epilepsy

From Aaushi
Jump to navigation Jump to search

Introduction

A tendency towards recurrent seizures.

Defined as >= 2 unprovoked seizures > 24 hours apart or

1 unprovoked seizure with a risk of further seizures of >= 60%[2]

Classification

Epilepsy syndromes:

* International League Against Epilepsy has updated its system for classifying epilepsies[16]

  • focal is now used instead of partial
  • focal seizures are now classified by awareness
  • the terms dyscognitive, simple partial, complex partial, psychic, & secondarily generalized are no longer used[16]

Etiology

* no mention of febrile seizures[14]

Epidemiology

  • cumulative lifetime incidence in U.S. is 3%[2]
  • 44% of patients with epilepsy report seizures under control[21]

Clinical manifestations

Diagnostic criteria

  • diagnosis of epilepsy requires 2 or more unprovoked seizures 24 hours apart[2][8], or
  • one unprovoked seizure plus >= 60% likelihood of additional seizure(s) within 10 years (a single seizure 1 month after a stroke), or
  • presence of an epilepsy syndrome

* resolution of epilepsy may be considered if

Laboratory

  • avoid routine drug levels in patients with epilepsy[23]
  • see ARUP consult[3]

Diagnostic procedures

Radiology

Complications

Management

* avoid valproic acid, phenobarbital, phenytoin, topiramate, carbamazepine in pregnant women & women of child-bearing age

More general terms

More specific terms

Additional terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1034-35
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. 3.0 3.1 ARUP Consult: Seizure Disorders - Epilepsy deprecated reference
  4. French JA, Pedley TA. Clinical practice. Initial management of epilepsy. N Engl J Med. 2008 Jul 10;359(2):166-76 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18614784
  5. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000 Feb 3;342(5):314-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10660394
  6. 6.0 6.1 Nei M, Hays R. Sudden unexpected death in epilepsy. Curr Neurol Neurosci Rep. 2010 Jul;10(4):319-26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20446062
  7. Arain AM, Abou-Khalil BW. Management of new-onset epilepsy in the elderly. Nat Rev Neurol. 2009 Jul;5(7):363-71 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19578343
  8. 8.0 8.1 8.2 Herman AO Epilepsy Case Definition Revised Physician's First Watch, April 15, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    Fisher RS et al A practical clinical definition of epilepsy. Epilepsia. April 14, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24730690 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/epi.12550/full
  9. 9.0 9.1 9.2 Selassie AW et al Premature Deaths Among Children with Epilepsy - South Carolina, 2000-2011 MMWR Weekly November 7, 2014 / 63(44);989-994 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6344a2.htm
  10. Gaffield ME, Culwell KR, Lee CR. The use of hormonal contraception among women taking anticonvulsant therapy. Contraception. 2011 Jan;83(1):16-29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21134499
  11. Glauser T, Ben-Menachem E, Bourgeois B et al Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013 Mar;54(3):551-63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23350722
  12. Jette N, Quan H, Tellez-Zenteno JF et al Development of an online tool to determine appropriateness for an epilepsy surgery evaluation. Neurology. 2012 Sep 11;79(11):1084-93. Epub 2012 Aug 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22895589
  13. Maschio M, Dinapoli L. Patients with brain tumor-related epilepsy. J Neurooncol. 2012 Aug;109(1):1-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22528794
  14. 14.0 14.1 14.2 14.3 14.4 Kao A Medscape: Quiz: January 12, 2016 Test Your Knowledge of Epilepsy and Seizure-related Conditions. http://reference.medscape.com/viewarticle/856770_2
  15. Ko DY, Benbadis SR Medscape: Epilepsy and Seizures. http://emedicine.medscape.com/article/1184846-overview
  16. 16.0 16.1 16.2 Scheffer IE et al ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. March 8, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28276062 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/epi.13709/full
    Fisher RS et al Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. March 8, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28276064 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/epi.13671/full
    Fisher RS et al Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. March 8, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28276060 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/epi.13670/full
    Zuberi SM, Perucca E. A new classification is born. Epilepsia. March 8, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28276059 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/epi.13694/full
  17. 17.0 17.1 Basen R. Epilepsy Patients Failing Regular Meds Improved with Medical Cannabis - Reported better overall health as well as seizure control in pilot study MedPage Today, Dec 05, 2017
    Papalia A, et al Has the New York Medical Marijuana Program benefited medically refractory epilepsy patients? American Epilepsy Society (AES) 2017; Abstract 2.186.
  18. 18.0 18.1 Drash W Girl has words for Aetna after brain surgery was denied. CNN. Dec 11, 2017 https://www.msn.com/en-us/news/us/girl-has-words-for-aetna-after-brain-surgery-was-denied/ar-BBGzd2w
  19. 19.0 19.1 George J. Stress-Reducing Techniques Lead to Fewer Seizures. Muscle relaxation, focused attention help patients with medication-resistant epilepsy. MedPage Today. Feb 15, 2018 https://www.medpagetoday.com/neurology/seizures/71192
    Haut SR, Lipton RB, Cornes S et al Behavioral interventions as a treatment for epilepsy: A multicenter randomized controlled trial. Neurology. 2018 Feb 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29444968
  20. 20.0 20.1 20.2 Gorton HC, Webb RT, Carr MJ et al Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurol. Published online April 9, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29630689 https://jamanetwork.com/journals/jamaneurology/fullarticle/2677847
    Devinsky O, Singh A, Friedman D. Deaths in Epilepsy. What We Are Missing. JAMA Neurol. Published online April 9, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29630704 https://jamanetwork.com/journals/jamaneurology/fullarticle/2677846
  21. 21.0 21.1 Tian N, Boring M, Kobau R, Zack MM, Croft JB. Active Epilepsy and Seizure Control in Adults - United States, 2013 and 2015. MMWR Morb Mortal Wkly Rep 2018;67:437-442 https://www.cdc.gov/mmwr/volumes/67/wr/mm6715a1.htm
  22. 22.0 22.1 22.2 22.3 22.4 22.5 Johnson EL, Krauss GL, Lee AK et al Association Between Midlife Risk Factors and Late-Onset Epilepsy. Results From the Atherosclerosis Risk in Communities Study. JAMA Neurol. Published online July 23, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30039175 https://jamanetwork.com/journals/jamaneurology/fullarticle/2688301
  23. 23.0 23.1 23.2 23.3 23.4 23.5 Choogin Wisely. Five Things Physicians and Patients Should Question. American Epilepsy Society. Aug 15, 2018 http://www.choosingwisely.org/societies/american-epilepsy-society/
  24. Dobrin S. Seizures and epilepsy in adolescents and adults. Dis Mon. 2012 Dec;58(12):708-29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23149523
  25. 25.0 25.1 Greb E More Evidence Epilepsy Tied to Risk for Major Cardiovascular Events. Medscape - Jul 07, 2021. https://www.medscape.com/viewarticle/954347
    Lee-Lane E, Torabi F, Lacey A et al Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events. Epilepsia 2021. May 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34046890 https://onlinelibrary.wiley.com/doi/10.1111/epi.16930
  26. The Human Epilepsy Project http://www.humanepilepsyproject.org/
  27. NINDS Epilepsy Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page
  28. Centers of Disease Control and Prevention (CDC) Epilepsy http://www.cdc.gov/epilepsy/index.html
  29. Epilepsy Foundation: State Driving Laws Database http://www.epilepsy.com/driving-laws

Patient information

epilepsy patient information