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;Chronic:
;Chronic:
*Drugs are often first chosen based on the seizure type: partial-onset, generalised-onset, and absence seizures. Also, some rare epileptic syndromes have become associated with particular treatments (e.g., infantile spasms) and some drugs have achieved "orphan drug" status for certain epilepsies.
*Monotherapy, polytherapy. Approval for "adjunctive use" or "initial monotherapy".
*Difficult to arrange placebo-controlled trials for monotherapy. Alternative trial protocols are used.
*No cure (other than surgery), nor preventative (anti-epileptogenic).
*Most drugs have cognitive side effects, plus other effects.
*Problems with some drugs and pregnancy (esp. valproate).
*Modern drugs are more expensive but not necessarily any more effective. Supposed to be better tolerated, but few studies support this.
*Ketogentic diet is as effective as any modern anticonvulsant but is traditionally reserved for refractory epilepsy in children and is limited by resources to monitor the diet.
*Vagal nerve stimulator may help some but very rarely leads to seizure freedom. Can reduce seizure frequency but also (with use of a magnet switch) can be used to shorten a seizure in some people.
*Surgery is rationed and only those likely to benefit are chosen. However, it has pretty good success rates and is the only cure.
*Some surgery is palliative, not curative.

*Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, ''et al''. [http://www.blackwell-synergy.com/doi/full/10.1111/j.1528-1167.2006.00585.x 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.
*Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, ''et al''. [http://www.blackwell-synergy.com/doi/full/10.1111/j.1528-1167.2006.00585.x 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. [http://www.blackwell-synergy.com/doi/full/10.1111/j.1528-1167.2006.00584.x We live in the age of the clinical guideline] [Editorial]. Epilepsia. 2006 Jul;47(7):1091–3. PMID 16886972.
**Shorvon S. [http://www.blackwell-synergy.com/doi/full/10.1111/j.1528-1167.2006.00584.x We live in the age of the clinical guideline] [Editorial]. Epilepsia. 2006 Jul;47(7):1091–3. PMID 16886972.

Revision as of 23:00, 29 November 2007

Article structure

Classification

Seizure types

Main article: 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.

Status epilepticus

Signs and symptoms

Causes

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]

Mechanism

  • DO11.10 has bravely volunteered to tack this subject.
Dump
  • The chemistry of neurons, channels (sodium, calcium), GABA.
  • The structure of how neurons link up and migrate to the appropriate part of the brain.
  • The concept of a seizure threshold.
  • The role of the corpus callosum in spreading a seizure between hemispheres.
  • What we learn from animal models.
  • A seizure is "excessive or synchronous neuronal activity in the brain". What makes it excessive (excite/inhibit)? Why does it become synchronous?
  • How does a partial-onset seizure spread to become generalised? Why do some remain partial?
  • How goes a general-onset seizure start without a focus?
  • Why are absence seizures such an exception (they have their own drugs, to some extent, and are one of the idiopathic epilepsies).
  • Are seizures damaging in themselves (controvesial)? Perhaps some more so than others (infantile spasms are one of the "catastrophic" epilepsy syndromes).
  • Why are some epilepsies "benign"?
  • What stops a seizure (self-limiting)? Why do some not stop (status)?
  • Nair, Dileep R. "Epilepsy". Retrieved 2007-11-27.

Diagnosis

Treatment

Chronic
  • Drugs are often first chosen based on the seizure type: partial-onset, generalised-onset, and absence seizures. Also, some rare epileptic syndromes have become associated with particular treatments (e.g., infantile spasms) and some drugs have achieved "orphan drug" status for certain epilepsies.
  • Monotherapy, polytherapy. Approval for "adjunctive use" or "initial monotherapy".
  • Difficult to arrange placebo-controlled trials for monotherapy. Alternative trial protocols are used.
  • No cure (other than surgery), nor preventative (anti-epileptogenic).
  • Most drugs have cognitive side effects, plus other effects.
  • Problems with some drugs and pregnancy (esp. valproate).
  • Modern drugs are more expensive but not necessarily any more effective. Supposed to be better tolerated, but few studies support this.
  • Ketogentic diet is as effective as any modern anticonvulsant but is traditionally reserved for refractory epilepsy in children and is limited by resources to monitor the diet.
  • Vagal nerve stimulator may help some but very rarely leads to seizure freedom. Can reduce seizure frequency but also (with use of a magnet switch) can be used to shorten a seizure in some people.
  • Surgery is rationed and only those likely to benefit are chosen. However, it has pretty good success rates and is the only cure.
  • Some surgery is palliative, not curative.
Emergency
Surgery

Prognosis

Epidemiology

Society

  • Discuss legal implications, stigma, disability rights. Issues regarding how society handles the person with epilepsy and individual seizures. Briefly mention issues regarding photosensitive epilepsy.

History

I'll have a go at drafting this section. Any contributory sources or facts or questions are welcome. -- Colin.

Notes

  1. ^ Engel J Jr. Report of the ILAE classification core group. Epilepsia. 2006 Sep;47(9):1558–68. PMID 16981873.
  2. ^ ILAE
  3. ^ ILAE
  4. ^ ILAE
  5. ^ ILAE
  6. ^ ILAE
  7. ^ ILAE
  8. ^ ILAE
  9. ^ ILAE
  10. ^ ILAE

Bibliography

Bibliography

Books

  • Engel J, Pedley TA, Aicardi J, Dichter MA, Moshe S. Epilepsy: A Comprehensive Textbook. 2nd ed. Lippincott Williams & Wilkins; 2007. ISBN 0781757770.
  • Arzimanoglou A, Guerrini R, Aicardi J. Aicardi's Epilepsy in Children. 3rd ed. Lippincott Williams & Wilkins; 2002. ISBN 0781726980.
  • Shorvon S, Perucca E, Fish D, Dodson WE, editors. The Treatment of Epilepsy. 2nd ed. Blackwell Science Ltd; 2004. ISBN 0632060468.
  • Levy RH, Mattson RH, Meldrum BS , Perucca E. Antiepileptic Drugs. 5th ed. Lippincott Williams & Wilkins; 2002. ISBN 0781723213.
  • Panayiotopoulos CP. A Clinical Guide to Epileptic Syndromes and Their Treatment. 2nd ed. London: Springer-Verlag; 2007. ISBN 1846286433.
  • Roger J, Dravet C, Bureau M, Genton P, Tassinari CA, Wolf P, editors. Epileptic Syndromes in Infancy, Childhood and Adolescence. 4th ed. John Libbey Eurotext; 2005. ISBN 2742005692.
  • Bromfield EG, Cavazos JE, Sirven JI, editors. An Introduction to Epilepsy. Bethesda (MD): National Institute of Neurological Disorders and Stroke; 2006.
    • Shame the text has no inline citations, only a list of references for each chapter. -- Colin.

Journals

Epilepsy Currents is the journal of the AES. Freely available online to all readers.

Web sites

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.
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

Comprises a number of PDF documents that contain a wealth of UK-focused data and guidelines built on evidence-based-medicine.
These Scottish guidelines, like the NICE equivalent for England & Wales, are thoroughly reviewed and evidence-based.
A substantial number of guidelines with an American flavour. Often jointly supported by the American Epilepsy Society.
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