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This article may be too technical for a general audience. Please help improve this article by providing more context and better explanations of technical details. See Wikipedia:Make technical articles accessible for more information on how to do this, even for articles which are inherently technical.

Epilepsy was a good article nominee, but did not meet the good article criteria at the time. There are suggestions below for improving the article. Once these are addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake. Reviewed version: October 14, 2006

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Previous discussions have been archived here: Archive 1; Archive 2.

Contents 1 Rage epilepsy? 2 Can surgery be curative? 3 Unsourced sections 3.1 Overview 3.2 Electrophysiology 4 Communicating about epilepsy 5 'Lesser Seizure' Section 6 Provocant? 7 Phenobarbital omitted from treatments list 8 SUDEP 9 Image 10 More up-to-date surgery statistics? 11 Plan to update/organize 'Seizure syndromes' section 12 Replace 'Controversy' with 'Morbidity and Mortality' section??

Rage epilepsy?

Someone has created a new article at Rage Epilepsy. It looks suspect to me (like someone is using Wikipedia to publish a new theory), but I don't know much about this area. If some of the regular editors for this article would please take a look at it, I'd appreciate it. Thanks, WhatamIdoing (talk) 00:17, 20 January 2008 (UTC)

Can surgery be curative?

Anybody know when, or if, being seizure free as a direct result of surgery constitutes, medically speaking, being 'cured'? This article says medicines can 'control' but not 'cure' it- what, therefore, does successful surgery do? 86.42.84.131 (talk) 07:10, 24 January 2008 (UTC)

See Facts about epilepsy surgery. Drugs don't remove the underlying seizure-causing problem (just suppress it, to varying degrees of success). Surgery can eliminate the cause (but not always, and not all forms of surgery attempt this). Colin°^Talk 08:54, 24 January 2008 (UTC)

Also, do not confuse medicine with surgery. Medical intervention usually refers to therapeutic intervention, not surgical intervention. This may help explain why the two statements you mention don't actually contradict eachother. Surgery can 'cure' epilepsy but it is reserved for severe cases, but medicines (or medical inerventions/drugs) cannot. I hope this helps. 79.184.57.240 (talk) 15:45, 14 August 2008 (UTC)

Unsourced sections

Overview

Epilepsy is the most common neurological condition in children and the third most common in adults after Alzheimer’s and stroke. Despite modern therapy, about one million people continue to experience seizures or significant side effects from treatment. This poses a major problem for the management of epilepsy in these patients. An Epilepsy Foundation report published in 2000 revealed that epilepsy costs the US more than $16.6 billion a year in health care and unemployment.

Epilepsy is a generic term used to define a family of seizure disorders. A person with recurring seizures is said to have epilepsy.

A seizure is a brief disturbance of electrical activity in the brain.

Prevalence: More than 3 million people in the U.S. have some form of epilepsy. Thirty percent of them are children under the age of 18. A large number of children and adults have undetected or untreated epilepsy.

Incidence: About 200,000 new cases of seizure disorders and epilepsy are diagnosed each year.

Age of onset: Epilepsy primarily affects the very young and the very old, although anyone can get epilepsy at anytime. Twenty percent of cases develop before the age of five. Fifty percent develop before the age of 25. It is increasingly associated with the elderly, and there are as many cases of epilepsy in those 60 years of age and older as in children 10 years of age and under.

Causes: In about 70 percent of cases there is no known cause. Of the remaining 30 percent, the following are the most frequent causes:

• Brain tumor and/or stroke.
• Head trauma, especially from automobile accidents, gunshot wounds, sports accidents, and falls and blows. The more severe the injury, the greater the risk of developing epilepsy.
• Poisoning, such as lead poisoning, and substance abuse. For example, more than 5,000 persons each year are reported to suffer seizures caused by alcoholism.
• Infection, such as meningitis, viral encephalitis, lupus erythematosus and, less frequently, mumps, measles, diphtheria and others.
• Maternal injury, infection or systemic illness that affects the developing brain of the fetus during pregnancy.

Role of heredity: All people inherit varying degrees of susceptibility to seizures. The genetic factor is assumed to be greater when no specific cause can be identified.

A Worldwide Problem: The World Health Organization estimates there are 40 to 50 million people with epilepsy throughout the world. The annual incidence in third-world nations is twice that of the United States (2/100 compared to 1/100). In many countries the condition remains a stigmatizing condition surrounded with mystical beliefs and social taboos. On a global basis, an astonishing three fourths of people with epilepsy receive no treatment for their seizures.

Electrophysiology

Most epileptics seize without warning. Their seizures can have dangerous or fatal consequences especially if they come at a bad time and lead to an accident. In the brain, identifiable electrical changes precede the clinical onset of a seizure by tens of seconds, and these changes can be recorded in an electroencephalogram (EEG). Many people have wondered^{weasel words} if EEGs might be used to predict seizures minutes or even hours ahead of time, but as of now, this sort of prediction has not been feasible.^[1] Many researchers are working^{weasel words} , however, to create a system capable of detecting seizures before they clinically manifest themselves.

The early detection of a seizure has many potential benefits. Advanced warning would allow patients to take action to minimize their risk of injury and, in some circumstances, would allow them to summon help. An automatic detection system could also be made to trigger pharmacological intervention in the form of fast-acting drugs or electrical stimulation.

It is relatively easy to place the electrodes needed to record an EEG, but it has not been so easy to develop an algorithm to detect the onset of a seizure. For any given patient, assuming his or her seizures originate in one focus, seizure-onset EEG patterns are largely conserved from one seizure episode to the next. Unfortunately, there is great EEG variation between patients, both in terms of baseline and in terms of seizure-onset patterns. This variation has made the development of a generic, "one-size-fits-all" algorithm difficult.

Patient-specific algorithms based on machine learning have shown more promise^{citation needed}. Machine learning algorithms compute binary decision trees from manually labeled training sets of data. EEG data must be translated into a format that the computer can interpret. Important information must be kept while superfluous information must be discarded. Although there are many conceivable ways of performing this “feature extraction,” wavelet decomposition seems to be an effective way of extracting pertinent information from EEG signals^{citation needed}.

The training set for the machine-learning algorithm must be labeled by hand. For an algorithm being developed by Dr. Steven Schachter of Beth Israel Deaconess Medical Center and Prof. John Guttag and Ali Shoeb of MIT, EEG recordings are split into two-second time windows, and each window is labeled as “seizure onset” or “not seizure onset.”

The algorithm then takes the labeled training set and uses it to construct a decision tree capable of classifying unlabeled EEG patterns as “seizure onset” or “not seizure onset.” The training set is unavoidably unbalanced because most time windows do not involve seizures. Certain algorithms, such as the support vector machine algorithm chosen by Schachter and Guttag, are better suited than others to handle this unbalanced training set^{citation needed}.

In the hospital, the patient-specific algorithm of Schachter and Guttag has worked fairly well. In one trial, it detected 131 out of 139 seizures in 36 patients^{citation needed}. In another, it caught 53 out of 58 seizures^{citation needed}. The algorithm outperformed generic algorithms^{citation needed}.

Communicating about epilepsy

Modern treatment enables many people with epilepsy (seizure disorders) to lead normal lives. But age-old fears and prejudices continue to cause social problems that too often severely limit their participation and personal fulfillment^{citation needed}.

So many misconceptions surround epilepsy that communicators may inadvertently add to the negative image of the disorder merely by choice of language^{citation needed}. The following is an effort to call attention to usage of terms that in some manner communicate a negative image of epilepsy.

Disease

Many people with epilepsy prefer the term disorder, since the condition is not a disease in the usual sense of the term—it is a disorder characterized by a recurring disturbance in the electrical activity of the brain. To the general public, the term disease has connotations of being unsightly, progressive and contagious^{citation needed}. Epilepsy and seizure disorder(s) are equally acceptable terms that may be used interchangeably.

Epileptic

Like all individuals with disabilities, people with epilepsy dislike labels, such as in “He’s an epileptic.” This dislike can be summed up by the statement, “epilepsy is what I have, not what I am.” The preferred terminology is person with epilepsy or child with epilepsy, rather than epileptic, which can be cumbersome for headlines, something that is, in fact, rarely an issue (see Stereotyping below). Use of epileptic as an adjective, as in “epileptic seizures” is appropriate.

Fit

Although the term fit is commonly used by the medical profession in the English-speaking world outside of the U.S.^{citation needed}, most individuals^{citation needed} with epilepsy in the U.S. are particularly sensitive to the description of seizures as fits. The feeling is^{weasel words} that this word connotes mental derangement or loss of emotional control^{citation needed}. Some associate^{weasel words} the word with the symptoms of rabies in animals. Seizures or, in some cases, convulsions, is preferred. (Convulsion is a more specific term that more aptly describes a single type of seizure involving muscle contractions throughout the entire body. Not all epileptic seizures are convulsions. Some seizures may amount to only a momentary stare.)

Control

Seizures are controlled with medication, persons with epilepsy are not. “Controlled epileptic” is particularly to be avoided as it often gives the impression that the person needs to be restrained from willful, aggressive behavior^{citation needed}. The adjective violent as a description of a seizure is also unfortunate because the term implies a threat to others and a force out of control^{citation needed}.

Stereotyping

In the past, stereotyping has created unfounded associations between epilepsy and crime or violence, and between epilepsy and mental incompetence. “Epileptic Charged in Murder” makes as much sense as “Insomniac Charged in Murder,” yet this type of headline is not uncommon^{citation needed}.

Persistent Myth

Perhaps the most persistent myth is that a person having a seizure can swallow his tongue. It is not physically possible to swallow your tongue. The tongue, if relaxed, could possibly block the airway. The way to avoid this is to turn the person on her side so the tongue falls away to the side of the mouth.

Lesser Seizures

All seizures are serious. Absence seizures (formerly known as petit mal) may seem less severe than generalized tonic-clonic seizures (formerly known as grand mal), but they’re not^{citation needed}. Although tonic-clonic seizures (or convulsions) are more dramatic and expose the person experiencing them to serious injury, a child who has 50–75 absence seizures an hour may suffer more severe consequences from them—such as a severe functional disability—than a person who has two or three tonic-clonic seizures a year^{citation needed}. The parents of the child who has almost debilitating absence seizures will likely—and rightfully—take exception^{citation needed} to their child’s condition being referred to a lesser form of epilepsy.

The above text contains speculation, personal opinion and is completely unsourced. Colin°^Talk 12:42, 17 April 2008 (UTC) Colin°^Talk 12:42, 17 April 2008 (UTC)

'Lesser Seizure' Section

I think the wording should be more objective. It reads as if whoever wrote it was emotionally involved. Sad, but it is out of place here. —Preceding unsigned comment added by 24.108.93.159 (talk) 03:27, 4 April 2008 (UTC)

Provocant?

Forgive me, but can someone please explain to me what a "provocant" is? I came across it in the "triggers" section. I looked it up, but could not find it anywhere. One would assume that it is something that provokes, except that the sentence begins with "The diagnosis of epilepsy requires that the seizures be unprovoked." Can someone clarify please?-Fogelmatrix 21:49, 11 April 2008 (UTC)

Phenobarbital omitted from treatments list

I note in the reading that about halfway down the page, listed are the drugs used to treat epilepsy, and then another listing of drugs used to abort seizures or end status epilepticus. The FDA Web site notes that Dilantin or phenobarbital are the primary medications used to control epilepsy, but phenobarbital is not listed in those used to control epilepsy here.

(On a side note, I have epilepsy, diagnosed by the US Navy in 1995, and after going through all the fancy new drugs that cost a bunch with bad reaction one after another, the Navy prescribed phenobarbital, which the Veterans Administration has never changed. This has done the trick for me.)

According to the World Health Organization, phenobarbital is the primary anti-convulsant in most contries. It is listed on the WHO Essential Medicines List, 17th edition, and may be found at http://www.who.int/medicines/publications/EssMedList15.pdf

Of note: phenobarbital has never been approved for use by the FDA. The laws requiring testing for safety and efficacy were enacted long after phenobarbital first appeared. Those laws allowed a grandfather clause that permitted medications to be sold only for their intended purposes if they had already had a long established record of safety, and later, efficacy, in the marketplace. According to the FDA Web site, the FDA estimates 2% of medications legally sold today in the USA are not approved. A program is now in place at the FDA to require approval of all medications, though (in my own opinion) this puts medications like aspirin and phenobarbital, which cannot be patented, at risk of disappearing from the market.

I recomend that phenobarbital be added to the list of medicines used to -treat- epilepsy. I would do this myself but am unsure of editing Wiki pages properly.

- J. Kulacz 96.18.50.143 (talk) 01:18, 23 April 2008 (UTC)

SUDEP

Any reason why this entry doesn't mention suden unexpected death in epilepsy (SUDEP)? There's an article about it in the current Science. Some of the doctors quoted said that patients at risk of SUDEP should be told about it, because some of them don't realize how important it is to control their epilepsy. Nbauman (talk) 04:33, 15 July 2008 (UTC)

Image

Why is there an image of benign familial macrocephaly? It has almost nothing to do with epilepsy. Nbauman (talk) 17:57, 7 August 2008 (UTC)

I agree, we should really have a video of a seizure. --Steven Fruitsmaak (Reply) 21:07, 9 August 2008 (UTC)

Maybe not have a video of a seizure. This may be distressing to those newly diagnosed or anyone else looking for information on epilepsy. If you can provide a warning before showing the seizure it would be fine. But I would advise against it anyway. Maybe a brain with the temporal lobes highlighted or something benign like that. 79.184.57.240 (talk) 15:51, 14 August 2008 (UTC)

Note that Wikipedia isn't censored. Doesn't have to be a grand mal seizure though, might be abscence or partial. --Steven Fruitsmaak (Reply) 22:07, 14 August 2008 (UTC)

More up-to-date surgery statistics?

Hi. I had a right temporal lobectomy in 1996. It was the best decision I have ever made. Since that I have gone on to university, finished in the top 10 in my year, and been awarded a PhD. I'm still probably awful at calculus, quadratic equations and such like as I slept through most of those crucial school days and never got it back. Anyway, that's my background. I think this article would be considerably better if the section on surgery was updated with modern statistics and methods as I imagine there are enormous improvements in technology and success rates since the group who underwent surgery between 1965 and 1974- or indeed in my case since 1996. I think the potential for success in surgery is underplayed in this otherwise very, very good article. Also, it would be good if some informed person could put the relevant research concerning the power of the brain to heal and recover from years of seizures. My surgeon emphasised that strongly at the time, and that gave me huge hope and confidence. Things can be a lot brighter, and it would be absolutely awful if people suited for surgery avoided it out of fear of the unknown. There are, sadly, far too many people in that category and this article could really tackle some of those groundless fears with updated results. I do not mean to be flippant but the operation was a breeze; it was the fear in the months after that the surgery might not succeed that was isolating. What is post-operative treatment like now? I was given a review by the surgeon after 3 months, an MRI and a series of tests by a clinical psychologist to compare with the same tests that I underwent before the operation, and that was it. All the best. Fyodor Dostoevsky (talk) 00:27, 28 August 2008 (UTC)

Plan to update/organize 'Seizure syndromes' section

I wish to edit the 'Seizure Syndromes' section to conform to the ILAE-accepted classification scheme. I also plan to edit, within the individual epilepsy syndromes currently listed, the medications listed as "most common" or "first choice" to a list of commonly used medications within each syndrome where appropriate Karmattol (talk) 14:49, 4 September 2008 (UTC)

I'm encouraged to hear this. Bear in mind this article gets over 2000 hits per day so restructuring is best done in a sandbox if it could lead to instability (lots of red links, poor flow, etc). This important article is woefully under-sourced. I think this section is probably too long and doesn't really give any overview of seizure syndromes. It is very "listy" which isn't encouraged within an article (though a standalone list is an acceptable format). I wondered if there is scope for a Epilepsy syndromes list article, in a similar vein to Seizure types. This fits with summary style approach for dealing with large subjects. Some of the syndrome articles were edited a while ago by Dpryan (talk · contribs). IMO they are over-detailed on the genetics and pathophysiology and written at expert level rather than for the general reader (it is great to have experts editing, however).

In terms for treatment choices, here are some consensus reviews I've found:

• Wheless JW, Clarke DF, Arzimanoglou A, Carpenter D. Treatment of pediatric epilepsy: European expert opinion, 2007. Epileptic Disord. 2007 Dec;9(4):353-412. PMID 18077226.

• Wheless JW, Clarke DF, Carpenter D. Treatment of pediatric epilepsy: expert opinion, 2005. J Child Neurol. 2005 Dec;20 Suppl 1:S1-56; quiz S59-60. PMID 16615562.

• Arzimanoglou A, Wheless JW. Children with epilepsy: are they the same on both sides of the Atlantic, and do the same treatments work? Epileptic Disord. 2007 Dec;9(4):351-2. PMID 18077225.

This discusses the above two EU vs US expert opinions.

• Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006 Jul;47(7):1094-120. PMID 16886973.

Colin°^Talk 17:25, 4 September 2008 (UTC)

Question: I'm relatively new to this. By 'sandbox' I guess you mean a transitional, practice area that will allow some review before widespread posting. Right now my working copy is on my home page. Would posting this section when it is ready on this page serve as a 'sandbox'? Karmattol (talk) 20:46, 4 September 2008 (UTC)

Replace 'Controversy' with 'Morbidity and Mortality' section??

Question: I note that the "Controversy" section is devoted to speculation on the possibility of epilepsy contributing to behaviors of a particular historical figure; in this case the founder of a church. It doesn't seem "encyclopedic" to include this section since one could speculate about epilepsy in any number of individuals, and in any case, probably would be better to include these speculations, even if properly sourced, in the articles of these individuals or as a sublist in the "List of Famous People with Epilepsy". I propose eliminating this section and replacing it with a 'Morbidity and Mortality' section in which one can outline the variety of comorbidites, problems, and risks which accompany the diagnosis of epilepsy. Karmattol (talk) 11:34, 24 September 2008 (UTC)

That section keeps getting inserted ([1],[2],[3]) and I keep removing it. I've not been watching this article closely enough recently. It is gone. Colin°^Talk 11:42, 24 September 2008 (UTC)

Thanks Karmattol (talk) 21:46, 24 September 2008 (UTC)

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