacred Disease, he proposed that epilepsy was not divine in origin and instead was a medically treatable problem originating in the brain. He accused those of attributing a sacred cause to the disease of spreading ignorance through a belief in superstitious magic. Hippocrates proposed that heredity was important as a cause, described worse outcomes if the disease presents at an early age, and made note of the physical characteristics as well as the social shame associated with it. Instead of referring to it as the sacred disease, he used the term great disease, giving rise to the modern term grand mal, used for tonic–clonic seizures. Despite his work detailing the physical origins of the disease, his view was not accepted at the time. Evil spirits continued to be blamed until at least the 17th century.In Ancient Rome people did not eat or drink with the same pottery as that used by someone who was affected.BOOK, Temkin, Owsei, vanc, The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology, JHU Press, 9781421400532, Section 1,weblink en, 1994-03-01, People of the time would spit on their chest believing that this would keep the problem from affecting them. According to Apuleius and other ancient physicians, in order to detect epilepsy, it was common to light a piece of gagates, whose smoke would trigger the seizure.BOOK, Stol, Marten, vanc, Epilepsy in Babylonia, 1993, BRILL, 978-9072371638, 143,weblink en, Occasionally a spinning potter's wheel was used, perhaps a reference to photosensitive epilepsy.BOOK, Harding, Graham F. A., Jeavons, Peter M., vanc, Photosensitive Epilepsy, 1994, Cambridge University Press, 9781898683025, 2,weblink en, In most cultures, persons with epilepsy have been stigmatized, shunned, or even imprisoned. As late as in the second half of the 20th century, in Tanzania and other parts of Africa epilepsy was associated with possession by evil spirits, witchcraft, or poisoning and was believed by many to be contagious.JOURNAL, Jilek-Aall L, Morbus sacer in Africa: some religious aspects of epilepsy in traditional cultures, Epilepsia, 40, 3, 382–6, March 1999, 10080524, 10.1111/j.1528-1157.1999.tb00723.x, In the Salpêtrière, the birthplace of modern neurology, Jean-Martin Charcot found people with epilepsy side-by-side with the mentally ill, those with chronic syphilis, and the criminally insane.{{fact|date=June 2019}} In ancient Rome, epilepsy was known as the morbus comitialis ('disease of the assembly hall') and was seen as a curse from the gods. In northern Italy, epilepsy was once traditionally known as Saint Valentine's malady.BOOK, Illes, Judika, vanc, Encyclopedia of Mystics, Saints & Sages,weblink 26 February 2013, 2011-10-11, HarperCollins, 978-0-06-209854-2, 1238, Saint Valentine is invoked for healing as well as love. He protects against fainting and is requested to heal epilepsy and other seizure disorders. In northern Italy, epilepsy was once traditionally known as Saint Valentine's Malady., live,weblink" title="web.archive.org/web/20140111113232weblink">weblink 11 January 2014, dmy-all, In the mid-1800s, the first effective anti-seizure medication, bromide, was introduced.JOURNAL, Perucca P, Gilliam FG, Adverse effects of antiepileptic drugs, The Lancet. Neurology, 11, 9, 792–802, September 2012, 22832500, 10.1016/S1474-4422(12)70153-9, The first modern treatment, phenobarbital, was developed in 1912, with phenytoin coming into use in 1938.BOOK, Medical toxicology, 2004, Lippincott Williams & Wilkins, Philadelphia [u.a.], 978-0-7817-2845-4, 789,weblink E. Martin, Caravati, vanc, 3rd,

Society and culture

{{See also|List of people with epilepsy}}

Stigma

Stigma is commonly experienced, around the world, by those with epilepsy.JOURNAL, de Boer HM, Epilepsy stigma: moving from a global problem to global solutions, Seizure, 19, 10, 630–6, December 2010, 21075013, 10.1016/j.seizure.2010.10.017, It can affect people economically, socially and culturally. In India and China, epilepsy may be used as justification to deny marriage. People in some areas still believe those with epilepsy to be cursed. In parts of Africa, such as Tanzania and Uganda, epilepsy is incorrectly claimed to be associated with possession by evil spirits, witchcraft, or poisoning and is believed by many to be contagious. Before 1971 in the United Kingdom, epilepsy was considered grounds for the annulment of marriage. The stigma may result in some people with epilepsy denying that they have ever had seizures.BOOK, Neligan A, Hauser WA, Sander JW, The epidemiology of the epilepsies, 107, 113–33, 2012, 22938966, 10.1016/B978-0-444-52898-8.00006-9, 978-0-444-52898-8, Handbook of Clinical Neurology, Epilepsy,

Economics

Seizures result in direct economic costs of about one billion dollars in the United States. Epilepsy resulted in economic costs in Europe of around 15.5 billion Euros in 2004. In India epilepsy is estimated to result in costs of US$1.7 billion or 0.5% of the GDP. It is the cause of about 1% of emergency department visits (2% for emergency departments for children) in the United States.JOURNAL, Martindale JL, Goldstein JN, Pallin DJ, Emergency department seizure epidemiology, Emergency Medicine Clinics of North America, 29, 1, 15–27, February 2011, 21109099, 10.1016/j.emc.2010.08.002,

Vehicles

{{See also|Epilepsy and driving}}Those with epilepsy are at about twice the risk of being involved in a motor vehicular collision and thus in many areas of the world are not allowed to drive or only able to drive if certain conditions are met. In some places physicians are required by law to report if a person has had a seizure to the licensing body while in others the requirement is only that they encourage the person in question to report it themselves. Countries that require physician reporting include Sweden, Austria, Denmark and Spain. Countries that require the individual to report include the UK and New Zealand and the physician may report if they believe the individual has not already. In Canada, the United States and Australia the requirements around reporting vary by province or state. If seizures are well controlled most feel allowing driving is reasonable. The amount of time a person must be free from seizures before they can drive varies by country. Many countries require one to three years without seizures. In the United States the time needed without a seizure is determined by each state and is between three months and one year.BOOK, Epilepsy : a comprehensive textbook, 2008, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-5777-5, 2279,weblink 2nd, Engel J, Pedley TA, Those with epilepsy or seizures are typically denied a pilot license.BOOK, Bor, Robert, vanc, Aviation Mental Health: Psychological Implications for Air Transportation, 2012, Ashgate Publishing, 978-1-4094-8491-2, 148,weblink In Canada if an individual has had no more than one seizure, they may be considered after five years for a limited license if all other testing is normal.WEB, Seizure Disorders,weblink Transport Canada, Government of Canada, 29 December 2013, dead,weblink" title="web.archive.org/web/20131230232523weblink">weblink 30 December 2013, dmy-all, Those with febrile seizures and drug related seizures may also be considered. In the United States, the Federal Aviation Administration does not allow those with epilepsy to get a commercial pilot license.BOOK, Wilner, Andrew N., vanc, Epilepsy 199 answers : a doctor responds to his patients' questions, 2008, Demos Health, New York, 978-1-934559-96-3, 52,weblink 3rd, live,weblink 17 May 2016, dmy-all, Rarely, exceptions can be made for persons who have had an isolated seizure or febrile seizures and have remained free of seizures into adulthood without medication.WEB, Guide for Aviation Medical Examiners,weblink Federal Aviation Administration, 29 December 2013, live,weblink" title="web.archive.org/web/20131017045628weblink">weblink 17 October 2013, dmy-all, In the United Kingdom, a full national private pilot license requires the same standards as a professional driver's license.WEB, National PPL (NPPL) Medical Requirements,weblink Civil Aviation Authority, 29 December 2013, live,weblink" title="web.archive.org/web/20131016233956weblink">weblink 16 October 2013, dmy-all, This requires a period of ten years without seizures while off medications.WEB, For Medical Practitioners: At a glance Guide to the current Medical Standards of Fitness to Drive,weblink 29 December 2013, Drivers Medical Group, 8, 2013, live,weblink 30 December 2013, dmy-all, Those who do not meet this requirement may acquire a restricted license if free from seizures for five years.

Support organizations

There are organizations that provide support for people and families affected by epilepsy. The Out of the Shadows campaign, a joint effort by the World Health Organization, the International League Against Epilepsy and the International Bureau for Epilepsy, provides help internationally. In the United States, the Epilepsy Foundation is a national organization that works to increase the acceptance of those with the disorder, their ability to function in society and to promote research for a cure.WEB, Epilepsy Foundation of America - EFA,weblink Healthfinder.gov, US Department of Health and Human Services, 28 July 2014, 28 April 2011, live,weblink" title="web.archive.org/web/20140716080153weblink">weblink 16 July 2014, dmy-all, The Epilepsy Foundation, some hospitals, and some individuals also run support groups in the United States.BOOK, Engel J, Pedley TA, Epilepsy: a comprehensive textbook, 2008, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 9780781757775, 2245, 2nd,weblink

Research

Seizure prediction refers to attempts to forecast epileptic seizures based on the EEG before they occur. {{as of|2011}}, no effective mechanism to predict seizures has been developed.JOURNAL, Carney PR, Myers S, Geyer JD, Seizure prediction: methods, Epilepsy & Behavior, 22 Suppl 1, S94–101, December 2011, 22078526, 3233702, 10.1016/j.yebeh.2011.09.001, Kindling, where repeated exposures to events that could cause seizures eventually causes seizures more easily, has been used to create animal models of epilepsy.BOOK, Epilepsy: a comprehensive textbook, 2008, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 9780781757775, 426,weblink 2nd, Engel J, Gene therapy is being studied in some types of epilepsy.JOURNAL, Walker MC, Schorge S, Kullmann DM, Wykes RC, Heeroma JH, Mantoan L, Gene therapy in status epilepticus, Epilepsia, 54 Suppl 6, 43–5, September 2013, 24001071, 10.1111/epi.12275,weblink Medications that alter immune function, such as intravenous immunoglobulins, are poorly supported by evidence.JOURNAL, Walker L, Pirmohamed M, Marson AG, Immunomodulatory interventions for focal epilepsy syndromes, The Cochrane Database of Systematic Reviews, 6, 6, CD009945, June 2013, 23803963, 10.1002/14651858.CD009945.pub2, Noninvasive stereotactic radiosurgery is, {{as of|2012|lc=y}}, being compared to standard surgery for certain types of epilepsy.JOURNAL, Quigg M, Rolston J, Barbaro NM, Radiosurgery for epilepsy: clinical experience and potential antiepileptic mechanisms, Epilepsia, 53, 1, 7–15, January 2012, 22191545, 3519388, 10.1111/j.1528-1167.2011.03339.x,

Other animals

Epilepsy occurs in a number of other animals including dogs and cats and is the most common brain disorder in dogs.JOURNAL, Thomas WB, Idiopathic epilepsy in dogs and cats, The Veterinary Clinics of North America. Small Animal Practice, 40, 1, 161–79, January 2010, 19942062, 10.1016/j.cvsm.2009.09.004, It is typically treated with anticonvulsants such as phenobarbital or bromide in dogs and phenobarbital in cats. Imepitoin is also used in dogs.JOURNAL, Rundfeldt C, Löscher W, The pharmacology of imepitoin: the first partial benzodiazepine receptor agonist developed for the treatment of epilepsy, CNS Drugs, 28, 1, 29–43, January 2014, 24357084, 10.1007/s40263-013-0129-z, While generalized seizures in horses are fairly easy to diagnose, it may be more difficult in non-generalized seizures and EEGs may be useful.JOURNAL, van der Ree M, Wijnberg I, A review on epilepsy in the horse and the potential of Ambulatory EEG as a diagnostic tool, The Veterinary Quarterly, 32, 3–4, 159–67, 2012, 23163553, 10.1080/01652176.2012.744496,

References

{{Reflist}}

Further reading

  • BOOK, Atlas, epilepsy care in the world, 2005, 2005, Programme for Neurological Diseases and Neuroscience, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, 978-92-4-156303-1,weblink World Health Organization, Department of Mental Health and Substance Abuse, Programme for Neurological Diseases and Neuroscience; Global Campaign against Epilepsy; International League against Epilepsy,
  • JOURNAL, Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, Hirsch E, Jain S, Mathern GW, Moshé SL, Nordli DR, Perucca E, Tomson T, Wiebe S, Zhang YH, Zuberi SM, ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology, Epilepsia, 58, 4, 512–521, April 2017, 28276062, 5386840, 10.1111/epi.13709,

External links

{{Medical resourcesG40}}-{{ICD1041g|40}}345}}| MedlinePlus = 000694| eMedicineSubj = neuro| eMedicineTopic = 415| DiseasesDB = 4366| MeshID = D004827}}{{Commons category|Epilepsy}} {{Diseases of the nervous system}}{{Seizures and epilepsy}}

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