- n.
WordNet
- a sudden occurrence (or recurrence) of a disease; "he suffered an epileptic seizure" (同)ictus, raptus
- the taking possession of something by legal process
- a disorder of the central nervous system characterized by loss of consciousness and convulsions
- of or relating to or characteristic of epilepsy; "epileptic seizure"
- a person who has epilepsy
PrepTutorEJDIC
- 〈U〉〈C〉つかむ(つかまれる)こと / 〈U〉〈C〉強奪;差し押さえ;逮捕 / 〈C〉(病気・恐怖などが)襲うこと,発作
- てんかん
- てんかん[性]の / てんかん患者
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/26 21:07:30」(JST)
wiki en
"Epilepsia" and "Epileptic" redirect here. For the journal, see Epilepsia (journal). For the graphic novel, see Epileptic (graphic novel).
| Epilepsy | |
|---|---|
| Classification and external resources | |
Generalized 3 Hz spike and wave discharges on an electroencephalogram
|
|
| ICD-10 | G40-G41 |
| ICD-9 | 345 |
| DiseasesDB | 4366 |
| MedlinePlus | 000694 |
| eMedicine | neuro/415 |
| MeSH | D004827 |
Epilepsy (from the Ancient Greek verb ἐπιλαμβάνειν meaning "to seize, possess, or afflict")[1] is a group of long-term neurological disorders characterized by epileptic seizures.[2] These seizures are episodes that can vary from brief and nearly undetectable to long periods of vigorous shaking.[3] 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.[4]
In most cases the cause is unknown, although some people develop epilepsy as the result of brain injury, stroke, brain cancer, and drug and alcohol misuse, among others. Epileptic seizures are the result of excessive and abnormal cortical nerve cell activity in the brain.[4] The diagnosis typically involves ruling out other conditions that might cause similar symptoms (such as syncope) as well as figuring out if any immediate causes are present. Epilepsy can often be confirmed with an electroencephalogram.
Epilepsy cannot be cured, but seizures are controllable with medication in about 70% of cases.[5] In those whose seizures do not respond to medication, surgery, neurostimulation or dietary changes may be considered. Not all epilepsy syndromes are lifelong, and a substantial number of people improve to the point that medication is no longer needed.
About 1% of people worldwide (65 million) have epilepsy,[6] and nearly 80% of cases occur in developing countries.[3] Epilepsy becomes more common as people age.[7][8] In the developed world, onset of new cases occurs most frequently in infants and the elderly;[9] in the developing world this is in older children and young adults,[10] due to differences in the frequency of the underlying causes. About 5–10% of all people will have an unprovoked seizure by the age of 80,[11] and the chance of experiencing a second seizure is between 40 and 50%.[12] In many areas of the world those with epilepsy either have their ability to drive restricted or disallowed,[13] but most are able to return to driving after a period of time without seizures.
Contents
- 1 Signs and symptoms
- 1.1 Seizures
- 1.2 Postictal
- 1.3 Psychosocial
- 2 Causes
- 2.1 Genetics
- 2.2 Secondary
- 2.3 Syndromes
- 3 Mechanism
- 4 Diagnosis
- 4.1 Definition
- 4.2 Classification
- 4.3 Lab tests
- 4.4 EEG
- 4.5 Imaging
- 4.6 Differential diagnosis
- 5 Prevention
- 6 Management
- 6.1 First aid
- 6.2 Medications
- 6.3 Surgery
- 6.4 Other
- 6.5 Alternative medicine
- 7 Prognosis
- 7.1 Mortality
- 8 Epidemiology
- 9 History
- 10 Society and culture
- 10.1 Stigma
- 10.2 Economics
- 10.3 Vehicles
- 10.4 Support organizations
- 11 Research
- 12 Other animals
- 13 References
- 14 Further reading
- 15 External links
Signs and symptoms[edit]
Someone who has bitten the tip of their tongue while having a seizure
Epilepsy is characterized by a long-term risk of recurrent seizures.[14] These seizures may present in several ways depending on the part of the brain involved and the person's age.[14][15]
Seizures[edit]
The most common type (60%) of seizures are convulsive.[15] Of these, two-thirds begin as focal seizures (which may then become generalized) while one-third begin as generalized seizures.[15] The remaining 40% of seizures are non-convulsive. An example of this type is the absence seizure, which presents as a decreased level of consciousness and usually lasts about 10 seconds.[16][17]
Focal seizures are often preceded by certain experiences, known as an aura.[18] These may include: sensory (visual, hearing or smell), psychic, autonomic, or motor phenomena.[16] Jerking activity may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a Jacksonian march.[19] Automatisms may occur; these are non-consciously generated activities and mostly simple repetitive movements like smacking of the lips or more complex activities such as attempts to pick something up.[19]
There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures.[20] They all involve a loss of consciousness and typically happen without warning. Tonic-clonic seizures present with a contraction of the limbs followed by their extension along with arching of the back which lasts 10–30 seconds (the tonic phase). A cry may be heard due to contraction of the chest muscles. This is then followed by a shaking of the limbs in unison (clonic phase). Tonic seizures produce constant contractions of the muscles. A person often turns blue as breathing is stopped. In clonic seizures there is shaking of the limbs in unison. After the shaking has stopped it may take 10–30 minutes for the person to return to normal; this period is called the "post-ictal phase".
Loss of bowel or bladder control may occur during a seizure.[3] The tongue may be bitten at either the tip or on the sides during a seizure.[21] In tonic-clonic seizure, bites to the sides are more common.[21] Tongue bites are also relatively common in psychogenic non-epileptic seizures.[21]
Myotonic seizures involved spasms of muscles in either a few areas or all over.[22] Absence seizures can be subtle with only a slight turn of the head or eye blinking.[16] The person does not fall over and returns to normal right after it ends.[16] Atonic seizures involve the loss of muscle activity for greater than one second.[19] This typically occurs on both sides of the body.[19]
About 6% of those with epilepsy have seizures that are often triggered by specific events and are known as reflex seizures.[23] Those with reflex epilepsy have seizures that are only triggered by specific stimuli.[24] Common triggers include flashing lights and sudden noises.[23] In certain types of epilepsy, seizures happen more often during sleep,[25] and in other types they occur almost only when sleeping.[26]
Postictal[edit]
After the active portion of a seizure, there is typically a period of confusion referred to as the postictal period before a normal level of consciousness returns.[18] This usually lasts 3 to 15 minutes[27] but may last for hours.[28] Other common symptoms include: feeling tired, headache, difficulty speaking, and abnormal behavior.[28] Psychosis after a seizure is relatively common, occurring in 6-10% of people.[29] Often people do not remember what happened during this time.[28] Localized weakness, known as Todd's paralysis, may also occur after a focal seizure. When it occurs it typically lasts for seconds to minutes but may rarely last for a day or two.[30]
Psychosocial[edit]
Epilepsy can have adverse effects on social and psychological well-being.[15] These effects may include social isolation, stigmatization, or disability.[15] They may result in lower educational achievement and worse employment outcomes.[15] Learning difficulties are common in those with the condition, and especially among children with epilepsy.[15] The stigma of epilepsy can also affect the families of those with the disease.[3]
Certain disorders occur more often in people with epilepsy, depending partly on the epilepsy syndrome present. These include: depression, anxiety disorders, and migraines.[31] Attention-deficit hyperactivity disorder affects three to five times more children with epilepsy than children in the general population.[32] ADHD and epilepsy have significant consequences on a child's behavioral, learning, and social development.[33] Epilepsy is also more common in those with autism.[34]
Causes[edit]
See also: Causes of seizures
Epilepsy is not a single disease but a symptom that can result from a number of different disorders.[15] By definition the seizures occur spontaneously and without an immediate cause.[6] The underlying cause may be identified as genetic or as due to structural or metabolic problems, but in 60%[3][15] of cases the cause is unknown.[35] Genetic, congenital, and developmental conditions are more common among younger people, while brain tumors and strokes are more likely in older people.[15] Seizures may also occur as a result of other health problems.[20] Epileptic seizures that occur right around a specific cause, such as a stroke, head injury, toxic ingestion or metabolic problem, are known as acute symptomatic seizures and are in the broader classification of seizure-related disorders rather than epilepsy itself.[6][36] Many of the causes of acute symptomatic seizures can also lead to latter seizures in which case it is known as secondary epilepsy.[3]
Genetics[edit]
Genetics is believed to be involved in the majority of cases, either directly or indirectly.[37] Some epilepsies are due to a single gene defect (1-2%); most are due to the interaction of multiple genes and environmental factors.[37] Each of the single gene defects is rare with more than 200 in all described.[38] Some of the genes involved affect ion channels, enzymes, GABA, and G protein-coupled receptors.[22]
In identical twins, if one is affected there is a 50-60% chance that the other will also be affected.[37] In non-identical twins the risk is 15%.[37] These risks are greater in those with generalized than focal seizures.[37] If both twins are affected, most of the time they have the same epileptic syndrome (70-90%).[37] Close relatives have a risk five times that of the general population.[39] Between 1 and 10% of those with Down syndrome and 90% of those with Angelman syndrome have epilepsy.[39]
Secondary[edit]
Epilepsy may occur as a result of a number of other conditions including: tumors, strokes, head trauma, infections of the central nervous system, genetic abnormalities, and as a result of brain damage around the time of birth.[3][20] Of those with brain tumors, almost 30% have epilepsy, making them the cause of about 4% of cases.[39] The risk is greatest for tumors in the temporal lobe and those that grow slowly.[39] Other mass lesions such as cerebral cavernous malformations and arterial venous malformations have risks as high as 40–60%.[39] Of those who have had a stroke, 2-4% develop epilepsy.[39] In the United Kingdom strokes account for 15% of cases[15] and it is believed to be the cause in 30% of the elderly.[39] Between 6 and 20% of epilepsy is believed to be due to head trauma.[39] Mild brain injury increases the risk about two-fold while severe brain injury increases the risk seven-fold.[39] In those who have experienced a high powered gunshot wound to the head, the risk is about 50%.[39]
The risk of epilepsy following meningitis is less than 10%; that disease more commonly causes seizures during the infection itself.[39] In herpes simplex encephalitis the risk of a seizure is around 50%[39] with a high risk of epilepsy following (up to 25%).[40][41] Infection with the pork tapeworm, which can result in neurocysticercosis, is the cause of up to half of epilepsy cases in areas of the world where the parasite is common.[39] Epilepsy may also occur after other brain infections such as cerebral malaria, toxoplasmosis, and toxocariasis.[39] Chronic alcohol use increases the risk of epilepsy: those who drink six units of alcohol per day have a two and a half fold increase in risk.[39] Other risks include Alzheimer's disease, multiple sclerosis, tuberous sclerosis, and autoimmune encephalitis.[39] Getting vaccinated does not increase the risk of epilepsy.[39] Malnutrition is a risk factor seen mostly in the developing world.[10] It is unclear however if it is a direct cause.[10]
Syndromes[edit]
See also: List of epilepsy syndromes
There are a number of epilepsy syndromes which are typically grouped by age of onset into: neonatal period, childhood, adulthood, and those with no strong age relationship.[20] Additionally there are groups with specific constellations of symptoms, those due to specific metabolic or structural causes, and those of unknown cause.[20] The ability to classify a case of epilepsy into a specific syndrome occurs more often with children.[36] Some types include: benign rolandic epilepsy (2.8 per 100,000), childhood absence epilepsy (0.8 per 100,000) and juvenile myoclonic epilepsy (0.7 per 100,000).[36] Febrile seizures and benign neonatal seizures are not forms of epilepsy.[20]
Mechanism[edit]
Normally brain electrical activity is non synchronous.[16] In epileptic seizures, due to structural or functional problems within the brain,[3] a group of neurons begin firing in an abnormal, excessive,[15] and synchronized manner.[16] This results in a wave of depolarization known as a paroxysmal depolarizing shift.[42]
Normally after an excitatory neuron fires it becomes more resistant to firing for a period of time.[16] This is due in part from the effect of inhibitory neurons, electrical changes within the excitatory neuron, and the negative effects of adenosine.[16] In epilepsy the resistance of excitatory neurons to fire during this period is decreased.[16] This may occur due to changes in ion channels or inhibitory neurons not functioning properly.[16] This then results in a specific area from which seizures may develop, known as a "seizure focus".[16] Another mechanism of epilepsy may be the up-regulation of excitatory circuits or down-regulation of inhibitory circuits following an injury to the brain.[16][43] These secondary epilepsies occur through processes known as epileptogenesis.[16][43] Failure of the blood–brain barrier may also be a causal mechanism as it would allow substances in the blood to enter the brain.[44]
Focal seizures begin in one hemisphere of the brain while generalized seizures begin in both hemispheres.[20] Some types of seizures may change brain structure, while others appear to have little effect.[45] Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.[45]
Diagnosis[edit]
An EEG can aid in locating the focus of the epileptic seizure.
The diagnosis of epilepsy is typically made based on the description of the seizure and surrounding events.[15] An electroencephalogram and neuroimaging are also usually part of the workup.[15] While figuring out a specific epileptic syndrome is often attempted, it is not always possible.[15] Video and EEG monitoring may be useful in difficult cases.[46]
Definition[edit]
In practice epilepsy is defined as two or more epileptic seizures, separated by more than 24 hours, without a clear cause; where an epileptic seizure is defined as temporary signs and symptoms resulting from abnormal electrical activity within the brain.[6] It can also be viewed as a disorder in which people have had at least one epileptic seizure with an ongoing risk of having more.[6]
The International League Against Epilepsy and the International Bureau for Epilepsy—collaborating partners of the World Health Organization[47]—define epilepsy in their 2005 joint statement as "a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure."[48][49]
Classification[edit]
Those with seizures should be classified by seizure type, underlying cause, epilepsy syndrome, and events during and around the time of the seizures.[46] Seizure types are organized by whether the source of the seizure is localized (focal seizures) or distributed (generalized seizures) within the brain.[20] Generalized seizures are divided according to the effect on the body and include: tonic-clonic (grand mal), absence (petit mal), myoclonic, clonic, tonic, and atonic seizures.[20][50] Some seizures such as epileptic spasms are of an unknown type.[20]
Focal seizures (previously known as partial seizures[15]) used to be divided into simple partial or complex partial seizure.[20] This is no longer recommended, and instead it is preferred to describe what has occurred during a seizure.[20]
Lab tests[edit]
For adults, the testing of electrolyte, blood glucose and calcium levels is important to rule out problems with these as causes.[46] An electrocardiogram can rule out problems with the rhythm of the heart.[46] A lumbar puncture may be useful to diagnose a central nervous system infection but is not routinely needed.[11] In children additional tests may be required such as urine biochemistry and blood testing looking for metabolic disorders.[46][51]
A high blood prolactin level within the first 20 minutes following a seizure may be useful to confirm an epileptic seizure as opposed to psychogenic non-epileptic seizure.[52][53] Serum prolactin level is less useful for detecting partial seizures.[54] If it is normal an epileptic seizure is still possible[53] and a serum prolactin does not separate epileptic seizures from syncope.[55] It is not recommended as a routine part of diagnosis epilepsy.[46]
EEG[edit]
An electroencephalogram (EEG) can assist in showing brain activity suggestive of an increased risk of seizures. It is only recommended for those who are likely to have had an epileptic seizure on the basis of symptoms. In the diagnosis of epilepsy, electroencephalography may help distinguish the type of seizure or syndrome present. In children it is typically only needed after a second seizure. It cannot be used to rule out the diagnosis, and may be falsely positive in those without the disease. It certain situations it may be useful to perform the EEG while the affected individual sleeping or sleep deprived.[46]
Imaging[edit]
Diagnostic imaging by CT scan and MRI is recommended after a first non-febrile seizure to detect structural problems in and around the brain.[46] MRI is generally a better imaging test except when bleeding is suspected.[11] Imaging may be done at a later point in time in those who return to normal while in the emergency room.[11] If a person has a previous diagnosis of epilepsy with previous imaging, repeat imaging is usually not needed with subsequent seizures.[46]
Differential diagnosis[edit]
Diagnosis can be difficult and misdiagnosis is frequent (occurring in about 5 to 30% of cases).[15] A number of other conditions may present very similar signs and symptoms to epilepsy, including: syncopy, hyperventilation, migraines, narcolepsy, panic attacks and psychogenic non-epileptic seizures (PNES).[56][57] Approximately one in five people seen at epilepsy clinics have PNES[11] and of those who have PNES about 10% also have epilepsy.[58] Separating the two based on the seizure episode alone without further testing is often difficult.[58]
Children may have behaviors that are easily mistaken for epileptic seizures but are not. These include: breath-holding spells, bed wetting, night terrors, tics and shudder attacks.[57] Gastroesophageal reflux may cause arching of the back and twisting of the head to the side in infants.[57]
Prevention[edit]
While many cases are not preventable, efforts to reduce head injuries, provide good care around the time of birth, and reduce environmental parasites such as the port tapeworm may be effective.[3] Efforts in one part of Central America to decrease rates of port tapeworm resulted in a 50% decrease in new cases of epilepsy.[10]
Management[edit]
Epilepsy is usually treated with daily medication once a second seizure has occurred,[15][46] but for those at high risk, medication may be started after the first seizure.[46] In some cases, a special diet, the implantation of a neurostimulator, or neurosurgery can be helpful.
First aid[edit]
Rolling a person with an active tonic-clonic seizure onto their side and into the recovery position helps prevent fluids from getting into the lungs.[59] Putting fingers, a bite block or tongue depressor in the mouth is not recommended as it might make the person vomit or result in the rescuer being bitten.[18][59] Efforts should be taken to prevent further self-injury.[18] Spinal precautions are generally not needed.[59]
If a seizure lasts longer than 5 minutes or if there are more than two seizures in an hour without a return to normal between them it is a medical emergency known as status epilepticus.[46][60] This may require medical help to keep the airway open and protected.[46] A nasopharyngeal airway may be useful for this.[59] At home the recommended initial medication for seizure of a long duration is midazolam placed in the cheek.[61] Diazepam may also be used rectally.[61] In hospital intravenous lorazepam is preferred.[46] If two doses of benzodiazepines are not effective other medications such as phenytoin or pentobarbital are recommended.[46]
Medications[edit]
Anticonvulsants
The mainstay treatment of epilepsy is anticonvulsant medications, possibly for the person's entire life.[15] The choice of anticonvulsant is based on seizure type, epilepsy syndrome, other medications used, other health problems, and the person's age and lifestyle.[61] A single medication is recommended initially[62] and if this is not effective a single other medication is then recommended.[46] Two medications at once is only recommended if a single medication does not work.[46] The first agent tried works in about half of people, while a second agent helps in about 13% and a third or two agents at the same time may help an additional 4%.[63] About 30% of people continue to have seizures despite anticonvulsant treatment.[5]
There are a number of medications available. Phenytoin, carbamazepine and valproate appear to be equally effect in both focal and generalized seizures.[64][65] Controlled release carbamazepine appears to work as well as immediate release carbamazepine, and may have fewer side effects.[66] In the United Kingdom, carbamazepine or lamotrigine is recommended as first-line treatment for focal seizure with levetiracetam and valproate being second-line due to issues of cost and side effects.[46] Valproate is recommended first-line for generalized seizures with lamotrigine being second-line.[46] In those with absence seizures ethosuximide or valproate is recommended, while in myoclonic seizures and tonic or atonic seizures valproate is recommended.[46] The least expensive anticonvulsant is phenobarbital at around $5 USD a year.[10] The World Health Organization gives it a first-line recommendation in the developing world and it is commonly used their.[67][68] Access however may be difficult as some countries label it as a controlled drug.[10]
Adverse effects from medications are reported in 10 to 90% of people, depending on how and from whom the data is collected.[69] Most adverse effects are dose-related and mild.[69] Some examples include mood changes, sleepiness, or an unsteadiness in gait.[69] Some medications have side effects that are not related to dose such as rashes, liver toxicity, or suppression of the bone marrow.[69] Up to a quarter of people stop treatment due to adverse effects.[69] Some medications may cause birth defects when used in pregnancy.[46] Valproate is of particular concern especially during the first trimester.[70] The risk of untreated epilepsy however is believed to be greater than the risk of the medications.[70]
Slowly stopping medications may be reasonable in some people who do not have a seizure for two to four years; however around a third of people have a recurrence, most often during the first six months.[46][71] Stopping is possible in about 70% of children and 60% of adults.[3] Routine anti-seizure medicine levels in the blood are not required in adults or children who are well controlled.[46]
Surgery[edit]
Epilepsy surgery may be an option for people with focal seizures that remain a problem despite other treatments.[72] These other treatments include at least a trial of two or three medications.[73] The goal of surgery is total control of seizures[74] and this may be achieved in 60-70% of cases.[73] Common procedures include: cutting out the hippocampus via an anterior temporal lobe resection, removal of tumors, and removing parts of the neocortex.[73] Some procedures such as a corpus callosotomy are attempted in an effort to decrease the number of seizures rather than cure the condition.[73] Following surgery medications may be slowly stopped in many.[73]
Neurostimulation may be another option in those who are not candidates for surgery.[46] Three types have been shown to be effective in those who do not respond to medications: vagus nerve stimulation, anterior thalamic stimulation, and closed-loop responsive stimulation.[75]
Other[edit]
A ketogenic diet (high-fat, low-carbohydrate, adequate-protein) appears to decrease the number of seizures by half in about 30-40% of children.[76] About 10% manage to stay on the diet for a few years, 30% had constipation, and other adverse effects were common.[76] Less radical diets were easier to tolerate and may be effective.[76] It is unclear why this diet works.[77] Exercise has been proposed as possibly useful for preventing seizures[78] with some data to support this claim.[79]
Avoidance therapy consists of minimizing or eliminating triggers. For example, in those who are sensitive to light, using a small television, avoiding video-games or wearing dark glasses may be useful.[80] Some claim that seizure response dogs, a form of service dog, can predict seizures. Evidence for this, however, is poor.[81] Operant-based biofeedback based on the EEG waves has some support in those who do not respond to medications.[82] Psychological methods should not, however, be used to replace medications.[46]
Alternative medicine[edit]
Alternative medicine, including acupuncture,[83] psychological interventions,[84] vitamins,[85] and yoga,[86] have no reliable evidence to support their use in epilepsy. The use of cannabis is not supported by the evidence.[87] Melatonin is insufficiently supported by evidence.[88]
Prognosis[edit]
Disability-adjusted life year for epilepsy per 100,000 inhabitants in 2004.
|
no data
<50
50-72.5
72.5-95
95-117.5
117.5-140
140-162.5
|
162.5-185
185-207.5
207.5-230
230-252.5
252.5-275
>275
|
Epilepsy cannot be cured, but medication alone can control seizures effectively in about 70% of cases.[5] Of those with generalized seizure more than 80% can be well controlled with medications while this is true in only 50% of people with focal seizures.[75] One predictor of long-term outcome is the number of seizures that occur in the first six months.[15] Other factors increasing the risk of a poor outcome include: little response to the initial treatment, generalized seizures, a family history of epilepsy, psychiatric problems, and waves on the EEG representing generalized epileptiform activity.[89] In the developing world 75% of people are either untreated or not appropriately treated.[3] In Africa 90% do not get treatment.[3] This is partly related to appropriate medications not being available or being too expensive.[3]
Mortality[edit]
People with epilepsy are at an increased risk of death.[90] This increase is between 1.6 and 4.1 fold greater than that of the general population[91] and is often related to: the underlying cause of the seizures, status epilepticus, suicide, trauma, and sudden unexpected death in epilepsy (SUDEP).[90] Death from status epilepticus is primarily due to an underlying problem rather than missing doses of medications.[90] The risk of suicide is increased between two and six times in those with epilepsy.[92][93] The cause of this is unclear.[92] SUDEP appears to be partly related to the frequency of generalized tonic-clonic seizures[94] and accounts for about 15% of epilepsy related deaths.[89] It is unclear how to decrease its risk.[94] The greatest increase in mortality from epilepsy is among the elderly.[91] Those with epilepsy due to an unknown cause have little increased risk.[91] In the United Kingdom it is estimated that 40-60% of deaths are possibly preventable.[15] In the developing world many deaths are due to untreated epilepsy leading to falls or status epilepticus.[10]
Epidemiology[edit]
Epilepsy is one of the most common serious neurological disorders[95] affecting about 65 million people globally.[6] It affects 1% of the population by age 20 and 3% of the population by age 75.[8] It is more common in males than females with the overall difference being small.[10][36] Most of those with the disease (80%) are in the developing world.[3]
The number of people who currently have active epilepsy is in the range 5–10 per 1,000, with active epilepsy defined as someone with epilepsy who has had a least one seizure in the last five years.[36][96] Epilepsy begins each year in 40–70 per 100,000 in developed countries and 80–140 per 100,000 in developing countries.[3] Poverty is a risk and includes both being from a poor country and being poor relative to others within one's country.[10] In the developed world epilepsy most commonly starts either in the young or in the old.[10] In the developing world its onset is more common in older children and young adults due to the higher rates of trauma and infectious diseases.[10] In developed countries the number of cases a year has decreased in children and increased among the elderly between the 1970s and 2003.[96] This has been attributed partly to better survival following strokes in the elderly.[36]
History[edit]
The oldest medical records show that epilepsy has been affecting people since the beginning of recorded history.[97] Throughout ancient history, the disorder was thought to be a spiritual condition.[97] The world's oldest description of an epileptic seizure comes from a text in Akkadian (a language used in ancient Mesopotamia) and was written around 2000 BCE.[1] The person described in the text was diagnosed as being under the influence of a Moon god, and underwent an exorcism.[1] Epileptic seizures are listed in the Code of Hammurabi (c. 1790 BCE) as reason for which a purchased slave may be returned for a refund,[1] and the Edwin Smith Papyrus (c. 1700 BCE) describes cases of individuals with epileptic convulsions.[1]
The oldest known detailed record of the disorder itself is in the Sakikkū, a Babylonian cuneiform medical text from 1067–1046 BCE.[97] This text gives signs and symptoms, details treatment and likely outcomes,[1] and describes many features of the different seizure types.[97] As the Babylonians had no biomedical understanding of the nature of disease, they attributed the seizures to possession by evil spirits and called for treating the condition through spiritual means.[97] Around 900 BCE, Punarvasu Ātreya described epilepsy as loss of consciousness;[98] this definition was carried forward into the Ayurvedic text of Charaka Samhita (about 400 BCE).[99]
Hippocrates, 17th century engraving by Peter Paul Rubens of an antique bust.
The ancient Greeks had contradictory views of the disease. They thought of epilepsy as a form of spiritual possession, but also associated the condition with genius and the divine. One of the names they gave to it was the sacred disease. Epilepsy appears within Greek mythology: it is associated with the Moon goddesses Selene and Artemis, who afflicted those who upset them. The Greeks thought that important figures such as Julius Caesar and Hercules had the disease.[1] The notable exception to this divine and spiritual view was that of the school of Hippocrates. In the fifth century BCE, Hippocrates rejected the idea that the disease was caused by spirits. In his landmark work On the Sacred Disease, he proposed that epilepsy was not divine in origin and instead was a medically treatable problem originating in the brain.[1][97] He accused those of attributing a sacred cause to the disease of spreading ignorance through a belief in superstitious magic.[1] Hippocrates proposed that heredity was important as a cause, described worse outcomes if the disease presents at an early age, and made note of the physical characteristics as well as the social shame associated with it.[1] Instead of referring to it as the sacred disease, he used the term great disease, giving rise to the modern term grand mal, used for generalized seizures.[1] Despite his work detailing the physical origins of the disease, his view was not accepted at the time.[97] Evil spirits continued to be blamed until at least the 17th century.[97]
In most cultures, persons with epilepsy have been stigmatized, shunned, or even imprisoned; in the Salpêtrière, the birthplace of modern neurology, Jean-Martin Charcot found people with epilepsy side-by-side with the mentally ill, those with chronic syphilis, and the criminally insane.[100] In ancient Rome, epilepsy was known as the Morbus Comitialis ('disease of the assembly hall') and was seen as a curse from the gods. In northern Italy, epilepsy was once traditionally known as Saint Valentine's malady.[101]
In the mid 1800s the first effective anti seizure medication, bromide, was introduced.[69] The first modern treatment, phenobarbital, was developed in 1912, with phenytoin coming into use in 1938.[102]
Society and culture[edit]
See also: List of people with epilepsy
Stigma[edit]
Stigma is commonly experienced, around the world, by those with epilepsy.[103] It can affect people economically, socially and culturally.[103] In India and China epilepsy may be used as justification to deny marriage.[3] People in some areas still believe those with epilepsy to be cursed.[10] In Tanzania, as in other parts of Africa, epilepsy is associated with possession by evil spirits, witchcraft, or poisoning and is believed by many to be contagious.[100] It of course is not.[10] Before 1970 the United Kingdom had laws which prevented people with epilepsy from marrying.[3] The stigma may result in some people with epilepsy denying that they have ever had seizures.[36]
Economics[edit]
Seizures result in direct economic costs of about one billion dollars in the United States.[11] Epilepsy resulted in economic costs in Europe of around 15.5 billion Euros in 2004.[15] In India epilepsy is estimated to result in costs of 1.7 billion USD or 0.5% of the GDP.[3] It is the cause of about 1% of emergency department visits (2% for emergency departments for children) in the United States.[104]
Vehicles[edit]
See also: Epilepsy and driving
Those with epilepsy are at about twice the risk of being involved in a motor vehicular collision and thus in many areas of the world are not allowed to drive or only able to drive if certain conditions are met.[13] In some places physicians are require by law to report if a person has had a seizure to the licensing body while in others the requirement is only that they encourage the person in question to report it themselves.[13] Countries that require physician reporting include: Sweden, Austria, Denmark and Spain.[13] Countries that require the individual to report include: the UK, and New Zealand and the physician may report if they believe the individual has not already.[13] In Canada, the United States and Australia the requirements around reporting vary by province or state.[13] If seizures are well controlled most feel allowing driving is reasonable.[105] The amount of time a person must be free from seizures before they can drive varies by country.[105] Many countries require one to three years without seizures.[105] In the United States the time needed without a seizure is determined by each state and is between three months and one year.[105]
Those with epilepsy or seizures are typically denied a pilot license.[106] In Canada if an individual has had no more than one seizure, they may be considered after five years for a limited license if all other testing is normal.[107] Those with febrile seizures and drug related seizures may also be considered.[107] In the United States, the Federal Aviation Administration does not allow those with epilepsy to get a commercial pilot license.[108] Rarely, exceptions can be made for persons who have had an isolated seizure or febrile seizures and have remained free of seizures into adulthood without medication.[109] In the United Kingdom, a full national private pilot license requires the same standards as a professional drivers license.[110] This requires a period of ten years without seizures while off medications.[111] Those who do not meet this requirement may acquire a restricted license if free from seizures for five years.[110]
Support organizations[edit]
There are a number of non-profit organizations that provide support to people and families affected by epilepsy. In the UK this includes the Joint Epilepsy Council of the UK and Ireland.[46] Purple day was established in 2008 to increase awareness around epilepsy and occurs on March 28.[112] Other efforts to increase knowledge include the "Out of the Shadows" campaign, a joint effort by the World Health Organization, the International League Against Epilepsy and the International Bureau for Epilepsy.[3]
Research[edit]
Seizure prediction refers to attempts to forecasting epileptic seizures based on the EEG before they occur.[113] As of 2011, no effective mechanism to predict seizures has been developed.[113] Kindling, where repeated exposures to events that could cause seizures eventually causes seizures more easily, has been used to create animal models of epilepsy.[114]
Gene therapy is being studied in some types of epilepsy.[115] Medications which alter immune function such as intravenous immunoglobulins are poorly supported by evidence.[116] Noninvasive stereotactic radiosurgery is, as of 2012, being compared to standard surgery for certain types of epilepsy.[117]
Other animals[edit]
Main article: Epilepsy in animals
Epilepsy occurs in a number of other animals including dogs and cats and is the most common brain disorder in dogs.[118] It is typically treated with anticonvulsants such as phenobarbital or bromide in dogs and phenobarbital in cats.[119] While generalized seizures in horses are fairly easy to diagnosis, no generalized seizures may be more difficult and an EEGs may be useful.[120]
References[edit]
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|date=(help) - ^ Somjen, George G. (2004). Ions in the Brain Normal Function, Seizures, and Stroke.. New York: Oxford University Press. p. 167. ISBN 978-0-19-803459-9.
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- ^ a b Jilek-Aall, L (1999). "Morbus sacer in Africa: some religious aspects of epilepsy in traditional cultures". Epilepsia 40 (3): 382–6. doi:10.1111/j.1528-1157.1999.tb00723.x. PMID 10080524.
- ^ Illes, Judika (2011-10-11). Encyclopedia of Mystics, Saints & Sages. HarperCollins. p. 1238. ISBN 978-0-06-209854-2. Retrieved 26 February 2013. "Saint Valentine is invoked for healing as well as love. He protects against fainting and is requested to heal epilepsy and other seizure disorders. In northern Italy, epilepsy was once traditionally known as Saint Valentine's Malady."
- ^ E. Martin Caravati (2004). Medical toxicology (3. ed. ed.). Philadelphia [u.a.]: Lippincott Williams & Wilkins. p. 789. ISBN 978-0-7817-2845-4.
- ^ a b de Boer, HM (Dec 2010). "Epilepsy stigma: moving from a global problem to global solutions.". Seizure : the journal of the British Epilepsy Association 19 (10): 630–6. doi:10.1016/j.seizure.2010.10.017. PMID 21075013.
- ^ Martindale, JL; Goldstein, JN; Pallin, DJ (February 2011). "Emergency department seizure epidemiology.". Emergency medicine clinics of North America 29 (1): 15–27. doi:10.1016/j.emc.2010.08.002. PMID 21109099. Cite uses deprecated parameters (help)
- ^ a b c d Jerome Engel, Jr., Timothy A. Pedley, ed. (2008). Epilepsy : a comprehensive textbook (2nd ed. ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 2279. ISBN 978-0-7817-5777-5.
- ^ Bor, Robert (2012). Aviation Mental Health: Psychological Implications for Air Transportation. Ashgate Publishing. p. 148. ISBN 978-1-4094-8491-2.
- ^ a b "Seizure Disorders". Transport Canada. Government of Canada. Retrieved 29 December 2013.
- ^ Wilner, Andrew N. (2008). Epilepsy 199 answers : a doctor responds to his patients' questions (3rd ed. ed.). New York: Demos Health. p. 52. ISBN 978-1-934559-96-3.
- ^ "Guide for Aviation Medical Examiners". Federal Aviation Administration. Retrieved 29 December 2013.
- ^ a b "National PPL (NPPL) Medical Requirements". Civil Aviation Authority. Retrieved 29 December 2013.
- ^ Drivers Medical Group (2013). "For Medical Practitioners: At a glance Guide to the current Medical Standards of Fitness to Drive". p. 8. Retrieved 29 December 2013.
- ^ Canada. Parliament. Senate (2010). Debates of the Senate: Official Report (Hansard)., Issues 1-23. Queen's Printer. p. 165.
- ^ a b Carney, PR.; Myers, S.; Geyer, JD. (Dec 2011). "Seizure prediction: methods.". Epilepsy Behav. 22 Suppl 1: S94–101. doi:10.1016/j.yebeh.2011.09.001. PMID 22078526.
- ^ Jerome Engel, ed. (2008). Epilepsy : a comprehensive textbook (2nd ed. ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 426. ISBN 9780781757775.
- ^ Walker, MC.; Schorge, S.; Kullmann, DM.; Wykes, RC.; Heeroma, JH.; Mantoan, L. (Sep 2013). "Gene therapy in status epilepticus.". Epilepsia. 54 Suppl 6: 43–5. doi:10.1111/epi.12275. PMID 24001071.
- ^ Walker, L; Pirmohamed, M; Marson, AG (27 June 2013). "Immunomodulatory interventions for focal epilepsy syndromes.". The Cochrane database of systematic reviews 6: CD009945. doi:10.1002/14651858.CD009945.pub2. PMID 23803963. Cite uses deprecated parameters (help)
- ^ Quigg, M; Rolston, J; Barbaro, NM (Jan 2012). "Radiosurgery for epilepsy: clinical experience and potential antiepileptic mechanisms.". Epilepsia 53 (1): 7–15. doi:10.1111/j.1528-1167.2011.03339.x. PMID 22191545. Cite uses deprecated parameters (help)
- ^ Thomas, WB (January 2010). "Idiopathic epilepsy in dogs and cats". Veterinary Clinics of North America, Small Animal Practice 40 (1): 161–79. doi:10.1016/j.cvsm.2009.09.004. PMID 19942062.
- ^ Thomas, WB (2010 Jan). "Idiopathic epilepsy in dogs and cats.". The Veterinary clinics of North America. Small animal practice 40 (1): 161–79. doi:10.1016/j.cvsm.2009.09.004. PMID 19942062. Check date values in:
|date=(help) - ^ van der Ree, M; Wijnberg, I (2012). "A review on epilepsy in the horse and the potential of Ambulatory EEG as a diagnostic tool.". The Veterinary quarterly 32 (3-4): 159–67. doi:10.1080/01652176.2012.744496. PMID 23163553. Cite uses deprecated parameters (help)
Further reading[edit]
- National Institute for Health and Clinical Excellence (January 2012). The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Clinical Guideline Centre.
- World health organization, Department of mental health and substance abuse, Programme for neurological diseases and neuroscience ; Global campaign against epilepsy ; International league against epilepsy (2005). Atlas, epilepsy care in the world, 2005 (pdf). Geneva: Programme for Neurological Diseases and Neuroscience, Department of Mental Health and Substance Abuse, World Health Organization. ISBN 92-4-156303-6.
External links[edit]
| Wikimedia Commons has media related to Epilepsy. |
- Epilepsy on the Open Directory Project
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UpToDate Contents
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- 1. 非痙攣性てんかん重積状態 nonconvulsive status epilepticus
- 2. 局在関連（焦点性）てんかん：原因および臨床的特徴 localization related focal epilepsy causes and clinical features
- 3. 成人における痙攣性のてんかん重積状態：分類、臨床症状、および診断 convulsive status epilepticus in adults classification clinical features and diagnosis
- 4. 成人における痙攣性のてんかん重積状態：治療および予後 convulsive status epilepticus in adults treatment and prognosis
- 5. 小児におけるてんかん重積状態の臨床的特徴および合併症 clinical features and complications of status epilepticus in children
English Journal
- SCN1A rs3812718 polymorphism and susceptibility to epilepsy with febrile seizures: A meta-analysis.
- Tang L, Lu X, Tao Y, Zheng J, Zhao P, Li K, Li L.SourceDepartment of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
- Gene.Gene.2014 Jan 1;533(1):26-31. doi: 10.1016/j.gene.2013.09.071. Epub 2013 Sep 27.
- BACKGROUND: Evidence showed that the SCN1A IVS5N+5G>A polymorphism might be associated with susceptibility to epilepsy with febrile seizures (EFS), however, the published data were inconclusive. Therefore, a meta-analysis was performed to estimate the overall EFS risk with the polymorphism.METHOD
- PMID 24076350
- Carbonic Anhydrases and Brain pH in the Control of Neuronal Excitability.
- Ruusuvuori E, Kaila K.SourceDepartment of Biosciences, University of Helsinki, Helsinki, Finland, Eva.Ruusuvuori@Helsinki.fi.
- Sub-cellular biochemistry.Subcell Biochem.2014;75:271-90. doi: 10.1007/978-94-007-7359-2_14.
- H(+) ions are remarkably efficient modulators of neuronal excitability. This renders brain functions highly sensitive to small changes in pH which are generated "extrinsically" via mechanisms that regulate the acid-base status of the whole organism; and "intrinsically", by activity-induced transmemb
- PMID 24146384
- Interstitial 2q24.3 deletion including SCN2A and SCN3A genes in a patient with autistic features, psychomotor delay, microcephaly and no history of seizures.
- Celle ME, Cuoco C, Porta S, Gimelli G, Tassano E.SourceU.O. e Cattedra di Neuropsichiatria Infantile, Istituto G. Gaslini, Genova, Italy.
- Gene.Gene.2013 Dec 15;532(2):294-6. doi: 10.1016/j.gene.2013.09.073. Epub 2013 Sep 28.
- Mutations in neuronal voltage-gated sodium channel genes SCN1A, SCN2A, and SCN3A may play an important role in the etiology of neurological diseases and psychiatric disorders, besides various types of epilepsy. Here we describe a 3-year-old boy with autistic features, language delay, microcephaly an
- PMID 24080482
Japanese Journal
- Nationwide survey (incidence, clinical course, prognosis) of Rasmussen's encephalitis
- MUTO Ayako,OGUNI Hirokazu,TAKAHASHI Yukitoshi,SHIRASAKA Yukiyoshi,SAWAISHI Yukio,YANO Tamami,HOSHIDA Toru,OSAKA Hitoshi,NAKASU Satoru,AKASAKA Noriyuki,SUGAI Kenji,MIYAMOTO Akie,TAKAHASHI Satoru,SUZUKI Motomasa,OHMORI Iori,NABATAME Shin,OSAWA Makiko
- Brain & development 32(6), 445-453, 2010-06-01
- NAID 10027491620
- 接続性部分てんかん患者の脳磁図によるjerk-lockd back average
- 橋詰 智保,佐藤 綾子,渡司 博幸 [他]
- 臨床検査 53(5), 643-647, 2009-05
- NAID 40016687637
Related Links
- Temporary changes at Epilepsia: Owing to an unexpected illness Gary Mathern will need to step back from Epilepsia for a while. To ensure continued smooth handling of all Epilepsia Matters the Executive ...
- 2014 - Volume 55 Epilepsia 2013 - Volume 54 Epilepsia 2012 - Volume 53 Epilepsia 2011 - Volume 52 Epilepsia 2010 - Volume 51 Epilepsia 2009 - Volume 50 Epilepsia 2008 - Volume 49 Epilepsia 2007 - Volume 48 Epilepsia 2006 ...
Related Pictures
★リンクテーブル★
| リンク元 | 「てんかん」「epileptic」 |
| 拡張検索 | 「epilepsia partialis continua」 |
「てんかん」
091009 III
- 大脳灰白質神経細胞の過剰で無秩序な電気的発射による
- 種々の病因によってもたらされる慢性の脳疾患
WHOの定義
- さまざまな原因で起こる慢性の脳疾患で、大脳神経細胞の過剰な放電からくる繰り返す発作（てんかん発作）を主な徴候とし、多種多様な臨床及び検査所見を伴う
分類
-
- 1. 運動徴候を有するもの
- 2. 知覚症状を有するもの
- 3. 自律神経症状ないし徴候を有するもの
- 4. 精神症状を有するもの
- 1. 単純部分発作に意識の障害が続く
- a. 単純部分発作で発症し、意識障害が次に続く
- b. 自動症を伴う
- 2. 意識障害で発症
- a. 意識障害のみを伴う
- b. 自動症を伴う
- C. 部分発作で続発性全般発作に進展するもの partial seizure with secondary generalization
- 1. 単純部分発作で全身発作に進展
- 2. 複雑郡分発作で全身発作に進展
- 3. 単純部分発作で複雑部分発作、全身発作へと進展
- 全般発作 primarily generalized seizure
- A. 欠神発作(小発作) absence seizure(petit mal)
- B. ミオクローヌス発作 myoclonic seizure
- C. 間代発作 clonic seizure
- D. 強直発作 tonic seizure
- E. 強直-間代発作 tonic-clonic seizure (grand mal)
- F. 脱力発作 atonic seizure
- 未分類てんかん発作 unclassified seizure
てんかん、てんかん症候群および発作性関連疾患の分類(1989) (PED.1424)
- 1. 局在関連性てんかんおよび症候群
- 2. 全般性てんかん及び症候群
- 2-1. 特発性
- 2-2. 潜因性あるいは症候性
- West症候群(infantile spasms, 電撃・点頭・礼拝痙攣)
- Lennox-Gastaut症候群
- ミオクロニー失立発作てんかん
- ミオクロニー欠神てんかん
- 2-3.
- 3. 焦点性か全般性かを決定できないてんかん及び症候群
- 3-1. 全般発作と症候発作を併有するてんかん
- 新生児発作
- 乳児重症ミオクロニーてんかん
単純化
- 特発性：原因不明
- 特発性全般性てんかん
- 特発性局所関連性てんかん：大脳の特定の位置に焦点がある
- 症候性：先行疾患あり
- 症候性全般性てんかん
- 症候性局所関連性てんかん：大脳の特定の位置に焦点がある
疫学
- 200人に1人 (0.5%)
- 人口1000対3-10(0.3-1.0%) (PSY.376)
- 小児期～思春期、老年期(60歳以降)に好発
病因
- 遺伝的素因、周産期異常、炎症、腫瘍、外傷など
- 乳児(0-2歳)、幼児(2-10歳)
- 出産障害(酸素不足)、先天性異常、熱性血栓症
- 成人
- 外傷、腫瘍
- GABA作動性ニューロンなどの抑制性のニューロンは損傷を受けやすい→ニューロンの過剰興奮につながる
症状
- 発作前症状
- 発作症状
- 発作後症状：
- post ictal state：もうろうとした状態。
- postictal psychosis：発作後精神病はてんかんの発作後に幻覚妄想状態が出現するものであり、数時間から数日の経過で消退する。
- 発作間欠期症状
- 慢性経過のてんかんで幻覚妄想状態が出現しうる、らしい。
診断
- てんかん発作→バイタルサインの確認→医療面接→身体所見・神経学的所見
医療面接
病歴の問診
- てんかん治療ガイドライン2010
- 発作の頻度
- 発作の状況と誘因（光過敏性など)
- 発作の前および発作中の症状（身体的，精神的症候および意識障害)
- 症状の持続
- 発作に引き続く症状
- 外傷，咬舌，尿失禁の有無
- 発作後の頭痛と筋肉痛
- 複数回の発作のある患者では初発年齢
- 発作および発作型の変化・推移
- 最終発作
- 発作と覚醒・睡眠との関係
身体所見・神経学的所見
- 1. 外傷、咬舌の有無
- 2. 尿失禁の有無
- 3. 意識レベル：発作時の意識の有無、post ictal state(発作後のもうろう状態)
- 4. 眼位：眼球偏倚(皮質注視中枢が興奮することにより、病側と反対側を見つめる)
- 5. 局所神経症状の有無
治療
「epileptic」
- adj.
- (医)てんかんの/てんかん性の。癲癇にかかったような、痙攣的な
- n.
- 癲癇患者