Seizure

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Epileptic seizure
Other namesEpileptic fit, [1] seizure, fit, convulsions [2]
Spike-waves.png
Generalized 3 Hz spike and wave discharges in an electroencephalogram (EEG) of a patient with epilepsy
Specialty Neurology, emergency medicine
Symptoms Variable [3]
Complications Falling, drowning, car accidents, pregnancy complications, emotional health issues [4]
DurationTypically less than 2 minutes [3]
TypesFocal, generalized; provoked, unprovoked [5]
Causes Provoked: Low blood sugar, alcohol withdrawal, low blood sodium, fever, brain infection, traumatic brain injury [3] [5]
Unprovoked: Flashing lights or colours, unknown causes, previous stroke, brain injury, brain tumor [5] [6] [3]
Diagnostic method Based on symptoms, blood tests, medical imaging, electroencephalography [6]
Differential diagnosis Syncope, psychogenic seizure, migraine aura, transient ischemic attack [3] [7]
TreatmentLess than 5 min: Place person on their side, remove nearby dangerous objects
More than 5 min: Treat as status epilepticus [3] [5] [8]
Frequency≈10% of people (lifetime risk) [9] [10]

A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. [11] [12] Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, or consciousness. Symptoms vary widely. Some seizures involve subtle changes, such as brief lapses in attention or awareness (as seen in absence seizures), while others cause generalized convulsions with loss of consciousness (tonic–clonic seizures). [13] Most seizures last less than two minutes and are followed by a postictal period of confusion, fatigue, or other symptoms. [14] Status epilepticus is a medical emergency consisting of a seizure that lasts longer than five minutes, or multiple seizures without full recovery between episodes. [3] [15]

Contents

Seizures are classified as provoked, when triggered by a known cause such as fever, head trauma, or metabolic imbalance, or unprovoked, when no immediate trigger is identified. Recurrent unprovoked seizures define the neurological condition epilepsy. [12] [16]

Clinical features

The clinical signs and symptoms associated with a seizure are also referred to as seizure semiology. [17] [18] Seizure semiology varies depending on the brain regions involved and the type of seizure. This may affect movement, sensation, autonomic functions, or cognitive and emotional processing. [17] [19] Motor symptoms can include muscle stiffening (tonic activity), rhythmic jerking (clonic activity), sudden muscle jerks (myoclonus), sudden loss of muscle tone (atonia), or other repetitive involuntary movements (automatisms). [17] [20] Sensory disturbances may involve tingling, visual phenomena, or hallucinated sounds. [17] [21] Autonomic features can include changes in heart rate, respiration, or gastrointestinal sensations. [19] [22] Cognitive or emotional symptoms may manifest as confusion, fear, or altered perception. [17] [23]

Some individuals experience an aura before the seizure progresses, characterized by subjective sensations such as unusual smells, a sudden emotional shift, or feelings of déjà vu. [24] [25]

Most seizures last less than two minutes and are followed by a recovery phase known as the postictal state, which may include confusion, fatigue, or other neurologic symptoms. [14] Seizures lasting more than five minutes, or occurring in rapid succession without recovery, are classified as status epilepticus, a medical emergency that can result in long-term brain injury or death. [13]

Classification

Seizures are classified according to their site of onset in the brain, clinical features, and level of consciousness during the episode. In 2025, the International League Against Epilepsy (ILAE) released an updated classification to improve clarity, clinical relevance, and global applicability. The system distinguishes four major types: focal, generalized, unknown whether focal or generalized, and unclassified seizures. Seizures are further characterized based on whether consciousness is preserved or impaired, as determined by responsiveness during the event. [26]

Focal seizures

Focal seizures (previously known as partial seizures) originate within a network limited to one hemisphere of the brain. [27] They may arise from the cerebral cortex or subcortical structures. For a given seizure type, seizure usually starts in the same part of the brain each time. Once initiated, the seizure may remain localized or spread to adjacent areas, and in some cases, may propagate to the opposite hemisphere (contralateral spread). Despite this potential for spread, the initial focus remains consistent.

Focal seizures are subdivided based on whether consciousness is preserved or impaired, a classifier defined by awareness and responsiveness during the event. [26] They are also differentiated by the localization or spread of epileptiform activity. The three major classifications of focal seizures are described below: [26]

Focal seizures can manifest with motor, sensory, autonomic, cognitive, or emotional symptoms, depending on the regions involved. [26] They often present with unilateral symptoms, but bilateral symptoms may also be seen, even when a seizure is not classified as focal-to-bilateral. This is because several structures in the brain have bilateral effects in the body (e.g. primary visual cortex). [28] [29]

Focal impaired consciousness seizures are the most common type of seizure in individuals older than one year of age, affecting 36% of epilepsy patients overall. [28]

Generalized seizures

Cutout from a 20s long generalized spike-wave-complex (SWC) seen on EEG. Gen-20s SWK.png
Cutout from a 20s long generalized spike-wave-complex (SWC) seen on EEG.

Generalized seizures originate at a specific point within, and quickly spread across both hemispheres through interconnected brain networks.

They can be divided into three broad categories: [26] [30]

These categories include several subtypes of seizures, each with their own distinctive symptoms and diagnostic criteria. [26]

Like focal seizures, generalized seizures can present with asymmetric or bilateral symptoms, so thorough evaluation and history-gathering is necessary for diagnosis. One key difference between generalized and focal seizures is the age at onset, which is significantly lower in patients with generalized seizures. [29]

Generalized tonic–clonic seizures, previously known as grand mal seizures, are associated with the highest morbidity and mortality. They are the primary risk factor for sudden unexpected death in epilepsy (SUDEP). [31]

Unknown (whether focal or generalized) seizures

When available information is insufficient to determine whether a seizure is focal or generalized, it is classified as unknown. These seizures can be classified by level of consciousness and observable symptoms when possible. [26]

Unclassified seizures

Seizures are designated as unclassified when they are recognized as epileptic events, but insufficient information is available to assign them to any specific class. This is typically a temporary designation pending further clinical evaluation. [26]

Causes

Seizures can occur for many reasons and are broadly classified based on whether they are provoked (acute symptomatic) or unprovoked. Identifying the underlying cause is critical for guiding treatment and assessing the risk of recurrence. [13]

Provoked seizures

Provoked seizures are also known as acute symptomatic seizures. They are caused by an identifiable, transient condition affecting brain function. The temporal relationship between the cause and the seizure is important, but no single time frame has been established. [32] Common causes of acute symptomatic seizures include:

Unprovoked seizures

Unprovoked seizures occur without an immediate precipitating event. These include spontaneous seizures and reflex seizures, which are consistently triggered by specific stimuli (e.g., flashing lights) but arise due to an enduring predisposition, not a transient cause. [38]

They typically reflect an underlying neurological predisposition and are associated with a higher risk of recurrence, [13] meeting the diagnostic criteria for epilepsy when there are either two or more unprovoked (or reflex) seizures occurring more than 24 hours apart, or one unprovoked (or reflex) seizure with a recurrence risk of at least 60% over the next 10 years based on clinical and diagnostic findings.

Causes and contexts for unprovoked seizures include:

Mechanism

Seizures are the result of abnormal, excessive, and hypersynchronous neuronal activity in the brain. At a cellular level, they reflect a disruption of the normal balance between excitatory and inhibitory neurotransmission. Under healthy conditions, excitatory neurotransmission (mainly mediated by glutamate) and inhibitory neurotransmission (primarily via GABA) maintain cortical stability. An excess of excitation or a failure of inhibition can tip this balance, promoting hypersynchronous neuronal firing characteristic of seizures. [41] [42] [43] The generation of a seizure—the transition from an interictal to an ictal state—is known as ictogenesis. This process involves a cascade of physiological and network-level changes that lead to the sudden onset of pathological activity.

In provoked seizures (e.g., due to trauma, metabolic insults, or infections), acute disturbances in ionic gradients, neurotransmitter release, and neuronal membrane stability may transiently lower the threshold for seizure activity.

Brief seizures, such as absence seizures lasting 5–10 seconds, do not cause observable brain damage. [44] More prolonged seizures have a higher risk of neuronal death. [44] Prolonged and recurrent seizures, such as status epilepticus, typically cause brain damage. [44] Scarring of brain tissue (gliosis), neuronal death, and shrinking of areas of the brain (atrophy) are linked to recurrent seizures. [44] [45] These changes may lead to the development of epilepsy, in a process called epileptogenesis. [45]

Clinical evaluation

The clinical evaluation after a seizure event involves confirming if the episode was epileptic in nature, determining its type and cause, and distinguishing it from other conditions that can mimic seizures. A careful clinical history and targeted investigations are essential. [13] [3] The events preceding seizure onset, as well as the clinical signs observed during the episode, are critical for accurately classifying the seizure type. However, because most individuals do not recall the details of their own seizures, obtaining eyewitness accounts is often essential for an accurate diagnosis. [13] [3] [46] Video recordings, when available, provide valuable supplementary information, particularly in distinguishing epileptic seizures from mimics such as psychogenic nonepileptic seizures. [3]

Clinical history

The clinical history should include:

Medical history is also important, including:

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

Physical examination

A focused neurological examination can yield additional diagnostic clues, particularly soon after a seizure. Findings may include: [3]

Between seizures, the neurological examination is often normal. [3]

Laboratory tests

Laboratory testing is often performed in the evaluation of a new-onset seizure, particularly when a provoked cause is suspected. [13] Common investigations include:


Laboratory findings can help identify treatable causes of seizures and guide management decisions.

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

Electroencephalography (EEG)

An electroencephalogram (EEG) records electrical activity in the brain and can help support a diagnosis of epilepsy. Interictal EEG (which can be observed between seizure episodes) may reveal epileptiform abnormalities, such as spikes, sharp waves, or spike-and-wave discharges. However, an unremarkable EEG does not exclude epilepsy.

In certain cases, prolonged video EEG monitoring is used to capture seizures in real time and clarify seizure type, localization, or the diagnosis when psychogenic nonepileptic seizures are suspected.

EEG monitoring is frequently performed in the inpatient setting within a hospital's epilepsy monitoring unit (EMU), but in some cases, portable EEGs may be used in the outpatient setting for seizure monitoring. [49]

Neuroimaging

Brain imaging is recommended in most cases of new-onset unprovoked seizures to identify structural abnormalities that may predispose to epilepsy. Imaging techniques include: [3]

When CT findings are normal in patients with a first unprovoked seizure, a follow-up MRI is recommended because it may detect epileptogenic lesions not visible on CT. [50]

Differential diagnosis

Several conditions can mimic epileptic seizures and must be considered, including the following:

Differentiating these conditions from epileptic seizures relies on careful history-taking, examination, EEG findings, and, when necessary, additional cardiac, metabolic, or psychiatric evaluations.

Management

Management of seizures depends on the clinical context, including whether the seizure is isolated or part of an ongoing epileptic disorder, and whether it is provoked or unprovoked.

First aid during a seizure

Basic first aid during a tonic-clonic seizure focuses on ensuring the person's safety and preventing injury: [51]

For nonconvulsive seizures (such as absence seizures or focal impaired consciousness seizures), active physical first aid is often unnecessary. In these cases, observers should ensure the person is safe from harm, gently guide them away from danger if needed, and offer support and reassurance as they regain awareness.

Emergency medical treatment

If a convulsive seizure lasts longer than five minutes or if repeated seizures occur without full recovery between events, the situation is classified as status epilepticus, a medical emergency requiring rapid intervention. [53] In emergency care, the first-line therapy for status epilepticus is the administration of a benzodiazepine to terminate the seizure, with most guidelines recommending lorazepam, midazolam or diazepam. Early benzodiazepine treatment is associated with better seizure control and improved outcomes. [3]

If seizures persist despite benzodiazepine administration (second-line therapy), an intravenous antiseizure medication is given. Recommended options include fosphenytoin, valproate, or levetiracetam, depending on patient-specific factors and institutional protocols. [54] In cases of refractory status epilepticus (seizures continuing despite first- and second-line treatments), patients typically require intensive care unit management. This involves continuous EEG monitoring and administration of anesthetic agents such as propofol or continuous infusion of midazolam. [3]

Prompt recognition and treatment of status epilepticus are critical to prevent permanent neuronal injury, systemic complications, and death.

Management of provoked seizures

If a seizure is provoked by an acute reversible cause, treatment focuses on addressing the underlying condition. Long-term antiseizure medications are typically not needed once the acute cause has been resolved, unless seizures recur.

Management after unprovoked seizures

After a first unprovoked seizure, management depends on assessing the risk of recurrence. Antiseizure medication may be considered after a single event if risk factors for epilepsy are identified, such as epileptiform abnormalities on EEG or structural lesions on MRI. In other cases, careful observation may be appropriate.

Long-term management of epilepsy

Long-term management applies to individuals diagnosed with epilepsy. The goals are seizure control, minimizing adverse effects, and optimizing quality of life. [3]

It is recommended to start with one anti-seizure medication. [3] [55] Another may be added if one is not enough to control the seizure occurrence. [55] Approximately 70% of people can obtain full control with continuous use of medication. [56] The type of medication used is based on the type of seizure. [3] [55]

Anti-seizure medications may be slowly stopped after some time if a person has just experienced one seizure and has not had any more. [3] The decision to stop anti-seizure medications should be discussed between the doctor and patient, weighing the benefits and risks.

Doctor performing an epilepsy surgery at Jaslok Hospital, Mumbai. Epilepsy-surgery-in-progress.jpg
Doctor performing an epilepsy surgery at Jaslok Hospital, Mumbai.

In severe cases where seizures are uncontrolled by at least two anti-seizure medications, brain surgery can be a treatment option. [3] [55] Epilepsy surgery is especially useful for those with focal seizures, where the seizures are coming from a specific part of the brain. [55] The amount of brain removed during the surgery depends on the extent of the brain involved in the seizures. It can range from just removing one lobe of the brain (temporal lobectomy) to disconnecting an entire side of the brain (hemispherectomy). [3] The procedure can be curative, where seizures are eliminated. [3] However, if it is not curative, it can be palliative, reducing the frequency of seizures but not eliminating them. [57]

Other

Helmets may be used to protect the head during a seizure. Some claim that seizure response dogs, a form of service dog, can predict seizures. [58] Evidence for this, however, is poor. [58] Cannabis has also been used for the management of seizures that do not respond to anti-seizure medications. Research on its effectiveness is ongoing, but current research shows that it does reduce seizure frequency. [59] [60] A ketogenic diet or modified Atkins diet may help in those who have epilepsy who do not improve following typical treatments, with evidence for its effectiveness growing. [61] [62]

Prognosis

The prognosis after a first seizure depends on the underlying cause, seizure type, and patient-specific factors. In general, individuals who experience a single provoked seizure due to an acute and reversible cause (such as hypoglycemia or head trauma) have a low risk of recurrence once the underlying issue is treated. Following a first unprovoked seizure, the risk of more seizures in the next two years is around 40%. [63] Starting anti-seizure medications reduces the recurrence of seizures by 35% within the first two years. The greatest predictors of more seizures are problems either on the EEG or on imaging of the brain. Those with normal EEG and normal physical exam following a first unprovoked seizure had less risk of recurrence in the next two years, with a risk of 25%. 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. [64] The prognosis of epilepsy depends on seizure type, cause, and treatment response. About two-thirds of patients achieve seizure control with medication, while surgery or neuromodulation may help those with drug-resistant epilepsy. [65]

Epidemiology

Seizures are relatively common neurological events, with an estimated lifetime risk of experiencing at least one seizure approaching 8-10% within the general population. However, not all seizures are indicative of epilepsy; numerous episodes are provoked by transient factors such as infections, metabolic abnormalities, or trauma. In adults, the risk of seizure recurrence within the five years following a new-onset seizure is 35%; the risk rises to 75% in persons who have had a second seizure. [66] In children, the risk of seizure recurrence within the five years following a single unprovoked seizure is about 50%; the risk rises to about 80% after two unprovoked seizures. [67] In the United States in 2011, seizures resulted in an estimated 1.6 million emergency department visits; approximately 400,000 of these visits were for new-onset seizures. [66]

Global variations exist, with higher rates of seizures and epilepsy reported in regions with elevated prevalence of risk factors such as central nervous system infections, traumatic brain injury, and limited access to perinatal care. Seizures contribute significantly to the global burden of neurological disease, affecting individuals' quality of life, social participation, and access to education and employment.

History

Seizures have been recognized throughout recorded history. Early descriptions date back to ancient Mesopotamia around 2000 BCE, where seizures were often attributed to supernatural causes or demonic possession. [68] [69] Similar beliefs persisted across ancient cultures, including in Egypt, India, and Greece. [68] In the 5th century BCE, the physician Hippocrates challenged supernatural explanations in his treatise On the Sacred Disease , proposing that epilepsy was a disorder of the brain. [68] However, stigma surrounding seizures remained widespread for centuries.

Society and culture

Economics

Seizures result in direct economic costs of about one billion dollars in the United States. [6] Epilepsy results in economic costs in Europe of around €15.5 billion in 2004. [70] In India, epilepsy is estimated to result in costs of US$1.7 billion or 0.5% of the GDP. [56] They make up about 1% of emergency department visits (2% for emergency departments for children) in the United States. [71]

Research

Scientific work on the prediction of epileptic seizures began in the 1970s. Several techniques and methods have been proposed, but evidence regarding their usefulness is still lacking. [72]

Two promising areas include: (1) gene therapy, [73] and (2) seizure detection and seizure prediction. [74]

Gene therapy for epilepsy consists of employing vectors to deliver pieces of genetic material to areas of the brain involved in seizure onset. [73]

Seizure prediction is a special case of seizure detection in which the developed systems can issue a warning before the clinical onset of the epileptic seizure. [72] [74]

Computational neuroscience has brought a new perspective on seizures by considering the dynamical aspects. [75]

References

  1. ↑ Shorvon S (2009). Epilepsy. OUP Oxford. p. 1. ISBN   978-0-19-956004-2.
  2. ↑ "Epileptic Seizures - National Library of Medicine". PubMed Health. Archived from the original on 7 January 2017. Retrieved 16 October 2018.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Abou-Khalil, Bassel W.; Gallagher, Martin J.; Macdonald, Robert L. (2022). "Epilepsies". Bradley and Daroff's Neurology in Clinical Practice (8th ed.). Elsevier. pp. 1614–1663. ISBN   978-0-323-64261-3.
  4. ↑ Mayo Clinic Staff. "Seizures – Symptoms and causes". Mayo Clinic . Retrieved 4 June 2023.
  5. 1 2 3 4 Fisher, Robert S.; Acevedo, Carlos; Arzimanoglou, Alexis; Bogacz, Alicia; Cross, J. Helen; Elger, Christian E.; Engel, Jerome; Forsgren, Lars; French, Jacqueline A.; Glynn, Mike; Hesdorffer, Dale C.; Lee, B.I.; Mathern, Gary W.; Moshé, Solomon L.; Perucca, Emilio (2014). "ILAE Official Report: A practical clinical definition of epilepsy". Epilepsia. 55 (4): 475–482. doi: 10.1111/epi.12550 . ISSN   0013-9580.
  6. 1 2 3 Wilden JA, Cohen-Gadol AA (August 2012). "Evaluation of first nonfebrile seizures". American Family Physician. 86 (4): 334–340. PMID   22963022.
  7. 1 2 Winkel, Daniel; Cassimatis, Dimitri (2022). "Episodic Impairment of Consciousness". Bradley and Daroff's Neurology in Clinical Practice (8th ed.). Elsevier. pp. 8–16. ISBN   978-0-323-64261-3.
  8. ↑ Cruickshank, Moira; Imamura, Mari; Booth, Corinne; Aucott, Lorna; Counsell, Carl; Manson, Paul; Scotland, Graham; Brazzelli, Miriam (2022). "Pre-hospital and emergency department treatment of convulsive status epilepticus in adults: an evidence synthesis". Health Technology Assessment. 26 (20): 1–76. doi:10.3310/RSVK2062. ISSN   2046-4924. PMC   8977974 . PMID   35333156.
  9. ↑ Ferri FF (2018). Ferri's Clinical Advisor 2019 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 959. ISBN   978-0-323-55076-5.
  10. ↑ "Epilepsy". World Health Organization. 9 February 2023. Retrieved 4 June 2023.
  11. ↑ Anwar, Haleema; Khan, Qudsia Umaira; Nadeem, Natasha; Pervaiz, Iqra; Ali, Muhammad; Cheema, Fatima Fayyaz (12 June 2020). "Epileptic seizures". Discoveries (Craiova, Romania). 8 (2): e110. doi:10.15190/d.2020.7. ISSN   2359-7232. PMC   7305811 . PMID   32577498.
  12. 1 2 "Epilepsy and Seizures | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 30 October 2025.
  13. 1 2 3 4 5 6 7 8 9 10 11 Berkowitz, Aaron L. (2022), "Seizures & Epilepsy", Clinical Neurology & Neuroanatomy: A Localization-Based Approach (2 ed.), New York, NY: McGraw Hill, retrieved 28 April 2025
  14. 1 2 Pottkämper, Julia C. M.; Hofmeijer, Jeannette; van Waarde, Jeroen A.; van Putten, Michel J. A. M. (2020). "The postictal state-What do we know?". Epilepsia. 61 (6): 1045–1061. doi:10.1111/epi.16519. ISSN   1528-1167. PMC   7317965 . PMID   32396219.
  15. ↑ Migdady, I.; Rosenthal, E. S.; Cock, H. R. (2022). "Management of status epilepticus: a narrative review". Anaesthesia. 77 (S1): 78–91. doi:10.1111/anae.15606. ISSN   1365-2044. PMID   35001380.
  16. ↑ López, Salvador Vergara; Ramos-Jiménez, Christian; Reyes, Luis Adrián de la Cruz; Ruiz, Axel Kevin Galindo; Arriola, Luis Armando Baigts; Olivares, Juan Manuel Moncayo; Galindo, Enya Gabriela Aguirre; Pedroza, Iván Fabricio Pérez; San-Juan, Daniel (1 December 2021). "Epilepsy diagnosis based on one unprovoked seizure and ≥60% risk. A systematic review of the etiologies". Epilepsy & Behavior. 125 108392. doi:10.1016/j.yebeh.2021.108392. ISSN   1525-5050. PMID   34740089.
  17. 1 2 3 4 5 Beniczky, Sándor; Tatum, William O.; Blumenfeld, Hal; Stefan, Hermann; Mani, Jayanti; Maillard, Louis; Fahoum, Firas; Vinayan, Kollencheri Puthenveettil; Mayor, Luis Carlos; Vlachou, Maria; Seeck, Margitta; Ryvlin, Philippe; Kahane, Philippe (2022). "Seizure semiology: ILAE glossary of terms and their significance". Epileptic Disorders. 24 (3): 447–495. doi:10.1684/epd.2022.1430. ISSN   1950-6945. PMID   35770761.
  18. ↑ Boßelmann, Christian Malte (1 November 2021). "Seizures, semiology, and syndromes: A narrative review". Seizure - European Journal of Epilepsy. 92: 230–233. doi:10.1016/j.seizure.2021.09.019. ISSN   1059-1311. PMID   34607271.
  19. 1 2 D’Agnano, Daniela; Cernigliaro, Federica; Ferretti, Alessandro; Cascio, Salvatore Lo; Correnti, Edvige; Terrin, Gianluca; Santangelo, Andrea; Bellone, Giulia; Raieli, Vincenzo; Sciruicchio, Vittorio; Parisi, Pasquale (9 July 2024). "The Role of the Autonomic Nervous System in Epilepsy and Migraine: A Narrative Review". Journal of Integrative Neuroscience. 23 (7): 128. doi:10.31083/j.jin2307128. ISSN   0219-6352. PMID   39082300.
  20. ↑ Yang, Bowen; Mo, Jiajie; Zhang, Chao; Wang, Xiu; Sang, Lin; Zheng, Zhong; Gao, Dongmei; Zhao, Xuemin; Wang, Yao; Liu, Chang; Zhao, Baotian; Guo, Zhihao; Shao, Xiaoqiu; Zhang, Jianguo; Zhang, Kai (1 January 2022). "Clinical features of automatisms and correlation with the seizure onset zones: A cluster analysis of 74 surgically-treated cases". Seizure. 94: 82–89. doi:10.1016/j.seizure.2021.11.015. ISSN   1059-1311. PMID   34872021.
  21. ↑ D'Agnano, Daniela; Lo Cascio, Salvatore; Correnti, Edvige; Raieli, Vincenzo; Sciruicchio, Vittorio (10 April 2023). "A Narrative Review of Visual Hallucinations in Migraine and Epilepsy: Similarities and Differences in Children and Adolescents". Brain Sciences. 13 (4): 643. doi: 10.3390/brainsci13040643 . ISSN   2076-3425. PMC   10136509 . PMID   37190608.
  22. ↑ Rodriguez-Quintana, Jesús; Bueno-Florez, Silvia; Mora-Muñoz, Laura; Orrego-González, Eduardo; Barragan, Ana M.; Suárez-Burgos, Fabio; Velez-Van-Meerbeke, Alberto; Cendes, Fernando (1 February 2023). "Dysautonomia in people with epilepsy: A scoping review". Seizure - European Journal of Epilepsy. 105: 43–51. doi:10.1016/j.seizure.2022.12.003. ISSN   1059-1311. PMID   36702019.
  23. ↑ Alva-Diaz, Carlos; Cabanillas-Lazo, Miguel; Navarro-Flores, Alba; Martinez-Rivera, Raisa N.; Valdeiglesias-Abarca, Maria; Acevedo-Marino, Krystel; Pacheco-Barrios, Kevin; Ruiz-Garcia, Ramiro; Burneo, Jorge (2024). "Peri-ictal psychiatric manifestations in people with epilepsy: An umbrella review". Epilepsia Open. 9 (4): 1166–1175. doi:10.1002/epi4.12949. ISSN   2470-9239. PMC   11296096 . PMID   38816942.
  24. ↑ Akyuz, Enes; Arulsamy, Alina; Hasanli, Shams; Yilmaz, Elif Bilge; Shaikh, Mohd. Farooq (1 February 2023). "Elucidating the visual phenomena in epilepsy: A mini review". Epilepsy Research. 190 107093. doi:10.1016/j.eplepsyres.2023.107093. ISSN   0920-1211. PMID   36652852.
  25. ↑ Caprara, Ana Leticia Fornari; Tharwat Ali, Hossam; Elrefaey, Ahmed; Elejla, Sewar A.; Rissardo, Jamir Pitton (21 August 2023). "Somatosensory Auras in Epilepsy: A Narrative Review of the Literature". Medicines. 10 (8): 49. doi: 10.3390/medicines10080049 . ISSN   2305-6320. PMC   10456342 . PMID   37623813.
  26. 1 2 3 4 5 6 7 8 Beniczky, Sándor; Trinka, Eugen; Wirrell, Elaine; Abdulla, Fatema; Al Baradie, Raidah; Alonso Vanegas, Mario; Auvin, Stéphane; Singh, Mamta Bhushan; Blumenfeld, Hal; Bogacz Fressola, Alicia; Caraballo, Roberto; Carreno, Mar; Cendes, Fernando; Charway, Augustina; Cook, Mark (23 April 2025). "Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy". Epilepsia. 66 (6): 1804–1823. doi: 10.1111/epi.18338 . ISSN   0013-9580. PMC   12169392 . PMID   40264351.
  27. ↑ Ighodaro, Eseosa T.; Maini, Kushagra; Arya, Kapil; Sharma, Sandeep (2025), "Focal Onset Seizure", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   29763181 , retrieved 6 November 2025
  28. 1 2 Kumar, Anil; Ighodaro, Eseosa T.; Sharma, Sandeep (2025), "Focal Impaired Awareness Seizure", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30085572 , retrieved 7 November 2025
  29. 1 2 Beniczky, Sándor; Trinka, Eugen; Wirrell, Elaine; Singh, Mamta Bhushan; Blumenfeld, Hal; Bogacz Fressola, Alicia; Cendes, Fernando; Craiu, Dana; Frauscher, Birgit; Jansen, Floor E.; Kahane, Philippe; Kander, Veena; Kishk, Nirmeen; Khoo, Ching Soong; Lizcano, Angelica. "A practical guide to the updated seizure classification 2025". Epileptic Disorders. n/a (n/a). doi:10.1002/epd2.70110. ISSN   1950-6945.
  30. ↑ Kodankandath, Thomas V.; Theodore, Danny; Samanta, Debopam (2025), "Generalized Tonic-Clonic Seizure", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32119383 , retrieved 7 November 2025
  31. ↑ Salas-Puig, Xavier; Iniesta, Marc; Abraira, Laura; Puig, Josep; QUIN-GTC study group (2019). "Accidental injuries in patients with generalized tonic-clonic seizures. A multicenter, observational, cross-sectional study (QUIN-GTC study)". Epilepsy & Behavior. 92: 135–139. doi:10.1016/j.yebeh.2018.10.043. ISSN   1525-5069. PMID   30658321.
  32. ↑ Mauritz, Matthias; Hirsch, Lawrence J.; Camfield, Peter; Chin, Richard; Nardone, Raffaele; Lattanzi, Simona; Trinka, Eugen (2022). "Acute symptomatic seizures: an educational, evidence-based review". Epileptic Disorders. 24 (1): 26–49. doi:10.1684/epd.2021.1376. ISSN   1950-6945.
  33. ↑ Nardone, Raffaele; Brigo, Francesco; Trinka, Eugen (2016). "Acute Symptomatic Seizures Caused by Electrolyte Disturbances". Journal of Clinical Neurology. 12 (1): 21–33. doi:10.3988/jcn.2016.12.1.21. ISSN   1738-6586. PMC   4712283 . PMID   26754778.
  34. ↑ Chen, Hsien-Yi; Albertson, Timothy E.; Olson, Kent R. (2015). "Treatment of drug-induced seizures". British Journal of Clinical Pharmacology. 81 (3): 412–419. doi:10.1111/bcp.12720. ISSN   0306-5251. PMC   4767205 . PMID   26174744.
  35. ↑ Phillips, Haley N.; Tormoehlen, Laura (November 2020). "Toxin-Induced Seizures". Neurologic Clinics. 38 (4): 867–879. doi:10.1016/j.ncl.2020.07.004. ISSN   1557-9875. PMID   33040866.
  36. ↑ Xixis, Kathryn L.; Samanta, Debopam; Smith, Travis; Keenaghan, Michael (2024), "Febrile Seizure", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   28846243 , retrieved 1 November 2024
  37. ↑ Graves RC, Oehler K, Tingle LE (January 2012). "Febrile seizures: risks, evaluation, and prognosis". American Family Physician. 85 (2): 149–153. PMID   22335215.
  38. ↑ Berg, Anne T.; Berkovic, Samuel F.; Brodie, Martin J.; Buchhalter, Jeffrey; Cross, J. Helen; Van Emde Boas, Walter; Engel, Jerome; French, Jacqueline; Glauser, Tracy A.; Mathern, Gary W.; Moshé, Solomon L.; Nordli, Douglas; Plouin, Perrine; Scheffer, Ingrid E. (2010). "Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009" . Epilepsia. 51 (4): 676–685. doi:10.1111/j.1528-1167.2010.02522.x. ISSN   1528-1167. PMID   20196795.
  39. ↑ Chen, Jiayu; Ye, Haijiao; Zhang, Jie; Li, Aihong; Ni, Yaohui (2022). "Pathogenesis of seizures and epilepsy after stroke". Acta Epileptologica. 4 (1) 2. doi: 10.1186/s42494-021-00068-8 . ISSN   2524-4434.
  40. ↑ Vezzani, Annamaria; Fujinami, Robert S.; White, H. Steve; Preux, Pierre-Marie; Blümcke, Ingmar; Sander, Josemir W.; Löscher, Wolfgang (2015). "Infections, inflammation and epilepsy". Acta Neuropathologica. 131 (2): 211–234. doi:10.1007/s00401-015-1481-5. ISSN   0001-6322. PMC   4867498 . PMID   26423537.
  41. ↑ Tatti, Roberta; Haley, Melissa S.; Swanson, Olivia K.; Tselha, Tenzin; Maffei, Arianna (15 May 2017). "Neurophysiology and Regulation of the Balance Between Excitation and Inhibition in Neocortical Circuits". Biological Psychiatry. 81 (10): 821–831. doi:10.1016/j.biopsych.2016.09.017. ISSN   1873-2402. PMC   5374043 . PMID   27865453.
  42. ↑ Sarlo, Gabrielle L.; Holton, Kathleen F. (2021). "Brain concentrations of glutamate and GABA in human epilepsy: A review". Seizure - European Journal of Epilepsy. 91: 213–227. doi: 10.1016/j.seizure.2021.06.028 . PMID   34233236.
  43. ↑ Treiman, David M. (2001). "GABAergic Mechanisms in Epilepsy". Epilepsia. 42 (s3): 8–12. doi:10.1046/j.1528-1157.2001.042suppl.3008.x. ISSN   0013-9580. PMID   11520315 – via Wiley Online Library.
  44. 1 2 3 4 Dingledine, Ray; Varvel, Nicholas H.; Dudek, F. Edward (2014), Scharfman, Helen E.; Buckmaster, Paul S. (eds.), "When and How Do Seizures Kill Neurons, and Is Cell Death Relevant to Epileptogenesis?", Issues in Clinical Epileptology: A View from the Bench, vol. 813, Dordrecht: Springer Netherlands, pp. 109–122, doi:10.1007/978-94-017-8914-1_9, ISBN   978-94-017-8913-4, PMC   4624106 , PMID   25012371
  45. 1 2 Jerome Engel Jr.; Timothy A. Pedley, eds. (2008). Epilepsy: a comprehensive textbook (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 483. ISBN   978-0-7817-5777-5.
  46. ↑ Rowland, Kate; Lambert, Carl Earl (1 May 2022). "Evaluation After a First Seizure in Adults". American Family Physician. 105 (5): 507–513. ISSN   1532-0650. PMID   35559631.
  47. ↑ Scheffer, IE; Berkovic, SF; Capovilla, G; Connolly, MB; French, J; Guilhoto, LMF; Hirsch, E; Jansen, FE; Koutroumanidis, M; Zuberi, SM; Wiebe, S; Zelano, J (2017). "ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology". Epilepsia. 58 (4): 512–521. doi:10.1111/epi.13709. PMID   28276062.
  48. ↑ Patel, Jigar; Tran, Quincy K.; Martinez, Santiago; Wright, Halley; Pourmand, Ali (1 November 2022). "Utility of serum lactate on differential diagnosis of seizure-like activity: A systematic review and meta-analysis". Seizure: European Journal of Epilepsy. 102: 134–142. doi:10.1016/j.seizure.2022.10.007. ISSN   1059-1311.
  49. ↑ Biondi, Andrea; Santoro, Viviana; Viana, Pedro F.; Laiou, Petroula; Pal, Deb K.; Bruno, Elisa; Richardson, Mark P. (2022). "Noninvasive mobile EEG as a tool for seizure monitoring and management: A systematic review". Epilepsia. 63 (5): 1041–1063. doi:10.1111/epi.17220. ISSN   1528-1167. PMC   9311406 . PMID   35271736.
  50. ↑ Wirrell, Elaine (April 2022). "Evaluation of First Seizure and Newly Diagnosed Epilepsy". Continuum (Minneap Minn). 28 (2): 230–260. doi:10.1212/CON.0000000000001074. PMID   35393959.
  51. ↑ Asadi-Pooya, Ali A.; Hosseini, Seyed Ali; Hashemizadeh Fard Haghighi, Leila; Asadi-Pooya, Hanieh (2022). "Seizure first aid for people with epilepsy: opinions and knowledge of caregivers and healthcare professionals". Seizure. 102: 1–5. doi: 10.1016/j.seizure.2022.09.007 . ISSN   1532-2688. PMID   36130455.
  52. ↑ Rossi, Kyle C.; Baumgartner, Alexander J.; Goldenholz, Shira R.; Goldenholz, Daniel M. (December 2020). "Recognizing and refuting the myth of tongue swallowing during a seizure". Seizure. 83: 32–37. doi: 10.1016/j.seizure.2020.09.023 . ISSN   1532-2688. PMID   33080482. S2CID   222137755.
  53. ↑ Al-Mufti, Fawaz; Claassen, Jan (1 October 2014). "Neurocritical Care: Status Epilepticus Review" . Critical Care Clinics. 30 (4): 751–764. doi:10.1016/j.ccc.2014.06.006. ISSN   0749-0704. PMID   25257739.
  54. ↑ De Waele L, Boon P, Ceulemans B, Dan B, Jansen A, Legros B, et al. (December 2013). "First line management of prolonged convulsive seizures in children and adults: good practice points". Acta Neurologica Belgica. 113 (4): 375–380. doi:10.1007/s13760-013-0247-x. hdl: 1854/LU-4182539 . PMID   24019121. S2CID   17641491.
  55. 1 2 3 4 5 Liu, Gerald; Slater, Nicole; Perkins, Allen (15 July 2017). "Epilepsy: Treatment Options". American Family Physician. 96 (2): 87–96. ISSN   1532-0650. PMID   28762701.
  56. 1 2 "Epilepsy". Fact Sheets. World Health Organization. October 2012. Archived from the original on 11 March 2016. Retrieved 24 January 2013.
  57. ↑ Matern, Tyson S.; DeCarlo, Rebecca; Ciliberto, Michael A.; Singh, Rani K. (2021). "Palliative Epilepsy Surgery Procedures in Children". Seminars in Pediatric Neurology. 39 100912. doi:10.1016/j.spen.2021.100912. ISSN   1558-0776. PMID   34620461.
  58. 1 2 Doherty MJ, Haltiner AM (January 2007). "Wag the dog: skepticism on seizure alert canines". Neurology. 68 (4): 309. CiteSeerX   10.1.1.1003.1543 . doi:10.1212/01.wnl.0000252369.82956.a3. PMID   17242343. S2CID   33328776.
  59. ↑ Lattanzi, Simona; Trinka, Eugen; Striano, Pasquale; Rocchi, Chiara; Salvemini, Sergio; Silvestrini, Mauro; Brigo, Francesco (2021). "Highly Purified Cannabidiol for Epilepsy Treatment: A Systematic Review of Epileptic Conditions Beyond Dravet Syndrome and Lennox–Gastaut Syndrome". CNS Drugs. 35 (3): 265–281. doi:10.1007/s40263-021-00807-y. PMC   8005394 . PMID   33754312.
  60. ↑ Elliott, Jesse; DeJean, Deirdre; Clifford, Tammy; Coyle, Doug; Potter, Beth K.; Skidmore, Becky; Alexander, Christine; Repetski, Alexander E.; Shukla, Vijay; McCoy, Bláthnaid; Wells, George A. (2020). "Cannabis-based products for pediatric epilepsy: An updated systematic review". Seizure. 75: 18–22. doi: 10.1016/j.seizure.2019.12.006 . ISSN   1532-2688. PMID   31865133.
  61. ↑ Martin-McGill, Kirsty J.; Bresnahan, Rebecca; Levy, Robert G.; Cooper, Paul N. (24 June 2020). "Ketogenic diets for drug-resistant epilepsy". The Cochrane Database of Systematic Reviews. 2020 (6) CD001903. doi:10.1002/14651858.CD001903.pub5. ISSN   1469-493X. PMC   7387249 . PMID   32588435.
  62. ↑ Devi, Nagita; Madaan, Priyanka; Kandoth, Nidhun; Bansal, Dipika; Sahu, Jitendra Kumar (2023). "Efficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy: A Systematic Review and Network Meta-analysis". JAMA Pediatrics. 177 (3): 258–266. doi:10.1001/jamapediatrics.2022.5648. PMC   9887534 . PMID   36716045.
  63. ↑ Neligan, Aidan; Adan, Guleed; Nevitt, Sarah J; Pullen, Angie; Sander, Josemir W; Bonnett, Laura; Marson, Anthony G (23 January 2023). Cochrane Epilepsy Group (ed.). "Prognosis of adults and children following a first unprovoked seizure". Cochrane Database of Systematic Reviews. 2023 (1) CD013847. doi:10.1002/14651858.CD013847.pub2. PMC   9869434 . PMID   36688481.
  64. ↑ Bonnett LJ, Tudur-Smith C, Williamson PR, Marson AG (December 2010). "Risk of recurrence after a first seizure and implications for driving: further analysis of the Multicentre study of early Epilepsy and Single Seizures". BMJ. 341 c6477. doi:10.1136/bmj.c6477. PMC   2998675 . PMID   21147743.
  65. ↑ Asadi-Pooya, Ali A.; Brigo, Francesco; Lattanzi, Simona; Blümcke, Ingmar (29 July 2023). "Adult epilepsy". Lancet. 402 (10399): 412–424. doi:10.1016/S0140-6736(23)01048-6. PMID   37459868.
  66. 1 2 Gavvala JR, Schuele SU (December 2016). "New-Onset Seizure in Adults and Adolescents: A Review". JAMA. 316 (24): 2657–2668. doi:10.1001/jama.2016.18625. PMID   28027373.
  67. ↑ Camfield P, Camfield C (June 2015). "Incidence, prevalence and aetiology of seizures and epilepsy in children". Epileptic Disorders. 17 (2): 117–123. doi: 10.1684/epd.2015.0736 . PMID   25895502. S2CID   20719640.
  68. 1 2 3 Ali R, Connolly ID, Feroze AH, Awad AJ, Choudhri OA, Grant GA (June 2016). "Epilepsy: A Disruptive Force in History". World Neurosurgery. 90: 685–690. doi:10.1016/j.wneu.2015.11.060. PMID   26709155.
  69. ↑ Magiorkinis E, Sidiropoulou K, Diamantis A (January 2010). "Hallmarks in the history of epilepsy: epilepsy in antiquity". Epilepsy & Behavior. 17 (1): 103–108. doi:10.1016/j.yebeh.2009.10.023. PMID   19963440. S2CID   26340115.
  70. ↑ National Institute for Health and Clinical Excellence (January 2012). "Chapter 1: Introduction" (PDF). The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Clinical Guideline Centre. pp. 21–28. Archived (PDF) from the original on 16 December 2013.
  71. ↑ Martindale JL, Goldstein JN, Pallin DJ (February 2011). "Emergency department seizure epidemiology". Emergency Medicine Clinics of North America. 29 (1): 15–27. doi:10.1016/j.emc.2010.08.002. PMID   21109099.
  72. 1 2 Litt B, Echauz J (May 2002). "Prediction of epileptic seizures". The Lancet. Neurology. 1 (1): 22–30. doi:10.1016/S1474-4422(02)00003-0. PMID   12849542. S2CID   10109539.
  73. 1 2 Walker MC, Schorge S, Kullmann DM, Wykes RC, Heeroma JH, Mantoan L (September 2013). "Gene therapy in status epilepticus". Epilepsia. 54 (Suppl 6): 43–45. doi: 10.1111/epi.12275 . PMID   24001071. S2CID   13942394.
  74. 1 2 Mormann F, Andrzejak RG, Elger CE, Lehnertz K (February 2007). "Seizure prediction: the long and winding road". Brain. 130 (Pt 2): 314–333. doi: 10.1093/brain/awl241 . PMID   17008335.
  75. ↑ Depannemaecker D, Destexhe A, Jirsa V, Bernard C (August 2021). "Modeling seizures: From single neurons to networks". Seizure. 90: 4–8. doi: 10.1016/j.seizure.2021.06.015 . PMID   34219016. S2CID   235468072.
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