Epilepsy - Ajphi

Issue

Vol. 1 No. 1 (2024)

Date Log

Submitted
October 22, 2024
Accepted
October 22, 2024
Published
October 26, 2024

Epilepsy Demystified: Symptoms, Seizures, Types and Treatment Options

https://doi.org/10.69512/ajphi.v1i2.78
Gauri Adhikari, MD
Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal
Preeti Kharel
Nepal Medical College, Kathmandu, Nepal
https://orcid.org/0009-0002-7744-3160
Aakriti Karki, MD
Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh
https://orcid.org/0009-0007-4024-1617

Corresponding Author(s) : Gauri Adhikari, MD

gauryadhikary@gmail.com

The American Journal of Patient Health Info, Vol. 1 No. 1 (2024)

Abstract

Epilepsy is a long-term neurological condition where seizures recur due to abnormal electrical signals in the brain. These seizures can vary, with focal seizures starting in one area of the brain and generalized seizures affecting the brain more broadly. Diagnosing epilepsy involves looking at your medical history, symptoms, and tests like EEG or brain scans to get a clear picture. Treatment usually includes medications to control seizures, lifestyle adjustments, and sometimes surgery. If you remain seizure-free for 2 to 4 years, your doctor might gradually lower your medication and consider stopping it altogether.

Keywords

Epilepsy Seizure Classification Antiepileptic Drugs (AEDs) Electroencephalogram (EEG)
Adhikari, MD, G., Kharel, P., & Karki, MD, A. (2024). Epilepsy Demystified: Symptoms, Seizures, Types and Treatment Options. The American Journal of Patient Health Info, 1(1). https://doi.org/10.69512/ajphi.v1i2.78
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References
  1. Fisher RS, Boas W van E, Blume W, Elger C, Genton P, Lee P, et al. Epileptic Seizures and Epilepsy: Definitions Proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005;46:470–2. https://doi.org/10.1111/j.0013-9580.2005.66104.x.
  2. Falco-Walter J. Epilepsy—Definition, Classification, Pathophysiology, and Epidemiology. Seminars in Neurology [Internet]. 2020 Nov 5;40(06):617–23. Available from: https://pubmed.ncbi.nlm.nih.gov/33155183/
  3. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014;55:475–82. Available from: https://doi.org/10.1111/epi.12550.
  4. Huff JS, Fountain NB. Pathophysiology and Definitions of Seizures and Status Epilepticus. Emerg Med Clin North Am 2011;29:1–13. Available from: https://doi.org/10.1016/j.emc.2010.08.001.
  5. DeGiorgio CM, Curtis A, Carapetian A, Hovsepian D, Krishnadasan A, Markovic D. Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study. BMJ Open [Internet]. 2020 Aug 1;10(8): e035767. Available from: https://bmjopen.bmj.com/content/10/8/e035767
  6. Beghi E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020;54(2):185–91. Available from: https://karger.com/ned/article-pdf/54/2/185/3114419/000503831.pdf
  7. Sarmast ST, Abdullahi AM, Jahan N. Current Classification of Seizures and Epilepsies: Scope, Limitations and Recommendations for Future Action. Cureus [Internet]. 2020 Sep 20;12(9). Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575300/
  8. Sadleir LG, Scheffer IE, Smith S, Carstensen B, Carlin J, Connolly MB, et al. Factors influencing clinical features of absence seizures. Epilepsia 2008;49:2100–7. Available from: https://doi.org/10.1111/j.1528-1167.2008.01708.x.
  9. Crunelli V, Lőrincz ML, McCafferty C, Lambert RC, Leresche N, Di Giovanni G, et al. Clinical and experimental insight into pathophysiology, comorbidity and therapy of absence seizures. Brain [Internet]. 2020 May 21;143(8):2341–68. Available from: https://academic.oup.com/brain/article/143/8/2341/5841645
  10. Guilhoto LM. Absence epilepsy: Continuum of clinical presentation and epigenetics? Seizure 2017;44:53–7. https://doi.org/10.1016/j.seizure.2016.11.031.
  11. Nass RD, Zur B, Elger CE, Holdenrieder S, Surges R. Acute metabolic effects of tonic-clonic seizures. Epilepsia Open 2019;4:599–608. https://doi.org/10.1002/epi4.12364.
  12. Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia [Internet]. 2017 Mar 8;58(4):531–42. Available from: https://doi.org/10.1111/epi.13671.
  13. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Mar 8;58(4):512–21 Available from: https://doi.org/10.1111/epi.13709. Available from:
  14. Perucca P, Bahlo M, Berkovic SF. The Genetics of Epilepsy. Annual Review of Genomics and Human Genetics. 2020 Aug 31;21(1):205–30. Available from: https://doi.org/10.1146/annurev-genom-120219-074937.
  15. Fordington S, Manford M. A review of seizures and epilepsy following traumatic brain injury. Journal of Neurology. 2020 May 22;267(10). Available from: https://doi.org/10.1007/s00415-020-09926-w.
  16. Galovic M, Ferreira-Atuesta C, Abraira L, Döhler N, Sinka L, Brigo F, et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs & Aging [Internet]. 2021;38(4):285–99. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007525/
  17. Steriade C, Titulaer MJ, Vezzani A, Sander JW, Thijs RD. The association between systemic autoimmune disorders and epilepsy and its clinical implications. Brain. 2020 Nov 22;144(2):372–90. Available from: https://doi.org/10.1093/brain/awaa362.
  18. Reddy C, Saini AG. Metabolic Epilepsy. Indian Journal of Pediatrics. 2020 Oct 16;88(10):1025–32. Available from: https://doi.org/10.1007/s12098-020-03510-w.
  19. Hirsch E, French J, Scheffer IE, Bogacz A, Alsaadi T, Sperling MR, et al. ILAE definition of the Idiopathic Generalized Epilepsy Syndromes: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022 May 3. Available from: https://doi.org/10.1111/epi.17236.
  20. Febrile seizures: an overview | Drugs in Context [Internet]. www.drugsincontext.com. Available from: https://www.drugsincontext.com/febrile-seizures-an-overview/
  21. Hanif S, Musick ST. Reflex Epilepsy. Aging and disease. 2021;12(4):1010. Available from:
  22. Leibetseder A, Eisermann M, Jr WCL, Nobili L, von Oertzen TJ. How to distinguish seizures from non-epileptic manifestations. Epileptic Disorders. 2020 Dec;22(6):716–38. Available from: https://doi.org/10.1684/epd.2020.1234.
  23. Nass RD, Sassen R, Elger CE, Surges R. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure. 2017 Apr; 47:51–65. Available from: https://doi.org/10.1016/j.seizure.2017.02.013.
  24. Benbadis SR, Beniczky S, Bertram E, MacIver S, Moshé SL. The role of EEG in patients with suspected epilepsy. Epileptic Disorders. 2020 Apr;22(2):143–55. Available from: https://doi.org/10.1684/epd.2020.1151.
  25. Tatum WO, Rubboli G, Kaplan PW, Mirsatari SM, Radhakrishnan K, Gloss D, et al. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clinical Neurophysiology. 2018 May;129(5):1056–82. Available from: https://doi.org/10.1016/j.clinph.2018.01.019.
  26. Goodman AM, Szaflarski JP. Recent Advances in Neuroimaging of Epilepsy. Neurotherapeutics. 2021 May 3. Available from: https://doi.org/10.1007/s13311-021-01049-y.
  27. Rogawski MA, Löscher W. The neurobiology of antiepileptic drugs. Nature Reviews Neuroscience. 2004 Jul;5(7):553–64. Available from: https://doi.org/10.1038/nrn1430.
  28. Kim H, Kim DW, Lee ST, Byun JI, Seo JG, No YJ, et al. Antiepileptic Drug Selection According to Seizure Type in Adult Patients with Epilepsy. Journal of Clinical Neurology. 2020;16(4):547. Available from: https://doi.org/10.3988/jcn.2020.16.4.547.
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Gauri Adhikaria, Preeti Kharelb, Aakriti Karkic

a Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal

b Nepal Medical College, Kathmandu, Nepal

c Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh

Background

Epilepsy is a group of brain diseases characterized clinically by recurrent, unprovoked seizures [1,2,3 ]. On the other hand, a seizure is simply an abnormal electrical activity in the brain. It can lead to various symptoms, including convulsions, loss of consciousness, unusual sensations, or temporary confusion. [4]

Epilepsy impacts individuals across all age groups, affecting approximately 50 million people worldwide and around 3.4 million individuals in the United States alone. The number of cases of epilepsy is leading to over one hundred thousand new diagnoses annually in the US [5]. The rising trend may be attributed to an increasingly aging population, increasing its prevalence. [6]

Types of Epilepsy

When we hear the word seizure, we think of muscle spasms, involuntary body movements, and loss of consciousness. However, most seizures are surprisingly subtle and may be hard to recognize. [7]

1. Generalized Epilepsy

If a large part of the brain or the entire brain is involved, you may experience a loss of awareness without any warning. Your whole body may also stiffen or shake involuntarily. Generalized epilepsy is classified into different subtypes:

  • Absence Seizures (petit mal seizures): Seizures with brief lapses of consciousness characterized by staring blankly or subtle movements such as eye blinking or lip-smacking. [8-10]
  • Tonic-Clonic Seizures (grand mal seizures): These are dramatic seizures presenting with loss of consciousness and stiffening of muscles (tonic phase), followed by rhythmic jerking movements (clonic phase). [11, 12]
  • Myoclonic Seizures: You may have sudden, brief jerks or twitches of the muscles, often involving the arms and legs. [12]
  • Clonic Seizures: This is the type of seizure where you will have repetitive, rhythmic jerking movements of muscles. [12]

2. Focal Epilepsy

These seizures originate in a specific area or focus of the brain. Focal seizures can be categorized as

  • Focal Aware Seizures (simple partial seizures): These kinds of seizures occur without loss of consciousness. The individual remains aware of their surroundings but may experience unusual movements, sensations, or emotions. [13]
  • Focal Impaired Awareness Seizures (complex partial seizures): These seizures are characterized by altered consciousness or awareness. The person may appear confused, disoriented, or engage in purposeless movements. [13]
  • Focal to Bilateral Tonic-Clonic Seizures: These begin as focal seizures initially, but later, they spread to involve both sides of the brain, leading to a generalized tonic-clonic seizure. [13]

Risk Factors of Epilepsy

Figure 1.

The causes of epilepsy can be different for each person. Some episodes of seizure activity can be linked to genetics [14], brain trauma [15], stroke [16], autoimmune disorders [17], metabolic issues [18], or infectious diseases, while others may have no identifiable causes. [19]

Triggers of Epileptic Seizure

Some common triggers for epileptic seizures include:

Figure 2.

  • Sleep deprivation.
  • Fever. [20]
  • Flashing bright lights. [ 21]
  • Alcohol withdrawal.
  • Recreational drug Use.

Symptoms of Epilepsy

Figure 3.

  • Aura: Some people experience a warning sign or sensation before a seizure, known as an aura. Feelings of Deja vu, strange smells or tastes, visual disturbances, or sudden emotional changes are common.
  • Loss of Awareness: Epileptic seizures mostly involve loss of awareness or consciousness. During this time, the person may appear to stare blankly into space, be unresponsive, or be unable to communicate. [22]
  • Uncontrollable Movements: Seizures often involve uncontrollable movements. These can vary greatly, from jerking motions in the arms and legs to more subtle twitching or repetitive movements. During these movements, one might bite one’s tongue, which needs immediate attention.
  • Changes in Sensation: Some seizures may cause unusual sensations like tingling, numbness, or unusual feelings such as fear and panic.
  • Incontinence and Tongue Biting: In some cases, individuals may lose control of bodily functions, such as bladder or bowel control, with tongue biting. [22]
  • Status Epilepticus: Seizures typically last a few seconds to a few minutes. Prolonged seizures, or seizures that occur one after another without full recovery in between, are called status epilepticus and require immediate medical attention.

Diagnosis of Epilepsy

The diagnosis of epilepsy requires a detailed history and neurological examination. After that, your doctor will recommend various tests to diagnose it. Here is an overview of the diagnostic process:

  • Blood Tests: Blood tests are employed to check for epileptic vs. non-epileptic seizures. It rules out other conditions that might present with seizure - metabolic disorders, infections, and autoimmune disorders, among other medical conditions. [23]
  • Electroencephalogram (EEG): EEG is a critical diagnostic technique for epilepsy. It records the brain's electrical activity through electrodes placed on the scalp. In epilepsy, EEG detects abnormal patterns like spikes and sharp waves, indicating potential seizure activity and pinpointing the location of seizure onset within the brain. There are different types of EEG studies, including routine EEG, ambulatory EEG, and video EEG monitoring in specialized units. These aid in capturing and analyzing brain activity over varying durations, allowing for accurate diagnosis and treatment planning. [24,25]
  • Magnetic Resonance Imaging (MRI): It is the preferred neuroimaging modality for epilepsy evaluation due to its superior soft tissue contrast and ability to visualize detailed brain anatomy. It can detect a range of abnormalities, including medial temporal sclerosis (MTS) associated with Temporal Lobe Epilepsy, neocortical dysplasia, brain tumors, and vascular malformations, all of which can cause seizures. Specific MRI protocols like T1-weighted, T2-weighted, FLAIR, and diffusion-weighted MRI (DWI) are used to assess brain structure in relation to epilepsy. [26]
  • Computed Tomography (CT): CT scans, while less sensitive than MRI, are sometimes used for emergency evaluations or when MRI is contraindicated. They can identify large lesions, hemorrhages, or calcifications associated with epilepsy. In certain cases, advanced imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) may be employed to characterize brain function further and localize the seizure focus, aiding in treatment decisions for individuals with epilepsy.

Treatment of Epilepsy

While there is no definitive cure for epilepsy, treatments will help you control your symptoms.

Figure 4.

  • Antiepileptic Drugs (AEDs): The most common and primary treatment for epilepsy involves taking AEDs. They work by stabilizing the electrical activity in the brain and reducing the likelihood of seizures.[27] A wide range of AEDs are available, and the choice of AED depends on factors such as the type of seizures, patient age, potential side effects, and other medical conditions. [28] Treatment often starts with a single AED at a low dose, which may be adjusted based on seizure control and tolerability. Some patients may require combination therapy with more than one AED to achieve optimal seizure management. Some of the common examples of AEDs are Carbamazepine (Tegretol), Valproate (Depakote), and Levetiracetam (Keppra). [29]
  • Levetiracetam: Levetiracetam, marketed under Keppra, is a widely prescribed AED in the United States and globally due to its effectiveness and safety profile. Keppra is known for its broad-spectrum efficacy against various seizure types and is often used as adjunctive therapy alongside other AEDs. One of Keppra's key advantages is its minimal side effect profile, with common side effects such as dizziness, somnolence, and irritability being generally mild and transient and not requiring monitoring of blood Keppra levels for toxicity.
  • Ketogenic Diet: It is a diet high in fat and low in carbohydrates with adequate protein. The ketogenic diet is effective for drug-resistant epilepsies – providing seizure freedom, reducing seizure frequency, and improvement in cognition.[30] The diet induces a state of ketosis, where the body produces ketones from fat metabolism, which may have anticonvulsant effects on the brain. The ketogenic diet is typically supervised by a dietitian and requires strict adherence to specific macronutrient ratios. [31]
  • Surgery: Surgical intervention may be considered for individuals with epilepsy who do not respond to medications or have seizures originating from a specific, identifiable area of the brain. Common surgical procedures for epilepsy include resective surgery (removal of the seizure focus), corpus callosotomy (cutting the corpus callosum to prevent seizure spread), and multiple subpial transections (to disrupt seizure pathways). [32]
  • Vagus Nerve Stimulation (VNS): VNS involves implanting a device that delivers electrical impulses to the vagus nerve in the neck. These impulses can help reduce seizure frequency and severity. VNS is considered for individuals with refractory epilepsy who are not candidates for surgery or have not responded well to medications alone. [33]
  • Responsive Neurostimulation (RNS): RNS is a newer treatment option that involves implanting a device directly into the brain to detect and respond to electrical activity associated with seizures. The device delivers targeted electrical stimulation to disrupt seizure activity before it spreads. [34]
  • Lifestyle Modifications: Certain lifestyle changes can complement medical treatments and help manage epilepsy, such as getting adequate sleep, managing stress, avoiding alcohol and recreational drugs, and maintaining a regular schedule of meals and medications. [35] Identifying and avoiding seizure triggers, such as specific foods, drinks, or environmental factors, can be beneficial. [35]

Stopping Anti-Epileptic Drugs

It's important to continue your medications even if you have been seizure-free. Although you may feel fine, it's crucial to consult your doctor before stopping AEDs. [36] Typically, your doctor will gradually reduce the dosage and consider stopping your seizure medications entirely only after you have been seizure-free for a period of 2 to 4 years. [36] If you have experienced only one seizure episode, your doctor might recommend discontinuing treatment if you remain seizure-free for 6 to 12 months. [37]

There is a higher chance of remaining seizure-free without medications if:

  1. You had a few seizures before you started taking seizure medicine.
  2. Your seizures were controlled with just one type of medicine.
  3. You had normal results on a neurological examination.
  4. You had a normal EEG at the time of the diagnosis.
  5. Your CT scan or MRI brain results were normal.

What To do After a Seizure if You Witness a Seizure?

The Epilepsy Foundation recommends the following during an ongoing seizure: [38]

  • Stay with the patient until they are awake or alert after the seizure.
  • Ensure the safety of the patient by moving them away from harm.
  • Position them on their side if they are not awake and aware.
  • Make sure not to restrain the patient in any way.
  • Do not put anything in their mouth.

When to Call 911 or for Emergency Help?

If you see a seizure, be calm. However, do call for help if:

  1. The seizures last longer than 5 minutes.
  2. There are repeated seizures.
  3. The person had difficulty breathing.
  4. Seizures have occurred in water bodies such as lakes or swimming pools.
  5. The person is injured, pregnant, or sick.
  6. The person does not return to their usual after a seizure
  7. This is the person’s first seizure.

Epilepsy and Exercise

The relationship between exercise and seizures in epilepsy is complex and requires individualized consideration. While regular physical activity like walking, swimming, or yoga can provide notable health benefits such as stress reduction and improved mood, it can also influence seizure activity positively or negatively. [39, 40]

Individuals with epilepsy need to engage in moderate-intensity activities while taking precautions to avoid overheating, dehydration, or excessive exertion, which can trigger seizures in some cases. [39] Incorporating exercise into an overall epilepsy management strategy can enhance well-being while reducing the risk of seizures during physical activity.

Women and Epilepsy

Epilepsy can uniquely impact women due to hormonal influences on seizure patterns, particularly during puberty, menstruation, pregnancy, and menopause. Hormonal fluctuations can affect seizure frequency and severity in some cases. Certain AEDs may also impact reproductive health, leading to menstrual irregularities, polycystic ovary syndrome (PCOS), or decreased bone density.

Women with epilepsy require specialized care and consideration for contraception, fertility, and pregnancy. Medication safety and seizure control during pregnancy is crucial for maternal and fetal well-being. [41]

Driving and Seizure Disorder

Being on the road alone can pose a risk to yourself and others if you have episodes of seizures. Seizures can make you unconscious or cause motor and visual impairment, which might be risky if you are on the road. A person with epilepsy must be seizure-free for a certain period to be eligible for a driver’s license. According to the American Academy of Neurology (AAN), you must be seizure-free for at least 3 to 13 months, but this duration varies from state to state. You need clearance from your doctor before you can be on the road by yourself. [42] You should refer to your state driving laws to see the latest rules and eligibility for driving if you have seizures.

Questions to ask your Doctor

  1. How long should I continue my medication?
  2. When will I be able to drive?
  3. Should I breastfeed my child while I am on epilepsy medications?
  4. Are there some social support groups for those who have epilepsy?
  5. Do I need a referral to a neurologist?

Conflict of Interest

Gauri Adhikari is a senior research assistant at EHealthyInfo and receives financial compensation from the company. Preeti Kharel works as a paid research assistant at EHealthyInfo. Aakriti Karki is a non-paid research assistant at EHealthyInfo. There are no other conflicts of interest to report.

Peer Reviewed By

Dr. Dipesh Bhattarai, MD

References

  1. Fisher RS, Boas W van E, Blume W, Elger C, Genton P, Lee P, et al. Epileptic Seizures and Epilepsy: Definitions Proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005;46:470–2. https://doi.org/10.1111/j.0013-9580.2005.66104.x.
  2. Falco-Walter J. Epilepsy—Definition, Classification, Pathophysiology, and Epidemiology. Seminars in Neurology [Internet]. 2020 Nov 5;40(06):617–23. Available from: https://pubmed.ncbi.nlm.nih.gov/33155183/
  3. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014;55:475–82. Available from: https://doi.org/10.1111/epi.12550.
  4. Huff JS, Fountain NB. Pathophysiology and Definitions of Seizures and Status Epilepticus. Emerg Med Clin North Am 2011;29:1–13. Available from: https://doi.org/10.1016/j.emc.2010.08.001.
  5. DeGiorgio CM, Curtis A, Carapetian A, Hovsepian D, Krishnadasan A, Markovic D. Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study. BMJ Open [Internet]. 2020 Aug 1;10(8): e035767. Available from: https://bmjopen.bmj.com/content/10/8/e035767
  6. Beghi E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020;54(2):185–91. Available from: https://karger.com/ned/article-pdf/54/2/185/3114419/000503831.pdf
  7. Sarmast ST, Abdullahi AM, Jahan N. Current Classification of Seizures and Epilepsies: Scope, Limitations and Recommendations for Future Action. Cureus [Internet]. 2020 Sep 20;12(9). Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575300/
  8. Sadleir LG, Scheffer IE, Smith S, Carstensen B, Carlin J, Connolly MB, et al. Factors influencing clinical features of absence seizures. Epilepsia 2008;49:2100–7. Available from: https://doi.org/10.1111/j.1528-1167.2008.01708.x. Available from: https://pubmed.ncbi.nlm.nih.gov/18616552/
  9. Crunelli V, Lőrincz ML, McCafferty C, Lambert RC, Leresche N, Di Giovanni G, et al. Clinical and experimental insight into pathophysiology, comorbidity and therapy of absence seizures. Brain [Internet]. 2020 May 21;143(8):2341–68. Available from: https://academic.oup.com/brain/article/143/8/2341/5841645
  10. Guilhoto LM. Absence epilepsy: Continuum of clinical presentation and epigenetics? Seizure 2017;44:53–7. https://doi.org/10.1016/j.seizure.2016.11.031.
  11. Nass RD, Zur B, Elger CE, Holdenrieder S, Surges R. Acute metabolic effects of tonic-clonic seizures. Epilepsia Open 2019;4:599–608. https://doi.org/10.1002/epi4.12364.
  12. Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia [Internet]. 2017 Mar 8;58(4):531–42. Available from: https://doi.org/10.1111/epi.13671.
  13. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Mar 8;58(4):512–21 Available from: https://doi.org/10.1111/epi.13709. Available from:
  14. Perucca P, Bahlo M, Berkovic SF. The Genetics of Epilepsy. Annual Review of Genomics and Human Genetics. 2020 Aug 31;21(1):205–30. Available from: https://doi.org/10.1146/annurev-genom-120219-074937.
  15. Fordington S, Manford M. A review of seizures and epilepsy following traumatic brain injury. Journal of Neurology. 2020 May 22;267(10). Available from: https://doi.org/10.1007/s00415-020-09926-w.
  16. Galovic M, Ferreira-Atuesta C, Abraira L, Döhler N, Sinka L, Brigo F, et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs & Aging [Internet]. 2021;38(4):285–99. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007525/
  17. Steriade C, Titulaer MJ, Vezzani A, Sander JW, Thijs RD. The association between systemic autoimmune disorders and epilepsy and its clinical implications. Brain. 2020 Nov 22;144(2):372–90. Available from: https://doi.org/10.1093/brain/awaa362.
  18. Reddy C, Saini AG. Metabolic Epilepsy. Indian Journal of Pediatrics. 2020 Oct 16;88(10):1025–32. Available from: https://doi.org/10.1007/s12098-020-03510-w.
  19. Hirsch E, French J, Scheffer IE, Bogacz A, Alsaadi T, Sperling MR, et al. ILAE definition of the Idiopathic Generalized Epilepsy Syndromes: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022 May 3. Available from: https://doi.org/10.1111/epi.17236.
  20. Febrile seizures: an overview | Drugs in Context [Internet]. www.drugsincontext.com. Available from: https://www.drugsincontext.com/febrile-seizures-an-overview/
  21. Hanif S, Musick ST. Reflex Epilepsy. Aging and disease. 2021;12(4):1010. Available from: https://pubmed.ncbi.nlm.nih.gov/34221545/
  22. Leibetseder A, Eisermann M, Jr WCL, Nobili L, von Oertzen TJ. How to distinguish seizures from non-epileptic manifestations. Epileptic Disorders. 2020 Dec;22(6):716–38. Available from: https://doi.org/10.1684/epd.2020.1234.
  23. Nass RD, Sassen R, Elger CE, Surges R. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure. 2017 Apr; 47:51–65. Available from: https://doi.org/10.1016/j.seizure.2017.02.013.
  24. Benbadis SR, Beniczky S, Bertram E, MacIver S, Moshé SL. The role of EEG in patients with suspected epilepsy. Epileptic Disorders. 2020 Apr;22(2):143–55. Available from: https://doi.org/10.1684/epd.2020.1151.
  25. Tatum WO, Rubboli G, Kaplan PW, Mirsatari SM, Radhakrishnan K, Gloss D, et al. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clinical Neurophysiology. 2018 May;129(5):1056–82. Available from: https://doi.org/10.1016/j.clinph.2018.01.019.
  26. Goodman AM, Szaflarski JP. Recent Advances in Neuroimaging of Epilepsy. Neurotherapeutics. 2021 May 3. Available from: https://doi.org/10.1007/s13311-021-01049-y.
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