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<!--Epidemiology -->
<!--Epidemiology -->
5–10% of people who live to 80&nbsp;years old have at least one epileptic seizure<ref name=AFP2012/> and the chance of experiencing a second seizure is between 40% and 50%.<ref name=Berg2008>{{cite journal |last=Berg |first=AT |title=Risk of recurrence after a first unprovoked seizure |journal=Epilepsia |volume=49 Suppl 1 |issue= |pages=13–8 |year=2008 |pmid=18184149 |doi=10.1111/j.1528-1167.2008.01444.x}}</ref> About 50% of patients with an unprovoked apparent "first seizure" have had other minor seizures, so their diagnosis is epilepsy.<ref name=angusbmj2014/> Epilepsy affects about 1% of the population currently<ref name=WHO2009/> and affected about 4% of the population at some point in time.<ref name=AFP2012/> Most of those affected—nearly 80%—live in [[developing country|developing countries]].<ref name=WHO2009>{{cite web |url=http://www.who.int/mediacentre/factsheets/fs999/en/ | title = Epilepsy | series = Fact Sheets |date =October 2012 | accessdate = January 24, 2013 | publisher = [[World Health Organization]]}}</ref>
5–10% of people who live to 80&nbsp;years old have at least one epileptic seizure<ref name=AFP2012/> and the chance of experiencing a second seizure is between 40% and 50%.<ref name=Berg2008>{{cite journal |last=Berg |first=AT |title=Risk of recurrence after a first unprovoked seizure |journal=Epilepsia |volume=49 Suppl 1 |issue= |pages=13–8 |year=2008 |pmid=18184149 |doi=10.1111/j.1528-1167.2008.01444.x}}</ref> About 50% of patients with an unprovoked apparent "first seizure" have had other minor seizures, so their diagnosis is epilepsy.<ref name=angusbmj2014/> Epilepsy affects about 1% of the population currently<ref name=WHO2009/> and affected about 4% of the population at some point in time.<ref name=AFP2012/> Most of those affected—nearly 80%—live in [[developing country|developing countries]].<ref name=WHO2009>{{cite web |url=http://www.who.int/mediacentre/factsheets/fs999/en/ | title = Epilepsy | series = Fact Sheets |date =October 2012 | accessdate = January 24, 2013 | publisher = [[World Health Organization]]}}</ref>
{{trans F}}



==Signs and symptoms==
{{See also|Seizure types}}
The signs and symptoms of seizures vary depending on the type.<ref name=EB06/> The most common type of seizure is [[convulsive]] (60%).<ref name=NChp1/> Two-thirds of these begin as [[focal seizure]]s and become [[generalized seizure|generalized]] while one third begin as generalized seizures.<ref name=NChp1/> The remaining 40% of seizures are non-convulsive, an example of which is [[absence seizure]].<ref name="Hughes 404–12">{{cite journal|last=Hughes|first=JR|title=Absence seizures: a review of recent reports with new concepts.|journal=Epilepsy & behavior : E&B|date=August 2009|volume=15|issue=4|pages=404–12|pmid=19632158|doi=10.1016/j.yebeh.2009.06.007}}</ref>

===Focal seizures===
[[Focal seizure]]s are often preceded by certain experiences, known as an [[Aura (symptom)|aura]].<ref name=EB06/> These may include: sensory, visual, psychic, autonomic, [[olfactory]] or motor phenomena.<ref name=Ham2010>{{cite book|last=Hammer|first=edited by Stephen J. McPhee, Gary D.|title=Pathophysiology of disease : an introduction to clinical medicine|year=2010|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-162167-0|edition=6th|chapter=7}}</ref>

In a [[complex partial seizure]] a person may appear confused or dazed and can not respond to questions or direction. Focal seizure may become generalized.<ref name=Ham2010/>

Jerking activity may start in a specific muscle group and spread to surrounding muscle groups—known as a ''[[Jacksonian march]]''.<ref name=Brad2012>{{cite book|last=Bradley|first=Walter G.|title=Bradley's neurology in clinical practice.|year=2012|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=978-1-4377-0434-1|edition=6th|chapter=67}}</ref> Unusual activities that are not consciously created may occur.<ref name=Brad2012/> These are known as [[automatisms]] and include simple activities like smacking of the lips or more complex activities such as attempts to pick something up.<ref name=Brad2012/>

===Generalized seizures===
There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures.<ref name=NChp9/> They all involve a loss of consciousness and typically happen without warning.<ref name=Neuro2012/>

* Tonic-clonic seizures present with a contraction of the limbs followed by their extension, along with arching of the back for 10–30&nbsp;seconds.<ref name=Neuro2012/> A cry may be heard due to contraction of the chest muscles.<ref name=Neuro2012/> The limbs then begin to shake in unison.<ref name=Neuro2012/> After the shaking has stopped it may take 10–30&nbsp;minutes for the person to return to normal.<ref name=Neuro2012/>
* Tonic seizures produce constant contractions of the muscles.<ref name=Neuro2012/> The person may turn blue if breathing is impaired.<ref name=Neuro2012/>
* Clonic seizures involve shaking of the limbs in unison.<ref name=Neuro2012/>
* Myoclonic seizures involve spasms of muscles in either a few areas or generalized through the body.<ref name=Neuro2012/>
* Absence seizures can be subtle, with only a slight turn of the head or eye blinking.<ref name=Ham2010/> The person often does not fall over and may return to normal right after the seizure ends, though there may also be a period of post-ictal disorientation.<ref name="Ham2010"/>
* Atonic seizures involve the loss of muscle activity for greater than one second.<ref name=Brad2012/> This typically occurs bilaterally (on both sides of the body).<ref name=Brad2012/>

===Duration===
A seizure can last from a few seconds to more than five minutes, at which point it is known as [[status epilepticus]].<ref name=Trinka2012>{{cite journal|last=Trinka|first=E|author2=Höfler, J |author3=Zerbs, A |title=Causes of status epilepticus.|journal=Epilepsia|date=September 2012|volume=53 Suppl 4|pages=127–38|pmid=22946730|doi=10.1111/j.1528-1167.2012.03622.x}}</ref> Most tonic-clonic seizures last less than two or three minutes.<ref name=Trinka2012/> Absence seizures are usually around 10&nbsp;seconds in duration.<ref name="Hughes 404–12"/>

===Postictal===
After the active portion of a seizure, there is typically a period of confusion called the ''[[postictal]] period'' before a normal [[level of consciousness]] returns.<ref name=EB06/> This usually lasts 3 to 15 minutes<ref>{{cite book|last=Holmes|first=Thomas R.|title=Handbook of epilepsy|year=2008|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-7397-3|page=34|url=https://books.google.com/books?id=gLOv8XZ5u48C&pg=PA34|edition=4th}}</ref> but may last for hours.<ref name=Post2010/> Other common symptoms include: feeling tired, [[headache]], difficulty speaking, and abnormal behavior.<ref name=Post2010>{{cite book|last=Panayiotopoulos|first=CP|title=A clinical guide to epileptic syndromes and their treatment based on the ILAE classifications and practice parameter guidelines|year=2010|publisher=Springer|location=[London]|isbn=978-1-84628-644-5|page=445|url=https://books.google.com/books?id=yJQQzPTcbYIC&pg=PA445|edition=Rev. 2nd}}</ref> [[Psychosis]] after a seizure is relatively common, occurring in between 6 and 10% of people.<ref>{{cite book|title=Advanced therapy in epilepsy|year=2009|publisher=People's Medical Pub. House|location=Shelton, Conn.|isbn=978-1-60795-004-2|page=443|url=https://books.google.com/books?id=4W7UI-FPZmoC&pg=PA443|editor=James W. Wheless}}</ref> Often people do not remember what occurred during this time.<ref name=Post2010/>

==Causes==
{{Main article|Causes of seizures}}
Seizures have a number of causes. Of those with seizure about 25% have [[epilepsy]].<ref name="Stasiukyniene-2009">{{Cite journal | last1 = Stasiukyniene | first1 = V. | last2 = Pilvinis | first2 = V. | last3 = Reingardiene | first3 = D. | last4 = Janauskaite | first4 = L. | title = [Epileptic seizures in critically ill patients] | journal = Medicina (Kaunas) | volume = 45 | issue = 6 | pages = 501–7 | year = 2009 | doi = | pmid = 19605972 }}</ref> A number of conditions are associated with seizures but are not epilepsy including: most [[febrile seizures]] and those that occur around an acute infection, stroke, or toxicity.<ref name=Thur2011>{{cite journal|vauthors=Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D, Hesdorffer DC, Hauser WA, Kazis L, Kobau R, Kroner B, Labiner D, Liow K, Logroscino G, Medina MT, Newton CR, Parko K, Paschal A, Preux PM, Sander JW, Selassie A, Theodore W, Tomson T, Wiebe S |title=Standards for epidemiologic studies and surveillance of epilepsy.|journal=Epilepsia|date=September 2011|volume=52 Suppl 7|pages=2–26|pmid=21899536|doi=10.1111/j.1528-1167.2011.03121.x}}</ref> These seizures are known as "acute symptomatic" or "provoked" seizures and are part of the seizure-related disorders.<ref name=Thur2011/> In many the cause is unknown.

Different causes of seizures are common in certain age groups.
* During the [[neonatal]] period and early infancy the most common causes include [[hypoxic ischemic encephalopathy]], central nervous system (CNS) infections, trauma, congenital CNS abnormalities, and [[metabolic disorders]].
* The most frequent cause of seizures in children is febrile seizures, which happen in 2–5% of children between the ages of six months and five years.<ref>{{cite journal|last=Graves|first=RC|author2=Oehler, K |author3=Tingle, LE |title=Febrile seizures: risks, evaluation, and prognosis.|journal=American family physician|date=Jan 15, 2012|volume=85|issue=2|pages=149–53|pmid=22335215}}</ref>
* During childhood, well-defined epilepsy syndromes are generally seen.
* In adolescence and young adulthood, non-compliance with the medication regimen and sleep deprivation are potential triggers.
* Pregnancy and labor and childbirth, and the post-partum, or post-natal period (after birth) can be at-risk times, especially if there are certain complications like [[pre-eclampsia]].
* During adulthood, the likely causes are alcohol related, strokes, trauma, CNS infections, and brain tumors.<ref name = emcna2011/>
* In older adults, [[cerebrovascular disease]] is a very common cause. Other causes are CNS tumors, head trauma, and other degenerative diseases that are common in the older age group, such as [[dementia]].<ref>Harrison's Principles of Medicine. 15th edition</ref>

===Metabolic===
[[Dehydration]] can trigger epileptic seizures if it is severe enough.<ref>{{cite web|url=http://www.epilepsysociety.org.uk/diet-and-nutrition#.VY3ny2c63cs|title=diet and nutrition|publisher=}}</ref> A number of disorders including: [[Hypoglycemia|low blood sugar]], [[hyponatremia|low blood sodium]], [[hyperosmolar nonketotic hyperglycemia]], [[hypernatremia|high blood sodium]], [[hypocalcemia|low blood calcium]] and [[uremia|high blood urea]] levels may cause seizures.<ref name=Neuro2012>{{cite book|last=Simon|first=David A. Greenberg, Michael J. Aminoff, Roger P.|title=Clinical neurology|year=2012|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-175905-2|edition=8th|chapter=12}}</ref> As may [[hepatic encephalopathy]] and the genetic disorder [[porphyria]].<ref name=Neuro2012/>

===Mass lesions===
* [[cavernoma]] or [[cavernous malformation]] is a treatable medical condition that can cause seizures, headaches, and brain hemorrhages.
* [[arteriovenous malformation]] (AVM) is a treatable medical condition that can cause seizures, headaches, and brain hemorrhages.
* space-occupying lesions in the brain ([[abscess]]es, [[tumour]]s). In people with [[brain tumour]]s, the frequency of epilepsy depends on the location of the tumor in the [[cerebral cortex|cortical region]].<ref name="pmid15187884">{{cite journal|last=Hildebrand |first=J |title=Management of epileptic seizures |journal=Curr Opin Oncol |volume=16 |issue=4 |pages=314–7 |date=July 2004 |pmid=15187884|doi=10.1097/01.cco.0000127720.17558.38}}</ref>

===Medications===
Both medication and [[drug overdose]]s can result in seizures,<ref name=Neuro2012/> as may certain medication and [[drug withdrawal]].<ref name=Neuro2012/> Common drugs involved include: [[antidepressants]], [[antipsychotics]], [[cocaine]], [[insulin]], and the [[local anaesthetic]] [[lidocaine]].<ref name=Neuro2012/> Difficulties with withdrawal seizures commonly occurs after prolonged alcohol or [[sedative]] use, a condition known as [[delerium tremens]].<ref name=Neuro2012/>

===Infections===
*Infection with the [[Taenia solium|pork tapeworm]], which can cause [[neurocysticercosis]], is the cause of up to half of epilepsy cases in areas of the world where the parasite is common.<ref name=Bh2011>{{Cite journal |last1 = Bhalla | first1 = D. | last2 = Godet | first2 = B. | last3 = Druet-Cabanac | first3 = M. |last4 = Preux | first4 = PM. | title = Etiologies of epilepsy: a comprehensive review. | journal = Expert Rev Neurother | volume = 11 | issue = 6 | pages = 861–76 |date=Jun 2011| doi = 10.1586/ern.11.51 | PMID = 21651333 }}</ref>
* parasitic infections such as cerebral malaria
* [[infection]], such as [[encephalitis]] or [[meningitis]]<ref>{{cite book | last = Carlson | first = Neil | title = Physiology of Behavior | publisher = Pearson | series = Neurological Disorders | volume = 11th edition | date = January 22, 2012 | page = 550 | isbn = 0-205-23939-0}}</ref>

===Other===
Seizures may occur as a result of [[high blood pressure]], known as [[hypertensive encephalopathy]], or in pregnancy as [[eclampsia]] when accompanied by either seizures or a decreased level of consciousness.<ref name=Neuro2012/> [[Hyperthermia|Very high body temperatures]] may also be a cause.<ref name=Neuro2012/> Typically this requires a temperature greater than {{convert|42|C|F|1}}.<ref name=Neuro2012/>
* [[traumatic brain injury|Head injury]] may cause non-epileptic [[post-traumatic seizures]] or [[post-traumatic epilepsy]]
* About 3.5 to 5.5% of people with [[celiac disease]] also have seizures.<ref>{{cite journal|last1=Bushara|first1=KO|title=Neurologic presentation of celiac disease.|journal=Gastroenterology|date=April 2005|volume=128|issue=4 Suppl 1|pages=S92-7|pmid=15825133|doi=10.1053/j.gastro.2005.02.018}}</ref>
* Seizures in a person with a [[shunt (medical)|shunt]] may indicate failure
* Hemorrhagic [[stroke]] can occasionally present with seizures, [[embolism|embolic]] strokes generally do not (though epilepsy is a common later complication); [[cerebral venous sinus thrombosis]], a rare type of stroke, is more likely to be accompanied by seizures than other types of stroke
* [[multiple sclerosis]] may cause seizures

[[Electroconvulsive therapy]] (ECT) deliberately sets out to induce a seizure for the treatment of major depression.

== Mechanism ==

<!--Same as epilepsy -->
Normally brain electrical activity is non synchronous.<ref name=Ham2010/> In epileptic seizures, due to problems within the brain,<ref name=WHO2012/> a group of neurons begin firing in an abnormal, excessive,<ref name=NChp1>{{cite book|title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care|publisher=National Clinical Guideline Centre|chapter=Chapter 1: Introduction|pages=21–28|url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf|author=National Institute for Health and Clinical Excellence|date=January 2012}}</ref> and synchronized manner.<ref name=Ham2010/> This results in a wave of depolarization known as a [[paroxysmal depolarizing shift]].<ref>{{cite book|last=Somjen|first=George G.|title=Ions in the Brain Normal Function, Seizures, and Stroke.|year=2004|publisher=Oxford University Press|location=New York|isbn=978-0-19-803459-9|page=167|url=https://books.google.com/books?id=WjSoQVt-taYC&pg=PA167}}</ref>

Normally after an [[excitatory neuron]] fires it becomes more resistant to firing for a period of time.<ref name=Ham2010/> This is due in part from the effect of inhibitory neurons, electrical changes within the excitatory neuron, and the negative effects of [[adenosine]].<ref name=Ham2010/> In epilepsy the resistance of excitatory neurons to fire during this period is decreased.<ref name=Ham2010/> This may occur due to changes in [[ion channel]]s or inhibitory neurons not functioning properly.<ref name=Ham2010/> This then results in a specific area from which seizures may develop, known as a "seizure focus".<ref name=Ham2010/> Following an injury to the brain, another mechanism of epilepsy may be the up regulation of excitatory circuits or down regulation of inhibitory circuits.<ref name=Ham2010/><ref name=Gol2013/> These secondary epilepsies occur through processes known as [[epileptogenesis]].<ref name=Ham2010/><ref name=Gol2013>{{cite journal|last=Goldberg|first=EM|author2=Coulter, DA|title=Mechanisms of epileptogenesis: a convergence on neural circuit dysfunction.|journal=Nature Reviews. Neuroscience|date=May 2013|volume=14|issue=5|pages=337–49|pmid=23595016|doi=10.1038/nrn3482|pmc=3982383}}</ref> Failure of the [[blood–brain barrier]] may also be a causal mechanism.<ref>{{cite journal|last=Oby|first=E|author2=Janigro, D|title=The blood-brain barrier and epilepsy.|journal=Epilepsia|date=Nov 2006|volume=47|issue=11|pages=1761–74|pmid=17116015|doi=10.1111/j.1528-1167.2006.00817.x}}</ref>

Focal seizures begin in one [[cerebral hemisphere|hemisphere of the brain]] while generalized seizures begin in both hemispheres.<ref name=NChp9/> Some types of seizures may change brain structure, while others appear to have little effect.<ref name=Epi2008p483>{{cite book|title=Epilepsy : a comprehensive textbook|year=2008|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5777-5|page=483|url=https://books.google.com/books?id=TwlXrOBkAS8C&pg=PA483|edition=2nd|editor1=Jerome Engel, Jr. |editor2=Timothy A. Pedley }}</ref> [[Gliosis]], neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.<ref name=Epi2008p483/>

Seizure activity may be propagated through the brain's endogenous electrical fields.<ref name=electric_field_propagation>{{ cite journal |last1 = Qiu |first1 = Chen |last2 = Shivacharan |first2 = Rajat S |last3 = Zhang |first3 = Mingming |last4 = Durand |first4 = Dominique M |year = 2015 |title = Can Neural Activity Propagate by Endogenous Electrical Field? |journal = The Journal of neuroscience : the official journal of the Society for Neuroscience |quote = electric fields can be solely responsible for spike propagation at&nbsp;... This phenomenon could be important to explain the slow propagation of epileptic activity and other normal propagations at similar speeds. |laysummary = http://www.ncbi.nlm.nih.gov/pubmed/26631463 |doi = 10.1523/JNEUROSCI.1045-15.2015|pmid = 26631463 |pages = 15800–11 |issue = 48 |volume = 35 |pmc=4666910}}</ref>

==Diagnosis==
[[File:EEG Recording Cap.jpg|thumb|An EEG can aid in locating the focus of the epileptic seizure.]]
It is important to distinguish primary seizures from secondary causes. Depending on the presumed cause [[blood tests]] and/or [[lumbar puncture]] may be useful.<ref name=AFP2012>{{cite journal|last=Wilden|first=JA|author2=Cohen-Gadol, AA|title=Evaluation of first nonfebrile seizures.|journal=American family physician|date=Aug 15, 2012|volume=86|issue=4|pages=334–40|pmid=22963022}}</ref> [[Hypoglycemia]] may cause seizures and should be ruled out. An [[electroencephalogram]] and brain imaging with [[CT scan]] or [[MRI scan]] is recommended in the work-up of seizures not associated with a fever.<ref name=AFP2012/><ref name=EB10/>

===Classification===
[[Seizure type]]s are organized by whether the source of the seizure is localized ([[focal seizures]]) or distributed ([[generalized seizure]]s) within the brain.<ref name=NChp9>{{cite book|title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care|publisher=National Clinical Guideline Centre|chapter=Chapter 9: Classification of seizures and epilepsy syndromes|pages=119–129|url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf|author=National Institute for Health and Clinical Excellence|date=January 2012}}</ref> Generalized seizures are divided according to the effect on the body and include [[Tonic-clonic seizure|tonic-clonic]] (grand mal), [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, and [[Atonic seizure|atonic]] seizures.<ref name=NChp9/><ref>{{cite book|author=Simon D. Shorvon|title=The treatment of epilepsy|year=2004|publisher=Blackwell Pub|location=Malden, Mass.|isbn=978-0-632-06046-7|edition=2nd|url=https://books.google.com/books?id=TfrwxdXcmosC&pg=PA3}}</ref> Some seizures such as [[epileptic spasms]] are of an unknown type.<ref name=NChp9/>

Focal seizures (previously called ''partial seizures''<ref name=NChp1/>) are divided into [[Simple partial seizure|simple partial]] or [[complex partial seizure]].<ref name=NChp9/> Current practice no longer recommends this, and instead prefers to describe what occurs during a seizure.<ref name=NChp9/>

===Physical examination===
[[File:Bittentongue.JPG|thumb|An individual who has bitten the tip of their tongue while having a seizure]]
Most people are in a [[postictal state]] (drowsy or confused) following a seizure. They may show signs of other injuries. A bite mark on the side of the tongue helps confirm a seizure when present, but only a third of people who have had a seizure have such a bite.<ref name=EB2014>{{cite journal|last1=Peeters|first1=SY|last2=Hoek|first2=AE|last3=Mollink|first3=SM|last4=Huff|first4=JS|title=Syncope: risk stratification and clinical decision making.|journal=Emergency medicine practice|date=April 2014|volume=16|issue=4|pages=1–22; quiz 22–3|pmid=25105200}}</ref>

===Tests===
An [[electroencephalography]] is only recommended in those who likely had an epileptic seizure and may help determine the type of seizure or syndrome present.<!-- <ref name=NChp4> --> In children it is typically only needed after a second seizure.<!-- <ref name=NChp4> --> It cannot be used to rule out the diagnosis and may be falsely positive in those without the disease.<!-- <ref name=NChp4> --> In certain situations it may be useful to prefer the EEG while sleeping or sleep deprived.<ref name=NChp4>{{cite book|title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care|publisher=National Clinical Guideline Centre|chapter=4|pages=57–83|url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf|author=National Institute for Health and Clinical Excellence|date=January 2012}}</ref>

<!-- Same as Epilepsy -->
Diagnostic imaging by [[CT scan]] and [[MRI]] is recommended after a first non-febrile seizure to detect structural problems inside the brain.<ref name=NChp4/> MRI is generally a better imaging test except when intracranial bleeding is suspected.<ref name=AFP2012/> Imaging may be done at a later point in time in those who return to their normal selves while in the emergency room.<ref name=AFP2012/> If a person has a previous diagnosis of epilepsy with previous imaging repeat imaging is not usually needed with subsequent seizures.<ref name=NChp4/>

In adults, testing electrolytes, [[blood glucose]] and calcium levels is important to rule these out as causes, as is an [[electrocardiogram]].<ref name=NChp4/> A lumbar puncture may be useful to diagnose a [[central nervous system]] infection but is not routinely needed.<ref name=AFP2012/> Routine antiseizure medical levels in the blood are not required in adults or children.<ref name=NChp4/> In children additional tests may be required.<ref name=NChp4/>

A high blood [[prolactin]] level within the first 20 minutes following a seizure may be useful to confirm an epileptic seizure as opposed to [[psychogenic non-epileptic seizure]].<ref>{{cite journal|last=Luef|first=G|title=Hormonal alterations following seizures.|journal=Epilepsy & behavior : E&B|date=October 2010|volume=19|issue=2|pages=131–3|pmid=20696621|doi=10.1016/j.yebeh.2010.06.026}}</ref><ref name=Ahmad2004>{{cite journal |vauthors=Ahmad S, Beckett MW |title=Value of serum prolactin in the management of syncope |journal=Emergency medicine journal : EMJ |volume=21 |issue=2 |pages=e3 |year=2004 |pmid=14988379 |pmc=1726305 |doi=10.1136/emj.2003.008870}}</ref> Serum prolactin level is less useful for detecting partial seizures.<ref name="pmid15256189">{{cite journal |vauthors=Shukla G, Bhatia M, Vivekanandhan S, etal |title=Serum prolactin levels for differentiation of nonepileptic versus true seizures: limited utility |journal=Epilepsy & behavior : E&B |volume=5|issue=4 |pages=517–21 |year=2004 |pmid=15256189 |doi=10.1016/j.yebeh.2004.03.004}}</ref> If it is normal an epileptic seizure is still possible<ref name=Ahmad2004/> and a serum prolactin does not separate epileptic seizures from syncope.<ref name=Chen2005>{{cite journal |vauthors=Chen DK, So YT, Fisher RS |title=Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |journal=Neurology |volume=65 |issue=5 |pages=668–75 |year=2005|pmid=16157897 |doi=10.1212/01.wnl.0000178391.96957.d0}}</ref> It is not recommended as a routine part of diagnosis epilepsy.<ref name=NChp4/>

===Differential diagnosis===
Differentiating an epileptic seizure from other conditions such as [[Syncope (medicine)|syncope]] can be difficult.<ref name=EB06/> Other possible conditions that can mimic a seizure include: [[decerebrate posturing]], [[psychogenic seizures]], [[tetanus]], [[dystonia]], [[migraine headache]]s, and [[strychnine#Symptoms|strychnine poisoning]].<ref name=EB06/> In addition, 5% of people with a positive [[tilt table test]] may have seizure-like activity that seems to be due to [[cerebral hypoxia]].<ref name="pmid12963568">{{cite journal |vauthors=Passman R, Horvath G, Thomas J, etal |title=Clinical spectrum and prevalence of neurologic events provoked by tilt table testing |journal=Arch. Intern. Med. |volume=163 |issue=16 |pages=1945–8 |year=2003|pmid=12963568 |doi=10.1001/archinte.163.16.1945}}</ref> Convulsions may occur due to psychological reasons and this is known as a [[psychogenic non-epileptic seizure]]. [[Non-epileptic seizures]] may also occur due to a number of other reasons.

==Prevention==
A number of measures have been attempted to prevent seizures in those at risk. Following [[traumatic brain injury]] anticonvulsants decrease the risk of early seizures but not late seizures.<ref>{{cite journal|last1=Weston|first1=J|last2=Greenhalgh|first2=J|last3=Marson|first3=AG|title=Antiepileptic drugs as prophylaxis for post-craniotomy seizures.|journal=The Cochrane database of systematic reviews|date=4 March 2015|issue=3|pages=CD007286|doi=10.1002/14651858.CD007286.pub3|pmid=25738821}}</ref>

In those with a history of [[febrile seizures]], medications (both [[antipyretic]]s and anticonvulsants) have not been found effective for prevention. Some, in fact, may cause harm.<ref>{{cite journal|last=Offringa|first=M|author2=Newton, R|title=Prophylactic drug management for febrile seizures in children.|journal=The Cochrane database of systematic reviews|date=Apr 18, 2012|volume=4|pages=CD003031|pmid=22513908|doi=10.1002/14651858.CD003031.pub2}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/28225210|date=May 2017}}

There is no clear evidence that antiepileptic drugs are effective or not effective at preventing seizures following a [[craniotomy]],<ref>{{Cite journal|last=Weston|first=Jennifer|last2=Greenhalgh|first2=Janette|last3=Marson|first3=Anthony G.|date=2015-03-04|title=Antiepileptic drugs as prophylaxis for post-craniotomy seizures|url=|journal=The Cochrane Database of Systematic Reviews|volume=|issue=3|pages=CD007286|doi=10.1002/14651858.CD007286.pub3|issn=1469-493X|pmid=25738821|via=}}</ref> following [[subdural hematoma]],<ref>{{cite journal|last=Ratilal|first=BO|author2=Pappamikail, L |author3=Costa, J |author4= Sampaio, C |title=Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.|journal=The Cochrane database of systematic reviews|date=Jun 6, 2013|volume=6|pages=CD004893|pmid=23744552|doi=10.1002/14651858.CD004893.pub3}}</ref> after a [[stroke]],<ref>{{cite journal|last2=Wood|first2=E|last3=Kwan|first3=J|date=24 January 2014|title=Antiepileptic drugs for the primary and secondary prevention of seizures after stroke.|journal=The Cochrane database of systematic reviews|issue=1|pages=CD005398|doi=10.1002/14651858.CD005398.pub3|pmid=24464793|last1=Sykes|first1=L}}</ref><ref>{{Cite journal|last=Price|first=Michelle|last2=Günther|first2=Albrecht|last3=Kwan|first3=Joseph S. K.|date=2016-04-21|title=Antiepileptic drugs for the primary and secondary prevention of seizures after intracranial venous thrombosis|url=|journal=The Cochrane Database of Systematic Reviews|volume=4|pages=CD005501|doi=10.1002/14651858.CD005501.pub4|issn=1469-493X|pmid=27098266|via=}}</ref>&nbsp;or after [[subarachnoid haemorrhage]],<ref>{{cite journal|last=Marigold|first=R|author2=Günther, A |author3=Tiwari, D |author4= Kwan, J |title=Antiepileptic drugs for the primary and secondary prevention of seizures after subarachnoid haemorrhage.|journal=The Cochrane database of systematic reviews|date=Jun 5, 2013|volume=6|pages=CD008710|pmid=23740537|doi=10.1002/14651858.CD008710.pub2}}</ref> for both people who have had a previous seizure, and those who have not.

==Management==
Potentially sharp or dangerous objects should be moved from the area around a person experiencing a seizure, so that the individual is not hurt. After the seizure if the person is not fully conscious and alert, they should be placed in the [[recovery position]]. A seizure longer than five minutes is a medical emergency known as [[status epilepticus]].<ref name=Trinka2012/> Contrary to a common misconception, bystanders should not attempt to force objects into the mouth of the person suffering a seizure, as doing so may cause injury to the teeth and gums.<ref>{{cite web|url=https://www.nytimes.com/2008/04/22/health/22real.html|title=The Claim: During a Seizure, You Can Swallow Your Tongue|first=Anahad|last=O’connor|date=22 April 2008|publisher=|via=NYTimes.com}}</ref>

===Medication===
The first line treatment of choice for someone who is actively seizing is a [[benzodiazepine]], most guidelines recommend [[lorazepam]].<!-- <ref name=EB10/> --> This may be repeated if there is no effect after 10 minutes.<!-- <ref name=EB10/> --> If there is no effect after two doses, [[barbiturate]]s or [[propofol]] may be used.<ref name=EB10/> Benzodiazepines given by a non-intravenous route appear to be better than those given by intravenous as the intravenous takes time to start.<ref>{{cite journal|last1=Alshehri|first1=A|last2=Abulaban|first2=A|last3=Bokhari|first3=R|last4=Kojan|first4=S|last5=Alsalamah|first5=M|last6=Ferwana|first6=M|last7=Murad|first7=MH|title=Intravenous versus Non-Intravenous Benzodiazepines for the Abortion of Seizures: A Systematic Review and Meta-analysis of Randomized Controlled Trials.|journal=Academic emergency medicine : official journal of the Society for Academic Emergency Medicine|date=25 March 2017|pmid=28342192}}</ref>

Ongoing anti-epileptic medications are not typically recommended after a first seizure except in those with structural lesions in the brain.<ref name=EB10/> They are generally recommended after a second one has occurred.<ref name=EB10/> Approximately 70% of people can obtain full control with continuous use of medication.<ref name=WHO2009/> Typically one type of anticonvulsant is preferred. Following a first seizure, while immediate treatment with an anti-seizure drug lowers the probability of seizure recurrence up to five years it does not change the risk of death and there are potential side effects.<ref>{{cite journal|last1=Leone|first1=MA|last2=Giussani|first2=G|last3=Nolan|first3=SJ|last4=Marson|first4=AG|last5=Beghi|first5=E|title=Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure.|journal=The Cochrane database of systematic reviews|date=6 May 2016|volume=5|pages=CD007144|doi=10.1002/14651858.CD007144.pub2|url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007144.pub2/full|pmid= 27150433|accessdate=6 June 2016}}</ref>

In seizures related to toxins, up to two doses of benzodiazepines should be used.<!-- <ref name=Tox2011/> --> If this is not effective [[pyridoxine]] is recommended.<!-- <ref name=Tox2011/> --> [[Phenytoin]] should generally not be used.<ref name=Tox2011>{{cite journal|last=Sharma|first=AN|author2=Hoffman, RJ|title=Toxin-related seizures.|journal=Emergency medicine clinics of North America|date=Feb 2011|volume=29|issue=1|pages=125–39|pmid=21109109|doi=10.1016/j.emc.2010.08.011}}</ref>

There is a lack of evidence for preventative anti epileptic medications in the management of seizures, primary or secondary to [[intracranial venous thrombosis]].<ref>{{Cite journal|title=Antiepileptic drugs for the primary and secondary prevention of seizures after intracranial venous thrombosis|url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005501.pub3/full|doi=10.1002/14651858.cd005501.pub3 | journal=Cochrane Database of Systematic Reviews|pmid=25086250|issue=8|author=Price M, Günther A, Kwan JS|page=CD005501}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/27098266|date=May 2017}}

===Other===
Helmets may be used to provide protection to the head during a seizure. Some claim that [[seizure response dog]]s, a form of [[service dog]], can predict seizures.<!-- <ref name=Doh2007/> --> Evidence for this, however, is poor.<ref name=Doh2007>{{cite journal|last=Doherty|first=MJ|author2=Haltiner, AM|title=Wag the dog: skepticism on seizure alert canines.|journal=Neurology|date=Jan 23, 2007|volume=68|issue=4|pages=309|pmid=17242343|doi=10.1212/01.wnl.0000252369.82956.a3}}</ref> At present there is not enough evidence to support the use of [[cannabis (drug)|cannabis]] for the management of seizures, although this is an ongoing area of research.<ref>{{cite journal|last1=Gloss|first1=D|last2=Vickrey|first2=B|title=Cannabinoids for epilepsy|journal=The Cochrane database of systematic reviews|date=5 March 2014|volume=3|pages=CD009270|pmid=24595491|doi=10.1002/14651858.CD009270.pub3}}</ref><ref>{{cite journal|last1=Belendiuk|first1=KA|last2=Baldini|first2=LL|last3=Bonn-Miller|first3=MO|title=Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders.|journal=Addiction science & clinical practice|date=21 April 2015|volume=10|issue=1|pages=10|pmid=25896576|doi=10.1186/s13722-015-0032-7|pmc=4636852}}</ref> There is tentative evidence that a [[ketogenic diet]] may help in those who have epilepsy and is reasonable in those who do not improve following typical treatments.<ref>{{cite journal|last1=Martin|first1=K|last2=Jackson|first2=CF|last3=Levy|first3=RG|last4=Cooper|first4=PN|title=Ketogenic diet and other dietary treatments for epilepsy.|journal=The Cochrane database of systematic reviews|date=9 February 2016|volume=2|pages=CD001903|pmid=26859528|doi=10.1002/14651858.CD001903.pub3}}</ref>

==Prognosis==
Following a first seizure, the risk of more seizures in the next two years is 40%–50%.<ref name=AFP2012/> The greatest predictors of more seizures are problems either on the electroencephalogram or on imaging of the brain.<ref name=AFP2012/> In adults, after 6 months of being seizure-free after a first seizure, the risk of a subsequent seizure in the next year is less than 20% regardless of treatment.<ref>{{cite journal|last=Bonnett|first=LJ|author2=Tudur-Smith, C |author3=Williamson, PR |author4=Marson, AG |title=Risk of recurrence after a first seizure and implications for driving: further analysis of the Multicentre study of early Epilepsy and Single Seizures|journal=BMJ (Clinical research ed.)|date=2010-12-07|volume=341|pages=c6477|pmid=21147743|pmc=2998675|doi=10.1136/bmj.c6477}}</ref> Up to 7% of seizures that present to the emergency department (ER) are in status epilepticus.<ref name=EB10>{{cite web |url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=212 |title=Current Guidelines For Management Of Seizures In The Emergency Department |format=PDF |work= |accessdate=}}</ref> In those with a status epilepticus, mortality is between 10% and 40%.<ref name=EB06/> Those who have a seizure that is provoked (occurring close in time to an acute brain event or toxic exposure) have a low risk of re-occurrence, but have a higher risk of death compared to those with epilepsy.<ref name=Nel2012>{{cite journal|last=Neligan|first=A|author2=Hauser, WA |author3=Sander, JW |title=The epidemiology of the epilepsies.|journal=Handbook of clinical neurology|year=2012|volume=107|pages=113–33|pmid=22938966|doi=10.1016/B978-0-444-52898-8.00006-9}}</ref>

==Epidemiology==
5–10% of people who live to 80&nbsp;years old have at least one epileptic seizure<ref name=AFP2012/><ref name=angusbmj2014>{{cite journal | journal = BMJ | author = Angus-Leppan H | title = First seizures in adults | year = 2014 | volume = 348 | page = g2470 | doi = 10.1136/bmj.g2470 | pmid = 24736280}}</ref> and the chance of experiencing a second seizure is between 40% and 50%.<ref name=Berg2008/> About 0.7% in the general population of the United States go to an emergency department after a seizure in a given year,<ref name=EB06/> 7% of them with status epilepticus.<ref name = emcna2011>{{cite journal |vauthors=Martindale JL, Goldstein JN, Pallin DJ |title=Emergency department seizure epidemiology |journal=Emerg. Med. Clin. North Am. |volume=29 |issue=1 |pages=15–27 |year=2011 |pmid=21109099 |doi=10.1016/j.emc.2010.08.002 }}</ref> Known epilepsy though is an uncommon cause of seizures in the emergency department, accounting for a minority of seizure-related visits.<ref name = emcna2011/> About 50% of patients with an unprovoked apparent "first seizure" have had other minor seizures, so their diagnosis is epilepsy.<ref name=angusbmj2014/>

==History==
The word epilepsy derives from the Greek word for "attack."<ref>{{cite web|title=Epilepsy (Seizure Disorder)|url=http://www.medicinenet.com/seizure/article.htm|accessdate=30 March 2012}}</ref> Seizures were long viewed as an otherworldly condition and this view was seen by [[Hippocrates]] (400 BC) as treating it as a ''sacred disease'' which he wrote about and concluded that it had natural causes just as other diseases did.<ref name=EB06>{{cite web|last=Shearer|first=Peter|title=Seizures and Status Epilepticus: Diagnosis and Management in the Emergency Department|url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=77|work=Emergency Medicine Practice}}</ref><ref>{{cite web | title=On the Sacred Disease|url=http://classics.mit.edu/Hippocrates/sacred.html}}</ref>

<!--Medication -->
In the mid 1800s the first anti seizure medication, [[bromide]], was introduced.<ref>{{cite journal|last=Perucca|first=P|author2=Gilliam, FG|title=Adverse effects of antiepileptic drugs.|journal=Lancet neurology|date=September 2012|volume=11|issue=9|pages=792–802|pmid=22832500|doi=10.1016/S1474-4422(12)70153-9}}</ref>

<!--Classification -->
Following standardization proposals devised by [[Henri Gastaut]] and published in 1970,<ref name="Gastaut1970">{{cite journal | author = Gastaut H | title = Clinical and electroencephalographical classification of epileptic seizures. | journal = Epilepsia |volume = 11 | issue = 1 | pages = 102–13 | year = 1970 | pmid = 5268244 | doi = 10.1111/j.1528-1157.1970.tb03871.x}}</ref> terms such as "petit mal", "grand mal", "Jacksonian", "psychomotor", and "temporal-lobe seizure" have fallen into disuse.

==Society and culture==

===Economics===
<!--Same as section at Epilepsy -->
Seizures result in direct economic costs of about one billion dollars in the United States.<ref name=AFP2012/> Epilepsy results in economic costs in Europe of around 15.5 billion Euros in 2004.<ref name=NChp1/> In India, epilepsy is estimated to result in costs of 1.7&nbsp;billion USD or 0.5% of the GDP.<ref name=WHO2012>{{cite web | url=http://www.who.int/mediacentre/factsheets/fs999/en/ | title = Epilepsy |series = Fact Sheets |date =October 2012 | accessdate = January 24, 2013 | publisher =[[World Health Organization]]}}</ref> They make up about 1% of emergency department visits (2% for emergency departments for children) in the United States.<ref name = emcna2011/>

===Driving===
Many areas of the world require a minimum of six months from the last seizure before people can drive a vehicle.<ref name=AFP2012/>

==Research==
Scientific work into the prediction of epileptic seizures began in the 1970s. Several techniques and methods have been proposed, but evidence regarding their usefulness is still lacking.<ref>{{cite journal |vauthors=Litt B, Echauz J |title=Prediction of epileptic seizures|journal=Lancet Neurol |volume=1 |issue=1 |pages=22–30 |date=May 2002 |pmid=12849542|doi=10.1016/S1474-4422(02)00003-0}}</ref>

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==參考資料==
==參考資料==
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== 外部連結 ==
{{Medical resources
| DiseasesDB = 19011
| ICD10 = {{ICD10|G|40||g|40}}, {{ICD10|P|90||p|90}}, {{ICD10|R|56||r|56}}
| ICD9 = {{ICD9|345.9}}, {{ICD9|780.3}}
| ICDO =
| OMIM =
| MedlinePlus =003200
| eMedicineSubj = neuro
| eMedicineTopic = 415
| eMedicine_mult = {{eMedicine2|neuro|694}}
| MeshID = D012640
}}
{{Wiktionary}}
* {{dmoz|Health/Conditions_and_Diseases/Neurological_Disorders/Epilepsy/}}

{{General symptoms and signs}}
{{Seizures and epilepsy}}

{{DEFAULTSORT:Epileptic Seizure}}
[[Category:Epilepsy|*]]
[[Category:Symptoms and signs: General]]
{{portal bar|醫學|神經科學|生物}}

2017年7月23日 (日) 02:29的版本

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。
  关于与「癲癇發作」標題相近或相同的条目页，請見「癲癇」。
癲癇發作
Epileptic seizure
同义词Epileptic fit, seizure, fit
Generalized 3 Hz spike and wave discharges in EEG
分类和外部资源
醫學專科神經內科
ICD-10G40、​P90、​R56
DiseasesDB19011
MedlinePlus003200
eMedicine1184846、​1609294
[编辑此条目的维基数据]

癲癇發作 （英文：epileptic seizure, also known as an epileptic fit, seizure or fit） 是因為腦中的過度的神经振荡而出現的醫學徵狀或症狀。 [1]

已隱藏部分未翻譯内容，歡迎參與翻譯。

An epileptic seizure, also known as an epileptic fit, seizure or fit, is a brief episode of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.[1] The outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness (absence seizure). Diseases of the brain characterized by an enduring predisposition to generate epileptic seizures are collectively called epilepsy.[1][2] Seizures can also occur in people who do not have epilepsy for various reasons including brain trauma, drug use, elevated body temperature, low blood sugar and low levels of oxygen. Additionally, there are a number of conditions that look like epileptic seizures but are not. A first seizure generally does not require long term treatment with anti-seizure medications unless there is a specific problem on either electroencephalogram or brain imaging.[3] 5–10% of people who live to 80 years old have at least one epileptic seizure[3] and the chance of experiencing a second seizure is between 40% and 50%.[4] About 50% of patients with an unprovoked apparent "first seizure" have had other minor seizures, so their diagnosis is epilepsy.[5] Epilepsy affects about 1% of the population currently[6] and affected about 4% of the population at some point in time.[3] Most of those affected—nearly 80%—live in developing countries.[6]


Signs and symptoms

参见：Seizure types

The signs and symptoms of seizures vary depending on the type.[7] The most common type of seizure is convulsive (60%).[8] Two-thirds of these begin as focal seizures and become generalized while one third begin as generalized seizures.[8] The remaining 40% of seizures are non-convulsive, an example of which is absence seizure.[9]

Focal seizures

Focal seizures are often preceded by certain experiences, known as an aura.[7] These may include: sensory, visual, psychic, autonomic, olfactory or motor phenomena.[10]

In a complex partial seizure a person may appear confused or dazed and can not respond to questions or direction. Focal seizure may become generalized.[10]

Jerking activity may start in a specific muscle group and spread to surrounding muscle groups—known as a Jacksonian march.[11] Unusual activities that are not consciously created may occur.[11] These are known as automatisms and include simple activities like smacking of the lips or more complex activities such as attempts to pick something up.[11]

Generalized seizures

There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures.[12] They all involve a loss of consciousness and typically happen without warning.[13]

  • Tonic-clonic seizures present with a contraction of the limbs followed by their extension, along with arching of the back for 10–30 seconds.[13] A cry may be heard due to contraction of the chest muscles.[13] The limbs then begin to shake in unison.[13] After the shaking has stopped it may take 10–30 minutes for the person to return to normal.[13]
  • Tonic seizures produce constant contractions of the muscles.[13] The person may turn blue if breathing is impaired.[13]
  • Clonic seizures involve shaking of the limbs in unison.[13]
  • Myoclonic seizures involve spasms of muscles in either a few areas or generalized through the body.[13]
  • Absence seizures can be subtle, with only a slight turn of the head or eye blinking.[10] The person often does not fall over and may return to normal right after the seizure ends, though there may also be a period of post-ictal disorientation.[10]
  • Atonic seizures involve the loss of muscle activity for greater than one second.[11] This typically occurs bilaterally (on both sides of the body).[11]

Duration

A seizure can last from a few seconds to more than five minutes, at which point it is known as status epilepticus.[14] Most tonic-clonic seizures last less than two or three minutes.[14] Absence seizures are usually around 10 seconds in duration.[9]

Postictal

After the active portion of a seizure, there is typically a period of confusion called the postictal period before a normal level of consciousness returns.[7] This usually lasts 3 to 15 minutes[15] but may last for hours.[16] Other common symptoms include: feeling tired, headache, difficulty speaking, and abnormal behavior.[16] Psychosis after a seizure is relatively common, occurring in between 6 and 10% of people.[17] Often people do not remember what occurred during this time.[16]

Causes

主条目：Causes of seizures

Seizures have a number of causes. Of those with seizure about 25% have epilepsy.[18] A number of conditions are associated with seizures but are not epilepsy including: most febrile seizures and those that occur around an acute infection, stroke, or toxicity.[19] These seizures are known as "acute symptomatic" or "provoked" seizures and are part of the seizure-related disorders.[19] In many the cause is unknown.

Different causes of seizures are common in certain age groups.

  • During the neonatal period and early infancy the most common causes include hypoxic ischemic encephalopathy, central nervous system (CNS) infections, trauma, congenital CNS abnormalities, and metabolic disorders.
  • The most frequent cause of seizures in children is febrile seizures, which happen in 2–5% of children between the ages of six months and five years.[20]
  • During childhood, well-defined epilepsy syndromes are generally seen.
  • In adolescence and young adulthood, non-compliance with the medication regimen and sleep deprivation are potential triggers.
  • Pregnancy and labor and childbirth, and the post-partum, or post-natal period (after birth) can be at-risk times, especially if there are certain complications like pre-eclampsia.
  • During adulthood, the likely causes are alcohol related, strokes, trauma, CNS infections, and brain tumors.[21]
  • In older adults, cerebrovascular disease is a very common cause. Other causes are CNS tumors, head trauma, and other degenerative diseases that are common in the older age group, such as dementia.[22]

Metabolic

Dehydration can trigger epileptic seizures if it is severe enough.[23] A number of disorders including: low blood sugar, low blood sodium, hyperosmolar nonketotic hyperglycemia, high blood sodium, low blood calcium and high blood urea levels may cause seizures.[13] As may hepatic encephalopathy and the genetic disorder porphyria.[13]

Mass lesions

Medications

Both medication and drug overdoses can result in seizures,[13] as may certain medication and drug withdrawal.[13] Common drugs involved include: antidepressants, antipsychotics, cocaine, insulin, and the local anaesthetic lidocaine.[13] Difficulties with withdrawal seizures commonly occurs after prolonged alcohol or sedative use, a condition known as delerium tremens.[13]

Infections

Other

Seizures may occur as a result of high blood pressure, known as hypertensive encephalopathy, or in pregnancy as eclampsia when accompanied by either seizures or a decreased level of consciousness.[13] Very high body temperatures may also be a cause.[13] Typically this requires a temperature greater than 42 °C（107.6 °F）.[13]

Electroconvulsive therapy (ECT) deliberately sets out to induce a seizure for the treatment of major depression.

Mechanism

Normally brain electrical activity is non synchronous.[10] In epileptic seizures, due to problems within the brain,[28] a group of neurons begin firing in an abnormal, excessive,[8] and synchronized manner.[10] This results in a wave of depolarization known as a paroxysmal depolarizing shift.[29]

Normally after an excitatory neuron fires it becomes more resistant to firing for a period of time.[10] This is due in part from the effect of inhibitory neurons, electrical changes within the excitatory neuron, and the negative effects of adenosine.[10] In epilepsy the resistance of excitatory neurons to fire during this period is decreased.[10] This may occur due to changes in ion channels or inhibitory neurons not functioning properly.[10] This then results in a specific area from which seizures may develop, known as a "seizure focus".[10] Following an injury to the brain, another mechanism of epilepsy may be the up regulation of excitatory circuits or down regulation of inhibitory circuits.[10][30] These secondary epilepsies occur through processes known as epileptogenesis.[10][30] Failure of the blood–brain barrier may also be a causal mechanism.[31]

Focal seizures begin in one hemisphere of the brain while generalized seizures begin in both hemispheres.[12] Some types of seizures may change brain structure, while others appear to have little effect.[32] Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.[32]

Seizure activity may be propagated through the brain's endogenous electrical fields.[33]

Diagnosis

An EEG can aid in locating the focus of the epileptic seizure.

It is important to distinguish primary seizures from secondary causes. Depending on the presumed cause blood tests and/or lumbar puncture may be useful.[3] Hypoglycemia may cause seizures and should be ruled out. An electroencephalogram and brain imaging with CT scan or MRI scan is recommended in the work-up of seizures not associated with a fever.[3][34]

Classification

Seizure types are organized by whether the source of the seizure is localized (focal seizures) or distributed (generalized seizures) within the brain.[12] Generalized seizures are divided according to the effect on the body and include tonic-clonic (grand mal), absence (petit mal), myoclonic, clonic, tonic, and atonic seizures.[12][35] Some seizures such as epileptic spasms are of an unknown type.[12]

Focal seizures (previously called partial seizures[8]) are divided into simple partial or complex partial seizure.[12] Current practice no longer recommends this, and instead prefers to describe what occurs during a seizure.[12]

Physical examination

An individual who has bitten the tip of their tongue while having a seizure

Most people are in a postictal state (drowsy or confused) following a seizure. They may show signs of other injuries. A bite mark on the side of the tongue helps confirm a seizure when present, but only a third of people who have had a seizure have such a bite.[36]

Tests

An electroencephalography is only recommended in those who likely had an epileptic seizure and may help determine the type of seizure or syndrome present. In children it is typically only needed after a second seizure. It cannot be used to rule out the diagnosis and may be falsely positive in those without the disease. In certain situations it may be useful to prefer the EEG while sleeping or sleep deprived.[37]

Diagnostic imaging by CT scan and MRI is recommended after a first non-febrile seizure to detect structural problems inside the brain.[37] MRI is generally a better imaging test except when intracranial bleeding is suspected.[3] Imaging may be done at a later point in time in those who return to their normal selves while in the emergency room.[3] If a person has a previous diagnosis of epilepsy with previous imaging repeat imaging is not usually needed with subsequent seizures.[37]

In adults, testing electrolytes, blood glucose and calcium levels is important to rule these out as causes, as is an electrocardiogram.[37] A lumbar puncture may be useful to diagnose a central nervous system infection but is not routinely needed.[3] Routine antiseizure medical levels in the blood are not required in adults or children.[37] In children additional tests may be required.[37]

A high blood prolactin level within the first 20 minutes following a seizure may be useful to confirm an epileptic seizure as opposed to psychogenic non-epileptic seizure.[38][39] Serum prolactin level is less useful for detecting partial seizures.[40] If it is normal an epileptic seizure is still possible[39] and a serum prolactin does not separate epileptic seizures from syncope.[41] It is not recommended as a routine part of diagnosis epilepsy.[37]

Differential diagnosis

Differentiating an epileptic seizure from other conditions such as syncope can be difficult.[7] Other possible conditions that can mimic a seizure include: decerebrate posturing, psychogenic seizures, tetanus, dystonia, migraine headaches, and strychnine poisoning.[7] In addition, 5% of people with a positive tilt table test may have seizure-like activity that seems to be due to cerebral hypoxia.[42] Convulsions may occur due to psychological reasons and this is known as a psychogenic non-epileptic seizure. Non-epileptic seizures may also occur due to a number of other reasons.

Prevention

A number of measures have been attempted to prevent seizures in those at risk. Following traumatic brain injury anticonvulsants decrease the risk of early seizures but not late seizures.[43]

In those with a history of febrile seizures, medications (both antipyretics and anticonvulsants) have not been found effective for prevention. Some, in fact, may cause harm.[44][已过时]

There is no clear evidence that antiepileptic drugs are effective or not effective at preventing seizures following a craniotomy,[45] following subdural hematoma,[46] after a stroke,[47][48] or after subarachnoid haemorrhage,[49] for both people who have had a previous seizure, and those who have not.

Management

Potentially sharp or dangerous objects should be moved from the area around a person experiencing a seizure, so that the individual is not hurt. After the seizure if the person is not fully conscious and alert, they should be placed in the recovery position. A seizure longer than five minutes is a medical emergency known as status epilepticus.[14] Contrary to a common misconception, bystanders should not attempt to force objects into the mouth of the person suffering a seizure, as doing so may cause injury to the teeth and gums.[50]

Medication

The first line treatment of choice for someone who is actively seizing is a benzodiazepine, most guidelines recommend lorazepam. This may be repeated if there is no effect after 10 minutes. If there is no effect after two doses, barbiturates or propofol may be used.[34] Benzodiazepines given by a non-intravenous route appear to be better than those given by intravenous as the intravenous takes time to start.[51]

Ongoing anti-epileptic medications are not typically recommended after a first seizure except in those with structural lesions in the brain.[34] They are generally recommended after a second one has occurred.[34] Approximately 70% of people can obtain full control with continuous use of medication.[6] Typically one type of anticonvulsant is preferred. Following a first seizure, while immediate treatment with an anti-seizure drug lowers the probability of seizure recurrence up to five years it does not change the risk of death and there are potential side effects.[52]

In seizures related to toxins, up to two doses of benzodiazepines should be used. If this is not effective pyridoxine is recommended. Phenytoin should generally not be used.[53]

There is a lack of evidence for preventative anti epileptic medications in the management of seizures, primary or secondary to intracranial venous thrombosis.[54][已过时]

Other

Helmets may be used to provide protection to the head during a seizure. Some claim that seizure response dogs, a form of service dog, can predict seizures. Evidence for this, however, is poor.[55] At present there is not enough evidence to support the use of cannabis for the management of seizures, although this is an ongoing area of research.[56][57] There is tentative evidence that a ketogenic diet may help in those who have epilepsy and is reasonable in those who do not improve following typical treatments.[58]

Prognosis

Following a first seizure, the risk of more seizures in the next two years is 40%–50%.[3] The greatest predictors of more seizures are problems either on the electroencephalogram or on imaging of the brain.[3] In adults, after 6 months of being seizure-free after a first seizure, the risk of a subsequent seizure in the next year is less than 20% regardless of treatment.[59] Up to 7% of seizures that present to the emergency department (ER) are in status epilepticus.[34] In those with a status epilepticus, mortality is between 10% and 40%.[7] Those who have a seizure that is provoked (occurring close in time to an acute brain event or toxic exposure) have a low risk of re-occurrence, but have a higher risk of death compared to those with epilepsy.[60]

Epidemiology

5–10% of people who live to 80 years old have at least one epileptic seizure[3][5] and the chance of experiencing a second seizure is between 40% and 50%.[4] About 0.7% in the general population of the United States go to an emergency department after a seizure in a given year,[7] 7% of them with status epilepticus.[21] Known epilepsy though is an uncommon cause of seizures in the emergency department, accounting for a minority of seizure-related visits.[21] About 50% of patients with an unprovoked apparent "first seizure" have had other minor seizures, so their diagnosis is epilepsy.[5]

History

The word epilepsy derives from the Greek word for "attack."[61] Seizures were long viewed as an otherworldly condition and this view was seen by Hippocrates (400 BC) as treating it as a sacred disease which he wrote about and concluded that it had natural causes just as other diseases did.[7][62]

In the mid 1800s the first anti seizure medication, bromide, was introduced.[63]

Following standardization proposals devised by Henri Gastaut and published in 1970,[64] terms such as "petit mal", "grand mal", "Jacksonian", "psychomotor", and "temporal-lobe seizure" have fallen into disuse.

Society and culture

Economics

Seizures result in direct economic costs of about one billion dollars in the United States.[3] Epilepsy results in economic costs in Europe of around 15.5 billion Euros in 2004.[8] In India, epilepsy is estimated to result in costs of 1.7 billion USD or 0.5% of the GDP.[28] They make up about 1% of emergency department visits (2% for emergency departments for children) in the United States.[21]

Driving

Many areas of the world require a minimum of six months from the last seizure before people can drive a vehicle.[3]

Research

Scientific work into the prediction of epileptic seizures began in the 1970s. Several techniques and methods have been proposed, but evidence regarding their usefulness is still lacking.[65]

參考資料

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外部連結

分類
編輯維基數據鏈接
外部資源
查看维基词典中的词条「癲癇發作」。
体温
热：
冷：
疼痛
不适与疲倦
其他
基本
治療
生活的不便（英语：Issues for people with epilepsy）
癲癇的類別（英语：Seizure types）
聚焦式癲癇發作（英语：Focal seizure）
總體
脑痫重積狀態
肌陣攣性脑痫（英语：Myoclonic epilepsy）
假性脑痫（英语：Non-epileptic seizure）
相關疾病
脑痫支持性團體組織
检索自“https://zh.wikipedia.org/w/index.php?title=癲癇發作&oldid=45324059”