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An epileptic seizure is "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain".<ref>Engel J Jr. [http://www.blackwell-synergy.com/doi/full/10.1111/j.1528-1167.2006.00215.x Report of the ILAE classification core group]. Epilepsia. 2006 Sep;47(9):1558–68. PMID 16981873.</ref> |
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There are three main types of seizures: partial, generalized, and unclassified. In terms of their origin within the brain, seizures may be described as either ''partial'' (focal) or ''generalized''. Partial seizures only involve a localized part of the brain, whereas generalized seizures involve the the whole of both hemispheres. The term ''secondary generalisation'' may be used to describe a partial seizure that later spreads to the whole of the cortex and becomes generalized. |
There are three main types of seizures: partial, generalized, and unclassified. In terms of their origin within the brain, seizures may be described as either ''partial'' (focal) or ''generalized''. Partial seizures only involve a localized part of the brain, whereas generalized seizures involve the the whole of both hemispheres. The term ''secondary generalisation'' may be used to describe a partial seizure that later spreads to the whole of the cortex and becomes generalized. |
Revision as of 12:49, 25 November 2007
Article structure
Signs and symptoms
- Engel J Jr. Report of the ILAE classification core group. Epilepsia. 2006 Sep;47(9):1558–68. PMID 16981873.
- Engel J Jr; International League Against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia. 2001 Jun;42(6):796–803. PMID 11422340.
- Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005 Apr;46(4):470-2. PMID 15816939.
- Beghi E, Berg A, Carpio A, Forsgren L, Hesdorffer DC, Hauser WA, Malmgren K, Shinnar S, Temkin N, Thurman D, Tomson T. Comment on epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) [letter]. Epilepsia. 2005 Oct;46(10):1698–9; author reply 1701–2. PMID 16190948.
- Gomez-Alonso J, Andrade C, Koukoulis A. On the definition of epileptic seizures and epilepsy [letter]. Epilepsia. 2005 Oct;46(10):1699–700; author reply 1701–2. PMID 16190949.
- Ahmed SN. Epileptic seizures and epilepsy [letter]. Epilepsia. 2005 Oct;46(10):1700–1; author reply 1701–2. PMID 16190950.
- Lüders HO, Acharya J, Alexopoulos A, 'et al'. Are epilepsy classifications based on epileptic syndromes and seizure types outdated? Epileptic Disord. 2006 Mar;8(1):81–5. PMID 16567333.
Seizure types
An epileptic seizure is "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain".[1]
There are three main types of seizures: partial, generalized, and unclassified. In terms of their origin within the brain, seizures may be described as either partial (focal) or generalized. Partial seizures only involve a localized part of the brain, whereas generalized seizures involve the the whole of both hemispheres. The term secondary generalisation may be used to describe a partial seizure that later spreads to the whole of the cortex and becomes generalized.
While most seizures can be neatly split into partial and generalized, some cannot. For example, a seizure that is generalized only within one hemisphere of the brain. Alternatively, there may be many focal points (multifocal seizures) that are distributed in a symmetrical or asymmetrical pattern.
- Partial seizures - Simple partial seizures, Complex partial seizures, Partial seizures evolving to secondarily generalized seizures
- Generalized seizures - Absence seizures (Older term: petit mal), Myoclonic seizures, Clonic seizures, Tonic seizures, Tonic-clonic seizures (Older term: grand mal), Atonic seizures
Status epilepticus
Characteristics
Causes
- Shostak S, Ottman R. Ethical, legal, and social dimensions of epilepsy genetics. Epilepsia. 2006 Oct;47(10):1595-602. PMID 17054679.
Triggers
- Flickering light[2]
- Thinking music[3]
- Eating[4]
- Praxis [Exercise?][5]
- Somatosensory [Explain][6]
- Proprioceptive [Explain][7]
- Reading[8]
- Exposure to hot water[9]
- Being startled[10]
Pathophysiology
Diagnosis
- Baumer JH; "Paediatric Accident and Emergency Research Group". Evidence based guideline for post-seizure management in children presenting acutely to secondary care. Arch Dis Child. 2004 Mar;89(3):278-80. PMID 14977713.
Treatment
- Chronic
- Glauser T, Ben-Menachem E, Bourgeois B, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006 Jul;47(7):1094–120. PMID 16886973.
- Shorvon S. We live in the age of the clinical guideline [Editorial]. Epilepsia. 2006 Jul;47(7):1091–3. PMID 16886972.
- Tudur Smith C, Marson AG, Chadwick DW, Williamson PR. Multiple treatment comparisons in epilepsy monotherapy trials (PDF). Trials. 2007 Nov 5;8(1):34 [Epub ahead of print]. PMID 17983480.
- Dunkley C, Cross JH. NICE guidelines and the epilepsies: how should practice change? Arch Dis Child. 2006 Jun;91(6):525-8. PMID 16714728.
- Choudhery V, Townend W. Best evidence topic reports. Lorazepam or diazepam in paediatric status epilepticus. Emerg Med J. 2006 Jun;23(6):472-3. PMID 16714516.
- Wilby J, Kainth A, Hawkins N, et al'. Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation (PDF). Health Technol Assess. 2005 Apr;9(15):1-157, iii-iv. PMID 15842952.
- Marson AG, Al-Kharusi AM, Alwaidh M, et al. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet. 2007 Mar 24;369(9566):1000-15. PMID 17382827.
- Marson AG, Al-Kharusi AM, Alwaidh M, et al. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet. 2007 Mar 24;369(9566):1016-26. PMID 17382828.
- Marson AG, Appleton R, Baker GA, et al. A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial (PDF). Health Technol Assess. 2007 Oct;11(37):1-154. PMID 17903391.
- Koren G, Nava-Ocampo AA, Moretti ME, et al. Major malformations with valproic acid. Can Fam Physician. 2006 Apr;52:441-2, 444, 447. PMID 16639967.
- Emergency
- Connock M, Frew E, Evans BW, et al. Best evidence topic reports. Lorazepam or diazepam in paediatric status epilepticus (PDF). J. Health Technol Assess. 2006 Mar;10(7):iii, ix-118. PMID 16714516.
- Walker M. Status epilepticus: an evidence based guide. BMJ. 2005 Sep 24;331(7518):673-7. PMID 16179702.
- Surgery
- Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain. 2005 May;128(Pt 5):1188-98. Epub 2005 Mar 9. PMID 15758038.
Electrophysiology
Prognosis
- Kwan P, Sander JW. The natural history of epilepsy: an epidemiological view. J Neurol Neurosurg Psychiatry. 2004 Oct;75(10):1376-81. PMID 15377680.
- Lhatoo SD, Sander JW. Sudden unexpected death in epilepsy (PDF). Hong Kong Med J. 2002 Oct;8(5):354-8. PMID 12376713.
Legal implications
Epidemiology
- Udani V. Pediatric epilepsy – an Indian perspective. Indian J Pediatr. 2005 Apr;72(4):309-13. PMID 15876759.
History
- Hunt SJ, Morrow JI, Craig JJ. Are we failing those with 'The Falling Sickness'? Time to modernise the approach to epilepsy care. Ulster Med J. 2007 Jan;76(1):3-5. PMID 17288297.
- Pearce JM. Early accounts of epilepsy: a synopsis. J Neurol Neurosurg Psychiatry. 1998 May;64(5):679, 682. PMID 9598691.
- Pearce JM. Bromide, the first effective antiepileptic agent. J Neurol Neurosurg Psychiatry. 2002 Mar;72(3):412. PMID 11861713.
Notes
Bibliography
External links
Bibliography
[Query: Anything that is not "evidence-based" should be excluded, should it not? Awadewit | talk 04:47, 19 November 2007 (UTC)]
Books
Journals
- Epilepsy Currents is the journal of the AES. Freely available online to all readers.
Web sites
- Atlas: Epilepsy Care in the World. World Health Organisation. September 2005. ISBN 9241563036. (Available in chapter downloads from WHO's Global Epilepsy Campaign Website).
- Probably the most useful resource for international facts and figures. The campaign website also contains reports from around the world, though it doesn't seem to have moved on since 2005.
- WHO Epilepsy Factsheets. World Health Organisation. February 2001.
- Has a few interesting resources. The History and the Social Consequences factsheets look promising but basic.
- Has a large number of articles, literature reviews and other information pages for the professional. Some are reprints of work published in journals; others seem to be written for NSE.
- The authority on classification and terminology. Useful glossary and extensive information on seizure types and syndromes.
- Loads of clinical overviews of various topics. Not as highly regarded as established peer-reviewed print journals.
Clinical guildelines
- NICE Clinical Guideline 20: Epilepsy. National Institute for Health and Clinical Excellence. October 2004.
- Comprises a number of PDF documents that contain a wealth of UK-focused data and guidelines built on evidence-based-medicine.
- SIGN Guideline 81: Diagnosis and management of epilepsies in children and young people. Scottish Intercollegiate Guidelines Network. March 2005.
- These Scottish guidelines, like the NICE equivalent for England & Wales, are thoroughly reviewed and evidence-based.
- SIGN Guideline 70: Diagnosis and management of epilepsy in adults. Scottish Intercollegiate Guidelines Network. October 2005. (Also available as HTML here.)
- A substantial number of guidelines with an American flavour. Often jointly supported by the American Epilepsy Society.