Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings G00-G99 - Diseases of the Nervous system (G00-G09 Inflammatory diseases of the Central nervous system ( Bacterial meningitis G00-G99 - Diseases of the Nervous system (G00-G09 Inflammatory diseases of the Central nervous system ( Bacterial meningitis The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books In Medicine, a chronic disease is a Disease that is long-lasting or recurrent An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting ^[1][2] These seizures are transient signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. ^[3] About 50 million people worldwide have epilepsy at any one time. ^[4] Epilepsy is usually controlled, but not cured, with medication, although surgery may be considered in difficult cases. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as a group of syndromes with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.

Classification

Epilepsies are classified in five ways:

1. By their first cause (or etiology). Etiology (alternatively aetiology, aitiology) is the study of causation.
2. By the observable manifestations of the seizures, known as semiology.
3. By the location in the brain where the seizures originate.
4. As a part of discrete, identifiable medical syndromes. In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician
5. By the event that triggers the seizures, as in primary reading epilepsy.

In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use. ^[5] This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes. ^[6] This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment. ^[7]

Diagnosis

The diagnosis of epilepsy requires the presence of recurrent, unprovoked seizures; accordingly, it is usually made based on the medical history. The medical history or Anamnesis of a Patient is information gained by a Physician or other healthcare professional by asking specific questions EEG, brain MRI, SPECT, PET, and magnetoencephalography may be useful to discover an etiology for the epilepsy, discover the affected brain region, or classify the epileptic syndrome, but these studies are not useful in making the initial diagnosis. Single photon emission computed tomography (SPECT or less commonly SPET is a Nuclear medicine tomographic imaging technique using Gamma rays. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the Magnetoencephalography ( MEG) is an imaging technique used to measure the Magnetic fields produced by electrical activity in the Etiology (alternatively aetiology, aitiology) is the study of causation.

Long-term video-EEG monitoring for epilepsy is the gold standard for diagnosis, but it is not routinely employed owing to its high cost, low availability and inconvenience. Long-term video-EEG monitoring, also known as video telemetry is a Diagnostic technique used in certain patients with Epilepsy or Seizures.

Convulsive or other seizure-like activity, non-epileptic in origin, can be observed in many other medical conditions. These non-epileptic seizures can be hard to differentiate and may lead to misdiagnosis. Non-epileptic seizures are paroxysmal events that mimic an Epileptic seizure but do not involve abnormal rhythmic discharges of cortical Neurons They are

Epilepsy covers conditions with different aetiologies, natural histories and prognoses, each requiring different management strategies. A full medical diagnosis requires a definite categorisation of seizure and syndrome types. ^[8]

Triggers

The diagnosis of epilepsy requires that the seizures be unprovoked, with the implication that the provocant is assumed to be something obviously harmful. Seizures due to alcohol or drug withdrawal, or immediately after a head injury, for example, do not imply a diagnosis of epilepsy. Most forms of epilepsy result in seizures that happen apparently spontaneously and at random. However, in some epilepsy syndromes, the provocant can reasonably be considered to be part of normal daily life. Examples of these normal provocants include reading, hot water on the head, hyperventilation, and flashing or flickering lights. In Medicine, hyperventilation (or overbreathing) is the state of Breathing faster and/or deeper than necessary bringing about lightheadedness and other This last provocant is a special type of reflex epilepsy called photosensitive epilepsy. Reflex Epilepsy ( also known as environmental epilepsy) is the cognomen to Seizures which are generated by a person’s acuteness to sensor stimulation caused by the Photosensitive epilepsy is a form of Epilepsy in which Seizures are triggered by visual stimuli that form patterns in time or space such as flashing lights bold Although it is mistakenly assumed that photosensitivity is a common element to all forms of epilepsy, among both patients and the public, only between 2-14% of people with epilepsy are affected by flickering lights. Photosensitivity amongst the general population is in the range of 0. 3-3%. Though, most people who are sensitive to light will never have a seizure during their life.

Certain environmental factors can lead to an increased likelihood of seizures in someone with epilepsy or in certain syndromes, for example:

• Being asleep
• The transition between sleep and wakefulness (hypnogogia)
• Tiredness and sleep deprivation
• Illness
• Constipation
• Menstruation
• Stress or anxiety
• Alcohol consumption
• Pictures with excessive flashing

Epidemiology

Epilepsy is one of the most common of the serious neurological disorders. Hypnagogia ( Greek ὕπνος húpnos "sleep" + the root found in ἄγω ágō "to lead away conduct convey" ἀγωγεύς Illness (sometimes referred to as ill-health or ail) can be defined as a state of poor Health. Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. ^[9] Genetic, congenital, and developmental conditions are mostly associated with it among younger patients; tumors are more likely over age 40; head trauma and central nervous system infections may occur at any age. A genetic disorder is a condition caused by abnormalities in Genes or Chromosomes While some diseases such as Cancer, are due to genetic abnormalities acquired A congenital disorder is a disease or disorder that is present at birth Developmental disorders are disorders that occur at some stage in a Child 's development often retarding the development See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Traumatic brain injury. THIS PAGE IS FOR INFORMATION ON HEAD INJURY (NOT SPECIFICALLY THE BRAIN--> Head injury is Central nervous system infections are those Infections of the Central nervous system (CNS The prevalence of active epilepsy is roughly in the range 5–10 per 1000 people. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given Up to 50 per 1000 people experience nonfebrile seizures at some point in life; epilepsy's lifetime prevalence is relatively high because most patients either stop having seizures or (less commonly) die of it. A febrile seizure, also known as a fever fit or febrile convulsion is a Convulsion triggered by a rise in Body temperature. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given Epilepsy's approximate annual incidence rate is 40–70 per 100,000 in industrialized countries and 100–190 per 100,000 in resource-poor countries; socioeconomically deprived people are at higher risk. Incidence is a measure of the risk of developing some new condition within a specified period of time In industrialized countries the incidence rate decreased in children but increased among the elderly during the three decades prior to 2003, for reasons not fully understood. ^[10]

Children with epilepsy are three to nine times more likely to have mental health problems than healthy children. Although the search for risk factors has often produced inconsistent results, there is evidence that the development of mental health problems in children with epilepsy is moderated and mediated by family risk factors. Attention-deficit/hyperactivity disorder (ADHD) affects three to five times more children with epilepsy than children in the general population, and children with epilepsy also have significantly higher rates of depression and anxiety. Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population ^[11] There is a strikingly higher prevalence of epilepsy in children with autism, and evidence suggests that epilepsy is a risk factor for autism, independent of other central nervous system problems. Language development. The terminology ^[12]

Seizure types

Main article: Seizure types

Seizure types are organized firstly according to whether the source of the seizure within the brain is localized (partial or focal onset seizures) or distributed (generalized seizures). The numerous epileptic Seizure types are most commonly defined and grouped according to a scheme proposed by the International League Against Epilepsy (ILAE in 1981 Focal seizures (also called partial seizures) are Seizures which affect only a small part of the brain and are split into two main categories Simple partial Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a simple partial seizure; otherwise it is a complex partial (psychomotor) seizure. Simple partial seizures are Seizures which affect only a small region of the brain often the Temporal lobes and/or Hippocampi. A complex partial seizure is an epileptic Seizure that is limited to one Cerebral hemisphere and causes Impairment of Awareness A partial seizure may spread within the brain - a process known as secondary generalization. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include absence (petit mal), myoclonic, clonic, tonic, tonic-clonic (grand mal) and atonic seizures. Absence seizures are one of several kinds of Seizures These seizures are sometimes referred to as petit mal seizures (from the French for "little illness" Myoclonus (maɪˈɒklənəs is brief involuntary twitching of a Muscle or a group of muscles Clonus (from the Greek for "violent confused motion" is a series of involuntary Muscular contractions due to sudden stretching of the muscle Tonic-clonic seizures are a type of Generalized seizure affecting the entire brain Atonic seizures (also called drop seizures, drop attacks, or akinetic seizures) are a minor type of Seizure.

Seizure syndromes

There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:

• Infantile spasms (West syndrome) is associated with brain development abnormalities, tuberous sclerosis, and perinatal insults to the brain. West syndrome, otherwise known as infantile spasms is an uncommon to rare and serious form of Epilepsy in Infants It is named after the English physician West syndrome, otherwise known as infantile spasms is an uncommon to rare and serious form of Epilepsy in Infants It is named after the English physician Tuberous sclerosis or tuberous sclerosis complex ( TSC) is a rare multi-system genetic disease that causes benign tumours to grow in the Brain It affects infants (as implied by its name), which by definition is between 30 days to 1 year of life. It carries a poor prognosis such that only 5-10% of children with infantile spasms will develop normal to near-normal function, while more than two-thirds will have severe deficits. The typical seizures are characterized by sudden flexor and extensor spasms of head, trunk, and extremities. The key EEG finding in these patients is a hypsarrhythmia, or a high-voltage slow wave with multifocal spikes. Hypsarrhythmia is abnormal Interictal high amplitude waves and a background of irregular spikes seen in Electroencephalogram, mostly in infant diagnosed with The first line treatment for these patients is adrenocorticotropic hormone (ACTH or corticotropin) since traditional antiepileptic drugs generally cannot adequately control seizure activity. Adrenocorticotropic hormone ( ACTH or corticotropin) is a Polypeptide Hormone produced and secreted by the Pituitary gland Adrenocorticotropic hormone ( ACTH or corticotropin) is a Polypeptide Hormone produced and secreted by the Pituitary gland Adrenocorticotropic hormone ( ACTH or corticotropin) is a Polypeptide Hormone produced and secreted by the Pituitary gland Vigabatrin is also used in many countries, and is particularly effective when tuberous sclerosis is the cause of seizures. Vigabatrin is an Anticonvulsant that inhibits the Catabolism of GABA.
  

  Generalized 3 Hz spike and wave discharges in EEG
• Childhood absence epilepsy affects children between the ages of 4 and 12 years of age. Childhood absence epilepsy (CAE also known as Pyknolepsy is a subtype of Idiopathic generalized epilepsy and is characterized by brief impairment of consciousness ( Absence These patients have recurrent absence seizures that can occur hundreds of times a day. On EEG, one finds the stereotyped generalized 3 Hz spike and wave discharges. A subset of these patients will also develop generalized tonic-clonic seizures. This condition carries a fairly good prognosis in that these children do not usually show cognitive decline or neurological deficits. First line treatment for pure absence seizures is ethosuximide. Ethosuximide is a Succinimide Anticonvulsant, used mainly in Absence seizures Uses Approved It is approved for absence If patients do not respond or have mixed seizures along with their absence seizures, then valproic acid can be used. Valproic acid ( VPA) is a Chemical compound that has found clinical use as an Anticonvulsant and mood-stabilizing drug, primarily in
• Dravet's syndrome Severe myoclonic epilepsy of infancy (SMEI). Generalized epilepsy with febrile seizures plus (GEFS+ is a syndromic Autosomal dominant disorder where afflicted individuals can exhibit numerous Epilepsy This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. Onset is in the first year of life and symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys are twice as often affected as girls. Prognosis is poor. In 2005, there were at least around 450 cases reported in the worldwide literature but now it is impossible to count the known cases because many probably have been published twice because of the genetic research. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptional. ^[13]
• Benign focal epilepsies of childhood The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. Benign familial neonatal convulsions (BFNC is a rare Autosomal dominant inherited form of Epilepsy. Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. Prognosis is quite good overall with seizures disappearing by adolescence. There is no consensus on the first line treatment, however most cases respond well to most anticonvulsants. The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic
• Juvenile myoclonic epilepsy (JME) begins in patients aged 8 to 20 years. Juvenile myoclonic epilepsy (JME also known as Janz syndrome is a fairly common form of Idiopathic generalized epilepsy, representing 5-10% of all epilepsies These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls. EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e. g. , freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. Valproic acid is the first line treatment, whereas carbamazepine can actually worsen symptoms. Valproic acid ( VPA) is a Chemical compound that has found clinical use as an Anticonvulsant and mood-stabilizing drug, primarily in This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.
• Temporal lobe epilepsy is the most common epilepsy of adults. Temporal lobe epilepsy is a form of focal Epilepsy, a chronic neurological condition characterized by recurrent Seizures While In most cases, the epileptogenic region is found in the mesial temporal structures (e. g. , the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. Most of these patients have complex partial seizures sometimes preceded by an aura, and some TLE patients also suffer from secondary generalised tonic-clonic seizures. An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy Tonic-clonic seizures are a type of Generalized seizure affecting the entire brain If the patient does not respond sufficiently to medical treatment, surgery may be considered.
• Fetal alcohol syndrome (FAS) is caused by prenatal alcohol exposure and results in central nervous system (CNS) damage. History Historical references Anecdotal accounts of prohibitions against maternal alcohol use from biblical, ancient Greek, and ancient Roman In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD. ^[14]
• Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a rare epileptic disorder that causes frequent violent seizures during sleep. Autosomal dominant Nocturnal Frontal lobe Epilepsy (ADNFLE is a rare epileptic disorder that causes frequent violent seizures during sleep These seizures often involve complex motor movements, such as hand clenching, arm raising/lowering, and knee bending. Vocalizations such as shouting, moaning, or crying are also common. ADNFLE is often misdiagnosed as nightmares. Attacks often occur in clusters and typically first manifest in childhood. ADNFLE has a genetic basis with four known loci, three with known causative genes. These genes encode various nicotinic acetylcholine receptor α and β subunits CHRNA4, CHRNB2, and CHRNA2. Structure Nicotinic receptors with a molecular mass of 290 kDa, are made up of five subunits arranged symmetrically around the central pore.
• Frontal lobe epilepsy
• Lennox-Gastaut syndrome
• Occipital lobe epilepsy

Treatment

Epilepsy is usually treated with medication prescribed by a physician; primary caregivers, neurologists, and neurosurgeons all frequently care for people with epilepsy. Frontal lobe epilepsy is the second most common type of Epilepsy, after Temporal lobe epilepsy. Lennox-Gastaut syndrome (LGS also known as Lennox syndrome, is a difficult-to-treat form of childhood-onset Epilepsy that most often appears between the second and Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health Primary care is a term used for the activity of a Health care provider who acts as a first point of consultation for all patients Neurosurgery is the surgical discipline focused on treating those central, Peripheral nervous system and spinal column diseases amenable to surgical In some cases the implantation of a stimulator of the vagus nerve, or a special diet can be helpful. The vagus nerve (ˈveɪˌgəs (VĀ-gəs (also called pneumogastric nerve or cranial nerve X) is the tenth of twelve paired Cranial nerves, and is the Neurosurgical operations for epilepsy can be palliative, reducing the frequency or severity of seizures; or, in some patients, an operation can be curative. Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms

Responding to a seizure

In most cases, the proper emergency response to a generalized tonic-clonic epileptic seizure is simply to prevent the patient from self-injury by moving him or her away from sharp edges, placing something soft beneath the head, and carefully rolling the person into the recovery position to avoid asphyxiation. Tonic-clonic seizures are a type of Generalized seizure affecting the entire brain In Anatomy, the head of an Animal is the Rostral part (from Anatomical position that usually comprises the Brain, Eyes The recovery position or more technically known as the lateral recumbent position is a First aid technique recommended for assisting people who are unconscious In some cases the person may seem to start snoring loudly following a seizure, before coming to. Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during Breathing while Sleeping In some cases the sound This merely indicates that the person is beginning to breathe properly and does not mean he or she is suffocating. Should the person regurgitate, the material should be allowed to drip out the side of the person's mouth by itself. If a seizure lasts longer than 5 minutes, or if the seizures begin coming in 'waves' one after the other - then Emergency Medical Services should be contacted immediately. Emergency medical services (abbreviated to the initialism "EMS" in many countries are a branch of Emergency services dedicated to providing out-of-hospital Prolonged seizures may develop into status epilepticus, a dangerous condition requiring hospitalization and emergency treatment. Status epilepticus (SE refers to a life-threatening condition in which the Brain is in a state of persistent Seizure.

Objects should never be placed in a person's mouth by anybody - including paramedics - during a seizure as this could result in serious injury to either party. The mouth, buccal cavity, or oral cavity is the first portion of the Alimentary canal that receives food and begins digestion by mechanically breaking up Despite common folklore, it is not possible for a person to swallow their own tongue during a seizure. History The concept of folklore developed as part of the 19th century ideology of Romantic nationalism, leading to the reshaping of oral traditions to serve modern ideological The tongue is the large bundle of Skeletal muscles on the floor of the Mouth that manipulates Food for chewing and swallowing (deglutition However, it is possible that the person will bite their own tongue, especially if an object is placed in the mouth.

With other types of seizures such as simple partial seizures and complex partial seizures where the person is not convulsing but may be hallucinating, disoriented, distressed, or unconscious, the person should be reassured, gently guided away from danger, and sometimes it may be necessary to protect the person from self-injury, but physical force should be used only as a last resort as this could distress the person even more. A complex partial seizure is an epileptic Seizure that is limited to one Cerebral hemisphere and causes Impairment of Awareness In complex partial seizures where the person is unconscious, attempts to rouse the person should not be made as the seizure must take its full course. After a seizure, the person may pass into a deep sleep or otherwise they will be disoriented and often unaware that they have just had a seizure, as amnesia is common with complex partial seizures. The person should remain observed until they have completely recovered, as with a tonic-clonic seizure.

After a seizure, it is typical for a person to be exhausted and confused. Often the person is not immediately aware that they have just had a seizure. During this time one should stay with the person - reassuring and comforting them - until they appear to act as they normally would. Seldom during seizures do people lose bladder or bowel control. In some instances the person may vomit after coming to. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the People should not eat or drink until they have returned to their normal level of awareness, and they should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure - this is common for those having just experienced a more violent type of seizure such as a tonic-clonic. In about 50% of people with epilepsy, headaches may occur after a seizure. These headaches share many features with migraines, and respond to the same medications.

It is helpful if those present at the time of a seizure make note of how long and how severe the seizure was. It is also helpful to note any mannerisms displayed during the seizure. For example, the individual may twist the body to the right or left, may blink, might mumble nonsense words, or might pull at clothing. Any observed behaviors, when relayed to a neurologist, may be of help in diagnosing the type of seizure which occurred.

Pharmacologic treatment

Main article: Anticonvulsant

Mechanisms of Drug Action:- 1- Sodium channel blockers (voltage dependent) 2- Calcium channel blockers (T-type) 3- Potentiate the effect of GABA (inhibitory) 4- Decrease the excitatory transmission (glutaminic) Some medications can be taken daily in order to prevent seizures altogether or reduce the frequency of their occurrence. The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic These are termed "anticonvulsant" or "antiepileptic" drugs (sometimes AEDs). All such drugs have side effects that are idiosyncratic and others that are dosage-dependent. It is not possible to predict who will suffer from side effects or at what dose the side effects will appear.

Some people with epilepsy will experience a complete remission when treated with an anticonvulsant medication. If this does not occur, the dose of medication may be increased, or another medication may be added to the first. The general strategy is to increase the medication dose until either the seizures are controlled, or until dose-limiting side effects appear; at which point the medication dose is reduced to the highest amount that does not produce undesirable side effects.

A study found that in 83% of patients on a two drug regime to control their epilepsy could be slowly transferred completely off of one of the drugs and be controlled with a single drug regime without any increase in seizure frequency. Surprisingly it was found that 36% of patients showed greater seizure control on a single drug regime for epilepsy control than on a two drug regime. Side effects were also decreased in those taking a single drug regime. It was concluded that overall a reduction in polypharmacy may be benefitial for most patients who have intractable epilepsy. ^[15]

Serum levels of AEDs can be checked to determine medication compliance and to assess the effects of drug-drug interactions; some physicians do not use serum levels to fine tune medication, but other physicians believe that serum levels provide excellent data for tailoring medications to suit an individual's specific and relatively variable body chemistry. Compliance (or Adherence) is a medical term that is used to indicate a patient's correct following of medical advice For example, therapeutic doses (the dose at which seizures are controlled and side effects are minimal and tolerable) may vary widely from among patients. The therapeutic ranges provided by pharmaceutical companies are only ranges and by using blood serum levels and seizures diaries, better seizure control can sometimes be reached. In some cases (such as a seizure flurry) serum levels can be useful to know if the level is very high or very low.

If a person's epilepsy cannot be brought under control after adequate trials of two or three (experts vary here) different drugs, that person's epilepsy is generally said to be 'medically refractory. '

Various drugs may prevent seizures or reduce seizure frequency: these include carbamazepine (common brand name Tegretol), clobazam (Frisium), clonazepam (Klonopin), ethosuximide (Zarontin), felbamate (Felbatol), fosphenytoin (Cerebyx), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin), pregabalin (Lyrica), primidone (Mysoline), sodium valproate (Epilim), tiagabine (Gabitril), topiramate (Topamax), valproate semisodium (Depakote, Epival), valproic acid (Depakene, Convulex), vigabatrin (Sabril), and zonisamide (Zonegran). Carbamazepine ("CBZ" is an Anticonvulsant and mood stabilizing drug used primarily in the treatment of Epilepsy and Bipolar disorder Clobazam is a drug which is a Benzodiazepine derivative It has been marketed as an Anxiolytic since 1975 and an Anticonvulsant since 1984 Clonazepam (marketed by Roche under the trade-names Klonopin in the United States and Rivotril, Ravotril or Rivatril in Europe South Ethosuximide is a Succinimide Anticonvulsant, used mainly in Absence seizures Uses Approved It is approved for absence Felbamate (marketed under the brand name Felbatol by MedPointe) is an Anticonvulsant drug used in the treatment of Epilepsy. Fosphenytoin ( Cerebyx, Parke-Davis; Prodilantin, Pfizer Holding France) is a water-soluble Phenytoin Prodrug used only Gabapentin (brand name Neurontin) is a medication originally developed for the treatment of Epilepsy. Lamotrigine (marketed as Lamictal (ləˈmɪktəl by GlaxoSmithKline, called Lamictin in South Africa, he למוג'ין ( Lamogine Levetiracetam ( INN) (lɛvɨtɪˈræsɨtæm Oxcarbazepine (marketed as Trileptal by Novartis or Trexapin by Taro is an Anticonvulsant and mood stabilizing drug, used primarily Phenobarbital ( INN) or phenobarbitone (former BAN) is a Barbiturate, first marketed as Luminal by Friedr Phenytoin sodium is a commonly used Antiepileptic. Phenytoin acts to dampen the unwanted runaway brain activity seen in seizure by reducing electrical conductance among brain Pregabalin ( INN) (prɨˈgæbəlɨn is an Anticonvulsant drug used for Neuropathic pain and as an adjunct therapy for Partial seizures with or Primidone is an Anticonvulsant of the Pyrimidinedione class whose active Metabolites Phenobarbital (major and phenylethylmalonamide (PEMA (minor See also Valproic acid Sodium valproate ( INN) or valproate sodium ( USAN) is the sodium salt of Valproic acid and is an Tiagabine (taɪˈæɡəbiːn] is an anti-convulsive Topiramate (brand name Topamax) is an Anticonvulsant drug produced by Ortho-McNeil Neurologics and Noramco Inc See also Valproic acid Valproate semisodium ( INN) or divalproex sodium ( USAN) consists of a compound of Sodium valproate and Valproic acid ( VPA) is a Chemical compound that has found clinical use as an Anticonvulsant and mood-stabilizing drug, primarily in Vigabatrin is an Anticonvulsant that inhibits the Catabolism of GABA. Zonisamide is a Sulfonamide Anticonvulsant approved for use as an adjunctive therapy in adults with partial-onset seizures History

Other drugs are commonly used to abort an active seizure or interrupt a seizure flurry; these include diazepam (Valium) and lorazepam (Ativan). Diazepam (daɪˈæzɨpæm first marketed as Valium by Hoffmann-La Roche, is a Benzodiazepine derivative Drug. Lorazepam (also known by its brand name Ativan or Temesta) is a Benzodiazepine drug with short to medium duration of action Drugs used only in the treatment of refractory status epilepticus include paraldehyde (Paral), midazolam (Versed), and pentobarbital (Nembutal). Status epilepticus (SE refers to a life-threatening condition in which the Brain is in a state of persistent Seizure. Paraldehyde is the cyclic form of three Acetaldehyde molecules (a trimer Midazolam (marketed under brand names Dormicum, Flormidal, Versed, Hypnovel and Dormonid, pronounced mɪˈdæzəlæm Pentobarbital is a short-acting Barbiturate that is available as both a Free acid and a Sodium salt, the former of which is only slightly soluble in water

Bromides were the first of the effective anticonvulsant pure compounds, but are no longer used in humans^[16] due to their toxicity and low efficacy. Potassium bromide ( K[[Bromine Br]] is a salt, widely used as an Anticonvulsant and a Sedative in the late 19th and early 20th centuries Toxicity is the degree to which a substance is able to damage an exposed organism Efficacy is the capacity to produce a desired size of an effect under Ideal or Optimal conditions

It has been found that taking valproates while pregnant can have high chances of reduced IQ towards children. Valproic acid ( VPA) is a Chemical compound that has found clinical use as an Anticonvulsant and mood-stabilizing drug, primarily in ^[17][18]

Many epileptics have found that marijuana is an effective medical treatment of epilepsy, and a telephone survey conducted in 2003 revealed that more than twice as many epileptics use marijuana than the general population. Medical cannabis refers to the use of the Cannabis plant as a physician-recommended Herbal therapy as well as synthetic THC and Cannabinoids ^[19][20]

Surgical treatment

Surgical treatment can be an option for epilepsy when an underlying brain abnormality, such as a benign tumor or an area of scar tissue (e. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic g. hippocampal sclerosis) can be identified. Formaida Sclerosis or Ammon's horn sclerosis (AHS is the most common type of neuropathological damage seen in individuals with Temporal lobe epilepsy (TLE The abnormality must be removable by a neurosurgeon.

Surgery is usually only offered to patients when their epilepsy has not been controlled by adequate attempts with multiple medications. Before surgery is offered, the medical team conducts many tests to assess whether removal of brain tissue will result in unacceptable problems with memory, vision, language or movement, which are controlled by different parts of the brain. In Psychology, memory is an organism's ability to store retain and subsequently retrieve information In Psychology, visual perception is the ability to interpret information from Visible light reaching the Eyes The resulting Perception is also A language is a dynamic set of visual auditory or tactile Symbols of Communication and the elements used to manipulate them The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain These tests usually include a neuropsychological evaluation, which sometimes includes an intracarotid sodium amobarbital test (Wada test) - although this invasive procedure is being replaced by non-invasive functional MRI in many centres. Neuropsychology is the applied scientific discipline that studies the structure and function of the Brain related to specific psychological processes and overt behaviors The Wada test, also known as the " intracarotid Sodium Amobarbital procedure" (ISAP is used to establish which cerebral functions The Wada test, also known as the " intracarotid Sodium Amobarbital procedure" (ISAP is used to establish which cerebral functions Resective surgery, as opposed to palliative, successfully eliminates or significantly reduces seizures in about 50-90% of the patients who undergo it (the exact percentage depends on the particulars of the case and surgeon in question. ) Many patients decide not to undergo surgery owing to fear or the uncertainty of having a brain operation.

The most common form of resective surgical treatment for epilepsy is to remove the front part of either the right or left temporal lobe. The temporal lobes are parts of the cerebrum that are involved in speech, Memory, and Hearing. A study of 48 patients who underwent this operation, anterior temporal lobectomy, between 1965 and 1974 determined the long-term success of the procedure. Anterior temporal lobectomy is the complete removal of the anterior portion of the temporal lobe of the Brain. Year 1965 ( MCMLXV) was a Common year starting on Friday (link will display full calendar of the 1965 Gregorian calendar. Year 1974 ( MCMLXXIV) was a Common year starting on Tuesday (link will display full calendar of the 1974 Gregorian calendar. Of the 48 patients, 21 had had no seizures that caused loss of consciousness since the operation. Three others had been free of seizures for at least 19 years. The rest had either never been completely free of seizures or had died between the time of the surgery and commencement of the study. ^[21]

Palliative surgery for epilepsy is intended to reduce the frequency or severity of seizures. Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms Examples are callosotomy or commissurotomy to prevent seizures from generalizing (spreading to involve the entire brain), which results in a loss of consciousness. Corpus callosotomy (or less frequently callotomy) is a Surgical procedure that disconnects the Cerebral hemispheres resulting in a condition called A commissurotomy is a Surgical incision of a Commissure in the body as one made in the heart to relieve constriction of the mitral valve or one made in the brain This procedure can therefore prevent injury due to the person falling to the ground after losing consciousness. It is performed only when the seizures cannot be controlled by other means. Resective surgery can be considered palliative if it is undertaken with the expectation that it will reduce but not eliminate seizures.

Hemispherectomy is a drastic operation in which most or all of one half of the cerebral cortex is removed. Hemispherectomy is a Surgical procedure where one Cerebral hemisphere (half of the Brain) is removed or disabled It is reserved for people suffering from the most catastrophic epilepsies, such as those due to Rasmussen syndrome. Rasmussen's encephalitis, also Chronic Focal Encephalitis (CFE is a rare progressive neurological disorder, characterized by frequent and severe Seizures loss of If the surgery is performed on very young patients (2-5 years old), the remaining hemisphere may acquire some rudimentary motor control of the ipsilateral body; in older patients, paralysis results on the side of the body opposite to the part of the brain that was removed. Because of these and other side effects it is usually reserved for patients who have exhausted other treatment options.

Other treatment

The ketogenic diet can be effective and is mainly used in children whose epilepsy has not been controlled with medication. The ketogenic diet is a high fat adequate Protein, low carbohydrate diet, primarily used to treat difficult-to-control (refractory Epilepsy in children As with anticonvulsant drugs, the mechanism behind the effect is not fully understood. The ketogenic diet is very high in fat and very low in carbohydrates. Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water Carbohydrates (from ' Hydrates of Carbon ' or saccharides ( Greek σάκχαρον meaning " Sugar " are the most This treatment was developed in the 1920s at the Mayo clinic, but was largely forgotten with the discovery of modern anti-epileptic drugs. Mayo Clinic is a Non-profit medical practice Its headquarters the Mayo Medical School and its research facilities are in Rochester Minnesota in Since the 1990s, it has returned to the anti-epileptic treatment arsenal and is available from most paediatric epilepsy centres.

A study conducted by Johns Hopkins reported that 50% of those patients starting the Ketogenic diet reported a decrease in seizures of 50% or more, with 29% of patients reporting a 90% reduction in symptoms; these patients had previously tried an average of six anticonvulsant drugs.

Vagus nerve stimulation (VNS) is a recently developed form of seizure control which uses an implanted electrical device, similar in size, shape and implant location to a heart pacemaker, which connects to the vagus nerve in the neck. Vagus nerve stimulation (VNS is an adjunctive treatment for certain types of intractable Epilepsy and major depression. For other uses see Pacemaker (disambiguation A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker The vagus nerve (ˈveɪˌgəs (VĀ-gəs (also called pneumogastric nerve or cranial nerve X) is the tenth of twelve paired Cranial nerves, and is the The neck is the part of the Body on many limbed Vertebrates that distinguishes the head from the Torso or trunk Once in place the device can be set to emit electronic pulses, stimulating the vagus nerve at pre-set intervals and milliamp levels. Treatment studies have shown that approximately 50% of those treated in this fashion will show significant seizure frequency reduction.

The Responsive Neurostimulator System (RNS) is currently undergoing clinical study prior to FDA approval. This system relies upon a device implanted just under the scalp. The leads attached to the device are implanted either on the brain surface or in the brain area itself and are located close to the area where the seizures are believed to start. When a seizure begins, small amounts of electrical stimulation are delivered to suppress it. This system is different from the VNS system in that the RNS relies on direct brain stimulation and the RNS is a responsive system. The VNS pulses at predetermined intervals previously set by medical personnel. The RNS system is designed to respond to detected signs that a seizure is about to begin and can record events and allow customized response patterns which may provide a greater degree of seizure control. ^[22]

A seizure response dog is a form of service dog that is trained to summon help or ensure personal safety when a seizure occurs. Seizure response dogs are a special type of Service dog, specifically trained to help someone who has seizures A service dog is a type of Assistance dog, specifically trained to help people who have disabilities other than visual or Hearing impairment These are not suitable for everybody and not all dogs can be so trained. Rarely, a dog may develop the ability to sense a seizure before it occurs. ^[23]

A number of systematic reviews by the Cochrane Collaboration into treatments for epilepsy looked at acupuncture,^[24] psychological interventions,^[25] vitamins^[26] and yoga^[27] and found there is no reliable evidence to support the use of these as treatments for epilepsy. A systematic review is a Literature review focused on a single question which tries to identify appraise select and synthesize all high quality research evidence relevant to The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical History Antiquity In China, the practice of acupuncture can perhaps be traced as far back as Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and A vitamin is an Organic compound required as a Nutrient in tiny amounts by an Organism. Yoga ( Sanskrit: योग, IAST: yóga, joːgə refers to traditional physical and mental disciplines originating in India, to the Evidence-based medicine (EBM aims to apply Evidence gained from the Scientific method to certain parts of medical practice Further studies are needed on the subject.

Pathophysiology

Mutations in several genes have been linked to some types of epilepsy. In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance Several genes that code for protein subunits of voltage-gated and ligand-gated ion channels have been associated with forms of generalized epilepsy and infantile seizure syndromes. Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl Voltage-gated ion channels are a class of transmembrane Ion channels that are activated by changes in electrical Potential difference near the channel these The Ligand-gated ion channels, also referred to as LGICs, or ionotropic receptors, are a group of intrinsic transmembrane ion channels that are Ion channels are pore-forming Proteins that help establish and control the small Voltage Gradient across the Plasma membrane of all living ^[28] Several ligand-gated ion channels have been linked to some types of frontal and generalized epilepsies. Epilepsy-related mutations in some non-ion channel genes have also been identified.

One interesting finding in animals is that repeated low-level electrical stimulation to some brain sites can lead to permanent increases in seizure susceptibility: in other words, a permanent decrease in seizure "threshold. " This phenomenon, known as kindling (by analogy with the use of burning twigs to start a larger fire) was discovered by Dr. Graham Goddard in 1967. Chemical stimulation can also induce seizures; repeated exposures to some pesticides have been shown to induce seizures in both humans and animals. One mechanism proposed for this is called excitotoxicity. Excitotoxicity is the pathological process by which nerve cells are damaged and killed by glutamate and similar substances The roles of kindling and excitotoxicity, if any, in human epilepsy are currently hotly debated.

Other causes of epilepsy are brain lesions, where there is scar tissue or another abnormal mass of tissue in an area of the brain.

History and stigma

The word epilepsy is derived from the Greek epilepsia, which in turn can be broken into epi- (upon) and lepsis (to take hold of, or seizure)^[29] In the past, epilepsy was associated with religious experiences and even demonic possession. A religion is a set of Tenets and practices often centered upon specific Supernatural and moral claims about Reality, the Cosmos Spirit possession is a concept of Paranormal, Supernatural and/or Superstitious belief in which spirits, gods, daemons In ancient times, epilepsy was known as the "Sacred Disease" because people thought that epileptic seizures were a form of attack by demons, or that the visions experienced by persons with epilepsy were sent by the gods. In Spirituality including Religion, visions comprise Inspirational renderings generally of a Future state and/or of a mythical See also List of deities A deity is a Postulated Preternatural or Supernatural Being, who is always Among animist Hmong families, for example, epilepsy was understood as an attack by an evil spirit, but the affected person could become revered as a shaman through these otherworldly experiences. Animism (from Latin anima ( Soul, Life) commonly refers to a religious belief that Souls or Spirits exist in Animals The terms Hmong (m̥ɔ̃ŋ and Mong ( both refer to an Asian ethnic group in the mountainous regions of southern China. [1]

However, in most cultures, persons with epilepsy have been stigmatized, shunned, or even imprisoned; in the Salpêtrière, the birthplace of modern neurology, Jean-Martin Charcot found people with epilepsy side-by-side with the mentally retarded, those with chronic syphilis, and the criminally insane. Pitié-Salpêtrière Hospital ( Groupe hospitalier de la Pitié-Salpétrière) is a world-renowned Teaching hospital located in Paris, France. Jean-Martin Charcot ( 29 November 1825 – 16 August 1893) was a French Neurologist and professor of Anatomical pathology Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. In Tanzania to this day, as with other parts of Africa, epilepsy is associated with possession by evil spirits, witchcraft, or poisoning and is believed by many to be contagious. Tanzania ˌtænzəˈniːə officially the United Republic of Tanzania (Jamhuri ya Muungano wa Tanzania is a country in East Africa bordered by Kenya ^[30] In ancient Rome, epilepsy was known as the Morbus Comitialis ('disease of the assembly hall') and was seen as a curse from the gods.

Stigma continues to this day, in both the public and private spheres, but polls suggest it is generally decreasing with time, at least in the developed world; Hippocrates remarked that epilepsy would cease to be considered divine the day it was understood. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca ^[31]

Notable people with epilepsy

Main article: List of people with epilepsy

Many notable people, past and present, have carried the diagnosis of epilepsy. Wikipedia talkFeatured lists for an explanation of this and other inclusion tags below -->This is a list of notable people who have or had the medical condition In many cases, their epilepsy is a footnote to their accomplishments; for some, it played an integral role in their fame. Historical diagnoses of epilepsy are not always certain; there is controversy about what is considered an acceptable amount of evidence in support of such a diagnosis.

Legal implications

Most people diagnosed with epilepsy are forbidden by their local laws from operating vehicles. However, there are usually exceptions for those who can prove that they have stabilized their condition. Those few whose seizures do not cause impairment of consciousness, or whose seizures only arise from sleep, may be exempt from such restrictions, depending on local laws. There is an ongoing debate in bioethics over who should bear the burden of ensuring that an epilepsy patient does not drive a car or fly an airplane. Bioethics is the philosophical study of the ethical controversies brought about by advances in Biology and Medicine.

In the U.S., people with epilepsy can drive if their seizures are controlled with treatment and they meet the licensing requirements in their state. The United States of America —commonly referred to as the How long they have to be free of seizures varies in different states, but it is most likely to be between three months and a year. ^[32][33] The majority of the 50 states place the burden on patients to report their condition to appropriate licensing authorities so that their privileges can be revoked where appropriate. A minority of states place the burden of reporting on the patient's physician. After reporting is carried out, it is usually the driver's licensing agency that decides to revoke or restrict a driver's license.

In the UK, it is the responsibility of the patients to inform the Driver and Vehicle Licensing Agency (DVLA) if they have epilepsy. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Driver and Vehicle Licensing Agency (DVLA (Asiantaeth Trwyddedu Gyrwyr a Cherbydau is the organisation of UK Government responsible for maintaining a database of ^[34] The DVLA rules are quite complex,^[35] but in summary,^[36] those continuing to have seizures or who are within 6 months of medication change may have their licence revoked. A doctor who becomes aware that a patient with uncontrolled epilepsy is continuing to drive has, after reminding the patient of their responsibility, a duty to break confidentiality and inform the DVLA. The doctor should advise the patient of the disclosure and the reasons why their failure to notify the agency obliged the doctor to act.

The Epilepsy Foundation's Jeanne A. Carpenter
 Epilepsy Legal Defense Fund is dedicated to advancing the rights of people with epilepsy by changing discriminatory practices, policies and laws and to ending epilepsy-related discrimination and injustice through education and increased access to legal services for individuals with epilepsy through a system of managed referrals and legal support to a nationwide network of attorneys committed to this cause.

Additionally, the Epilepsy Foundation is a vigorous advocate for people with epilepsy. In the United States, the Foundation has been active in Congress, the executive branch, and the courts, focusing attention on the needs of those with epilepsy. Priorities for the Foundation include: the availability of affordable quality health care, the search for the cure, and the protection of civil rights for people with epilepsy.

Epilepsy in popular culture

• The Lost Prince - A 2003 British television drama about Prince John, who had epilepsy
• Black Eyed Peas song Let's Get Retarded contains the lyrics 'Bop your head like epilepsy'. The Lost Prince is an acclaimed British television drama produced by Talkback Thames for the BBC and originally broadcast in two episodes The Black Eyed Peas is an American hip hop group from Los Angeles.

Important investigators of epilepsy

• Jean-Martin Charcot
• John Hughlings Jackson
• Hans Berger
• Herbert Jasper
• Wilder Penfield
• H. Houston Merritt
• William G. Lennox

See also

• Seizure
• Non-epileptic seizures
• Epilepsy in animals
• Seizure response dog
• Jacksonian seizure
• Photosensitive epilepsy
• Post-traumatic epilepsy
• Temporal lobe epilepsy
• Abdominal epilepsy
• Generalised epilepsy
• ISAS (Ictal-Interictal SPECT Analysis by SPM)
• Medical research related to low-carbohydrate diets

References

External links

• Epilepsy at the Open Directory Project