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Epilepsy
Other namesSeizure disorder
The electroencephalogram recording of a person with childhood absence epilepsy showing a seizure. The waves are black on a white background.
Generalized 3 Hz spike-and-wave discharges on an electroencephalogram
Specialty Neurology
SymptomsPeriods of vigorous shaking, nearly undetectable spells [1]
DurationLong term [2]
CausesUnknown, brain injury, stroke, brain tumors, infections of the brain, birth defects [2] [3] [4]
Diagnostic methodElectroencephalogram, ruling out other possible causes [5]
Differential diagnosis Fainting, alcohol withdrawal, electrolyte problems [5]
TreatmentMedication, surgery, neurostimulation, dietary changes [6] [7]
PrognosisControllable in 70% [8]
Frequency50 million (2022) [1]
Deaths125,000 (2015) [9]

Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. [10] Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking. [1] These episodes can result in physical injuries, including occasionally broken bones. [2] In epilepsy, seizures have a tendency to recur and, as a rule, have no immediate underlying cause. [11] Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. [12] People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to their condition. [2]

The underlying mechanism of epileptic seizures is excessive and abnormal neuronal activity in the cortex of the brain. [12] The reason this occurs in most cases of epilepsy is unknown. [2] Some cases occur as the result of brain injury, stroke, brain tumors, infections of the brain, or birth defects through a process known as epileptogenesis. [2] [3] [4] Known genetic mutations are directly linked to a small proportion of cases. [5] [13] The diagnosis involves ruling out other conditions that might cause similar symptoms, such as fainting, and determining if another cause of seizures is present, such as alcohol withdrawal or electrolyte problems. [5] This may be partly done by imaging the brain and performing blood tests. [5] Epilepsy can often be confirmed with an electroencephalogram (EEG), but a normal test does not rule out the condition. [5]

Epilepsy that occurs as a result of other issues may be preventable. [2] Seizures are controllable with medication in about 70% of cases; [8] inexpensive anti-seizure medications are often available. [2] In those whose seizures do not respond to medication, surgery, neurostimulation or dietary changes may then be considered. [6] [7] Not all cases of epilepsy are lifelong, and many people improve to the point that treatment is no longer needed. [2]

As of 2022, about 50 million people have epilepsy (0.5-1% of the population). [14] [1] Around 70% of cases occur in the developing world. [1] In 2015, it resulted in 125,000 deaths, an increase from 112,000 in 1990. [9] [15] Epilepsy is more common in older people. [16] [17] In the developed world, onset of new cases occurs most frequently in babies and the elderly. [18] In the developing world, onset is more common in older children and young adults due to differences in the frequency of the underlying causes. [19] About 5–10% of people will have an unprovoked seizure by the age of 80, [20] and the chance of experiencing a second seizure is between 40 and 50%. [21] In many areas of the world, those with epilepsy either have restrictions placed on their ability to drive or are not permitted to drive until they are free of seizures for a specific length of time. [22] The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, 'to seize, possess, or afflict'. [23]

References

  1. ^ a b c d e "Epilepsy". www.who.int. World Health Organization. Archived from the original on 3 June 2022. Retrieved 3 June 2022.
  2. ^ a b c d e f g h i "Epilepsy Fact sheet". WHO. February 2016. Archived from the original on 11 March 2016. Retrieved 4 March 2016.
  3. ^ a b Hammer, Gary D.; McPhee, Stephen J., eds. (2010). "7". Pathophysiology of disease : an introduction to clinical medicine (6th ed.). New York: McGraw-Hill Medical. ISBN  978-0-07-162167-0.
  4. ^ a b Goldberg EM, Coulter DA (May 2013). "Mechanisms of epileptogenesis: a convergence on neural circuit dysfunction". Nature Reviews. Neuroscience. 14 (5): 337–49. doi: 10.1038/nrn3482. PMC  3982383. PMID  23595016.
  5. ^ a b c d e f Longo, Dan L (2012). "369 Seizures and Epilepsy". Harrison's principles of internal medicine (18th ed.). McGraw-Hill. p. 3258. ISBN  978-0-07-174887-2.
  6. ^ a b Bergey GK (June 2013). "Neurostimulation in the treatment of epilepsy". Experimental Neurology. 244: 87–95. doi: 10.1016/j.expneurol.2013.04.004. PMID  23583414.
  7. ^ a b Martin-McGill, Kirsty J.; Jackson, Cerian F.; Bresnahan, Rebecca; Levy, Robert G.; Cooper, Paul N. (7 November 2018). "Ketogenic diets for drug-resistant epilepsy". The Cochrane Database of Systematic Reviews. 11: CD001903. doi: 10.1002/14651858.CD001903.pub4. ISSN  1469-493X. PMC  6517043. PMID  30403286.
  8. ^ a b Eadie MJ (December 2012). "Shortcomings in the current treatment of epilepsy". Expert Review of Neurotherapeutics. 12 (12): 1419–27. doi: 10.1586/ern.12.129. PMID  23237349.
  9. ^ a b Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M.; Bhutta, Zulfiqar A.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Zian; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Dicker, Daniel J.; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Foreman, Kyle; Forouzanfar, Mohammad H.; Fraser, Maya S.; Fullman, Nancy; Gething, Peter W.; Goldberg, Ellen M.; Graetz, Nicholas; Haagsma, Juanita A.; Hay, Simon I.; Huynh, Chantal; Johnson, Catherine O.; Kassebaum, Nicholas J.; Kinfu, Yohannes; Kulikoff, Xie Rachel (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi: 10.1016/s0140-6736(16)31012-1. PMC  5388903. PMID  27733281. {{ cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) ( help)
  10. ^ Wiebe, Samuel (2020). "375. The epilepsies". In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine. Vol. 2 (26th ed.). Philadelphia: Elsevier. pp. 2358–2370. ISBN  978-0-323-53266-2. Archived from the original on 11 June 2022. Retrieved 3 June 2022.
  11. ^ Chang BS, Lowenstein DH (September 2003). "Epilepsy". The New England Journal of Medicine. 349 (13): 1257–66. doi: 10.1056/NEJMra022308. PMID  14507951.
  12. ^ a b Fisher R, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J (2005). "Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)". Epilepsia. 46 (4): 470–2. doi: 10.1111/j.0013-9580.2005.66104.x. PMID  15816939.
  13. ^ Pandolfo, M. (Nov 2011). "Genetics of epilepsy". Seminars in Neurology. 31 (5): 506–18. doi: 10.1055/s-0031-1299789. PMID  22266888.
  14. ^ Fiest, KM; Sauro, KM; Wiebe, S; Patten, SB; Kwon, CS; Dykeman, J; Pringsheim, T; Lorenzetti, DL; Jetté, N (17 January 2017). "Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies". Neurology. 88 (3): 296–303. doi: 10.1212/WNL.0000000000003509. PMID  27986877.
  15. ^ GBD 2013 Mortality Causes of Death Collaborators (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi: 10.1016/S0140-6736(14)61682-2. PMC  4340604. PMID  25530442. Archived from the original on 10 March 2021. Retrieved 15 July 2020. {{ cite journal}}: |author1= has generic name ( help)CS1 maint: numeric names: authors list ( link)
  16. ^ Brodie MJ, Elder AT, Kwan P (November 2009). "Epilepsy in later life". The Lancet. Neurology. 8 (11): 1019–30. doi: 10.1016/S1474-4422(09)70240-6. PMID  19800848.
  17. ^ Holmes, Thomas R.; Browne, Gregory L. (2008). Handbook of epilepsy (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 7. ISBN  978-0-7817-7397-3. Archived from the original on 31 March 2021. Retrieved 15 July 2020.
  18. ^ Wyllie's treatment of epilepsy : principles and practice (5th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. 2010. ISBN  978-1-58255-937-7. Archived from the original on 24 June 2016.
  19. ^ Newton CR, Garcia HH (September 2012). "Epilepsy in poor regions of the world". Lancet. 380 (9848): 1193–201. doi: 10.1016/S0140-6736(12)61381-6. PMID  23021288.
  20. ^ Wilden JA, Cohen-Gadol AA (August 2012). "Evaluation of first nonfebrile seizures". American Family Physician. 86 (4): 334–40. PMID  22963022.
  21. ^ Berg AT (2008). "Risk of recurrence after a first unprovoked seizure". Epilepsia. 49 Suppl 1: 13–8. doi: 10.1111/j.1528-1167.2008.01444.x. PMID  18184149.
  22. ^ L Devlin A, Odell M, L Charlton J, Koppel S (December 2012). "Epilepsy and driving: current status of research". Epilepsy Research. 102 (3): 135–52. doi: 10.1016/j.eplepsyres.2012.08.003. PMID  22981339.
  23. ^ Magiorkinis E, Sidiropoulou K, Diamantis A (January 2010). "Hallmarks in the history of epilepsy: epilepsy in antiquity". Epilepsy & Behavior. 17 (1): 103–8. doi: 10.1016/j.yebeh.2009.10.023. PMID  19963440.