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ACKNOWLEDGEMENT

I would like to express my sincere gratitude to the biology teacher Mrs. Geeta Pillai mam and the lab assistant Mr. Soni Jee for giving me support and guidance during the conduct of investigations and providing me all necessary apparatus and assistance.

     INTRODUCTION SIGNS AND SYMPTOMS CAUSES PARTHOPHYSIOLOGY CLASSIFICATION  SEIZURE TYPES  EPILEPSY SYNDROMES  MANAGEMENT  MEDICATION  SURGERY  OTHERS  DEATH  HISTORY  SOCIETY AND CULTURE  LEGAL IMPLICATION  NOTABLE CASES  REFERENCE .

EPILEPSY Epilepsy (from the Ancient Greek (epilēpsía) — "seizure") is a common and diverse set of chronic neurological disorders characterized by seizures. Epileptic seizures result from abnormal. excessive or hypersynchronous neuronal activity in the brain. About 50 million . Some definitions of epilepsy require that seizures be recurrent and unprovoked. but others require only a single seizure combined with brain alterations which increase the chance of future seizures.

Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. epileptic seizures may occur in recovering patients. but not cured. Epilepsy becomes more common as people age. all involving episodic abnormal electrical activity in the brain and numerous seizures. However. . and nearly 90% of epilepsy occurs in developing countries. Epilepsy should not be understood as a single disorder. but rather as syndromic with vastly divergent symptoms. with medication.people worldwide have epilepsy. Epilepsy is usually controlled. over 30% of people with epilepsy do not have seizure control even with the best available medications. Surgery may be considered in difficult cases. Onset of new cases occurs most frequently in infants and the elderly. As a consequence of brain surgery.

Epilepsy Classification and external resources Generalized 3 Hz spike and wave discharges in EEG ICD-10 ICD-9 Diseases D. Medline Plus e-Medicine MeSH G40-G41 345 4366 000694 neuro/415 D004827 .B.

The diagnosis of epilepsy usually requires that the seizures occur spontaneously. For example. Other precipitants can . certain epilepsy syndromes require particular precipitants or triggers for seizures to occur. Nevertheless. These seizures may present in a number of different ways.Epilepsy is characterized by a long term risk of recurrent seizures. Photosensitive epilepsy can be limited to seizures triggered by flashing lights. These are termed reflex epilepsy. patients with primary reading epilepsy have seizures triggered by reading.

febrile seizures are fairly common. Emotional stress. In fact. children with childhood absence epilepsy may be susceptible to hyperventilation.  During late infancy and early childhood. Catamenial epilepsy is the term denoting seizures linked to the menstrual cycle. These may be caused by many different things. alcohol and febrile illness are examples of precipitants cited by patients with epilepsy. heat stress. flashing lights and hyperventilation are activating procedures used in clinical EEG to help trigger seizures to aid diagnosis. the menstrual cycle in women with epilepsy can influence patterns of seizure recurrence. some thought to be things such as CNS infections and trauma. Likewise. Notably. sleep itself. There are different causes of epilepsy that are common in certain age groups. the influence of various precipitants varies with the epilepsy syndrome. . For example. sleep deprivation.trigger an epileptic seizure in patients who otherwise would be susceptible to spontaneous seizures.

   During childhood. head trauma. Other causes associated with these age groups are stress. . Further. trauma. These findings suggest that acute seizures are a predictable consequence of disruption of the BBB by either artificial or inflammatory mechanisms. well-defined epilepsy syndromes are generally seen. CNS infections. In older adults. idiopathic epilepsy is less common. Other causes are CNS tumors. cerebro-vascular disease is a very common cause. it is important to understand physiological conditions that may predispose the individual to a seizure occurrence. the causes are more likely to be secondary to any CNS lesion. During adolescence and adulthood. brain tumors. When investigating the causes of seizures. such as dementia. Several clinical and experimental data have implicated the failure of blood–brain barrier (BBB) function in triggering chronic or acute seizures. and other degenerative diseases that are common in the older age group. some studies implicate the interactions between a common blood protein—albumin and atrocities. and illicit drug use and alcohol withdrawal.

be released from these neurons in large amounts. thus making the neuron hyper excitable. which — by binding with nearby glutamatergic neurons — triggers excessive calcium (Ca2+) release in these post-synaptic cells. . One speculated mechanism for some forms of inherited epilepsy are mutations of the genes that code for sodium channel proteins. Another possible mechanism involves mutations leading to ineffective GABA (the brain's most common inhibitory neurotransmitter) action. Epilepsy-related mutations in some non-ion channel genes have also been identified. an excitatory neurotransmitter. Glutamate. Such excessive calcium release can be neurotoxin to the affected cell. these defective sodium channels stay open for too long. which are permeable to Ca2+ entry after binding of both glutamate and glycine). The hippocampus. subsequent spread of excitation. Several genes that code for protein subunits of voltage-gated and ligand-gated ion channels have been associated with forms of generalized epilepsy and infantile seizure syndromes. therefore. which contains a large volume of just such glutamatergic neurons (and NMDA receptors. and possible neuronal death. may.Mutations in several genes have been linked to some types of epilepsy. is especially vulnerable to epileptic seizure.

One interesting finding in animals is that repeated low-level electrical stimulation to some brain sites can lead to permanent decrease in seizure "threshold. One mechanism proposed for this is called excito-toxicity. . several ligand-gated ion channels have been linked to some types of frontal and generalized epilepsies. repeated exposures to some pesticides have been shown to induce seizures in both humans and animals. in human epilepsy are currently hotly debated." This phenomenon. if any. Epileptogenesis is the process by which a normal brain develops epilepsy after trauma. Graham Goddard in 1967.Much like the channelopathies in voltage-gated ion channels. It is important to note that these "kindled" animals do not experience spontaneous seizures. Chemical stimulation can also induce seizures. The roles of kindling and excitetoxicity. known as kindling (by analogy with the use of burning twigs to start a larger fire) was discovered by Dr. such as a lesion on the brain.

syndrome. known as semiology. 2. This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. Since 1997.Epilepsies are classified in five ways: 1. By the location in the brain where the seizures originate. the ILAE have been working on a new scheme that has five axes: ictal phenomenon. 3. By the observable manifestations of the seizures. By their first cause (or etiology). This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localization within the brain on the other. 5. identifiable medical syndromes. In 1989. As a part of discrete. etiology. 4. impairment. seizure type. the ILAE proposed a classification scheme for epilepsies and epileptic syndromes. such as reading or music In 1981. (pertaining to an epileptic seizure). the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use. By the event that triggers the seizures. .

then it is a simple partial seizure. Children may exhibit behaviors that are easily mistaken for epileptic seizures but are not caused by epilepsy. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. Partial seizures are further divided on the extent to which consciousness is affected. rocking. A partial seizure may spread within the brain . otherwise it is a complex partial (psychomotor) seizure. These include:    Inattentive staring Benign shudders (among children younger than age 2. myoclonic. usually when they are tired or excited) Self-gratification behaviors (nodding. and atonic seizures. These include absence (petit mal). clonic.a process known as secondary generalization.Seizure types are organized firstly according to whether the source of the seizure within the brain is localized (partial or focal onset seizures) or distributed (generalized seizures). head banging) . tonic-clonic (grand mal). tonic. If it is unaffected.

often in response to severe personal stress such as physical abuse) Conversion disorder can be distinguished from epilepsy because the episodes never occur during sleep and do not involve incontinence or self-injury.. and prognosis. Conversion disorder (flailing and jerking of the head. Each type of epilepsy presents with its own unique combination of seizure type. The most widespread classification of the epilepsies divides epilepsy syndromes by location or distribution of seizures (as revealed by the appearance of the seizures and by EEG) and by cause. Just as there are many types of seizures. treatment. . such as clinical features (e. behavior during the seizure) and expected causes. typical age of onset. or epilepsies of unknown localization. Epilepsy classification includes more information about the person and the episodes than seizure type alone. Syndromes are divided into localization-related epilepsies.g. there are many types of epilepsy syndromes. EEG findings. generalized epilepsies.

Localization-related epilepsies. idiopathic epilepsies are thought to arise from genetic abnormalities that lead to alteration of basic neuronal regulation. a small portion of the brain that serves as the irritant driving the epileptic response. In general. symptomatic. arise from an epileptic focus. and cryptogenic. sometimes termed partial or focal epilepsies. Epilepsies of unknown localization remain unclear as to whether they arise from a portion of the brain or from more widespread circuits. Epilepsy syndromes are further divided by presumptive cause: idiopathic. Symptomatic epilepsies arise from the effects of . arise from many independent foci (multifocal epilepsies) or from epileptic circuits that involve the whole brain. Generalized epilepsies. in contrast.

and although only 60 cases have been reported in the literature since 1976. such as a tumor. People with seizures that occur only after specific precipitants ("provoked seizures"). syndromic. have "epilepsies" that fall into this category. . because of its variety of EEG distributions. What can be even more confusing is that certain syndromes. featuring seizures such as infantile spasms. or cryptogenic depending on cause and can arise from both focal and generalized epileptic lesions. can be classified as idiopathic. Conditions such as ring chromosome 20 syndromes are gaining acknowledgment. Febrileare an example of seizures bound to a particular precipitant. Landau-Kleffner syndrome is epilepsy that.an epileptic lesion. The genetic component to epilepsy is receiving particular interest from the scientific community. whether that lesion is focal. falls uneasily in clear categories. such as West syndrome. or a defect in metabolism causing widespread injury to the brain. "more widespread cytogenetic chromosomal karyotyping in nonetiological cases of epilepsy" is likely. Some epileptic syndromes are difficult to fit within this classification scheme and fall in the unknown localization/etiology category. Cryptogenic epilepsies involve a presumptive lesion that is otherwise difficult or impossible to uncover during evaluation.

Epilepsy is usually treated with medication prescribed by a physician. it has been stressed that accurate differentiation between generalized and partial seizures is especially important in determining the appropriate treatment. In some cases the implantation of a stimulator of the vagus nerve. The proper initial response to a generalized tonic-clonic epileptic seizure is to roll the person on the side (recovery position) to prevent ingestion of fluids into the lungs. this should be allowed to drip out the side of the person's mouth. However. and placing something soft beneath the head. Neurosurgical operations for epilepsy can be palliative. and neurosurgeons all frequently care for people with epilepsy. Should the person regurgitate. in some patients. . The person should be prevented from self-injury by moving them away from sharp edges. or a special diet can be helpful. neurologists. reducing the frequency or severity of seizures. or. which can result in choking and death. primary caregivers. an operation can be curative. If a seizure lasts longer than 5 minutes. or if more than one seizure occurs without regaining consciousness emergency medical services should be contacted.

effectiveness for particular epilepsy syndromes.The mainstay of treatment of epilepsy is anticonvulsant medications. Some examples include mood changes. sleepiness. Some anticonvulsant medications have "idiosyncratic" side effects that can not be . and side-effects differ among the individual anticonvulsant medications. The choice among anticonvulsants and their effectiveness differs by epilepsy syndrome. Most side effects are mild and "dose-related" and can often be avoided or minimized by the use of the smallest effective amount. in a European survey.88% of patients with epilepsy. or unsteadiness in gait. reported at least one anticonvulsant related side-effect. Effectiveness . Safety and Side Effects . About 20% of patients with epilepsy continue to have breakthrough epileptic seizures despite best anticonvulsant treatment.The definition of "effective" varies. FDA approval usually requires that 50% of the patient treatment group had at least a 50% improvement in the rate of epileptic seizures. Some general findings about the use of anticonvulsants are outlined below. Often. Mechanisms. anticonvulsant medication treatment will be life long and can have major effects on quality of life.

Brain mapping by the technique of cortical electrical stimulation are other procedures used in the process of invasive testing in some patients. The goal for these procedures is total control of epileptic seizures. liver toxicity (hepatitis). in the process of treating the underlying lesion. Some examples include drug rashes. Epilepsy surgery is an option for people with focal seizures that remain resistant to treatment. or aplastic anemia. which. although anticonvulsant medications may still be required.predicted by dose. . The most common surgeries are the resection of lesions like tumors or arteriovenous malformations. often result in control of epileptic seizures caused by these lesions. Certain lesions require Long-term video-EEG monitoring with the use of intracranial electrodes if noninvasive testing was inadequate to identify the epileptic focus or distinguish the surgical target from normal brain tissue and function. Safety includes the consideration of teratogenicity (the effects of medications on fetal development) when women with epilepsy become pregnant.

. some patients decide not to undergo surgery owing to fear or the uncertainty of having a brain operation. Some neurosurgeons recommend selective surgery because of possible benefits in postoperative memory or language function. This procedure can therefore prevent injury due to the person falling to the ground after losing consciousness. and the most common type of epilepsy surgery is the anterior temporal lobectomy. The most common form of intractable epilepsy in these disorders in adults is temporal lobe epilepsy with hippocampal sclerosis. It is performed only when the seizures cannot be controlled by other means. Palliative surgery for epilepsy is intended to reduce the frequency or severity of seizures. durable.Other lesions are more subtle and feature epilepsy as the main or sole symptom. and results in decreased health care costs. Despite the efficacy of epilepsy surgery. or the removal of the front portion of the temporal lobe including the amygdala and hippocampus. Multiple subpial transections can also be used to decrease the spread of seizures across the cortex especially when the epileptic focus is located near important functional areas of the cortex. Resective surgery can be considered palliative if it is undertaken with the expectation that it will reduce but not eliminate seizures. which results in a loss of consciousness. Surgery for temporal lobe epilepsy is effective. Examples are callosotomy or commissurotomy to prevent seizures from generalizing (spreading to involve the entire brain).

people with epilepsy are at risk for death from four main problems: status epilepticus (most often associatedwith anticonvulsant noncompliance). and Sudden Unexpected Death In Epilepsy (SUDEP). suicide associ ated with depression. led by "Epilepsy Bereaved" drew attention to this important problem. ADHD and epilepsy have significant consequences on a child's . migraine and other headaches. The NICE National Sentinel Audit of Epilepsy-Related Deaths. those with more benign epilepsy syndromes have little risk for epilepsy-related death. Those at highest risk for epilepsy-related deaths usually have underlying neurological impairment or poorly controlled seizures. Attention-deficit/hyperactivity disorder (ADHD) affects three to five times more children with epilepsy than children in the general population.000 deaths occur every year in the UK as a result of epilepsy" and most of them are associated with seizures and 42% of deaths were potentially avoidable". trauma from seizures. and the risk of these "comorbidities" often varies with the epilepsy syndrome. Certain diseases also seem to occur in higher than expected rates in people with epilepsy.Beyond symptoms of the underlying diseases that can be a part of certain epilepsies. "1. infertility and low sexual libido. The Audit revealed. These diseases include depression and anxiety disorders.

or that the visions experienced by persons with epilepsy were sent by the gods. In the past. while the Ayurvedic text of Charaka Samhita (about 400BC). A chapter from a Babylonian textbook of medicine. epilepsy was understood as an attack by an evil spirit. but the affected person could become revered as a shaman through these otherworldly experiences. or even imprisoned. and it emphasizes the supernatural nature of epilepsy. for example. epilepsy was known as the "Sacred Disease" (as described in a 5th century BC treatise by Hippocrates) because people thought that epileptic seizures were a form of attack by demons. shunned. In most cultures. epilepsy was associated with religious experiences and even demonic possession. In ancient times. "loss of consciousness"..e. learning. describes epilepsy as "apasmara". Epilepsy is prevalent in autism. Among animist Hmong families. dating from about 2000BC and consisting of 40 tablets. and social development. records many of the different seizure types we recognize today. persons with epilepsy have been stigmatized. in the Salpêtrière. the birthplace . i.behavioral.

or whose seizures only arise from sleep. have a lengthy aura preceding impairment of consciousness. epilepsy is associated with possession by evil spirits. in both the public and private spheres. .of modern neurology. there are usually exceptions for those who can prove that they have stabilized their condition. at least in the developed world. Many jurisdictions forbid certain activities to persons suffering from epilepsy. Jean-Martin Charcot found people with epilepsy side-by-side with the mentally retarded. may be exempt from such restrictions. or other activities in which continuous vigilance is required. In ancient Rome. or poisoning and is believed by many to be contagious. In Tanzania to this day. However. and the criminally insane. witchcraft. as with other parts of Africa. epilepsy was known as the Morbus Comitialis ('disease of the assembly hall') and was seen as a curse from the gods. those with chronic syphilis. Those few whose seizures do not cause impairment of consciousness. Stigma continues to this day. Hippocrates remarked that epilepsy would cease to be considered divine the day it was understood. but polls suggest it is generally decreasing with time. The most commonly prohibited activities involve operation of vehicles or machinery.

past and present. for some. it played an integral role in their fame. In many cases. but is most likely to be between three months and a year. Historical diagnoses of epilepsy are not always certain. people with epilepsy can drive if their seizures are controlled with treatment and they meet the licensing requirements in their state. it is usually the driver's licensing agency that decides to revoke or restrict a driver's license.depending on local laws.. their epilepsy is a footnote to their accomplishments. The majority of the 50 states place the burden on patients to report their condition to appropriate licensing authorities so that their privileges can be revoked where appropriate. there is controversy about what is considered an acceptable amount of evidence in support of such a diagnosis.S. Many notable people. In the U. The amount of time someone needs to be free of seizures varies in different states. . have carried the diagnosis of epilepsy. After reporting is carried out. A minority of states place the burden of reporting on the patient's physician. There is an ongoing debate in bioethics over who should bear the burden of ensuring that an epilepsy patient does not drive a car or fly an airplane.

RESULTS: A total of 52. India. age-standardized .A longitudinal study of epilepsy in Kolkata. The survey was conducted annually for five consecutive years from March 2003 through February 2008. India. and mortality rates of epilepsy in the city of Kolkata. incidence. and the detailed follow-up was done by neurologists. There were 309 prevalent and 66 incident cases of active epilepsy. The prevalence and average annual incidence rate (AAIR) with 95% confidence interval (CI).377 (52. Abstract PURPOSE: This study aimed to determine the prevalence. This is the first such longitudinal study in a heterogeneous urban Indian population.74% men) individuals were screened. METHODS: A two-stage door-to-door survey of a stratified random sample was undertaken within the municipal limits of Kolkata. Trained field workers detected and interviewed the cases using a simple screening questionnaire.

54) per 100.03-34. Compared to the general population of Kolkata.79-641.80) per 100. Inc. however. There was no significant difference between slum and nonslum dwellers in epidemiologic parameters.000 population per year. The average annual mortality rate (AAMR) was 7.27 (21. but AAMR is higher. 20 cases of active epilepsy died. © 2010 International League Against Epilepsy. similar to that of developed nations.000 and 27.45-11.8 (509. the all-cause standardized mortality ratio (SMR) for persons with epilepsy was 2. respectively. CONCLUSIONS: The AAIR of epilepsy is comparable to that observed in developed countries.58 overall (men 3. The all-cause SMR for epilepsy relative to the general population is. were 572.26) per 100. The age-specific incidence rates of epilepsy showed bimodal distribution. During the 5-year period. women 1.000 per year.to World Standard Population.67.77). . Wiley Periodicals.63 (95% CI 4.

 http://en.osb&fp=ecb049eb56d1 82c6&biw=1024&bih=677 .cf.r_pw.in/#hl=en&cp=8&gs_id=3&xhr=t& q=Epilepsy&pf=p&sclient=psy-ab&site=&source= hp&pbx=1&oq=Epilepsy&aq=0&aqi=g4&aql=&gs_sm=& gs_upl=&bav=on.wikipedia.org/wiki/Epilepsy  http://answers.com/search?p=Epilepsy&fr=csc_answe rs_us  http://en.yahoo.org/wiki/Epilepsy_in_animals  http://www.yahoo.co.com/question/index?qid=20080712 105034AAiTvq8  http://search.wikipedia.r_gc.2.google..or.