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epilepsy [2023/11/07 12:40] – [Epilepsy Syndromes] andrewtaustinepilepsy [2023/11/10 14:50] (current) – kevin
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-====== Epilepsy: An Overview of Types ======+{{tag>Related}} ====== Epilepsy: An Overview of Types ====== 
 + 
 +Epilepsy is a neurological disorder[(Neurological disorder[[https://www.who.int/news-room/questions-and-answers/item/mental-health-neurological-disorders]])]  **characterised by the propensity for recurrent, unprovoked seizures**, which are transient occurrences of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. The disorder encompasses a spectrum of conditions with varying aetiologies, clinical presentations, and seizure types.  
 + 
 +In the absence of expert medical advice and appropriate oversight, individuals with a documented history of epilepsy must be precluded from receiving any form of Integral Eye Movement Therapy (IEMT). This contraindication arises from the necessity to mitigate potential risks and ensure the safety and well-being of the client, as such therapies may provoke seizures in susceptible individuals.  
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-Epilepsy is a neurological disorder **characterised by the propensity for recurrent, unprovoked seizures**, which are transient occurrences of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. The disorder encompasses a spectrum of conditions with varying aetiologies, clinical presentations, and seizure types.  
  
 ==== Classification Based on Seizure Type ==== ==== Classification Based on Seizure Type ====
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 The primary classification of epilepsy is determined by the **type of seizure**, which is categorised into two main groups: The primary classification of epilepsy is determined by the **type of seizure**, which is categorised into two main groups:
  
-  * **Focal Seizures**: Originating within networks limited to one hemisphere. These are subdivided based on the level of consciousness:+  * **Focal Seizures[(Focal Seizures[[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/seizure-types]])]**: Originating within networks limited to one hemisphere. These are subdivided based on the level of consciousness:
     * **With Retained Awareness**: Formerly known as simple partial seizures.     * **With Retained Awareness**: Formerly known as simple partial seizures.
     * **With Impaired Consciousness**: Previously referred to as complex partial seizures.     * **With Impaired Consciousness**: Previously referred to as complex partial seizures.
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   * **Generalised Seizures**: Engaging networks distributed across both hemispheres simultaneously. Types include:   * **Generalised Seizures**: Engaging networks distributed across both hemispheres simultaneously. Types include:
-    * **Absence Seizures**: Manifest as brief lapses in awareness. +    * **Absence Seizures**[(Absence Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/absence-seizures]])]: Manifest as brief lapses in awareness. 
-    * **Myoclonic Seizures**: Characterised by sudden, brief muscle jerks. +    * **Myoclonic Seizures**[(Myoclonic Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/myoclonic-seizures]])]: Characterised by sudden, brief muscle jerks. 
-    * **Tonic-Clonic Seizures**: Known for convulsive movements. +    * **Tonic-Clonic Seizures**[(Tonic-Clonic Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/tonic-clonic-seizures]])]: Known for convulsive movements. 
-    * **Atonic Seizures**: Leading to sudden loss of muscle tone.+    * **Atonic Seizures**[(Atonic Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/atonic-seizures]])]: Leading to sudden loss of muscle tone. 
 + 
 +===== Focal Seizures ===== 
 +Focal seizures, formerly known as partial seizures, originate within networks confined to one hemisphere of the brain. The clinical manifestations of these seizures are remarkably diverse, reflecting the region of the cortex in which the seizure originates. 
 + 
 +==== With Retained Awareness ==== 
 +These seizures, previously termed simple partial seizures, occur without a loss of consciousness. Individuals experiencing these seizures retain full awareness but may report autonomic phenomena such as heart palpitations, skin flushing, or epigastric rising sensations. Motor signs can include jerking or tonic posturing of a limb, while sensory symptoms might involve unusual sensations, such as numbness or the feeling of 'pins and needles'. Visual, auditory, olfactory, or gustatory hallucinations are also possible if the corresponding sensory cortex is involved. 
 + 
 +==== With Impaired Consciousness ==== 
 +Seizures with impaired consciousness, once called complex partial seizures, typically involve alterations in consciousness. The individual may exhibit unresponsiveness or a diminished awareness of the environment. Automatisms, such as lip-smacking, fumbling movements, or even walking, are often observed but executed without the individual's conscious control or recollection. These seizures frequently originate from the temporal lobe but can emanate from any cortical region. Postictal confusion is common, and the return to baseline may take minutes to hours. 
 + 
 +==== Evolution to Bilateral Tonic-Clonic Seizures ==== 
 +Some focal seizures can generalise, leading to bilateral tonic-clonic seizures. The initial focal onset may manifest as a warning or 'aura' before consciousness is lost and generalised convulsive movements begin. The tonic phase is characterised by a sudden loss of consciousness with muscle stiffening, while the clonic phase involves rhythmic jerking movements. Sudden cessation of respiration during the tonic phase may lead to cyanosis[(Cyanosis [[https://www.nhs.uk/conditions/blue-skin-or-lips-cyanosis/]])], and injuries can occur from falls or during convulsions. 
 + 
 +===== Generalised Seizures ===== 
 +Generalised seizures involve both cerebral hemispheres from the onset and are not preceded by focal activity. They represent a diverse group of seizure types, each with unique clinical features. 
 + 
 +==== Absence Seizures ==== 
 +Typically presenting in childhood and often misinterpreted as inattentiveness, absence seizures are brief, lasting only a few seconds. The hallmark of these seizures is a disruption of consciousness associated with a cessation of ongoing activities. A blank stare, subtle body movements, and automatism, such as blinking or slight twitching of the lips, are characteristic. The electroencephalogram (EEG) during these seizures shows a pattern of 3 Hz spike-and-wave discharges that are bilateral and symmetrical. 
 + 
 +==== Myoclonic Seizures ==== 
 +Myoclonic seizures are characterised by abrupt, brief muscle jerks, which may be singular or occur in a series. The jerks are typically symmetrical and can result in the dropping of objects or even falls. These seizures are often seen in conjunction with various epilepsy syndromes and can be an early warning sign of a more severe seizure type developing. 
 + 
 +==== Tonic-Clonic Seizures ==== 
 +The most dramatic and readily identified seizure type, tonic-clonic seizures involve an initial tonic phase with muscle rigidity, followed by a clonic phase with rhythmic muscle contractions. These seizures are often preceded by a loud cry due to the forcible expiration of air from the lungs, followed by a loss of consciousness. The postictal phase may involve deep sleep, headache, confusion, and disorientation. 
 + 
 +==== Atonic Seizures ==== 
 +Atonic seizures result in an abrupt loss of muscle tone, which often leads to falls and potential injury, hence the term 'drop attacks.' These seizures are particularly challenging to manage because of the suddenness and the risk of trauma. Protective headgear may be recommended for individuals with frequent atonic seizures to mitigate the risk of head injury.
  
 ==== Aetiological Classification ==== ==== Aetiological Classification ====
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 ==== Epilepsy Syndromes ==== ==== Epilepsy Syndromes ====
  
-In addition to seizure type and aetiology, **epilepsy syndromes** are recognised by a cluster of features that occur together, which can include:+In addition to seizure type and aetiology, **epilepsy syndromes[(Epilepsy Syndromes [[https://epilepsysociety.org.uk/about-epilepsy/information-parents/childhood-epilepsy-syndromes]])]** are recognised by a cluster of features that occur together, which can include:
   * **Specific Seizure Types**   * **Specific Seizure Types**
   * **EEG Findings**   * **EEG Findings**
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 This concept is instrumental in directing specific management strategies. This concept is instrumental in directing specific management strategies.
  
-===== Focal Seizures ===== +====== Management Strategies for Epilepsy ======
-Focal seizures arise from electrical disturbances in one hemisphere of the brain. They are categorised based on the individual's level of consciousness during the event.+
  
-==== With Retained Awareness ==== +The management of epilepsy is tailored to the individual, taking into account the type and frequency of seizures, epilepsy syndrome, and the patient's lifestyle and overall health. The overarching goal is to achieve seizure control with minimal side effects to enable a normal life as far as possible.
-These seizures do not impede the individual's awareness. Patients may experience twitching, changes in sensation such as tingling, dizziness, or flashing lights. These seizures are focal in nature and can be associated with motor, sensory, autonomic, or psychological symptoms that reflect the function of the affected area of the brain.+
  
-==== With Impaired Consciousness ==== +==== Pharmacotherapy ==== 
-In these seizures, the individual's consciousness is affected. The person may appear to be staring blankly and not respond to external stimuli. They may also perform repetitive movements, such as hand rubbing, chewing, swallowing, or walking in circles. These seizures may also be accompanied by automatisms - involuntary, coordinated movements that are purposeless.+Anti-seizure medications (ASMs) are the mainstay of epilepsy treatment. The choice of ASM is guided by several factors:
  
-==== Evolution to Bilateral Tonic-Clonic Seizures ==== +  * **Seizure Type** 
-Focal seizures can evolve, leading to bilateral tonic-clonic seizures. This progression is characterised by a sequence where muscle rigidity (the tonic phase) is followed by rhythmic muscle contractions (the clonic phase). These seizures can be dangerous and may require emergency medical attention if they persist for an extended period.+  * **Epilepsy Syndrome** 
 +  * **Patient Age and Sex** 
 +  * **Comorbid Conditions** 
 +  * **Potential Side Effects** 
 +  * **Patient's Personal Circumstances**
  
-===== Generalised Seizures ===== +Monotherapy is often the initial strategy, with combination therapy considered if monotherapy fails.
-Generalised seizures involve both hemispheres of the brain from the onset. They are broadly categorised into several types, each with distinct manifestations.+
  
-==== Absence Seizures ==== +==== Drug-Resistant Epilepsy ==== 
-These are brief, lasting seconds, and often manifest as subtle lapses in awareness. Common in children, absence seizures may be mistaken for daydreaming. They are characterised by subtle body movements and can occur hundreds of times per day if not treated.+In cases of drug-resistant epilepsy, alternative treatment strategies are considered:
  
-==== Myoclonic Seizures ==== +  * **Surgical Options**: Resection, disconnection procedures, or hemispherectomy. 
-Myoclonic seizures cause sudden, brief jerks of a muscle or a group of muscles. They may occur in a pattern or randomly. The jerks are typically bilateral, meaning they occur in the same parts of the body on both sides simultaneously.+  * **Pre-surgical Evaluation**: To assess the potential benefits and risks.
  
-==== Tonic-Clonic Seizures ==== +==== Neurostimulation Techniques ==== 
-Formerly known as 'grand mal' seizures, tonic-clonic seizures are what most people typically recognise as a seizure. They cause a loss of consciousness and violent muscle contractions. The tonic phase leads to muscle stiffness, while the clonic phase results in rhythmic jerking of the muscles.+For those unsuitable for surgery, neurostimulation presents an alternative:
  
-==== Atonic Seizures ==== +  * **Vagus Nerve Stimulation[(Vagus Nerve Stimulation [[https://epilepsysociety.org.uk/about-epilepsy/treatment/vagus-nerve-stimulation]])] (VNS)** 
-Also known as 'drop attacks,' atonic seizures lead to a loss of muscle control, which may cause the individual to suddenly collapse or drop down, posing a significant risk of injury.+  * **Deep Brain Stimulation (DBS)** 
 +  * **Responsive Neurostimulation (RNS)** 
 + 
 +These techniques use electrical impulses to reduce seizure frequency and severity. 
 + 
 +==== Dietary Therapies ==== 
 +Specific dietary modifications have proven effective, especially in children: 
 + 
 +  * **Ketogenic Diet**: A high-fat, low-carbohydrate diet. 
 +  * **Modified Atkins Diet** 
 +  * **Low Glycaemic Index Treatment** 
 + 
 +==== Psychosocial Interventions ==== 
 +Addressing the psychological and social aspects is crucial: 
 + 
 +  * **Improvement of Mental Health** 
 +  * **Social Integration** 
 +  * **Enhancement of Quality of Life** 
 + 
 +==== Regular Follow-up ==== 
 +Monitoring and adjusting treatment over time is necessary due to: 
 + 
 +  * **Treatment Efficacy** 
 +  * **Side Effects** 
 +  * **Changes in Patient's Condition** 
 + 
 +Management must be individualised and often requires a multi-disciplinary approach. Regular review and adaptation to the patient's changing needs are essential for optimal outcomes. 
 + 
 +The continuous evolution of precision medicine and ongoing research promise more targeted and effective treatments for epilepsy. 
 + 
 +====== Online Resources for Epilepsy ====== 
 + 
 +This list provides current online resources for individuals with epilepsy and healthcare professionals managing epilepsy, across both the USA and UK. 
 + 
 +==== For Patients and Therapists in the UK ==== 
 + 
 +  * **Epilepsy Society** 
 +    * Offers support, confidential helpline, information on living with epilepsy, safety, and free resources like ‘I have epilepsy’ cards. 
 +    * [[https://www.epilepsysociety.org.uk|Epilepsy Society Website]] 
 + 
 +==== For Patients in the USA ==== 
 + 
 +  * **Epilepsy Foundation** 
 +    * A comprehensive resource including a seizure tracking app, educational materials, medication lists, toolkits, and a 24/7 helpline. 
 +    * [[https://www.epilepsy.com|Epilepsy Foundation Website]] 
 + 
 +==== For Therapists in the USA ==== 
 + 
 +  * **American Epilepsy Society (AES)** 
 +    * A professional community focused on epilepsy research and treatment. 
 +    * [[https://www.aesnet.org|AES Website]] 
 + 
 +  * **Epilepsy Self-Management Programs & Resources** 
 +    * Encourages self-care and consistent routines to minimize seizure risk, part of AES resources. 
 +    * [[https://www.aesnet.org|AES Self-Management]] 
 + 
 +  * **Career Center** 
 +    * Offers job listings and resources for career advancement in epilepsy care. 
 +    * [[https://www.aesnet.org|AES Career Center]] 
 + 
 +  * **Epilepsy Currents Journal** 
 +    * Bi-monthly open access journal with research and treatment reviews. 
 +    * [[https://www.aesnet.org|Epilepsy Currents Journal]] 
 + 
 +  * **AES eModules** 
 +    * Self-paced online courses for enhancing knowledge on epilepsy. 
 +    * [[https://www.aesnet.org|AES eModules]] 
 + 
 +  * **Clinical Guidance** 
 +    * Provides current evidence-based clinical guidance for epilepsy care. 
 +    * [[https://www.aesnet.org|AES Clinical Guidance]]
  
  
 +----
  
  
  
  • Last modified: 2023/11/07 12:40
  • by andrewtaustin