Seizure

This paper collates guidance from the literature around how clinicians might best hold conversations about epilepsy risks, without undermining clinician skills of undertaking these conversations. Difficult conversations especially around risk of death are complex and can be misconstrued. There is ongoing debate around risk discussion rationale [1,2], however, recent research illustrates how better risk communication can change outcomes [3,4]. The focus of this paper is the communications directly.

As part of the brain’s immune system, the cerebral glymphatic system plays an important role in waste clearance from the brain [1,2]. Cerebral perivascular Virchow-Robin spaces (VRS) are functional networks of the cerebral glymphatic system surrounding the perforating arterioles and venules in the brain parenchyma [1,2]. They are always located between the endothelial basement membrane and the basement membrane of the glia limitans [3]. Additionally, the VRS are responsible for immune surveillance and drainage of soluble proteins and metabolic waste ...

Approximately 5-10% of the general population will experience a seizure in their lifetimes [1–3]. However, only 2-3% of them will have one or more recurrences leading to a diagnosis of epilepsy. The challenge for proper management of a first seizure (FS) is to differentiate between epileptic and non-epileptic FS, upon which the decision on prescribing an anti-epileptic drug (AED) will be based. There are several studies with various methods and settings such as community-based, hospital-based, or specific conditions-based studies, which ...

Risks in epilepsy include those directly related to the occurrence of seizures in vulnerable situations. Some of these include: driving (1); operating machinery (2,3); working at heights (3); working with electricity and electrical appliances (4); cooking and preparing food with open flames, hot liquids and using knives (5); bathing or swimming practice (6); or even just enjoying some recreational sports, such as surfing, sailing or horse riding (7). There are also situations that may provoke seizures with inherent risks resulting ...

Epilepsies are associated with increased morbidity and mortality due to their underlying causes and to recurrent seizures. These seizures are a common cause of accidents and injuries. In addition, generalized convulsive seizures (GCSs, focal to bilateral tonic-clonic and generalized tonic-clonic seizures of generalized or unknown onset [1]) may lead to sudden unexpected death in epilepsy (SUDEP), a major epilepsy-specific cause of death [2–6].

Epilepsy prevalence is approximately 0.6 – 1.0% across the worldwide general population [1]. It is much higher in the intellectual disability (ID) population, where around 22% have epilepsy [2]. It is also estimated that as many as one in four people with epilepsy (PWE) have an ID [3]. Whilst seizure control for all PWE is initially managed by licensed Anti-Epileptic Drugs (AEDs), those with ID are excluded from pre-market systemic trials [4]. Rates of treatment resistance are significantly higher in ...

The insula, also referred to as the Island of Reil, is a cortical structure located deep in the lateral sulcus covered by temporal, parietal and frontal operculae [1].

Epilepsy is a public health priority and since ancient times is accompanied by stigma [1,2,3]. This negative perception can affect people with epilepsy by limiting their social interaction and quality of life [4]. In medical practice definitions and classifications of diseases based on etiological, pathophysiological, diagnostic, therapeutic and prognostic descriptions are useful for providing a common language for clinical and epidemiological research. However diagnostic nomenclature can become a negative label for patients prioritizing disease over human integrity [5,6].

Psychogenic nonepileptic seizures (PNES) are involuntary experiential and behavioral responses to internal or external triggers that superficially resemble epileptic seizures but that are not associated with abnormal electroencephalographic electrical activity [1].

Epilepsy affects more than 50 million people worldwide and is characterized by recurrent unprovoked seizures. One of the main goals of treatment is to improve patient quality of life by optimizing the balance between seizure control and side effects of the antiepileptic drugs (AEDs). Although the majority of patients can be adequately controlled with AEDs, a significant number, estimated to be as high as 30% stay uncontrolled with conventional medical treatment. This can be further complicated if a patient has ...