Editing Epilepsy (section)

==Signs and symptoms==
[[File:Attaque; Periode Epileptoide. Planche XVII. Wellcome L0074938.jpg|thumb|upright=1.4|A still image of a generalized seizure]]
Epilepsy is characterized by a long-term tendency to experience recurrent, unprovoked seizures.<ref name="Adult2006">{{cite journal |vauthors=Duncan JS, Sander JW, Sisodiya SM, Walker MC |date=April 2006 |title=Adult epilepsy |journal=Lancet |volume=367 |issue=9516 |pages=1087–1100 |doi=10.1016/S0140-6736(06)68477-8 |pmid=16581409}}</ref> They may vary widely in their presentation depending on the affected brain regions, age of onset, and type of epilepsy.<ref name="Adult2006" /><ref name="National Clinical Guideline 21_28">{{cite book |author=National Clinical Guideline Centre |url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care |date=January 2012 |publisher=National Institute for Health and Clinical Excellence |pages=21–28 |archive-url=https://web.archive.org/web/20131216151008/http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |archive-date=16 December 2013 |url-status=live}}</ref>

===Seizures===
{{Main|Epileptic seizure}}
According to the 2025 classification by the [[International League Against Epilepsy]] (ILAE), seizures are grouped into four main classes: focal, generalized, unknown (whether focal or generalized), and unclassified.<ref name="Beniczky2025">{{Cite journal |last1=Beniczky |first1=Sándor |last2=Trinka |first2=Eugen |last3=Wirrell |first3=Elaine |last4=Abdulla |first4=Fatema |last5=Al Baradie |first5=Raidah |last6=Alonso Vanegas |first6=Mario |last7=Auvin |first7=Stéphane |last8=Singh |first8=Mamta Bhushan |last9=Blumenfeld |first9=Hal |last10=Bogacz Fressola |first10=Alicia |last11=Caraballo |first11=Roberto |last12=Carreno |first12=Mar |last13=Cendes |first13=Fernando |last14=Charway |first14=Augustina |last15=Cook |first15=Mark |date=2025-04-23 |title=Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy |journal=Epilepsia |language=en |doi=10.1111/epi.18338 |pmid=40264351 |issn=0013-9580|doi-access=free }}</ref>

==== Focal seizures ====
[[Focal seizure|Focal seizures]] originate in one [[Cerebral hemisphere|hemisphere]] of the brain and may involve localized or distributed networks.<ref name="Berg2010">{{Cite journal |last1=Berg |first1=Anne T. |last2=Berkovic |first2=Samuel F. |last3=Brodie |first3=Martin J. |last4=Buchhalter |first4=Jeffrey |last5=Cross |first5=J. Helen |last6=Van Emde Boas |first6=Walter |last7=Engel |first7=Jerome |last8=French |first8=Jacqueline |last9=Glauser |first9=Tracy A. |last10=Mathern |first10=Gary W. |last11=Moshé |first11=Solomon L. |last12=Nordli |first12=Douglas |last13=Plouin |first13=Perrine |last14=Scheffer |first14=Ingrid E. |date=2010 |title=Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009 |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2010.02522.x |journal=Epilepsia |language=en |volume=51 |issue=4 |pages=676–685 |doi=10.1111/j.1528-1167.2010.02522.x |pmid=20196795 |issn=1528-1167|url-access=subscription }}</ref> For a given seizure type, the site of onset tends to be consistent across episodes. Once initiated, the seizure may remain localized or spread to adjacent areas, and in some cases, may propagate to the opposite hemisphere (contralateral spread).<ref name="Beniczky2025" />

They are further classified based on the state of consciousness during the episode:<ref name="Beniczky2025" />

* Focal preserved consciousness seizure: the person remains aware and responsive.
* Focal impaired consciousness seizure: awareness and/or responsiveness are affected.

Certain experiences, known as [[Aura (symptom)|auras]] often precede focal seizures.<ref name="EB06">{{cite web |title=Seizures and Status Epilepticus: Diagnosis and Management in the Emergency Department |url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=77 |url-status=live |archive-url=https://web.archive.org/web/20101230141114/https://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=77 |archive-date=30 December 2010 |work=Emergency Medicine Practice |vauthors=Shearer P}}</ref> The seizures can include sensory (visual, hearing, or smell), psychic, autonomic, and motor phenomena depending on which part of the brain is involved.<ref name="Ham2010" /> Muscle jerks may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a [[Jacksonian march]].<ref name="Brad2012">{{cite book |title=Bradley's neurology in clinical practice. |vauthors=Bradley WG |publisher=Elsevier/Saunders |year=2012 |isbn=978-1-4377-0434-1 |edition=6th |location=Philadelphia, PA |chapter=67}}</ref>[[Automatism (medicine)|Automatisms]] may occur, which are non-consciously generated activities and mostly simple repetitive movements like smacking the lips or more complex activities such as attempts to pick up something.<ref name="Brad2012" /> Some focal seizures can evolve into focal-to-bilateral [[Generalized tonic–clonic seizure|tonic-clonic seizures]], where abnormal brain activity spreads to both hemispheres.<ref name="Beniczky2025" />

==== Generalized seizures ====
Generalized seizures originate at a specific point within, and quickly spread across both hemispheres through interconnected brain networks. Although the spread is rapid, the onset may appear asymmetric in some cases. These seizures typically impair consciousness from the outset and can take several forms, including:<ref name="Beniczky2025" />

* [[Generalized tonic–clonic seizure|Generalized tonic–clonic seizures]], often with an initial tonic phase followed by clonic jerking;
* [[Absence seizures]], which may present with eye blinking or automatisms;
* Other generalized seizures, a category that includes [[Tonic seizure|tonic]], [[Clonic seizure|clonic]], [[Myoclonus|myoclonic]], [[atonic seizure]]s and epileptic spasms.<ref name="National Clinical Guideline 119_1292">{{cite book |author=National Clinical Guideline Centre |url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care |date=January 2012 |publisher=National Institute for Health and Clinical Excellence |pages=119–129 |archive-url=https://web.archive.org/web/20131216151008/http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |archive-date=16 December 2013 |url-status=live}}</ref>

Tonic–clonic seizures are among the most recognizable seizure types, typically involving sudden loss of consciousness, stiffening (tonic phase), and rhythmic jerking (clonic phase) of the limbs.<ref name="Engel2008pg2797">{{cite book |url=https://books.google.com/books?id=6Kq4Zt2KOpcC&pg=PA2797 |title=Epilepsy: a comprehensive textbook |vauthors=Engel J |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |year=2008 |isbn=978-0-7817-5777-5 |edition=2nd |location=Philadelphia |page=2797 |archive-url=https://web.archive.org/web/20160520033255/https://books.google.com/books?id=6Kq4Zt2KOpcC&pg=PA2797 |archive-date=20 May 2016 |url-status=live}}</ref> This form of seizure — whether focal to bilateral, generalized, or of unknown onset — is given particular emphasis due to their clinical severity; they are associated with the highest risk of injury, medical complications, and [[sudden unexpected death in epilepsy]] (SUDEP).<ref name="Beniczky2025" />

Myoclonic seizures involve sudden, brief muscle jerks, which may affect specific muscle groups or the whole body.<ref name="Neuro2012">{{cite book |title=Clinical neurology |vauthors=Simon DA, Greenberg MJ, Aminoff RP |publisher=McGraw-Hill Medical |year=2012 |isbn=978-0-07-175905-2 |edition=8th |location=New York |chapter=12}}</ref><ref name="Stephenson1990">{{Cite book |url=https://www.worldcat.org/oclc/25711319 |title=Fits and faints |vauthors=Stephenson JB |date=1990 |publisher=Mac Keith Press |isbn=0-632-02811-4 |location=London |oclc=25711319}}</ref> They can cause falls and injury.<ref name="Neuro2012" /> Absence seizures are characterized by brief lapses in awareness, sometimes accompanied by subtle movements such as blinking or slight head turning.<ref name="Ham2010" /> The person typically recovers immediately afterward without confusion. Atonic seizures involve a sudden loss of muscle tone, often resulting in falls.<ref name="Brad2012" />

==== Triggers and reflex seizures ====
Certain external or internal factors may increase the likelihood of a seizure in individuals with epilepsy. These triggers do not cause epilepsy but can lower the seizure threshold in people who are already susceptible. Common triggers include [[sleep deprivation]], [[Stress (biology)|stress]], fever, illness, [[Catamenial epilepsy|menstruation]], alcohol, and certain medications. These do not cause seizures by themselves, but lower the threshold in people who are already susceptible.

A small subset of individuals have [[Reflex seizure|reflex epilepsy]], in which seizures are reliably provoked by specific stimuli. These reflex seizures account for about 6% of epilepsy cases.<ref name="Xue2006">{{cite journal |vauthors=Xue LY, Ritaccio AL |date=March 2006 |title=Reflex seizures and reflex epilepsy |journal=American Journal of Electroneurodiagnostic Technology |volume=46 |issue=1 |pages=39–48 |doi=10.1080/1086508X.2006.11079556 |pmid=16605171}}</ref><ref name="Reflex2008">{{cite book|title=Behavioral aspects of epilepsy: principles and practice|year=2008|publisher=Demos|location=New York|isbn=978-1-933864-04-4|page=125|url=https://books.google.com/books?id=a6Ygv5_RKKsC&pg=PA125|edition=[Online-Ausg.].|editor=Steven C. Schachter }}</ref> Common triggers include flashing lights ([[photosensitive epilepsy]]), sudden sounds, or specific cognitive tasks such as reading or performing calculations. In some epilepsy syndromes, seizures occur more frequently during sleep or upon awakening.<ref>{{cite journal | vauthors = Malow BA | title = Sleep and epilepsy | journal = Neurologic Clinics | volume = 23 | issue = 4 | pages = 1127–1147 | date = November 2005 | pmid = 16243619 | doi = 10.1016/j.ncl.2005.07.002 }}</ref><ref>{{cite journal | vauthors = Tinuper P, Provini F, Bisulli F, Vignatelli L, Plazzi G, Vetrugno R, Montagna P, Lugaresi E | title = Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep | journal = Sleep Medicine Reviews | volume = 11 | issue = 4 | pages = 255–267 | date = August 2007 | pmid = 17379548 | doi = 10.1016/j.smrv.2007.01.001 | hdl = 11380/1205981 }}</ref>

==== Seizure clusters ====
Seizure clusters refer to multiple seizures occurring over a short period of time, with incomplete recovery between events. They are distinct from [[status epilepticus]], though the two may overlap. Definitions vary across studies, but seizure clusters are typically described as two or more seizures within 24 hours or a noticeable increase in seizure frequency over a person’s usual baseline. Estimates of their prevalence range widely — from 5% to 50% of people with epilepsy — largely due to differing definitions and populations studied.<ref name="Jafarpour_2019">{{cite journal |vauthors=Jafarpour S, Hirsch LJ, Gaínza-Lein M, Kellinghaus C, Detyniecki K |date=May 2019 |title=Seizure cluster: Definition, prevalence, consequences, and management |journal=Seizure |volume=68 |pages=9–15 |doi=10.1016/j.seizure.2018.05.013 |pmid=29871784 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Faught E |date=September 2022 |title=Economic aspects of treating seizure clusters |journal=Epilepsia |volume=63 |issue=Suppl 1 |pages=S45–S54 |doi=10.1111/epi.17340 |pmid=35999172}}</ref> Seizure clusters are more common in individuals with drug-resistant epilepsy, high baseline seizure frequency, or certain epilepsy syndromes.<ref>{{cite journal |vauthors=Haut SR, Shinnar S, Moshé SL |date=January 2005 |title=Seizure clustering: risks and outcomes |journal=Epilepsia |volume=46 |issue=1 |pages=146–149 |doi=10.1111/j.0013-9580.2005.29004.x |pmid=15660781 |doi-access=free}}</ref> They are associated with increased emergency care utilization, worse quality of life, impaired psychosocial functioning, and possibly elevated risk of mortality.<ref>{{cite journal |vauthors=Chung S, Szaflarski JP, Choi EJ, Wilson JC, Kharawala S, Kaur G, Hirsch LJ |date=November 2021 |title=A systematic review of seizure clusters: Prevalence, risk factors, burden of disease and treatment patterns |journal=Epilepsy Research |volume=177 |pages=106748 |doi=10.1016/j.eplepsyres.2021.106748 |pmid=34521043}}</ref>

===Postictal state===
After the active portion of a seizure (the ictal state) there is typically a period of recovery during which there is confusion, referred to as the [[postictal state]], before a normal [[level of consciousness]] returns,<ref name="EB06" /> lasting minutes to days.<ref name="Pottkämper2020">{{Cite journal |last1=Pottkämper |first1=Julia C. M. |last2=Hofmeijer |first2=Jeannette |last3=van Waarde |first3=Jeroen A. |last4=van Putten |first4=Michel J. A. M. |year=2020 |title=The postictal state-What do we know? |journal=Epilepsia |volume=61 |issue=6 |pages=1045–1061 |doi=10.1111/epi.16519 |issn=1528-1167 |pmc=7317965 |pmid=32396219}}</ref><ref name="Post2010">{{cite book |url=https://books.google.com/books?id=yJQQzPTcbYIC&pg=PA445 |title=A clinical guide to epileptic syndromes and their treatment based on the ILAE classifications and practice parameter guidelines |vauthors=Panayiotopoulos CP |publisher=Springer |year=2010 |isbn=978-1-84628-644-5 |edition=Rev. 2nd |location=London |page=445}}</ref> This period is marked by confusion, [[headache]], [[fatigue]], or speech and motor disturbances. Some may experience [[Todd's paresis|Todd's paralysis]], a transient focal weakness.<ref name="Larner2010">{{cite book |url=https://books.google.com/books?id=mY-6eweiQm8C&pg=PA348 |title=A dictionary of neurological signs |vauthors=Larner AJ |publisher=Springer |year=2010 |isbn=978-1-4419-7095-4 |edition=3rd |location=New York |page=348}}</ref> Postictal psychosis occurs in approximately 2% of individuals with epilepsy, particularly after clusters of generalized tonic–clonic seizures.<ref>{{Cite journal |last1=Clancy |first1=Maurice J. |last2=Clarke |first2=Mary C. |last3=Connor |first3=Dearbhla J. |last4=Cannon |first4=Mary |last5=Cotter |first5=David R. |date=2014-03-13 |title=The prevalence of psychosis in epilepsy; a systematic review and meta-analysis |journal=BMC Psychiatry |language=en |volume=14 |issue=1 |pages=75 |doi=10.1186/1471-244X-14-75 |doi-access=free |issn=1471-244X |pmc=3995617 |pmid=24625201}}</ref><ref name="Post20102">{{cite book |url=https://books.google.com/books?id=yJQQzPTcbYIC&pg=PA445 |title=A clinical guide to epileptic syndromes and their treatment based on the ILAE classifications and practice parameter guidelines |vauthors=Panayiotopoulos CP |publisher=Springer |year=2010 |isbn=978-1-84628-644-5 |edition=Rev. 2nd |location=London |page=445}}</ref>

===Psychosocial===
Epilepsy can have substantial effects on psychological and social well-being. People with the condition may experience social isolation, stigma, or functional disability, which can contribute to lower educational attainment and reduced employment opportunities. These challenges often extend to family members, who may also encounter stigma and increased caregiving burden.<ref name="National Clinical Guideline 21_28" />

Several psychiatric and neurodevelopmental disorders are more common in individuals with epilepsy. These include [[major depressive disorder|depression]], [[anxiety disorder|anxiety]], [[obsessive–compulsive disorder]] (OCD),<ref>{{cite journal |vauthors=Kaplan PW |date=November 2011 |title=Obsessive-compulsive disorder in chronic epilepsy |journal=Epilepsy & Behavior |volume=22 |issue=3 |pages=428–432 |doi=10.1016/j.yebeh.2011.07.029 |pmid=21889913}}</ref> and [[migraine]].<ref>{{cite book |url=https://books.google.com/books?id=K-1UqhH2BtoC&pg=PA471 |title=Epilepsy Part I: Basic Principles and Diagnosis E-Book: Handbook of Clinical Neurology |vauthors=Stefan H |publisher=Newnes |year=2012 |isbn=978-0-444-53505-4 |edition=Volume 107 of Handbook of Clinical Neurology |page=471}}</ref> [[Attention deficit hyperactivity disorder]] (ADHD) is particularly prevalent among [[Epilepsy in children|children with epilepsy]], occurring three to five times more often than in the general population. ADHD and epilepsy together can markedly affect behavior, learning, and social development.<ref>{{cite journal |vauthors=Reilly CJ |date=May–June 2011 |title=Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy |journal=Research in Developmental Disabilities |volume=32 |issue=3 |pages=883–893 |doi=10.1016/j.ridd.2011.01.019 |pmid=21310586}}</ref> Epilepsy is also more common in children with [[Autism|autism spectrum disorder]].<ref>{{cite journal |vauthors=Levisohn PM |year=2007 |title=The autism-epilepsy connection |journal=Epilepsia |volume=48 |issue=Suppl 9 |pages=33–35 |doi=10.1111/j.1528-1167.2007.01399.x |pmid=18047599 |doi-access=free}}</ref>

Approximately, one-in-three people with epilepsy have a lifetime history of a psychiatric disorder.<ref>{{cite journal | vauthors = Lin JJ, Mula M, Hermann BP | title = Uncovering the neurobehavioural comorbidities of epilepsy over the lifespan | journal = Lancet | volume = 380 | issue = 9848 | pages = 1180–1192 | date = September 2012 | pmid = 23021287 | pmc = 3838617 | doi = 10.1016/s0140-6736(12)61455-x }}</ref> This association is thought to reflect a combination of shared neurobiological mechanisms and the psychosocial impact of living with a chronic neurological condition.<ref>{{cite journal | vauthors = Kanner AM, Schachter SC, Barry JJ, Hesdorffer DC, Mula M, Trimble M, Hermann B, Ettinger AE, Dunn D, Caplan R, Ryvlin P, Gilliam F, LaFrance WC | title = Depression and epilepsy: epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence | journal = Epilepsy & Behavior | volume = 24 | issue = 2 | pages = 156–168 | date = June 2012 | pmid = 22632406 | doi = 10.1016/j.yebeh.2012.01.007 }}</ref> Some research also suggests that psychiatric conditions such as depression may precede the onset of epilepsy in certain individuals, particularly those with focal epilepsy. However, the nature of this association remains under investigation and may involve shared pathways, diagnostic overlap, or other confounding factors.<ref>{{cite journal |vauthors=Adelöw C, Andersson T, Ahlbom A, Tomson T |date=February 2012 |title=Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy |journal=Neurology |volume=78 |issue=6 |pages=396–401 |doi=10.1212/wnl.0b013e318245f461 |pmid=22282649}}</ref>

Comorbid depression and anxiety are associated with poorer quality of life,<ref>{{cite journal |vauthors=Taylor RS, Sander JW, Taylor RJ, Baker GA |date=December 2011 |title=Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review |journal=Epilepsia |volume=52 |issue=12 |pages=2168–2180 |doi=10.1111/j.1528-1167.2011.03213.x |pmid=21883177 |doi-access=free}}</ref> increased healthcare utilization, reduced treatment response (including to surgery), and higher mortality.<ref>{{cite journal |vauthors=Lacey CJ, Salzberg MR, Roberts H, Trauer T, D'Souza WJ |date=August 2009 |title=Psychiatric comorbidity and impact on health service utilization in a community sample of patients with epilepsy |journal=Epilepsia |volume=50 |issue=8 |pages=1991–1994 |doi=10.1111/j.1528-1167.2009.02165.x |pmid=19490049 |doi-access=free}}</ref> Some studies suggest that these psychiatric conditions may influence quality of life more than seizure type or frequency.<ref>{{cite journal |vauthors=Boylan LS, Flint LA, Labovitz DL, Jackson SC, Starner K, Devinsky O |date=January 2004 |title=Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy |journal=Neurology |volume=62 |issue=2 |pages=258–261 |doi=10.1212/01.wnl.0000103282.62353.85 |pmid=14745064}}</ref> Despite their clinical importance, depression and anxiety often go underdiagnosed and undertreated in people with epilepsy.<ref>{{cite journal |vauthors=Munger Clary HM, Croxton RD, Allan J, Lovato J, Brenes G, Snively BM, Wan M, Kimball J, Wong MH, O'Donovan CA, Conner K, Jones V, Duncan P |date=March 2020 |title=Who is willing to participate in research? A screening model for an anxiety and depression trial in the epilepsy clinic |journal=Epilepsy & Behavior |volume=104 |issue=Pt A |pages=106907 |doi=10.1016/j.yebeh.2020.106907 |pmc=7282472 |pmid=32000099}}</ref>