Epilepsy

Epilepsy
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Name	Epilepsy
Field	Neurology
Symptoms	Seizures, confusion, loss of consciousness
Complications	Injury, status epilepticus, sudden unexpected death
Onset	Any age
Causes	Genetic, structural, metabolic, immune, infectious
Diagnosis	Electroencephalography, neuroimaging
Treatment	Antiseizure medications, surgery, neuromodulation

Epilepsy Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures that arise from abnormal electrical activity in the brain, with clinical presentations ranging from focal sensory phenomena to generalized convulsive events. Recognition, evaluation, and management involve multidisciplinary teams including neurologists, neurosurgeons, pediatricians and allied health professionals across hospitals, clinics, and rehabilitation centers.

Signs and symptoms

Seizure manifestations vary widely: focal impaired awareness seizures may produce automatisms, sensory changes, or transient aphasia, while generalized tonic-clonic seizures produce tonic stiffening followed by clonic jerking and postictal confusion and are recognized by emergency teams and first responders including International Committee of the Red Cross, World Health Organization, European Resuscitation Council. Complex partial events can be mistaken for psychiatric presentations evaluated by specialists at institutions such as Mayo Clinic, Johns Hopkins Hospital, Great Ormond Street Hospital and referred to epilepsy surgery programs at Cleveland Clinic, Massachusetts General Hospital, University College Hospital. Other signs include absence seizures with brief lapses of awareness, myoclonic jerks seen in juvenile myoclonic epilepsy populations studied at Karolinska Institutet, University of Toronto, Seoul National University Hospital and autonomic features that require consultation with services at St Bartholomew's Hospital, Sheba Medical Center, Royal Melbourne Hospital.

Causes and risk factors

Etiologies encompass genetic variants described by consortia such as Human Genome Project, structural lesions from traumatic brain injury tracked by Centers for Disease Control and Prevention, and infections including neurocysticercosis studied by teams at London School of Hygiene & Tropical Medicine, Oswaldo Cruz Foundation, All India Institute of Medical Sciences. Perinatal insults documented by research groups at University of Oxford, Yale School of Medicine, Karolinska Institutet increase lifetime risk, as do cerebrovascular disease cohorts recruited through Framingham Heart Study, European Stroke Organisation, American Heart Association. Metabolic and autoimmune causes are characterized in case series from Mayo Clinic Proceedings, New England Journal of Medicine authors affiliated with National Institutes of Health, Institut Pasteur, and demographic risk patterns are reported by population health units at World Health Organization, United Nations Children's Fund, European Centre for Disease Prevention and Control.

Pathophysiology and classification

Abnormal synchronous neuronal firing and altered excitatory–inhibitory balance driven by glutamatergic and GABAergic mechanisms have been elucidated in basic science laboratories at Max Planck Institute for Brain Research, Salk Institute, Riken Institute and inform classification systems developed by organizations such as International League Against Epilepsy, World Health Organization, American Academy of Neurology. Genetic epilepsies implicating ion channel genes were mapped with help from projects like 1000 Genomes Project, Deciphering Developmental Disorders Study, ClinGen and structural network dysfunction is investigated using neuroimaging networks pioneered at Massachusetts Institute of Technology, Stanford University, Beth Israel Deaconess Medical Center. Classification distinguishes focal, generalized, combined generalized and focal, and unknown onset syndromes according to criteria established by panels convened at Royal College of Physicians, European Academy of Neurology, Canadian Neurological Sciences Federation.

Diagnosis

Diagnosis relies on clinical history corroborated by witnesses, electroencephalography recorded in outpatient and inpatient settings such as at Epilepsy Foundation centers, ambulatory EEG services linked to National Health Service (England), video-EEG monitoring units at Cleveland Clinic, Toronto Western Hospital, Guy's and St Thomas' NHS Foundation Trust. Neuroimaging with MRI protocols from consortia like Human Connectome Project, European Magnetic Resonance Imaging Network, and PET or SPECT studies performed at radiology departments of Johns Hopkins Hospital, Mount Sinai Health System, Charité – Universitätsmedizin Berlin help identify lesions including mesial temporal sclerosis, cortical dysplasia, tumors cataloged by registries such as Surveillance, Epidemiology, and End Results Program and Global Burden of Disease collaborators. Genetic testing panels are offered by centers affiliated with Broad Institute, Wellcome Sanger Institute, University of California, San Francisco for suspected monogenic epilepsies, and differential diagnosis may involve consultations with specialists at American Epilepsy Society, International League Against Epilepsy meetings.

Treatment and management

Management includes antiseizure medications approved by regulatory agencies like Food and Drug Administration, European Medicines Agency, Medicines and Healthcare products Regulatory Agency with first-line drugs such as valproate, carbamazepine, levetiracetam and newer agents evaluated in trials at National Institute of Neurological Disorders and Stroke, European Clinical Trials Alliance, ClinicalTrials.gov. Surgical interventions including anterior temporal lobectomy, lesionectomy, and corpus callosotomy are offered at tertiary centers such as Barrow Neurological Institute, Mayo Clinic, University of California, Los Angeles for refractory cases, while neuromodulation therapies like vagus nerve stimulation, deep brain stimulation and responsive neurostimulation are provided through programs at Massachusetts General Hospital, Johns Hopkins Hospital, UCLA Health. Comprehensive care integrates rehabilitation services from Royal National Institute of Blind People or Stroke Association analogs, psychosocial support from organizations like Epilepsy Foundation, Young Epilepsy, Marie Curie Cancer Care and safety measures guided by national laws overseen by Department of Transportation (United States), Driver and Vehicle Licensing Agency.

Prognosis and epidemiology

Prognosis varies: many achieve seizure freedom with appropriate therapy as reported in longitudinal cohorts from Framingham Heart Study, British Medical Journal studies, while a subset experience drug-resistant epilepsy tracked by registries at European Epilepsy Database, US Epilepsy Centers and have increased risk of mortality including sudden unexpected death in epilepsy noted by investigations at National Institutes of Health, Centers for Disease Control and Prevention, World Health Organization. Global prevalence and incidence estimates come from analyses coordinated by Global Burden of Disease, World Health Organization, Institute for Health Metrics and Evaluation showing higher burdens in low- and middle-income countries studied by teams at London School of Hygiene & Tropical Medicine, University of Cape Town, Kilimanjaro Christian Medical Centre. Age-specific patterns highlight pediatric and elderly peaks documented by pediatric neurology units at Great Ormond Street Hospital, Children's Hospital of Philadelphia, and geriatric neurology services at Guy's and St Thomas' NHS Foundation Trust, Hospital of the University of Pennsylvania.

Category:Neurological disorders