Epilepsy - Wikipedia, The Free Encyclopedia
17
3/3/2015 Epilepsy Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Epilepsy 1/30 Epilepsy Generalized 3 Hz spike and wave discharges on an electroencephalogram Classification and external resources ICD10 G40 (http://apps.who.int/classifications/icd10/browse/2015/en#/G40)G41 (http://apps.who.int/classifications/icd10/browse/2015/en#/G41) ICD9 345 (http://www.icd9data.com/getICD9Code.ashx?icd9=345) DiseasesDB 4366 (http://www.diseasesdatabase.com/ddb4366.htm) MedlinePlus 000694 (http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm) eMedicine neuro/415 (http://www.emedicine.com/neuro/topic415.htm) MeSH D004827 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi? field=uid&term=D004827) Epilepsy From Wikipedia, the free encyclopedia Epilepsy (from the Ancient Greek verb ἐπιλαμβάνειν meaning "to seize, possess, or afflict") [1] is a group of neurological disorders characterized by epileptic seizures. [2][3] Epileptic seizures are episodes that can vary from brief and nearly undetectable to long periods of vigorous shaking. [4] In epilepsy, seizures tend to recur, and have no immediate underlying cause [2] while seizures that occur due to a specific cause are not deemed to represent epilepsy. [5] The cause of most cases of epilepsy is unknown, although some people develop epilepsy as the result of brain injury, stroke, brain tumor, and drug and alcohol misuse. Genetic mutations are linked to a small proportion of the disease. [6] Epileptic seizures are the result of excessive and abnormal cortical nerve cell activity in the brain. [5] The diagnosis typically involves ruling out other conditions that might cause similar symptoms such as fainting. Additionally, making the diagnosis involves determining if any other cause of seizures is present such as alcohol withdrawal or electrolyte problems. [6] This may be done by imaging the brain and performing blood tests. [6] Epilepsy can often be confirmed with an electroencephalogram (EEG) but a normal test does not rule out the condition. [6] Seizures are controllable with medication in about 70% of cases. [7] In those whose seizures do not respond to medication, surgery, neurostimulation or dietary changes may be considered. Not all cases of epilepsy are lifelong, and many people improve to the point that medication is no longer needed. About 1% of people worldwide (65 million) have epilepsy, [8] and nearly 80% of cases occur in developing countries. [4] In 2013 it resulted in 116,000 deaths up from 111,000 deaths in 1990. [9] Epilepsy becomes more common as people age. [10][11] In the developed world, onset of new cases occurs most frequently in infants and the elderly; [12] in the developing world this is in older children and young
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Transcript of Epilepsy - Wikipedia, The Free Encyclopedia
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3/3/2015 EpilepsyWikipedia,thefreeencyclopedia
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Epilepsy
Generalized3Hzspikeandwavedischargesonanelectroencephalogram
Classificationandexternalresources
ICD10 G40(http://apps.who.int/classifications/icd10/browse/2015/en#/G40)G41(http://apps.who.int/classifications/icd10/browse/2015/en#/G41)
ICD9 345(http://www.icd9data.com/getICD9Code.ashx?icd9=345)
DiseasesDB 4366(http://www.diseasesdatabase.com/ddb4366.htm)
MedlinePlus 000694(http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm)
eMedicine neuro/415(http://www.emedicine.com/neuro/topic415.htm)
MeSH D004827(https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D004827)
EpilepsyFromWikipedia,thefreeencyclopedia
Epilepsy(fromtheAncientGreekverbmeaning"toseize,possess,orafflict")[1]isagroupofneurologicaldisorderscharacterizedbyepilepticseizures.[2][3]Epilepticseizuresareepisodesthatcanvaryfrombriefandnearlyundetectabletolongperiodsofvigorousshaking.[4]Inepilepsy,seizurestendtorecur,andhavenoimmediateunderlyingcause[2]whileseizuresthatoccurduetoaspecificcausearenotdeemedtorepresentepilepsy.[5]
Thecauseofmostcasesofepilepsyisunknown,althoughsomepeopledevelopepilepsyastheresultofbraininjury,stroke,braintumor,anddrugandalcoholmisuse.Geneticmutationsarelinkedtoasmallproportionofthedisease.[6]Epilepticseizuresaretheresultofexcessiveandabnormalcorticalnervecellactivityinthebrain.[5]Thediagnosistypicallyinvolvesrulingoutotherconditionsthatmightcausesimilarsymptomssuchasfainting.Additionally,makingthediagnosisinvolvesdeterminingifanyothercauseofseizuresispresentsuchasalcoholwithdrawalorelectrolyteproblems.[6]Thismaybedonebyimagingthebrainandperformingbloodtests.[6]Epilepsycanoftenbeconfirmedwithanelectroencephalogram(EEG)butanormaltestdoesnotruleoutthecondition.[6]
Seizuresarecontrollablewithmedicationinabout70%ofcases.[7]Inthosewhoseseizuresdonotrespondtomedication,surgery,neurostimulationordietarychangesmaybeconsidered.Notallcasesofepilepsyarelifelong,andmanypeopleimprovetothepointthatmedicationisnolongerneeded.
About1%ofpeopleworldwide(65million)haveepilepsy,[8]andnearly80%ofcasesoccurindevelopingcountries.[4]In2013itresultedin116,000deathsupfrom111,000deathsin1990.[9]
Epilepsybecomesmorecommonaspeopleage.[10][11]Inthedevelopedworld,onsetofnewcasesoccursmostfrequentlyininfantsandtheelderly[12]inthedevelopingworldthisisinolderchildrenandyoung
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adults,[13]duetodifferencesinthefrequencyoftheunderlyingcauses.About510%ofallpeoplewillhaveanunprovokedseizurebytheageof80,[14]andthechanceofexperiencingasecondseizureisbetween40and50%.[15]Inmanyareasoftheworldthosewithepilepsyeitherhaverestrictionsplacedontheirabilitytodriveorarenotpermittedtodrive,[16]butmostareabletoreturntodrivingafteraperiodoftimewithoutseizures.
Contents
1Signsandsymptoms1.1Seizures1.2Postictal1.3Psychosocial
2Causes2.1Genetics2.2Acquired
3Pathophysiology3.1Epilepsy3.2Seizures
4Diagnosis4.1Definition4.2Classification4.3Syndromes4.4Tests4.5Differentialdiagnosis
5Prevention6Management
6.1Firstaid6.2Medications6.3Surgery6.4Other6.5Alternativemedicine
7Prognosis7.1Mortality
8Epidemiology9History10Societyandculture
10.1Stigma10.2Economics10.3Vehicles
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Aninstructionalvideoaboutepilepticseizures
Abitetothetipofthetongueduetoaseizure
10.4Supportorganizations11Research12Otheranimals13References14Furtherreading15Externallinks
Signsandsymptoms
Epilepsyischaracterizedbyalongtermriskofrecurrentseizures.[17]Theseseizuresmaypresentinseveralwaysdependingonthepartofthebraininvolvedandtheperson'sage.[17][18]
Seizures
Themostcommontype(60%)ofseizuresareconvulsive.[18]Ofthese,onethirdbeginasgeneralizedseizuresfromthestart,affectingbothhemispheresofthebrain.[18]Twothirdsbeginaspartialseizures(whichaffectonehemisphereofthebrain)whichmaythenprogresstogeneralizedseizures.[18]Theremaining40%ofseizuresarenonconvulsive.Anexampleofthistypeistheabsenceseizure,whichpresentsasadecreasedlevelofconsciousnessandusuallylastsabout10seconds.[19][20]
Partialseizuresareoftenprecededbycertainexperiences,knownasanaura.[21]Thesemayincludesensory(visual,hearingorsmell),psychic,autonomic,ormotorphenomena.[19]JerkingactivitymaystartinaspecificmusclegroupandspreadtosurroundingmusclegroupsinwhichcaseitisknownasaJacksonianmarch.[22]Automatismsmayoccurthesearenonconsciouslygeneratedactivitiesandmostlysimplerepetitivemovementslikesmackingofthelipsormorecomplexactivitiessuchasattemptstopicksomethingup.[22]
Therearesixmaintypesofgeneralizedseizures:tonicclonic,tonic,clonic,myoclonic,absence,andatonicseizures.[23]Theyallinvolvelossofconsciousnessandtypicallyhappenwithoutwarning.
Tonicclonicseizurespresentwithacontractionofthelimbsfollowedbytheirextensionalongwitharchingofthebackwhichlasts1030seconds(thetonicphase).Acrymaybeheardduetocontractionofthechestmuscles.Thisisthenfollowedbyashakingofthelimbsinunison(clonicphase).Tonicseizuresproduceconstantcontractionsofthemuscles.Apersonoftenturnsblueasbreathingisstopped.Inclonicseizuresthereisshakingofthelimbsinunison.Aftertheshakinghasstoppeditmaytake1030minutesforthepersontoreturntonormalthisperiodiscalledthe"postictalstate"or"postictal
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phase".Lossofbowelorbladdercontrolmayoccurduringaseizure.[4]Thetonguemaybebittenateitherthetiporonthesidesduringaseizure.[24]Intonicclonicseizure,bitestothesidesaremorecommon.[24]Tonguebitesarealsorelativelycommoninpsychogenicnonepilepticseizures.[24]
Myoclonicseizuresinvolvespasmsofmusclesineitherafewareasorallover.[25]Absenceseizurescanbesubtlewithonlyaslightturnoftheheadoreyeblinking.[19]Thepersondoesnotfalloverandreturnstonormalrightafteritends.[19]Atonicseizuresinvolvethelossofmuscleactivityforgreaterthanonesecond.[22]Thistypicallyoccursonbothsidesofthebody.[22]
About6%ofthosewithepilepsyhaveseizuresthatareoftentriggeredbyspecificeventsandareknownasreflexseizures.[26]Thosewithreflexepilepsyhaveseizuresthatareonlytriggeredbyspecificstimuli.[27]Commontriggersincludeflashinglightsandsuddennoises.[26]Incertaintypesofepilepsy,seizureshappenmoreoftenduringsleep,[28]andinothertypestheyoccuralmostonlywhensleeping.[29]
Postictal
Aftertheactiveportionofaseizure,thereistypicallyaperiodofconfusionreferredtoasthepostictalperiodbeforeanormallevelofconsciousnessreturns.[21]Thisusuallylasts3to15minutes[30]butmaylastforhours.[31]Othercommonsymptomsincludefeelingtired,headache,difficultyspeaking,andabnormalbehavior.[31]Psychosisafteraseizureisrelativelycommon,occurringin610%ofpeople.[32]
Oftenpeopledonotrememberwhathappenedduringthistime.[31]Localizedweakness,knownasTodd'sparalysis,mayalsooccurafterapartialseizure.Whenitoccursittypicallylastsforsecondstominutesbutmayrarelylastforadayortwo.[33]
Psychosocial
Epilepsycanhaveadverseeffectsonsocialandpsychologicalwellbeing.[18]Theseeffectsmayincludesocialisolation,stigmatization,ordisability.[18]Theymayresultinlowereducationalachievementandworseemploymentoutcomes.[18]Learningdifficultiesarecommoninthosewiththecondition,andespeciallyamongchildrenwithepilepsy.[18]Thestigmaofepilepsycanalsoaffectthefamiliesofthosewiththedisease.[4]
Certaindisordersoccurmoreofteninpeoplewithepilepsy,dependingpartlyontheepilepsysyndromepresent.Theseincludedepression,anxietydisorders,andmigraines.[34]Attentiondeficithyperactivitydisorderaffectsthreetofivetimesmorechildrenwithepilepsythanchildreninthegeneralpopulation.[35]ADHDandepilepsyhavesignificantconsequencesonachild'sbehavioral,learning,andsocialdevelopment.[36]Epilepsyisalsomorecommoninthosewithautism.[37]
Causes
Epilepsycanhavebothgeneticandacquiredcauses,withinteractionofthesefactorsinmanycases.[38]Establishedacquiredcausesincludeseriousbraintrauma,stroke,tumoursandproblemsinthebrainasaresultofapreviousinfective.[38]Inabout60%ofcasesthecauseisunknown.[4][18]Epilepsiescausedbygenetic,congenital,ordevelopmentalconditionsaremorecommonamongyoungerpeople,whilebraintumorsandstrokesaremorelikelyinolderpeople.[18]
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Seizuresmayalsooccurasaconsequenceofotherhealthproblems[23]iftheyoccurrightaroundaspecificcause,suchasastroke,headinjury,toxicingestionormetabolicproblem,theyareknownasacutesymptomaticseizuresandareinthebroaderclassificationofseizurerelateddisordersratherthanepilepsyitself.[8][39]
Genetics
Geneticsisbelievedtobeinvolvedinthemajorityofcases,eitherdirectlyorindirectly.[40]Someepilepsiesareduetoasinglegenedefect(12%)mostareduetotheinteractionofmultiplegenesandenvironmentalfactors.[40]Eachofthesinglegenedefectsisrare,withmorethan200inalldescribed.[41]
Mostgenesinvolvedaffectionchannels,eitherdirectlyorindirectly.[38]Theseincludegenesforionchannelsthemselves,enzymes,GABA,andGproteincoupledreceptors.[25]
Inidenticaltwins,ifoneisaffectedthereisa5060%chancethattheotherwillalsobeaffected.[40]Innonidenticaltwinstheriskis15%.[40]Theserisksaregreaterinthosewithgeneralizedratherthanpartialseizures.[40]Ifbothtwinsareaffected,mostofthetimetheyhavethesameepilepticsyndrome(7090%).[40]Othercloserelativesofapersonwithepilepsyhaveariskfivetimesthatofthegeneralpopulation.[42]Between1and10%ofthosewithDownsyndromeand90%ofthosewithAngelmansyndromehaveepilepsy.[42]
Acquired
Epilepsymayoccurasaresultofanumberofotherconditionsincludingtumors,strokes,headtrauma,previousinfectionsofthecentralnervoussystem,geneticabnormalities,andasaresultofbraindamagearoundthetimeofbirth.[4][23]Ofthosewithbraintumors,almost30%haveepilepsy,makingthemthecauseofabout4%ofcases.[42]Theriskisgreatestfortumorsinthetemporallobeandthosethatgrowslowly.[42]Othermasslesionssuchascerebralcavernousmalformationsandarteriovenousmalformationshaverisksashighas4060%.[42]Ofthosewhohavehadastroke,24%developepilepsy.[42]IntheUnitedKingdomstrokesaccountfor15%ofcasesanditisbelievedtobethecausein30%oftheelderly.[18][42]Between6and20%ofepilepsyisbelievedtobeduetoheadtrauma.[42]Mildbraininjuryincreasestheriskabouttwofoldwhileseverebraininjuryincreasestherisksevenfold.[42]
Inthosewhohaveexperiencedahighpoweredgunshotwoundtothehead,theriskisabout50%.[42]
Theriskofepilepsyfollowingmeningitisislessthan10%thatdiseasemorecommonlycausesseizuresduringtheinfectionitself.[42]Inherpessimplexencephalitistheriskofaseizureisaround50%[42]withahighriskofepilepsyfollowing(upto25%).[43][44]Infectionwiththeporktapeworm,whichcanresultinneurocysticercosis,isthecauseofuptohalfofepilepsycasesinareasoftheworldwheretheparasiteiscommon.[42]Epilepsymayalsooccurafterotherbraininfectionssuchascerebralmalaria,toxoplasmosis,andtoxocariasis.[42]Chronicalcoholuseincreasestheriskofepilepsy:thosewhodrinksixunitsofalcoholperdayhaveatwoandahalffoldincreaseinrisk.[42]OtherrisksincludeAlzheimer'sdisease,multiplesclerosis,tuberoussclerosis,andautoimmuneencephalitis.[42]Gettingvaccinateddoesnotincreasetheriskofepilepsy.[42]Malnutritionisariskfactorseenmostlyinthedevelopingworld,althoughitisunclearhoweverifitisadirectcauseoranassociation.[13]
Pathophysiology
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Normallybrainelectricalactivityisnonsynchronous.[19]Itsactivityisregulatedbyvariousfactorsbothwithintheneuronandthecellularenvironment.Factorswithintheneuronincludethetype,numberanddistributionofionchannels,changestoreceptorsandchangesofgeneexpression.[45]Factorsaroundtheneuronincludeionconcentrations,synapticplasticityandregulationoftransmitterbreakdownbyglialcells.[45][46]
Epilepsy
Theexactmechanismofepilepsyitselfisunknown.[47]Alittle,however,isknownaboutboththecellularandnetworkmechanismsofepilepsy.However,itisunknownunderwhichcircumstancesthebrainshiftsintotheactivityofaseizurewithitsexcessivesynchronization.[48][49]
Inepilepsytheresistanceofexcitatoryneuronstofireduringthisperiodisdecreased.[19]Thismayoccurduetochangesinionchannelsorinhibitoryneuronsnotfunctioningproperly.[19]Thisthenresultsinaspecificareafromwhichseizuresmaydevelop,knownasa"seizurefocus".[19]Anothermechanismofepilepsymaybetheupregulationofexcitatorycircuitsordownregulationofinhibitorycircuitsfollowinganinjurytothebrain.[19][50]Thesesecondaryepilepsiesoccurthroughprocessesknownasepileptogenesis.[19][50]Failureofthebloodbrainbarriermayalsobeacausalmechanismasitwouldallowsubstancesinthebloodtoenterthebrain.[51]
Seizures
Thereisevidencethatepilepticseizureareusuallynotarandomevent.Seizuresareoftenbroughtonbyfactorssuchaslackofsleep,stressorflickeringlightamongothers.Thetermseizurethresholdisusedtoindicatetheamountofstimulusnecessarytobringaboutaseizure.Seizurethresholdisloweredinepilepsy.[48]
Inepilepticseizuresagroupofneuronsbeginfiringinanabnormal,excessive,[18]andsynchronizedmanner.[19]Thisresultsinawaveofdepolarizationknownasaparoxysmaldepolarizingshift.[52]
Normally,afteranexcitatoryneuronfiresitbecomesmoreresistanttofiringforaperiodoftime.[19]Thisisdueinparttotheeffectofinhibitoryneurons,electricalchangeswithintheexcitatoryneuron,andthenegativeeffectsofadenosine.[19]
Partialseizuresbegininonehemisphereofthebrainwhilegeneralizedseizuresbegininbothhemispheres.[23]Sometypesofseizuresmaychangebrainstructure,whileothersappeartohavelittleeffect.[53]Gliosis,neuronalloss,andatrophyofspecificareasofthebrainarelinkedtoepilepsybutitisunclearifepilepsycausesthesechangesorifthesechangesresultinepilepsy.[53]
Diagnosis
Thediagnosisofepilepsyistypicallymadebasedonthedescriptionoftheseizureandtheunderlyingcause.[18]Anelectroencephalogramandneuroimagingarealsousuallypartoftheworkup.[18]Whilefiguringoutaspecificepilepticsyndromeisoftenattempted,itisnotalwayspossible.[18]VideoandEEGmonitoringmaybeusefulindifficultcases.[54]
Definition
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AnEEGcanaidinlocatingthefocusoftheepilepticseizure.
Epilepsyisadiseaseofthebraindefinedbyanyofthefollowingconditions:[3]
1. Atleasttwounprovoked(orreflex)seizuresoccurringgreaterthan24hoursapart2. Oneunprovoked(orreflex)seizureandaprobabilityoffurtherseizuressimilartothe
generalrecurrencerisk(atleast60%)aftertwounprovokedseizures,occurringoverthenext10years
3. Diagnosisofanepilepsysyndrome
Furthermoreepilepsyisconsideredtoberesolvedforindividualswhohadanagedependentepilepsysyndromebutarenowpastthethatageorthosewhohaveremainedseizurefreeforthelast10years,withnoseizuremedicinesforthelast5years.[3]
This2014definitionoftheInternationalLeagueAgainstEpilepsy[3]isarefinementoftheir2005definitionwhichwas"adisorderofthebraincharacterizedbyanenduringpredispositiontogenerateepilepticseizuresandbytheneurobiologic,cognitive,psychological,andsocialconsequencesofthiscondition.Thedefinitionofepilepsyrequirestheoccurrenceofatleastoneepilepticseizure."[55][56]
Itisthereforepossibletooutgrowepilepsyortoundergotreatmentthatcausestheepilepsytoberesolved.Resolutionofepilepsyunfortunatelydoesnotguaranteethatitwillnotreturn.Inthedefinition,epilepsyisnowcalledadisease,ratherthanadisorder.ThiswasadecisionoftheexecutivecommitteeoftheILAE,takenbecausetheword"disorder,"whileperhapshavinglessstigmathandoes"disease,"alsodoesnotexpressthedegreeofseriousnessthatepilepsydeserves.[3]
Thedefinitionispracticalinnatureandisdesignedforclinicaluse.Researchers,statisticallymindedepidemiologistsandotherspecializedgroupsmaychoosetousetheolderdefinitionoradefinitionoftheirowndevising.TheILAEconsidersdoingsoisperfectlyallowable,solongasitisclearwhatdefinitionisbeingused.[3]
Classification
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Incontrasttotheclassificationofseizureswhichfocusesonwhathappensduringaseizure,theclassificationofepilepsiesfocusesontheunderlyingcauses.Whenapersonisadmittedtohospitalafteranepilepticseizurethediagnosticworkupresultspreferablyintheseizureitselfbeingclassified(e.g.tonicclonic)andintheunderlyingdiseasebeingidentified(e.g.hippocampalsclerosis).[54]Thenameofthediagnosisfinallymadedependsontheavailablediagnosticresultsandtheapplieddefinitionsandclassifications(ofseizuresandepilepsies)anditsrespectiveterminology.
TheInternationalLeagueAgainstEpilepsy(ILAE)providedaclassificationoftheepilepsiesandepilepticsyndromesin1989asfollows:[57]
1. Localizationrelatedepilepsiesandsyndromes1. Unknowncause(e.g.benignchildhoodepilepsywithcentrotemporalspikes)2. Symptomatic/cryptogenic(e.g.temporallobeepilepsy)
2. Generalized1. Unknowncause(e.g.childhoodabsenceepilepsy)2. Cryptogenicorsymptomatic(e.g.LennoxGastautsyndrome)3. Symptomatic(e.g.earlyinfantileepilepticencephalopathywithsuppressionburst)
3. Epilepsiesandsyndromesundeterminedwhetherpartialorgeneralized1. Withbothgeneralizedandpartialseizures(e.g.epilepsywithcontinuousspike
wavesduringslowwavesleep)
4. Specialsyndromes(withsituationrelatedseizures)[57]
Thisclassificationwaswidelyacceptedbuthasalsobeencriticizedmainlybecausetheunderlyingcausesofepilepsy(whichareamajordeterminantofclinicalcourseandprognosis)werenotcoveredindetail.[58]In2010theILAECommissionforClassificationoftheEpilepsiesaddressedthisissueanddividedepilepsiesintothreecategories(genetic,structural/metabolic,unknowncause)[59]thatwererefinedintheir2011recommendationintofourcategoriesandanumberofsubcategoriesreflectingrecenttechnologicandscientificadvances.[60]
1. Unknowncause(mostlygeneticorpresumedgeneticorigin)1. Pureepilepsiesduetosinglegenedisorders2. Pureepilepsieswithcomplexinheritance
2. Symptomatic(associatedwithgrossanatomicorpathologicabnormalities)1. Mostlygeneticordevelopmentalcausation
1. Childhoodepilepsysyndromes2. Progressivemyoclonicepilepsies3. Neurocutaneoussyndromes4. Otherneurologicsinglegenedisorders5. Disordersofchromosomefunction6. Developmentalanomaliesofcerebralstructure
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2. Mostlyacquiredcauses1. Hippocampalsclerosis2. Perinatalandinfantilecauses3. Cerebraltrauma,tumororinfection4. Cerebrovasculardisorders5. Cerebralimmunologicdisorders6. Degenerativeandotherneurologicconditions
3. Provoked(aspecificsystemicorenvironmentalfactoristhepredominantcauseoftheseizures)
1. Provokingfactors2. Reflexepilepsies
4. Crytogenic(presumedsymptomaticnatureinwhichthecausehasnotbeenidentified)[60]
Syndromes
Casesofepilepsymaybeorganizedintoepilepsysyndromesbythespecificfeaturesthatarepresent.Thesefeaturesincludetheagethatseizurebegin,theseizuretypes,EEGfindings,amongothers.Identifyinganepilepsysyndromeisusefulasithelpsdeterminetheunderlyingcausesaswellaswhatantiseizuremedicationshouldbetried.[61][23]
Theabilitytocategorizeacaseofepilepsyintoaspecificsyndromeoccursmoreoftenwithchildrensincetheonsetofseizuresiscommonlyearly.[39]Lessseriousexamplesarebenignrolandicepilepsy(2.8per100,000),childhoodabsenceepilepsy(0.8per100,000)andjuvenilemyoclonicepilepsy(0.7per100,000).[39]Severesyndromeswithdiffusebraindysfunctioncaused,atleastpartly,bysomeaspectofepilepsy,arealsoreferredtoasepilepticencephalopathies.Theseareassociatedwithfrequentseizuresthatareresistanttotreatmentandseverecognitivedysfunction,forinstanceLennoxGastautsyndromeandWestsyndrome.[62]Geneticsisbelievedtoplayanimportantroleinepilepsiesbyanumberofmechanisms.Simpleandcomplexmodesofinheritancehavebeenidentifiedforsomeofthem.However,extensivescreeninghavefailedtoidentifymanysinglegenevariantsoflargeeffect.[63]Morerecentexomeandgenomesequencingstudieshavebeguntorevealanumberofdenovogenemutationsthatareresponsibleforsomeepilepticencephalopathies,includingCHD2andSYNGAP1[64][65][66]andDMN1,GABBR2,FASNandRYR3,[67]
Syndromesinwhichcausesarenotclearlyidentifiedaredifficulttomatchwithcategoriesofthecurrentclassificationofepilepsy.Categorizationforthesecaseswasmadesomewhatarbitrarily.[60]Theidiopathic(unknowncause)categoryofthe2011classificationincludessyndromesinwhichthegeneralclinicalfeaturesand/oragespecificitystronglypointtoapresumedgeneticcause.[60]Somechildhoodepilepsysyndromesareincludedintheunknowncausecategoryinwhichthecauseispresumedgenetic,forinstancebenignrolandicepilepsy.Othersareincludedinsymptomaticdespiteapresumedgeneticcause(inatleastinsomecases),forinstanceLennoxGastautsyndrome.[60]Clinicalsyndromesinwhichepilepsyisnotthemainfeature(e.g.Angelmansyndrome)werecategorizedsymptomaticbutitwasarguedtoincludethesewithinthecategoryidiopathic.[60]Classificationofepilepsiesandparticularlyofepilepsysyndromeswillchangewithadvancesinresearch.
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Tests
Anelectroencephalogram(EEG)canassistinshowingbrainactivitysuggestiveofanincreasedriskofseizures.Itisonlyrecommendedforthosewhoarelikelytohavehadanepilepticseizureonthebasisofsymptoms.Inthediagnosisofepilepsy,electroencephalographymayhelpdistinguishthetypeofseizureorsyndromepresent.Inchildrenitistypicallyonlyneededafterasecondseizure.Itcannotbeusedtoruleoutthediagnosis,andmaybefalselypositiveinthosewithoutthedisease.IncertainsituationsitmaybeusefultoperformtheEEGwhiletheaffectedindividualissleepingorsleepdeprived.[54]
DiagnosticimagingbyCTscanandMRIisrecommendedafterafirstnonfebrileseizuretodetectstructuralproblemsinandaroundthebrain.[54]MRIisgenerallyabetterimagingtestexceptwhenbleedingissuspected,forwhichCTismoresensitiveandmoreeasilyavailable.[14]Ifsomeoneattendstheemergencyroomwithaseizurebutreturnstonormalquickly,imagingtestsmaybedoneatalaterpoint.[14]Ifapersonhasapreviousdiagnosisofepilepsywithpreviousimaging,repeatingtheimagingisusuallynotneededeveniftherearesubsequentseizures.[54]
Foradults,thetestingofelectrolyte,bloodglucoseandcalciumlevelsisimportanttoruleoutproblemswiththeseascauses.[54]Anelectrocardiogramcanruleoutproblemswiththerhythmoftheheart.[54]Alumbarpuncturemaybeusefultodiagnoseacentralnervoussysteminfectionbutisnotroutinelyneeded.[14]Inchildrenadditionaltestsmayberequiredsuchasurinebiochemistryandbloodtestinglookingformetabolicdisorders.[54][68]
Ahighbloodprolactinlevelwithinthefirst20minutesfollowingaseizuremaybeusefultoconfirmanepilepticseizureasopposedtopsychogenicnonepilepticseizure.[69][70]Serumprolactinlevelislessusefulfordetectingpartialseizures.[71]Ifitisnormalanepilepticseizureisstillpossible[70]andaserumprolactindoesnotseparateepilepticseizuresfromsyncope.[72]Itisnotrecommendedasaroutinepartofthediagnosisofepilepsy.[54]
Differentialdiagnosis
Diagnosisofepilepsycanbedifficult.Anumberofotherconditionsmaypresentverysimilarsignsandsymptomstoseizures,includingsyncope,hyperventilation,migraines,narcolepsy,panicattacksandpsychogenicnonepilepticseizures(PNES).[73][74]Inparticularasyncopecanbeaccompaniedbyashortepisodeofconvulsions.[75]Nocturnalfrontallobeepilepsy,oftenmisdiagnosedasnightmares,wasconsideredtobeaparasomniabutlateridentifiedtobeepileptic.[76]Attacksofthemovementdisorderparoxysmaldyskinesiamaybetakenforepilepticseizures.[77]Thecauseofadropattackcanbe,amongmanyothers,anatonicseizure.[74]
Childrenmayhavebehaviorsthatareeasilymistakenforepilepticseizuresbutarenot.Theseincludebreathholdingspells,bedwetting,nightterrors,ticsandshudderattacks.[74]Gastroesophagealrefluxmaycausearchingofthebackandtwistingoftheheadtothesideininfants,whichmaybemistakenfortonicclonicseizures.[74]
Misdiagnosisisfrequent(occurringinabout5to30%ofcases).[18]Differentstudiesshowedthatinmanycasesseizurelikeattacksinapparenttreatmentresistantepilepsyhaveacardiovascularcause.[75][78]Approximately20%ofthepeopleseenatepilepsyclinicshavePNES[14]andofthosewho
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havePNESabout10%alsohaveepilepsy[79]separatingthetwobasedontheseizureepisodealonewithoutfurthertestingisoftendifficult.[79]
Prevention
Whilemanycasesarenotpreventable,effortstoreduceheadinjuries,providegoodcarearoundthetimeofbirth,andreduceenvironmentalparasitessuchastheporktapewormmaybeeffective.[4]EffortsinonepartofCentralAmericatodecreaseratesofporktapewormresultedina50%decreaseinnewcasesofepilepsy.[13]
Management
Epilepsyisusuallytreatedwithdailymedicationonceasecondseizurehasoccurred,[18][54]butforthoseathighrisk,medicationmaybestartedafterthefirstseizure.[54]Insomecases,aspecialdiet,theimplantationofaneurostimulator,orneurosurgerymayberequired.
Firstaid
Rollingapersonwithanactivetonicclonicseizureontotheirsideandintotherecoverypositionhelpspreventfluidsfromgettingintothelungs.[80]Puttingfingers,abiteblockortonguedepressorinthemouthisnotrecommendedasitmightmakethepersonvomitorresultintherescuerbeingbitten.[21][80]
Effortsshouldbetakentopreventfurtherselfinjury.[21]Spinalprecautionsaregenerallynotneeded.[80]
Ifaseizurelastslongerthan5minutesoriftherearemorethantwoseizuresinanhourwithoutareturntoanormallevelofconsciousnessbetweenthem,itisconsideredamedicalemergencyknownasstatusepilepticus.[54][81]Thismayrequiremedicalhelptokeeptheairwayopenandprotected[54]anasopharyngealairwaymaybeusefulforthis.[80]Athometherecommendedinitialmedicationforseizureofalongdurationismidazolamplacedinthemouth.[82]Diazepammayalsobeusedrectally.[82]
Inhospital,intravenouslorazepamispreferred.[54]Iftwodosesofbenzodiazepinesarenoteffective,othermedicationssuchasphenytoinarerecommended.[54]Convulsivestatusepilepticusthatdoesnotrespondtoinitialtreatmenttypicallyrequiresadmissiontotheintensivecareunitandtreatmentwithstrongeragentssuchasthiopentoneorpropofol.[54]
Medications
Themainstaytreatmentofepilepsyisanticonvulsantmedications,possiblyfortheperson'sentirelife.[18]Thechoiceofanticonvulsantisbasedonseizuretype,epilepsysyndrome,othermedicationsused,otherhealthproblems,andtheperson'sageandlifestyle.[82]Asinglemedicationisrecommendedinitially[83]
ifthisisnoteffective,switchingtoasingleothermedicationisrecommended.[54]Twomedicationsatonceisrecommendedonlyifasinglemedicationdoesnotwork.[54]Inabouthalf,thefirstagentiseffectiveasecondsingleagenthelpsinabout13%andathirdortwoagentsatthesametimemayhelpanadditional4%.[84]About30%ofpeoplecontinuetohaveseizuresdespiteanticonvulsanttreatment.[7]
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Anticonvulsants
Thereareanumberofmedicationsavailable.Phenytoin,carbamazepineandvalproateappeartobeequallyeffectiveinbothpartialandgeneralizedseizures.[85][86]Controlledreleasecarbamazepineappearstoworkaswellasimmediatereleasecarbamazepine,andmayhavefewersideeffects.[87]IntheUnitedKingdom,carbamazepineorlamotriginearerecommendedasfirstlinetreatmentforpartialseizures,withlevetiracetamandvalproateassecondlineduetoissuesofcostandsideeffects.[54]
Valproateisrecommendedfirstlineforgeneralizedseizureswithlamotriginebeingsecondline.[54]Inthosewithabsenceseizures,ethosuximideorvalproatearerecommendedvalproateisparticularlyeffectiveinmyoclonicseizuresandtonicoratonicseizures.[54]Ifseizuresarewellcontrolledonaparticulartreatment,itisnotusuallynecessarytoroutinelycheckthemedicationlevelsintheblood.[54]
Theleastexpensiveanticonvulsantisphenobarbitalataround$5USDayear.[13]TheWorldHealthOrganizationgivesitafirstlinerecommendationinthedevelopingworldanditiscommonlyusedthere.[88][89]Accesshowevermaybedifficultassomecountrieslabelitasacontrolleddrug.[13]
Adverseeffectsfrommedicationsarereportedin10to90%ofpeople,dependingonhowandfromwhomthedataiscollected.[90]Mostadverseeffectsaredoserelatedandmild.[90]Someexamplesincludemoodchanges,sleepiness,oranunsteadinessingait.[90]Certainmedicationshavesideeffectsthatarenotrelatedtodosesuchasrashes,livertoxicity,orsuppressionofthebonemarrow.[90]Uptoaquarterofpeoplestoptreatmentduetoadverseeffects.[90]Somemedicationsareassociatedwithbirthdefectswhenusedinpregnancy.[54]Valproateisofparticularconcern,especiallyduringthefirsttrimester.[91]Despitethis,treatmentisoftencontinuedonceeffective,becausetheriskofuntreatedepilepsyisbelievedtobegreaterthantheriskofthemedications.[91]
Slowlystoppingmedicationsmaybereasonableinsomepeoplewhodonothaveaseizurefortwotofouryearshowever,aroundathirdofpeoplehavearecurrence,mostoftenduringthefirstsixmonths.[54][92]Stoppingispossibleinabout70%ofchildrenand60%ofadults.[4]
Surgery
Epilepsysurgerymaybeanoptionforpeoplewithpartialseizuresthatremainaproblemdespiteothertreatments.[93]Theseothertreatmentsincludeatleastatrialoftwoorthreemedications.[94]Thegoalofsurgeryistotalcontrolofseizures[95]andthismaybeachievedin6070%ofcases.[94]Commonproceduresincludecuttingoutthehippocampusviaananteriortemporalloberesection,removaloftumors,andremovingpartsoftheneocortex.[94]Someproceduressuchasacorpuscallosotomyareattemptedinanefforttodecreasethenumberofseizuresratherthancurethecondition.[94]Followingsurgery,medicationsmaybeslowlywithdrawninmanycases.[94]
Neurostimulationmaybeanotheroptioninthosewhoarenotcandidatesforsurgery.[54]Threetypeshavebeenshowntobeeffectiveinthosewhodonotrespondtomedications:vagusnervestimulation,anteriorthalamicstimulation,andclosedloopresponsivestimulation.[96]
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Disabilityadjustedlifeyearforepilepsyper100,000inhabitantsin2004. nodata
275
Other
Aketogenicdiet(highfat,lowcarbohydrate,adequateprotein)appearstodecreasethenumberofseizuresbyhalfinabout3040%ofchildren.[97]Itisareasonableoptioninthosewhohaveepilepsythatisnotimprovedwithmedicationsandforwhomsurgeryisnotanoption.[97]About10%stayonthedietforafewyearsduetoissuesofeffectivenessandtolerability.[97]Sideeffectsincludestomachandintestinalproblemsin30%,andtherearelongtermconcernsofheartdisease.[97]Lessradicaldietsareeasiertotolerateandmaybeeffective.[97]Itisunclearwhythisdietworks.[98]Exercisehasbeenproposedaspossiblyusefulforpreventingseizures[99]withsomedatatosupportthisclaim.[100]
Avoidancetherapyconsistsofminimizingoreliminatingtriggers.Forexample,inthosewhoaresensitivetolight,usingasmalltelevision,avoidingvideogamesorwearingdarkglassesmaybeuseful.[101]OperantbasedbiofeedbackbasedontheEEGwaveshassomesupportinthosewhodonotrespondtomedications.[102]Psychologicalmethodsshouldnot,however,beusedtoreplacemedications.[54]Somedogs,alsoreferredtoasseizuredogs,mayhelpduringorafteraseizure.[103][104]
Itisnotclearifdogshavetheabilitytopredictseizuresbeforetheyoccur.[105]
Alternativemedicine
Alternativemedicine,includingacupuncture,[106]psychologicalinterventions,[107]routinevitamins,[108]
andyoga,[109]havenoreliableevidencetosupporttheiruseinepilepsy.Theuseofcannabisisnotsupportedbytheevidence.[110]Melatoninisinsufficientlysupportedbyevidence.[111]
Prognosis
Epilepsycannotusuallybecured,butmedicationcancontrolseizureseffectivelyinabout70%ofcases.[7]Ofthosewithgeneralizedseizures,morethan80%canbewellcontrolledwithmedicationswhilethisistrueinonly50%ofpeoplewithpartialseizures.[96]Onepredictoroflongtermoutcomeisthenumberofseizuresthatoccurinthefirstsixmonths.[18]Otherfactorsincreasingtheriskofapooroutcomeincludelittleresponsetotheinitialtreatment,generalizedseizures,afamilyhistoryofepilepsy,psychiatricproblems,andwavesontheEEGrepresentinggeneralizedepileptiformactivity.[112]Inthedevelopingworld75%ofpeopleareeitheruntreatedornotappropriatelytreated.[4]InAfrica90%donotgettreatment.[4]Thisispartlyrelatedtoappropriatemedicationsnotbeingavailableorbeingtooexpensive.[4]
Mortality
Peoplewithepilepsyareatanincreasedriskofdeath.[113]Thisincreaseisbetween1.6and4.1foldgreaterthanthatofthegeneralpopulation[114]andisoftenrelatedto:theunderlyingcauseoftheseizures,statusepilepticus,suicide,trauma,andsuddenunexpecteddeathinepilepsy(SUDEP).[113]Deathfromstatusepilepticusisprimarilyduetoanunderlyingproblemrather
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thanmissingdosesofmedications.[113]Theriskofsuicideisincreasedbetweentwoandsixtimesinthosewithepilepsy.[115][116]Thecauseofthisisunclear.[115]SUDEPappearstobepartlyrelatedtothefrequencyofgeneralizedtonicclonicseizures[117]andaccountsforabout15%ofepilepsyrelateddeaths.[112]Itisunclearhowtodecreaseitsrisk.[117]Thegreatestincreaseinmortalityfromepilepsyisamongtheelderly.[114]Thosewithepilepsyduetoanunknowncausehavelittleincreasedrisk.[114]IntheUnitedKingdomitisestimatedthat4060%ofdeathsarepossiblypreventable.[18]Inthedevelopingworldmanydeathsareduetountreatedepilepsyleadingtofallsorstatusepilepticus.[13]
Epidemiology
Epilepsyisoneofthemostcommonseriousneurologicaldisorders[118]affectingabout65millionpeopleglobally.[8]Itaffects1%ofthepopulationbyage20and3%ofthepopulationbyage75.[11]Itismorecommoninmalesthanfemaleswiththeoveralldifferencebeingsmall.[13][39]Mostofthosewiththedisease(80%)areinthedevelopingworld.[4]
Thenumberofpeoplewhocurrentlyhaveactiveepilepsyisintherange510per1,000,withactiveepilepsydefinedassomeonewithepilepsywhohashadaleastoneseizureinthelastfiveyears.[39][119]Epilepsybeginseachyearin4070per100,000indevelopedcountriesand80140per100,000indevelopingcountries.[4]Povertyisariskandincludesbothbeingfromapoorcountryandbeingpoorrelativetootherswithinone'scountry.[13]Inthedevelopedworldepilepsymostcommonlystartseitherintheyoungorintheold.[13]Inthedevelopingworlditsonsetismorecommoninolderchildrenandyoungadultsduetothehigherratesoftraumaandinfectiousdiseases.[13]Indevelopedcountriesthenumberofcasesayearhasdecreasedinchildrenandincreasedamongtheelderlybetweenthe1970sand2003.[119]Thishasbeenattributedpartlytobettersurvivalfollowingstrokesintheelderly.[39]
History
Theoldestmedicalrecordsshowthatepilepsyhasbeenaffectingpeoplesincethebeginningofrecordedhistory.[120]Throughoutancienthistory,thedisorderwasthoughttobeaspiritualcondition.[120]Theworld'soldestdescriptionofanepilepticseizurecomesfromatextinAkkadian(alanguageusedinancientMesopotamia)andwaswrittenaround2000BC.[1][1]ThepersondescribedinthetextwasdiagnosedasbeingundertheinfluenceofaMoongod,andunderwentanexorcism.[1]EpilepticseizuresarelistedintheCodeofHammurabi(c.1790BC)asreasonforwhichapurchasedslavemaybereturnedforarefund,[1]andtheEdwinSmithPapyrus(c.1700BC)describescasesofindividualswithepilepticconvulsions.[1]
TheoldestknowndetailedrecordofthedisorderitselfisintheSakikku,aBabyloniancuneiformmedicaltextfrom10671046BC.[120]Thistextgivessignsandsymptoms,detailstreatmentandlikelyoutcomes,[1]anddescribesmanyfeaturesofthedifferentseizuretypes.[120]AstheBabylonianshadnobiomedicalunderstandingofthenatureofdisease,theyattributedtheseizurestopossessionbyevilspiritsandcalledfortreatingtheconditionthroughspiritualmeans.[120]Around900BC,PunarvasuAtreyadescribedepilepsyaslossofconsciousness[121]thisdefinitionwascarriedforwardintotheAyurvedictextofCharakaSamhita(about400BC).[122]
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Hippocrates,17thcenturyengravingbyPeterPaulRubensofanantiquebust.
TheancientGreekshadcontradictoryviewsofthedisease.Theythoughtofepilepsyasaformofspiritualpossession,butalsoassociatedtheconditionwithgeniusandthedivine.Oneofthenamestheygavetoitwasthesacreddisease.[1][123]EpilepsyappearswithinGreekmythology:itisassociatedwiththeMoongoddessesSeleneandArtemis,whoafflictedthosewhoupsetthem.TheGreeksthoughtthatimportantfiguressuchasJuliusCaesarandHerculeshadthedisease.[1]ThenotableexceptiontothisdivineandspiritualviewwasthatoftheschoolofHippocrates.InthefifthcenturyBC,Hippocratesrejectedtheideathatthediseasewascausedbyspirits.InhislandmarkworkOntheSacredDisease,heproposedthatepilepsywasnotdivineinoriginandinsteadwasamedicallytreatableproblemoriginatinginthebrain.[1][120]Heaccusedthoseofattributingasacredcausetothediseaseofspreadingignorancethroughabeliefinsuperstitiousmagic.[1]Hippocratesproposedthathereditywasimportantasacause,describedworseoutcomesifthediseasepresentsatanearlyage,andmadenoteofthephysicalcharacteristicsaswellasthesocialshameassociatedwithit.[1]Insteadofreferringtoitasthesacreddisease,heusedthetermgreatdisease,givingrisetothemoderntermgrandmal,usedforgeneralizedseizures.[1]Despitehisworkdetailingthephysicaloriginsofthedisease,hisviewwasnotacceptedatthetime.[120]Evilspiritscontinuedtobeblameduntilatleastthe17thcentury.[120]
Inmostcultures,personswithepilepsyhavebeenstigmatized,shunned,orevenimprisonedintheSalptrire,thebirthplaceofmodernneurology,JeanMartinCharcotfoundpeoplewithepilepsysidebysidewiththementallyill,thosewithchronicsyphilis,andthecriminallyinsane.[124]InancientRome,epilepsywasknownastheMorbusComitialis('diseaseoftheassemblyhall')andwasseenasacursefromthegods.InnorthernItaly,epilepsywasoncetraditionallyknownasSaintValentine'smalady.[125]
Inthemid1800sthefirsteffectiveantiseizuremedication,bromide,wasintroduced.[90]Thefirstmoderntreatment,phenobarbital,wasdevelopedin1912,withphenytoincomingintousein1938.[126]
Societyandculture
Stigma
Stigmaiscommonlyexperienced,aroundtheworld,bythosewithepilepsy.[127]Itcanaffectpeopleeconomically,sociallyandculturally.[127]InIndiaandChinaepilepsymaybeusedasjustificationtodenymarriage.[4]Peopleinsomeareasstillbelievethosewithepilepsytobecursed.[13]InTanzania,asinotherpartsofAfrica,epilepsyisassociatedwithpossessionbyevilspirits,witchcraft,orpoisoningandisbelievedbymanytobecontagious,[124]forwhichthereisnoevidence.[13]Before1970theUnitedKingdomhadlawswhichpreventedpeoplewithepilepsyfrommarrying.[4]Thestigmamayresultinsomepeoplewithepilepsydenyingthattheyhaveeverhadseizures.[39]
Economics
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SeizuresresultindirecteconomiccostsofaboutonebilliondollarsintheUnitedStates.[14]EpilepsyresultedineconomiccostsinEuropeofaround15.5billionEurosin2004.[18]InIndiaepilepsyisestimatedtoresultincostsof1.7billionUSDor0.5%oftheGDP.[4]Itisthecauseofabout1%ofemergencydepartmentvisits(2%foremergencydepartmentsforchildren)intheUnitedStates.[128]
Vehicles
Thosewithepilepsyareatabouttwicetheriskofbeinginvolvedinamotorvehicularcollisionandthusinmanyareasoftheworldarenotallowedtodriveoronlyabletodriveifcertainconditionsaremet.[16]Insomeplacesphysiciansarerequiredbylawtoreportifapersonhashadaseizuretothelicensingbodywhileinotherstherequirementisonlythattheyencouragethepersoninquestiontoreportitthemselves.[16]CountriesthatrequirephysicianreportingincludeSweden,Austria,DenmarkandSpain.[16]CountriesthatrequiretheindividualtoreportincludetheUK,andNewZealandandthephysicianmayreportiftheybelievetheindividualhasnotalready.[16]InCanada,theUnitedStatesandAustraliatherequirementsaroundreportingvarybyprovinceorstate.[16]Ifseizuresarewellcontrolledmostfeelallowingdrivingisreasonable.[129]Theamountoftimeapersonmustbefreefromseizuresbeforetheycandrivevariesbycountry.[129]Manycountriesrequireonetothreeyearswithoutseizures.[129]IntheUnitedStatesthetimeneededwithoutaseizureisdeterminedbyeachstateandisbetweenthreemonthsandoneyear.[129]
Thosewithepilepsyorseizuresaretypicallydeniedapilotlicense.[130]InCanadaifanindividualhashadnomorethanoneseizure,theymaybeconsideredafterfiveyearsforalimitedlicenseifallothertestingisnormal.[131]Thosewithfebrileseizuresanddrugrelatedseizuresmayalsobeconsidered.[131]IntheUnitedStates,theFederalAviationAdministrationdoesnotallowthosewithepilepsytogetacommercialpilotlicense.[132]Rarely,exceptionscanbemadeforpersonswhohavehadanisolatedseizureorfebrileseizuresandhaveremainedfreeofseizuresintoadulthoodwithoutmedication.[133]IntheUnitedKingdom,afullnationalprivatepilotlicenserequiresthesamestandardsasaprofessionaldriver'slicense.[134]Thisrequiresaperiodoftenyearswithoutseizureswhileoffmedications.[135]Thosewhodonotmeetthisrequirementmayacquirearestrictedlicenseiffreefromseizuresforfiveyears.[134]
Supportorganizations
Thereareorganizationsthatprovidesupportforpeopleandfamiliesaffectedbyepilepsy.TheOutoftheShadowscampaign,ajointeffortbytheWorldHealthOrganization,theInternationalLeagueAgainstEpilepsyandtheInternationalBureauforEpilepsy,provideshelpinternationally.[4]TheJointEpilepsyCouncilservestheUKandIreland.[54]IntheUnitedStates,theEpilepsyFoundationisanationalorganizationthatworkstoincreasetheacceptanceofthosewiththedisease,theirabilitytofunctioninsocietyandtopromoteresearchforacure.[136]TheEpilepsyFoundation,somehospitals,andsomeindividualsalsorunsupportgroupsintheUnitedStates.[137]
Research
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SeizurepredictionreferstoattemptstoforecastepilepticseizuresbasedontheEEGbeforetheyoccur.[138]Asof2011,noeffectivemechanismtopredictseizureshasbeendeveloped.[138]Kindling,whererepeatedexposurestoeventsthatcouldcauseseizureseventuallycausesseizuresmoreeasily,hasbeenusedtocreateanimalmodelsofepilepsy.[139]
Genetherapyisbeingstudiedinsometypesofepilepsy.[140]Medicationsthatalterimmunefunction,suchasintravenousimmunoglobulins,arepoorlysupportedbyevidence.[141]Noninvasivestereotacticradiosurgeryis,asof2012,beingcomparedtostandardsurgeryforcertaintypesofepilepsy.[142]
Otheranimals
Epilepsyoccursinanumberofotheranimalsincludingdogsandcatsandisthemostcommonbraindisorderindogs.[143]Itistypicallytreatedwithanticonvulsantssuchasphenobarbitalorbromideindogsandphenobarbitalincats.[144]Imepitoinisalsobeingusedindogs.[145]Whilegeneralizedseizuresinhorsesarefairlyeasytodiagnose,itmaybemoredifficultinnongeneralizedseizuresandEEGsmaybeuseful.[146]
References
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7. ^abcEadie,MJ(December2012)."Shortcomingsinthecurrenttreatmentofepilepsy.".ExpertReviewofNeurotherapeutics12(12):141927.doi:10.1586/ern.12.129(https://dx.doi.org/10.1586%2Fern.12.129).PMID23237349(https://www.ncbi.nlm.nih.gov/pubmed/23237349).
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