Epilepsy

"Epilepsia" and "Epileptic" redirect here. For the journal, see Epilepsia (journal). For the comics, see Epileptic (comics).

Epilepsy
Other namesSeizure disorder Neurological disability
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
SpecialtyNeurology
SymptomsPeriods of loss of consciousness, abnormal shaking, staring, change in vision, mood changes and/or other cognitive disturbances [1]
DurationLong term[1]
CausesUnknown, brain injury, stroke, brain tumors, infections of the brain, birth defects[1][2][3]
Diagnostic methodElectroencephalogram, ruling out other possible causes[4]
Differential diagnosisFainting, alcohol withdrawal, electrolyte problems[4]
TreatmentMedication, surgery, neurostimulation, dietary changes[5][6]
PrognosisControllable in 69%[7]
Frequency51.7 million/0.68% (2021)[8]
Deaths140,000 (2021)[9]

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures.[10] An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons.[1] The occurrence of two or more unprovoked seizures defines epilepsy.[11] The occurrence of just one seizure may warrant the definition (set out by the International League Against Epilepsy) in a more clinical usage where recurrence may be able to be prejudged.[10] Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain.[1] These episodes can result in physical injuries, either directly, such as broken bones, or through causing accidents.[1] In epilepsy, seizures tend to recur and may have no detectable 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 the alarming nature of their symptoms.[11]

The underlying mechanism of an epileptic seizure is excessive and abnormal neuronal activity in the cortex of the brain,[12] which can be observed in the electroencephalogram (EEG) of an individual. The reason this occurs in most cases of epilepsy is unknown (cryptogenic);[1] 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.[1][2][3] Known genetic mutations are directly linked to a small proportion of cases.[4][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.[4] This may be partly done by imaging the brain and performing blood tests.[4] Epilepsy can often be confirmed with an EEG, but a normal reading does not rule out the condition.[4]

Epilepsy that occurs as a result of other issues may be preventable.[1] Seizures are controllable with medication in about 69% of cases;[7] inexpensive anti-seizure medications are often available.[1] In those whose seizures do not respond to medication; surgery, neurostimulation or dietary changes may be considered.[5][6] Not all cases of epilepsy are lifelong, and many people improve to the point that treatment is no longer needed.[1]

As of 2021, about 51 million people have epilepsy. Nearly 80% of cases occur in the developing world.[1][8] In 2021, it resulted in 140,000 deaths, an increase from 125,000 in 1990.[9][14][15] Epilepsy is more common in children and 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 at the extremes of age – in younger children and 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] The chance of experiencing a second seizure within two years after the first is around 40%.[21][22] 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.[23] The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, 'to seize, possess, or afflict'.[24]

  1. ^ a b c d e f g h i j k l "Epilepsy Fact sheet". WHO. February 2016. Archived from the original on 11 March 2016. Retrieved 4 March 2016.
  2. ^ a b Cite error: The named reference Ham2010 was invoked but never defined (see the help page).
  3. ^ a b Cite error: The named reference Gol2013 was invoked but never defined (see the help page).
  4. ^ a b c d e f Longo DL (2012). "369 Seizures and Epilepsy". Harrison's principles of internal medicine (18th ed.). McGraw-Hill. p. 3258. ISBN 978-0-07-174887-2.
  5. ^ 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. S2CID 45244964.
  6. ^ a b Martin-McGill KJ, Bresnahan R, Levy RG, Cooper PN (June 2020). "Ketogenic diets for drug-resistant epilepsy". The Cochrane Database of Systematic Reviews. 2020 (6): CD001903. doi:10.1002/14651858.CD001903.pub5. PMC 7387249. PMID 32588435.
  7. ^ a b Eadie MJ (December 2012). "Shortcomings in the current treatment of epilepsy". Expert Review of Neurotherapeutics. 12 (12): 1419–1427. doi:10.1586/ern.12.129. PMID 23237349. S2CID 207221378.
  8. ^ a b "GBD 2021 Cause and Risk Summary: EPILEPSY". Institute for Health Metrics and Evaluation (IHME). Seattle, USA: University of Washington. 2021. Archived (PDF) from the original on 19 July 2024. Retrieved 19 July 2024.
  9. ^ a b Sinmetz JD, Seeher KM, Schiess N, Nichols E, Cao B, Servili C, et al. (1 April 2024). "Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021". The Lancet Neurology. 23 (4). Elsevier: 344–381. doi:10.1016/S1474-4422(24)00038-3. hdl:1959.4/102176. PMC 10949203. PMID 38493795.
  10. ^ a b Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. (April 2014). "ILAE official report: a practical clinical definition of epilepsy". Epilepsia. 55 (4): 475–482. doi:10.1111/epi.12550. PMID 24730690. S2CID 35958237.
  11. ^ a b c "Epilepsy". World Health Organization. Retrieved 1 April 2023.
  12. ^ a b Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. (April 2005). "Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)". Epilepsia. 46 (4): 470–472. doi:10.1111/j.0013-9580.2005.66104.x. PMID 15816939. S2CID 21130724.
  13. ^ Pandolfo M (November 2011). "Genetics of epilepsy". Seminars in Neurology. 31 (5): 506–518. doi:10.1055/s-0031-1299789. PMID 22266888. S2CID 260320566.
  14. ^ Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (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.
  15. ^ Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. (GBD 2013 Mortality and 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): 117–171. doi:10.1016/S0140-6736(14)61682-2. hdl:11655/15525. PMC 4340604. PMID 25530442.
  16. ^ Cite error: The named reference pmid19800848 was invoked but never defined (see the help page).
  17. ^ Holmes TR, Browne GL (2008). Handbook of epilepsy (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 7. ISBN 978-0-7817-7397-3.
  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): 1193–1201. doi:10.1016/S0140-6736(12)61381-6. PMID 23021288. S2CID 13933909.
  20. ^ Wilden JA, Cohen-Gadol AA (August 2012). "Evaluation of first nonfebrile seizures". American Family Physician. 86 (4): 334–340. PMID 22963022.
  21. ^ Neligan A, Adan G, Nevitt SJ, Pullen A, Sander JW, Bonnett L, et al. (Cochrane Epilepsy Group) (January 2023). "Prognosis of adults and children following a first unprovoked seizure". The Cochrane Database of Systematic Reviews. 1 (1): CD013847. doi:10.1002/14651858.CD013847.pub2. PMC 9869434. PMID 36688481.
  22. ^ "Epilepsy: what are the chances of having a second seizure?". NIHR Evidence. National Institute for Health and Care Research. 16 August 2023. doi:10.3310/nihrevidence_59456. S2CID 260965684.
  23. ^ L Devlin A, Odell M, L Charlton J, Koppel S (December 2012). "Epilepsy and driving: current status of research". Epilepsy Research. 102 (3): 135–152. doi:10.1016/j.eplepsyres.2012.08.003. PMID 22981339. S2CID 30673360.
  24. ^ Magiorkinis E, Sidiropoulou K, Diamantis A (January 2010). "Hallmarks in the history of epilepsy: epilepsy in antiquity". Epilepsy & Behavior. 17 (1): 103–108. doi:10.1016/j.yebeh.2009.10.023. PMID 19963440. S2CID 26340115.