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Epileptic seizureFrom Wikipedia, the free encyclopedia

"Seizure" redirects here. For other uses, see Seizure (disambiguation).

Epileptic seizure

Generalized 3 Hz spike and wave discharges in EEG

Classification and external resources

Specialty  Neurology

ICD-10 G40, P90, R!

ICD-9-CM 34"9, #$0"3

DiseasesDB %90%%

MedlinePlus 003&00

eMedicine neuro'4% neuro'!94

MeSH (0%&!40

 An epileptic seizure (colloquially a fit) is a brief episode of signs or symptoms due to abnormalexcessive or synchronous neuronal activity in the brain.!" #he out$ard effect can vary fromuncontrolled %erking movement (tonic&clonic sei'ure) to as subtle as a momentary loss of a$areness(absence sei'ure). #he disease of the brain characteri'ed by an enduring predisposition to generate

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epileptic sei'ures is called epilepsy,!"" but sei'ures can also occur in people $ho do not haveepilepsy. Additionally, there are a number of conditions that look like epileptic sei'ures but are not.

 A first sei'ure generally does not require treatment unless there is a specific problem oneither electroencephalogram or brain imaging."

*+!- of people $ho live to years old have at least one epileptic sei'ure " and the chance of

experiencing a second sei'ure is bet$een /- and *-./"

 About *- of patients $ith anunprovoked apparent 0first sei'ure1 have had other minor sei'ures, so their diagnosis is epilepsy.*" 2pilepsy affects about !- of the population currently 3" and affects about /- of the population atsome point in time. " 4ost of those affected5nearly -5live in developing countries.3"

Contents

  hide" 

• ! 6igns and symptoms

o !.! Focal sei'ures

o !. 7enerali'ed sei'ures

o !. 8uration

o !./ 9ostictal

• :auses

o .! 4etabolic

o . 4ass lesions

o . 4edications

o ./ ;nfections

o .* <ther 

• 4echanism

• / 8iagnosis

o /.! :lassification

o /. 9hysical examination

o /. #ests

o /./ 8ifferential diagnosis

• * 9revention

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• 3 4anagement

o 3.! 4edication

o 3. <ther 

• = 9rognosis

• 2pidemiology

• > ?istory

• ! 6ociety and culture

o !.! 2conomics

o !. 8riving

• !! @esearch

• ! @eferences

• ! 2xternal links

Signs and symptomsedit"

See also: Seizure types

#he signs and symptoms of sei'ures vary depending on the type. =" #he most common type ofsei'ures are convulsive (3-)." #$o&thirds of these begin as focal sei'ures andbecome generali'ed $hile one third begin as generali'ed sei'ures." #he remaining /- of sei'uresare non&convulsive, an example of $hich is absence sei'ure.>"

Focal seizuresedit"

Focal sei'ures are often preceded by certain experiences, kno$n as an aura.=" #hese may includesensory, visual, psychic, autonomic, olfactory or motor phenomena.!"

;n a complex partial sei'ure a person may appear confused or da'ed and can not respond toquestions or direction. Focal sei'ure may become generali'ed. !"

Berking activity may start in a specific muscle group and spread to surrounding muscle groups5kno$n as a Jacksonian march.!!" Cnusual activities that are not consciously created may occur.!!" #hese are kno$n as automatisms and include simple activities like smacking of the lips or more

complex activities such as attempts to pick something up.!!"

Generalized seizuresedit"

#here are six main types of generali'ed sei'ures tonic&clonic, tonic, clonic, myoclonic, absence, andatonic sei'ures.!" #hey all involve a loss of consciousness and typically happen $ithout $arning. !"

• #onic&clonic sei'ures present $ith a contraction of the limbsfollo$ed by their extension, along $ith arching of the back for !+ seconds.!" A cry may be heard due to contraction of the chest

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muscles.!" #he limbs then begin to shake in unison.!" After theshaking has stopped it may take !+ minutes for the person toreturn to normal.!"

• #onic sei'ures produce constant contractions of the muscles. !" #heperson may turn blue if breathing is impaired.!"

• :lonic sei'ures involve shaking of the limbs in unison.!"

• 4yoclonic sei'ures involve spasms of muscles in either a fe$ areasor generali'ed through the body.!"

•  Absence sei'ures can be subtle, $ith only a slight turn of the heador eye blinking.!" #he person often does not fall over and mayreturn to normal right after the sei'ure ends, though there may alsobe a period of post&ictal disorientation.!"

•

 Atonic sei'ures involve the loss of muscle activity for greater thanone second.!!" #his typically occurs bilaterally (on both sides of thebody).!!"

Durationedit"

 A sei'ure can last from a fe$ seconds to more than five minutes, at $hich point it is kno$n as statusepilepticus.!/" 4ost tonic&clonic sei'ures last less than t$o or three minutes.!/"  Absence sei'ures areusually around ! seconds in duration.>"

Postictaledit"

 After the active portion of a sei'ure, there is typically a period of confusion calledthe  postictal  period  before a normal level of consciousness returns.=" #his usually lasts to !*minutes!*" but may last for hours. !3" <ther common symptoms include feeling tired, headache, 

difficulty speaking, and abnormal behavior .!3" 9sychosis after a sei'ure is relatively common,occurring in bet$een 3 and !- of people.!=" <ften people do not remember $hat occurred duringthis time.!3"

Causesedit"

Main article: auses o! seizures

6ei'ures have a number of causes. <f those $ith sei'ure about *- have epilepsy.!" A number ofconditions are associated $ith sei'ures but are not epilepsy including mostfebrile sei'ures andthose that occur around an acute infection, stroke, or toxicity.!>" #hese sei'ures are kno$n as DacutesymptomaticD or DprovokedD sei'ures and are part of the sei'ure&related disorders. !>" ;n many thecause is unkno$n.

8ifferent causes of sei'ures are common in certain age groups.

• 8uring the neonatal period and early infancy the most commoncauses include hypoxic ischemic encephalopathy, central nervoussystem (:E6) infections, trauma, congenital :E6 abnormalities,and metabolic disorders.

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• #he most frequent cause of sei'ures in children is febrile sei'ures,$hich happen in +*- of children bet$een the ages of six monthsand five years."

• 8uring childhood, $ell&defined epilepsy syndromes are generallyseen.

• ;n adolescence and young adulthood, non&compliance $ith themedication regimen and sleep deprivation are potential triggers.

• 9regnancy and labor and childbirth, and the post&partum, or post&natal period (after birth) can be at&risk times, especially if there arecertain complications like eclampsia.

• 8uring adulthood, the likely causes are alcohol related, strokes,trauma, :E6 infections, and brain tumors.!"

•

;n older adults, cerebrovascular disease is a very common cause.<ther causes are :E6 tumors, head trauma, and otherdegenerative diseases that are common in the older age group,such as dementia."

Metabolicedit"

8ehydration can trigger epileptic sei'ures if it is severe enough. " A number of disordersincluding lo$ blood sugar , lo$ blood sodium, hyperosmolar nonketotic hyperglycemia,high bloodsodium, lo$ blood calcium and high blood urea levels may cause sei'ures.!" As may hepaticencephalopathy and the genetic disorder porphyria.!"

Mass lesionsedit"

• cavernoma or  cavernous malformation is a treatable medicalcondition that can cause sei'ures, headaches, and brainhemorrhages.

• arteriovenous malformation (A4) is a treatable medical conditionthat can cause sei'ures, headaches, and brain hemorrhages.

• space&occupying lesions in the brain (abscesses, tumours). ;npeople $ith brain tumours, the frequency of epilepsy depends onthe location of the tumor in the cortical region./"

Medicationsedit"

Goth medication and drug overdoses can result in sei'ures,!" as may certain medication and drug$ithdra$al.!" :ommon drugs involved include antidepressants,antipsychotics, cocaine, insulin, andthe local anaesthetic lidocaine.!" 8ifficulties $ith $ithdra$al sei'ures commonly occurs afterprolonged alcohol or sedative use.!"

Infectionsedit"

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• ;nfection $ith the pork tape$orm, $hich cancause neurocysticercosis, is the cause of up to half of epilepsycases in areas of the $orld $here the parasite is common. *"

• parasitic infections such as cerebral malaria

• infection, such as encephalitis or meningitis 3"

Other edit"

6ei'ures may occur as a result of high blood pressure, kno$n as hypertensive encephalopathy, or inpregnancy as eclampsia $hen accompanied by either sei'ures or a decreased level ofconsciousness.!" ery high body temperatures may also be a cause.!" #ypically this requires atemperature greater than / H: (!=.3 HF). !"

• ?ead in%ury may cause non&epileptic post&traumaticsei'ures or  post&traumatic epilepsy

•  About .* to *.*- of people $ith celiac disease also have sei'ures.="

• 6ei'ures in a person $ith a shunt may indicate failure

• ?emorrhagic stroke can occasionally present $ithsei'ures, embolic strokes generally do not (though epilepsy is acommon later complication)I cerebral venous sinus thrombosis, arare type of stroke, is more likely to be accompanied by sei'uresthan other types of stroke

• multiple sclerosis may cause sei'ures

2lectroconvulsive therapy (2:#) deliberately sets out to induce a sei'ure for the treatment of ma%ordepression.

Mechanismedit"

Eormally brain electrical activity is non synchronous. !" ;n epileptic sei'ures, due to problems $ithinthe brain," a group of neurons begin firing in an abnormal, excessive," and synchroni'ed manner.!" #his results in a $ave of depolari'ation kno$n as a paroxysmal depolari'ing shift.>"

Eormally after an excitatory neuron fires it becomes more resistant to firing for a period of time.!" #his is due in part from the effect of inhibitory neurons, electrical changes $ithin the excitatoryneuron, and the negative effects of  adenosine.!" ;n epilepsy the resistance of excitatory neurons tofire during this period is decreased.!" #his may occur due to changes in ion channels or inhibitory

neurons not functioning properly.!" #his then results in a specific area from $hich sei'ures maydevelop, kno$n as a Dsei'ure focusD. !" Another cause of epilepsy may be the up regulation ofexcitatory circuits or do$n regulation of inhibitory circuits follo$ an in%ury to the brain. !"" #hesesecondary epilepsies, occur through processes kno$n as epileptogenesis.!"" Failure of the blood+brain barrier  may also be a causal mechanism.!"

Focal sei'ures begin in one hemisphere of the brain $hile generali'ed sei'ures begin in bothhemispheres.!" 6ome types of sei'ures may change brain structure, $hile others appear to havelittle effect." 7liosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsybut it is unclear if epilepsy causes these changes or if these changes result in epilepsy."

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Diagnosisedit"

 An 227 can aid in locating the focus of the epileptic sei'ure.

;t is important to distinguish primary sei'ures from secondary causes. 8epending on the presumedcause blood tests andJor  lumbar puncture may be useful." ?ypoglycemia may cause sei'ures andshould be ruled out. An electroencephalogram and brain imaging $ith:# scan or  4@; scan isrecommended in the $ork&up of sei'ures not associated $ith a fever.""

Classificationedit"

6ei'ure types are organi'ed by $hether the source of the sei'ure is locali'ed (focal sei'ures) ordistributed (generali'ed sei'ures) $ithin the brain.!" 7enerali'ed sei'ures are divided according tothe effect on the body and include tonic&clonic (grand mal), absence (petit mal), myoclonic, clonic,tonic, and atonic sei'ures.!"/" 6ome sei'ures such as epileptic spasms are of an unkno$n type.!"

Focal sei'ures (previously called partial seizures") are divided into simple partial or  complex partialsei'ure.!" :urrent practice no longer recommends this, and instead prefers to describe $hat occursduring a sei'ure.!"

Physical examinationedit"

6omeone $ho has bitten the tip of their tongue $hile having a sei'ure

4ost people are in a postictal state (dro$sy or confused) follo$ing a sei'ure. #hey may sho$ signsof other in%uries. A bite mark on the side of the tongue helps confirm a sei'ure $hen present, but onlya third of people $ho have had a sei'ure have such a bite. *"

Testsedit"

 An electroencephalography is only recommended in those $ho likely had an epileptic sei'ure andmay help determine the type of sei'ure or syndrome present. ;n children it is typically only neededafter a second sei'ure. ;t cannot be used to rule out the diagnosis and may be falsely positive inthose $ithout the disease. ;t certain situations it may be useful to prefer the 227 $hile sleeping orsleep deprived.3"

8iagnostic imaging by :# scan and 4@; is recommended after a first non&febrile sei'ure to detectstructural problems inside the brain. 3"4@; is generally a better imaging test except $hen intracranialbleeding is suspected." ;maging may be done at a later point in time in those $ho return to their

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normal selves $hile in the emergency room." ;f a person has a previous diagnosis of epilepsy $ithprevious imaging repeat imaging is not usually needed $ith subsequent sei'ures. 3"

;n adults testing electrolytes, blood glucose and calcium levels is important to rules these out ascauses.3"  As is an electrocardiogram.3" A lumbar puncture may be useful to diagnose a centralnervous system infection but is not routinely needed." @outine antisei'ure medical levels in theblood are not required in adults or children.3" ;n children additional tests may be required.3"

 A high blood prolactin level $ithin the first minutes follo$ing a sei'ure may be useful to confirm anepileptic sei'ure as opposed to psychogenic non&epileptic sei'ure.=""6erum prolactin level is lessuseful for detecting partial sei'ures.>" ;f it is normal an epileptic sei'ure is still possible" and aserum prolactin does not separate epileptic sei'ures from syncope./" ;t is not recommended as aroutine part of diagnosis epilepsy.3"

Differential diagnosisedit"

8ifferentiating an epileptic sei'ure from other conditions such as syncope can be difficult.=" <therpossible conditions that can mimic a sei'ure include decerebrate posturing,psychogenicsei'ures, tetanus, dystonia, migraine headaches, and strychnine poisoning.=" ;n addition, *- ofpeople $ith a positive tilt table test may have sei'ure&like activity that seems to be due to cerebralhypoxia./!" :onvulsions may occur due to psychological reasons and this is kno$n as a psychogenicnon&epileptic sei'ure. Eon&epileptic sei'uresmay also occur due to a number of other reasons.

Preventionedit"

 A number of measures have been attempted to prevent sei'ures in those at risk. Follo$ing traumaticbrain in%ury anticonvulsants decrease the risk of early sei'ures but not late sei'ures./"

;n those $ith a history of febrile sei'ures medications (both antipyretics and anticonvulsants) havenot been found effective for prevention. 6ome, in fact, may cause harm. /" ;n those $ithout a historyof sei'ures and a subdural hematoma the evidence is unclear regarding a benefit versus harm fromusing anticonvulsants.//" #his is also true follo$ing acraniotomy /*"needs update" as $ell as after stroke,/3"needs

update" intracranial venous thrombosis,/="needs update" and subarachnoid haemorrhage both in those $ho haveand have not had sei'ures./"

Managementedit"

9otentially sharp or dangerous ob%ects should be moved from the area around a personexperiencing a sei'ure, so that the individual is not hurt. After the sei'ure if the person is not fullyconscious and alert, they should be placed in the recovery position. A sei'ure longer than fiveminutes is a medical emergency kno$n as status epilepticus.!/" :ontrary to a commonmisconception, bystanders should not attempt to force ob%ects into the mouth of the person sufferinga sei'ure, as doing so may cause in%ury to the teeth and gums./>"

Medicationedit"

#he first line treatment of choice for someone $ho is actively sei'ing is a ben'odia'epine, most

guidelines recommend lora'epam. #his may be repeated if there is no effect after ! minutes. ;fthere is no effect after t$o doses, barbiturates or propofol may be used."

<ngoing medication is not typically needed after a first sei'ure and is generally only recommendedafter a second one has occurred or in those $ith structural lesions in the brain. " After a secondsei'ure anti&epileptic medications are recommended. Approximately =- of people can obtain fullcontrol $ith continuous use of medication. 3" #ypically one type of anticonvulsant is preferred.

;n sei'ures related to toxins, up to t$o doses of ben'odia'epines should be used. ;f this is noteffective pyridoxine is recommended. 9henytoin should generally not be used.*"

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Other edit"

?elmets may be used to provide protection to the head during a sei'ure. 6ome claim that sei'ureresponse dogs, a form of service dog, can predict sei'ures. 2vidence for this, ho$ever, is poor.*!"

Prognosisedit"

Follo$ing a first sei'ure, the risk of more sei'ures in the next t$o years is /-+*-." #he greatestpredictors of more sei'ures are problems either on the electroencephalogram or on imaging of thebrain." ;n adults, after 3 months of being sei'ure&free after a first sei'ure, the risk of a subsequentsei'ure in the next year is less than - regardless of treatment. *" Cp to =- of sei'ures thatpresent to the emergency department (2@) are in status epilepticus. " ;n those $ith a statusepilepticus, mortality is bet$een !- and /-. =" #hose $ho have a sei'ure that is provoked(occurring close in time to an acute brain event or toxic exposure) have a lo$ risk of re&occurrence,but have a higher risk of death compared to those $ith epilepsy.*"

Epidemiology edit"

*+!- of people $ho live to years old have at least one epileptic sei'ure "*" and the chance of

experiencing a second sei'ure is bet$een /- and *-./" About .=- in the general population ofthe Cnited 6tates go to an emergency department after a sei'ure in a given year,=" =- of them $ithstatus epilepticus.*/" Kno$n epilepsy though is an uncommon cause of sei'ures in the emergencydepartment, accounting for a minority of sei'ure&related visits. */" About *- of patients $ith anunprovoked apparent 0first sei'ure1 have had other minor sei'ures, so their diagnosis is epilepsy.*"

History edit"

#he $ord epilepsy derives from the 7reek $ord for Dattack.D**" 6ei'ures $ere long vie$ed as another$orldly condition being referred to by ?ippocrates in /G.:. as Dthe sacred diseaseD. ="

;n the mid !s the first anti sei'ure medication, bromide, $as introduced.*3"

Follo$ing standardi'ation proposals devised by ?enri 7astaut and published in !>=,*=" terms suchas Dpetit malD, Dgrand malD, DBacksonianD, DpsychomotorD, and Dtemporal&lobe sei'ureD have falleninto disuse.

Society and cultureedit"

conomicsedit"

6ei'ures result in direct economic costs of about one billion dollars in the Cnited 6tates." 2pilepsyresults in economic costs in 2urope of around !*.* billion 2uros in /." ;n ;ndia epilepsy isestimated to result in costs of !.= billion C68 or .*- of the 789." #hey make up about !- ofemergency department visits (- for emergency departments for children) in the Cnited 6tates.!"

Dri!ingedit"

4any areas of the $orld require a minimum of six months from the last sei'ure before people candrive a vehicle."

Researchedit"

6cientific $ork into the prediction of epileptic sei'ures began in the !>=s. 6everal techniques andmethods have been proposed, but evidence regarding their usefulness is still lacking. *"

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Referencesedit"

!. L Bump up to a b Fisher , #an $mde %oas &, %lume &, $lger ,'enton , ee , $ngel J (*++)."$pileptic seizures and epilepsy:de!initions proposed by the -nternational eague gainst $pilepsy(-$) and the -nternational %ureau !or $pilepsy

(-%$)" . $pilepsia 46  (/): /0+1*.doi :2+.222234.++25678+.*++.992+/. . M-; 2829757.

. "ump up # Fisher, S< ce#edo, < rzimanoglou, < %ogacz, <ross, J=< $lger, $< $ngel J, Jr< Forsgren, < French, J< 'lynn, M<=esdor!!er, ;< ee, %-< Mathern, '&< Mosh>, S< erucca, $<Sche!!er, -$< ?omson, ?< &atanabe, M< &iebe, S (pr *+2/). "-$@!!icial eport: practical clinical de!inition o!epilepsy.". $pilepsia 55  (/): /018* .doi :2+.22223epi.2*+ . M-; */05+97+ .

. L Bump up to a b c  d  e f  g  h i   j  k  l  m &ilden, J< ohen6'adol, (ug 2,*+2*). "$#aluation o! !irst non!ebrile seizures.". merican !amily

 physician 86  (/): 55/1/+. M-; **795+** .

/. L Bump up to a b %erg, ? (*++8). "isk o! recurrence a!ter a !irstunpro#oked seizure". $pilepsia. /7 Suppl 2: 2518. doi :2+.222234.2*862290.*++8.+2///. . M-; 2828/2/7.

*. L Bump up to a b c   ngus6eppan = (*+2/). "First seizures inadults". %MJ 348 : g*/0+ .doi :2+.22593bm4.g*/0+ . M-; */059*8+ .

3. L Bump up to a b c  "$pilepsy" . Fact Sheets. &orld =ealth @rganization.@ctober *+2*. etrie#edJanuary */, *+25.

=. L Bump up to a b c  d  e f  g  h Shearer, eter. "Seizures and Status

$pilepticus: ;iagnosis and Management in the $mergency;epartment" . $mergency Medicine ractice.

. L Bump up to a b c  d  e Aational -nstitute !or =ealth and linical$cellence (January *+2*). "hapter 2: -ntroduction". ?he $pilepsies:?he diagnosis and management o! the epilepsies in adults andchildren in primary and secondary care (;F). Aational linical'uideline entre. *21*8.

>. L Bump up to a b =ughes, J (ugust *++7). "bsence seizures: are#ieB o! recent reports Bith neB concepts.". $pilepsy C beha#ior :$C% 15  (/): /+/12*. doi :2+.2+2934.yebeh.*++7.+9.++0 .M-; 2795*28 .

!. L Bump up to a b c  d  e f  g  h i   j  k  l  m =ammer, edited by Stephen J. Mchee,'ary ;. (*+2+). "0".athophysiology o! disease : an introduction toclinical medicine (9th ed.). AeB Dork: Mc'raB6=illMedical. -S%A  708++029*290+ .

!!. L Bump up to a b c  d  e %radley, &alter '. (*+2*). "90". %radleyEsneurology in clinical practice. (9th ed.). hiladelphia, :$lse#ier3Saunders. -S%A  70862/500+/5/2.

7/23/2019 Epileptic Seizure

http://slidepdf.com/reader/full/epileptic-seizure 11/16

!. L Bump up to a b c  d  e f  g  Aational -nstitute !or =ealth and linical$cellence (January *+2*). "hapter 7: lassi!ication o! seizures andepilepsy syndromes". ?he $pilepsies: ?he diagnosis and management o! the epilepsies in adults and children in primary and secondarycare(;F). Aational linical 'uideline entre. 22712*7.

!. L Bump up to a b c  d  e f  g  h i   j  k  l  m n o  p q  r  Simon, ;a#id . 'reenberg,Michael J. mino!!, oger . (*+2*). "2*". linical neurology (8th ed.).AeB Dork: Mc'raB6=ill Medical. -S%A  7086++0207+* .

!/. L Bump up to a b c  ?rinka, $< =!ler, J< Gerbs, (September *+2*)."auses o! status epilepticus.".$pilepsia. 5 Suppl /: 2*0158. doi :2+.222234.2*862290.*+2*.+59**. .M-; **7/905+ .

!*. "ump up # =olmes, ?homas . (*++8). =andbook o! epilepsy  (/thed.). hiladelphia: ippincott &illiams C &ilkins.5/. -S%A  708+082005705.

!3. L Bump up to a b c  anayiotopoulos, (*+2+).   clinical guide toepileptic syndromes and their treatment based on the -$

classi!ications and practice parameter guidelines (e#. *nd ed.).HondonI: Springer. //. -S%A  70828/9*89// .

!=. "ump up # James &. &heless, ed. (*++7). d#anced therapy inepilepsy . Shelton, onn.: eopleEs Medical ub. =ouse.//5. -S%A  70829+07++/* .

!. "ump up # Stasiukyniene, .< il#inis, .< eingardiene, ;.<Janauskaite, . (*++7). "H$pileptic seizures in critically ill

 patientsI". Medicina (Kaunas) 45  (9): +210. M-; 279+70* .

!>. L Bump up to a b ?hurman, ;J< %eghi, $< %egley, $< %erg, ?<%uchhalter, J< ;ing, ;< =esdor!!er, ;< =auser, &< Kazis, <

Kobau, < Kroner, %< abiner, ;< ioB, K< ogroscino, '< Medina, M?<AeBton, < arko, K< aschal, < reu, M< Sander, J&< Selassie,

 < ?heodore, &< ?omson, ?< &iebe, S< -$ ommission on,$pidemiology (September *+22). "Standards !or epidemiologic studiesand sur#eillance o! epilepsy.". $pilepsia. * Suppl 0: *1*9. doi :2+.222234.2*862290.*+22.+52*2. . M-; *287759 .

. "ump up # 'ra#es, < @ehler, K< ?ingle, $ (Jan 2, *+2*). "Febrileseizures: risks, e#aluation, and prognosis.". merican !amily

 physician 85  (*): 2/715. M-; **55*2 .

!. L Bump up to a b Martindale, J< 'oldstein, JA< allin, ;J (February*+22). "$mergency department seizure epidemiology.". $mergency

medicine clinics o! Aorth merica 29 (2): 21*0 .doi :2+.2+2934.emc.*+2+.+8.++* . M-; *22+7+77.

. "ump up # ?arrisonMs 9rinciples of 4edicine. !*th edition

. "ump up # httpJJ$$$.epilepsysociety.org.ukJdiet&and&nutritionN.Onyc3cs

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/. "ump up # =ildebrand, J (July *++/). "Management o! epilepticseizures". urr @pin @ncol 16  (/): 52/10. doi :2+.2+703+2.cco.++++2*00*+.208.58 . M-; 228088/.

*. "ump up # %halla, ;.< 'odet, %.< ;ruet6abanac, M.< reu, M. (Jun*+22). "$tiologies o! epilepsy: a comprehensi#e re#ieB.". $pert e#Aeurother 11 (9): 892109. doi :2+.2893ern.22.2.M-; *292555.

3. "ump up # arlson, Aeil (January **, *+2*). hysiology o! %eha#ior.Aeurological ;isorders. 22th edition. earson.+. -S%A  +*+*5757+ .

=. "ump up # %ushara, K@ (pril *++). "Aeurologic presentation o!celiac disease.". 'astroenterology 128  (/ Suppl 2): S7*10. doi :2+.2+534.gastro.*++.+*.+28 . M-; 28*255.

. L Bump up to a b "$pilepsy" . Fact Sheets. &orld =ealth @rganization.@ctober *+2*. etrie#edJanuary */, *+25.

>. "ump up # Som4en, 'eorge '. (*++/). -ons in the %rain AormalFunction, Seizures, and Stroke.AeB Dork: @!ord Lni#ersity ress.290. -S%A  708+278+5/77.

. L Bump up to a b 'oldberg, $M< oulter, ; (May *+25). "Mechanismso! epileptogenesis: a con#ergence on neural circuitdys!unction.". Aature re#ieBs. Aeuroscience 14 (): 5501/7.doi :2+.2+583nrn5/8* . M-; *57+29 .

!. "ump up # @by, $< Janigro, ; (Ao# *++9). "?he blood6brain barrierand epilepsy.". $pilepsia 47  (22): 209210/. doi :2+.222234.2*862290.*++9.++820. . M-; 20229+2 .

. L Bump up to a b Jerome $ngel, Jr., ?imothy . edley, ed.(*++8). $pilepsy : a comprehensi#e tetbook  (*nd ed.). hiladelphia:&olters KluBer =ealth3ippincott &illiams C &ilkins./85. -S%A  708+0820000 .

. L Bump up to a b c  d  "urrent 'uidelines For Management @! Seizures-n ?he $mergency ;epartment"  (;F).

/. "ump up # Simon ;. Shor#on (*++/). ?he treatment o! epilepsy  (*nded.). Malden, Mass.: %lackBell ub. -S%A  7086+695*6+9+/960 .

*. "ump up # eeters, SD< =oek, $< Mollink, SM< =u!!, JS (pril *+2/)."Syncope: risk strati!ication and clinical decision making.". $mergencymedicine practice 16  (/): 21**< uiz **15.M-; *2+*++ .

3. L Bump up to a b c  d  e f  g  h Aational -nstitute !or =ealth and linical$cellence (January *+2*). "/".?he $pilepsies: ?he diagnosis andmanagement o! the epilepsies in adults and children in primary andsecondary care (;F). Aational linical 'uideline entre. 0185.

=. "ump up # ue!, ' (@ctober *+2+). "=ormonal alterations !olloBingseizures.". $pilepsy C beha#ior : $C% 19 (*): 25215. doi :2+.2+2934.yebeh.*+2+.+9.+*9 . M-; *+9799*2.

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. L Bump up to a b  hmad S, %eckett M& (*++/). "alue o! serum prolactin in the management o! syncope" . $mergency medicine 4ournal : $MJ 21 (*):e5.doi :2+.22593em4.*++5.++880+ . M  20*95+ . M-; 2/788507.

>. "ump up # Shukla ', %hatia M, i#ekanandhan S, et al. (*++/)."Serum prolactin le#els !or di!!erentiation o! nonepileptic #ersus trueseizures: limited utility". $pilepsy C beha#ior : $C% 5  (/): 201*2. doi :2+.2+2934.yebeh.*++/.+5.++/. M-; 2*9287.

/. "ump up # hen ;K, So D?, Fisher S (*++). "Lse o! serum prolactin in diagnosing epileptic seizures: report o! the ?herapeuticsand ?echnology ssessment Subcommittee o! the merican cademy o! Aeurology". Aeurology 65  (): 99810 .doi :2+.2*2*3+2.Bnl.++++208572.7970.d+ . M-; 2920870 .

/!. "ump up # assman , =or#ath ', ?homas J, et al. (*++5). "linicalspectrum and pre#alence o! neurologic e#ents pro#oked by tilt tabletesting". rch. -ntern. Med. 163 (29): 27/18 .doi :2+.2++23archinte.295.29.27/ . M-; 2*79598 .

/. "ump up # Schierhout, '< oberts, - (*++2). "nti6epileptic drugs !or pre#enting seizures !olloBing acute traumatic brain in4ury.". ?heochrane database o! systematic re#ieBs (/):;+++205. doi :2+.2++*32/9288.;+++205. M-; 22980+0+ .

/. "ump up # @!!ringa, M< AeBton, (pr 28, *+2*). "rophylactic drugmanagement !or !ebrile seizures in children.". ?he ochrane databaseo! systematic re#ieBs 4:;++5+52.doi :2+.2++*32/9288.;++5+52.pub* . M-; **257+8 .

//. "ump up # atilal, %@< appamikail, < osta, J< Sampaio, (Jun 9,*+25). "nticon#ulsants !or pre#enting seizures in patients Bith

chronic subdural haematoma.". ?he ochrane database o! systematicre#ieBs 6 :;++/875. doi :2+.2++*32/9288.;++/875.pub5.M-; *50//* .

/*. "ump up # ulman, J< 'reenhalgh, J< Marson, ' (Feb *8, *+25)."ntiepileptic drugs as prophylais !or post6craniotomy seizures.". ?heochrane database o! systematic re#ieBs2 :;++0*89. doi :2+.2++*32/9288.;++0*89.pub* . M-; *5/+0 .

/3. "ump up # KBan, J< &ood, $ (Jan *+, *+2+). "ntiepileptic drugs !orthe primary and secondary pre#ention o! seizures a!ter stroke.". ?heochrane database o! systematic re#ieBs (2):;++578. doi :2+.2++*32/9288.;++578.pub* . M-; *++720/.

/=. "ump up # KBan, J< 'uenther, (Jul 27, *++9). "ntiepileptic drugs!or the primary and secondary pre#ention o! seizures a!ter intracranial#enous thrombosis.". ?he ochrane database o! systematicre#ieBs (5):;+++2. doi :2+.2++*32/9288.;+++2.pub* .M-; 2989+77.

/. "ump up # Marigold, < 'Nnther, < ?iBari, ;< KBan, J (Jun , *+25)."ntiepileptic drugs !or the primary and secondary pre#ention o!seizures a!ter subarachnoid haemorrhage.". ?he ochrane database

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o! systematic re#ieBs 6 :;++802+ .doi :2+.2++*32/9288.;++802+.pub* . M-; *50/+50 .

/>. "ump up # httpJJ$$$.nytimes.comJJ/JJhealthJreal.html

*. "ump up # Sharma, A< =o!!man, J (Feb *+22). "?oin6related

seizures.". $mergency medicine clinics o! Aorth merica 29 (2): 2*157. doi :2+.2+2934.emc.*+2+.+8.+22.M-; *22+72+7.

*!. "ump up # ;oherty, MJ< =altiner, M (Jan *5, *++0). "&ag the dog:skepticism on seizure alert canines.". Aeurology 68  (/):5+7. doi :2+.2*2*3+2.Bnl.++++**597.8*79.a5.M-; 20*/*5/5.

*. "ump up # %onnett, J< ?udur6Smith, < &illiamson, < Marson, '(*+2+62*6+0). "isk o! recurrence a!ter a !irst seizure and implications!or dri#ing: !urther analysis o! the Multicentre study o! early $pilepsyand Single Seizures" . %MJ (linical research ed.) 341:c9/00. doi :2+.22593bm4.c9/00 . M  *77890 . M-; *22/00/5.

*. "ump up # Aeligan, < =auser, &< Sander, J& (*+2*). "?heepidemiology o! the epilepsies.".=andbook o! clinical neurology 107 :225155. doi :2+.2+293%7086+6///6*87868.++++967.M-; **758799 .

*/. L Bump up to a b Martindale J2, 'oldstein JA, allin ;J (*+22)."$mergency department seizure epidemiology". $merg Med linAorth m 29 (2): 21*0. doi :2+.2+2934.emc.*+2+.+8.++* .M-; *22+7+77.

**. "ump up # "$pilepsy (Seizure ;isorder)" . etrie#ed 5+ March *+2*.

*3. "ump up # erucca, < 'illiam, F' (September *+2*). "d#ersee!!ects o! antiepileptic drugs.".ancet neurology 11 (7): 07*18+*. doi :2+.2+293S2/0/6//**(2*)0+2567.M-; **85*++ .

*=. "ump up # 'astaut = (270+). "linical and electroencephalographicalclassi!ication o! epileptic seizures.". $pilepsia 11 (2): 2+*125. doi :2+.222234.2*86220.270+.tb+5802. .M-; *98*//.

*. "ump up # itt %, $chauz J (May *++*). "rediction o! epilepticseizures". ancet Aeurol 1 (2): **15+. doi :2+.2+293S2/0/6//**(+*)++++56+ . M-; 2*8/7/* .

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