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https://www.wikidoc.org/api.php?action=feedcontributions&feedformat=atom&user=Avinash+R+Sagi wikidoc - User contributions [en] 2026-04-11T16:37:08Z User contributions MediaWiki 1.45.1 https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166153 Epilepsy classification 2015-09-30T18:41:27Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]] and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Childhood absence epilepsy]]'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects children between the ages of 4 and 12 years of age<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * These patients have recurrent absence seizures that can occur hundreds of times a day<br /> * A subset of these patients will also develop generalized tonic-clonic seizures <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Stereotyped generalized 3 Hz spike and wave discharges<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Fairly good prognosis, these children do not usually show cognitive decline or neurological deficits <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment for pure absence seizures is [[ethosuximide]]<BR> <br /> * If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Onset in first year of life<br /> * Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Boys twice as often affected as girls <br /> * Most cases are sporadic <br /> * Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal<br /> * This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. From: [http://www.dravet.com www.dravet.com]<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Prognosis is poor<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Benign focal epilepsies of childhood]]''<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Benign rolandic epilepsy begins in children between the ages of 3 and 16 years<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> * Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> * Focal seizures may be less frequently reported than more obvious generalized seizures.<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | Prognosis is quite good overall with seizures disappearing by adolescence<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | [[Anticonvulsant]]s <br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Begins in patients aged 8 to 20 years<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * Have normal IQ and are otherwise neurologically intact<br /> * Known to occur more often in young girls<br /> * Alcohol is a major contributing factor<br /> * Is thought to be genetic, though that is not to say that juvenile myoclonic epilepsy will show in immediate family members<br /> * The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking <br /> * Often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams)<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms <br /> * Must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Temporal lobe epilepsy]]''<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Seizures begin in late childhood and adolescence<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * Most common epilepsy of adults<br /> * In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus)<br /> * There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> * Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; background: #F5F5F5;" | If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> |}<br /> <br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166150 Epilepsy classification 2015-09-30T18:39:06Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]] and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Childhood absence epilepsy]]'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects children between the ages of 4 and 12 years of age<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * These patients have recurrent absence seizures that can occur hundreds of times a day<br /> * A subset of these patients will also develop generalized tonic-clonic seizures <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Stereotyped generalized 3 Hz spike and wave discharges<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Fairly good prognosis, these children do not usually show cognitive decline or neurological deficits <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment for pure absence seizures is [[ethosuximide]]<BR> <br /> * If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Onset in first year of life<br /> * Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Boys twice as often affected as girls <br /> * Most cases are sporadic <br /> * Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal<br /> * This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. From: [http://www.dravet.com www.dravet.com]<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Prognosis is poor<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Benign focal epilepsies of childhood]]''<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Benign rolandic epilepsy begins in children between the ages of 3 and 16 years<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> * Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures.<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | Prognosis is quite good overall with seizures disappearing by adolescence<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | [[Anticonvulsant]]s <br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Begins in patients aged 8 to 20 years<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * Have normal IQ and are otherwise neurologically intact<br /> * Known to occur more often in young girls<br /> * Alcohol is a major contributing factor<br /> * Is thought to be genetic, though that is not to say that juvenile myoclonic epilepsy will show in immediate family members<br /> * The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking <br /> * Often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams)<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms <br /> * Must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Temporal lobe epilepsy]]''<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Seizures begin in late childhood and adolescence<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * Most common epilepsy of adults<br /> * In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus)<br /> <br /> * There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> * Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> |}<br /> <br /> <br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166113 Epilepsy classification 2015-09-30T18:22:48Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]] and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Childhood absence epilepsy]]'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects children between the ages of 4 and 12 years of age<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * These patients have recurrent absence seizures that can occur hundreds of times a day<br /> * A subset of these patients will also develop generalized tonic-clonic seizures <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Stereotyped generalized 3 Hz spike and wave discharges<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Fairly good prognosis, these children do not usually show cognitive decline or neurological deficits <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment for pure absence seizures is [[ethosuximide]]<BR> <br /> * If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Onset in first year of life<br /> * Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Boys twice as often affected as girls <br /> * Most cases are sporadic <br /> * Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal<br /> * This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. From: [http://www.dravet.com www.dravet.com]<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Prognosis is poor<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Benign focal epilepsies of childhood]]''<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Benign rolandic epilepsy begins in children between the ages of 3 and 16 years<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> * Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures.<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | Prognosis is quite good overall with seizures disappearing by adolescence<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | [[Anticonvulsant]]s <br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> <br /> <br /> * <br /> <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166107 Epilepsy classification 2015-09-30T18:16:08Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]] and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Childhood absence epilepsy]]'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects children between the ages of 4 and 12 years of age<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * These patients have recurrent absence seizures that can occur hundreds of times a day<br /> * A subset of these patients will also develop generalized tonic-clonic seizures <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Stereotyped generalized 3 Hz spike and wave discharges<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Fairly good prognosis, these children do not usually show cognitive decline or neurological deficits <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment for pure absence seizures is [[ethosuximide]]<BR> <br /> * If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Onset in first year of life<br /> * Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Boys twice as often affected as girls <br /> * Most cases are sporadic <br /> * Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal<br /> <br /> * This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. From: [http://www.dravet.com www.dravet.com]<br /> <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Prognosis is poor.<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> <br /> <br /> <br /> * .<br /> <br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166102 Epilepsy classification 2015-09-30T18:10:57Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]] and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Childhood absence epilepsy]]'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects children between the ages of 4 and 12 years of age<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> * These patients have recurrent absence seizures that can occur hundreds of times a day<br /> * A subset of these patients will also develop generalized tonic-clonic seizures <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Stereotyped generalized 3 Hz spike and wave discharges<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Fairly good prognosis, these children do not usually show cognitive decline or neurological deficits <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment for pure absence seizures is [[ethosuximide]]<BR> <br /> * If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> <br /> <br /> <br /> <br /> <br /> * <br /> <br /> <br /> <br /> . <br /> <br /> <br /> <br /> * ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI).<br /> This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. <br /> Onset in first year of life. Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal. From: [http://www.dravet.com www.dravet.com]<br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166099 Epilepsy classification 2015-09-30T18:04:20Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]] and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> * First line treatment for these patients is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> <br /> <br /> <br /> <br /> <br /> * ''[[Childhood absence epilepsy]]''<br /> Affects children between the ages of 4 and 12 years of age.<br /> These patients have recurrent absence seizures that can occur hundreds of times a day. <br /> On EEG, one finds the stereotyped generalized 3 Hz spike and wave discharges. <br /> A subset of these patients will also develop generalized tonic-clonic seizures. <br /> This condition carries a fairly good prognosis in that these children do not usually show cognitive decline or neurological deficits. <br /> First line treatment for pure absence seizures is [[ethosuximide]]. If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used.<br /> <br /> * ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI).<br /> This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. <br /> Onset in first year of life. Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal. From: [http://www.dravet.com www.dravet.com]<br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166066 Epilepsy classification 2015-09-30T17:42:30Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Description<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | ''[[Infantile spasms]] ([[West syndrome]])'' <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Affects infants (30 days to 1 year of life)<br /> | style="padding: 5px 5px; background: #F5F5F5;" | * Characterized by sudden flexor and extensor spasms of head, trunk, and extremities<BR><br /> * Associated with brain development abnormalities, [[tuberous sclerosis]], and perinatal insults to the brain <br /> | style="padding: 5px 5px; background: #F5F5F5;" | [[Hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> <br /> | style="padding: 5px 5px; background: #F5F5F5;" | Poor prognosis (more than two-thirds will have severe deficits)<br /> | style="padding: 5px 5px; background: #F5F5F5;" | * First line treatment for these patients is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]])<BR><br /> * [[Vigabatrin]] is particularly effective when tuberous sclerosis is the cause of seizures<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> <br /> <br /> <br /> <br /> <br /> * ''[[Childhood absence epilepsy]]''<br /> Affects children between the ages of 4 and 12 years of age.<br /> These patients have recurrent absence seizures that can occur hundreds of times a day. <br /> On EEG, one finds the stereotyped generalized 3 Hz spike and wave discharges. <br /> A subset of these patients will also develop generalized tonic-clonic seizures. <br /> This condition carries a fairly good prognosis in that these children do not usually show cognitive decline or neurological deficits. <br /> First line treatment for pure absence seizures is [[ethosuximide]]. If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used.<br /> <br /> * ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI).<br /> This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. <br /> Onset in first year of life. Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal. From: [http://www.dravet.com www.dravet.com]<br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166038 Epilepsy classification 2015-09-30T17:26:38Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Seizure Syndromes '''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Discription<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> * ''[[Infantile spasms]] ([[West syndrome]])'' <br /> Associated with brain development abnormalities, [[tuberous sclerosis]], and perinatal insults to the brain. <br /> Affects infants (as implied by its name), which by definition is between 30 days to 1 year of life.<br /> Carries a poor prognosis such that only 5-10% of children with infantile spasms will develop normal to near-normal function, while more than two-thirds will have severe deficits<br /> Characterized by sudden flexor and extensor spasms of head, trunk, and extremities. <br /> key EEG finding in these patients is a [[hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes. <br /> First line treatment for these patients is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]]) since traditional antiepileptic drugs generally cannot adequately control seizure activity. [[Vigabatrin]] is also used in many countries, and is particularly effective when tuberous sclerosis is the cause of seizures.<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> <br /> * ''[[Childhood absence epilepsy]]''<br /> Affects children between the ages of 4 and 12 years of age.<br /> These patients have recurrent absence seizures that can occur hundreds of times a day. <br /> On EEG, one finds the stereotyped generalized 3 Hz spike and wave discharges. <br /> A subset of these patients will also develop generalized tonic-clonic seizures. <br /> This condition carries a fairly good prognosis in that these children do not usually show cognitive decline or neurological deficits. <br /> First line treatment for pure absence seizures is [[ethosuximide]]. If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used.<br /> <br /> * ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI).<br /> This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. <br /> Onset in first year of life. Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal. From: [http://www.dravet.com www.dravet.com]<br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166035 Epilepsy classification 2015-09-30T17:25:53Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:<br /> {| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Medical therapy for Hodgkin's lymphoma'''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Discription<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> * ''[[Infantile spasms]] ([[West syndrome]])'' <br /> Associated with brain development abnormalities, [[tuberous sclerosis]], and perinatal insults to the brain. <br /> Affects infants (as implied by its name), which by definition is between 30 days to 1 year of life.<br /> Carries a poor prognosis such that only 5-10% of children with infantile spasms will develop normal to near-normal function, while more than two-thirds will have severe deficits<br /> Characterized by sudden flexor and extensor spasms of head, trunk, and extremities. <br /> key EEG finding in these patients is a [[hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes. <br /> First line treatment for these patients is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]]) since traditional antiepileptic drugs generally cannot adequately control seizure activity. [[Vigabatrin]] is also used in many countries, and is particularly effective when tuberous sclerosis is the cause of seizures.<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> <br /> * ''[[Childhood absence epilepsy]]''<br /> Affects children between the ages of 4 and 12 years of age.<br /> These patients have recurrent absence seizures that can occur hundreds of times a day. <br /> On EEG, one finds the stereotyped generalized 3 Hz spike and wave discharges. <br /> A subset of these patients will also develop generalized tonic-clonic seizures. <br /> This condition carries a fairly good prognosis in that these children do not usually show cognitive decline or neurological deficits. <br /> First line treatment for pure absence seizures is [[ethosuximide]]. If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used.<br /> <br /> * ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI).<br /> This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. <br /> Onset in first year of life. Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal. From: [http://www.dravet.com www.dravet.com]<br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Epilepsy_classification&diff=1166032 Epilepsy classification 2015-09-30T17:25:10Z

<p>Avinash R Sagi: </p> <hr /> <div> __NOTOC__<br /> {{Epilepsy}}<br /> {{CMG}} {{AE}} {{VVS}}<br /> ==Classification==<br /> Epilepsies are classified five ways:<br /> # By their first cause (or [[etiology]]).<br /> # By the observable manifestations of the seizures, known as semiology.<br /> # By the location in the brain where the seizures originate.<br /> # As a part of discrete, identifiable medical [[syndrome]]s.<br /> # By the event that triggers the seizures, as in primary reading epilepsy.<br /> <br /> In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.<ref name="ILEA1981">{{cite journal<br /> | author =<br /> | title = Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 22<br /> | issue = 4<br /> | pages = 489-501<br /> | year = 1981<br /> | id = PMID 6790275}}</ref> This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.<ref name="ILEA1989">{{cite journal<br /> | author =<br /> | title = Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.<br /> | journal = Epilepsia<br /> | volume = 30<br /> | issue = 4<br /> | pages = 389-99<br /> | year =1989<br /> | id = PMID 2502382}}</ref> This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localisation within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes: ictal phenomenon, seizure type, syndrome, etiology and impairment.<ref name="ILAE">{{cite web<br /> | url = http://www.ilae-epilepsy.org/Visitors/Centre/ctf/overview.cfm<br /> | title = A Proposed Diagnostic Scheme For People With Epileptic Seizures And With Epilepsy: Report Of The Ilae Task Force On Classification And Terminology<br /> | accessdate = 2006-07-18<br /> | author = Jerome Engel<br /> | publisher = ILAE<br /> }}</ref><br /> <br /> === Seizure types ===<br /> {{Main|Seizure types}}<br /> Seizure types are organized firstly according to whether the source of the seizure within the brain is localized ([[Focal seizures|''partial'' or ''focal'']] onset seizures) or distributed (''generalized'' seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a ''[[Simple partial seizure|simple partial]]'' seizure; otherwise it is a ''[[Complex partial seizure|complex partial]]'' (psychomotor) seizure. A partial seizure may spread within the brain - a process known as ''secondary generalization''. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include [[Absence seizure|absence]] (petit mal), [[Myoclonus|myoclonic]], [[Clonus|clonic]], tonic, [[Tonic-clonic seizure|tonic-clonic]] (grand mal) and [[Atonic seizure|atonic]] seizures.<br /> <br /> === Seizure Syndromes ===<br /> There are many different epilepsy syndromes, each presenting with its own unique combination of seizure type, typical age of onset, EEG findings, treatment, and prognosis. Below are some common seizure syndromes:{| style="border: 0px; font-size: 90%; margin: 3px;" align=center<br /> |+ '''Medical therapy for Hodgkin's lymphoma'''<br /> ! style="background: #4479BA; color:#FFF;" | Type of seizure <br /> ! style="background: #4479BA; color:#FFF;" | Typical age of onset<br /> ! style="background: #4479BA; color:#FFF;" | Discription<br /> ! style="background: #4479BA; color:#FFF;" | EEG findings<br /> ! style="background: #4479BA; color:#FFF;" | Prognosis<br /> ! style="background: #4479BA; color:#FFF;" | Treatment<br /> <br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | ---------<br /> |-<br /> | style="padding: 5px 5px; background: #F5F5F5;" |<br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> | style="padding: 5px 5px; background: #F5F5F5;" | <br /> |}<br /> * ''[[Infantile spasms]] ([[West syndrome]])'' <br /> Associated with brain development abnormalities, [[tuberous sclerosis]], and perinatal insults to the brain. <br /> Affects infants (as implied by its name), which by definition is between 30 days to 1 year of life.<br /> Carries a poor prognosis such that only 5-10% of children with infantile spasms will develop normal to near-normal function, while more than two-thirds will have severe deficits<br /> Characterized by sudden flexor and extensor spasms of head, trunk, and extremities. <br /> key EEG finding in these patients is a [[hypsarrhythmia]], or a high-voltage slow wave with multifocal spikes. <br /> First line treatment for these patients is [[adrenocorticotropic hormone]] ([[ACTH]] or [[corticotropin]]) since traditional antiepileptic drugs generally cannot adequately control seizure activity. [[Vigabatrin]] is also used in many countries, and is particularly effective when tuberous sclerosis is the cause of seizures.<br /> [[image:Spike-waves.png|right|thumb|Generalized 3 Hz spike and wave discharges in EEG]]<br /> <br /> * ''[[Childhood absence epilepsy]]''<br /> Affects children between the ages of 4 and 12 years of age.<br /> These patients have recurrent absence seizures that can occur hundreds of times a day. <br /> On EEG, one finds the stereotyped generalized 3 Hz spike and wave discharges. <br /> A subset of these patients will also develop generalized tonic-clonic seizures. <br /> This condition carries a fairly good prognosis in that these children do not usually show cognitive decline or neurological deficits. <br /> First line treatment for pure absence seizures is [[ethosuximide]]. If patients do not respond or have mixed seizures along with their absence seizures, then [[valproic acid]] can be used.<br /> <br /> * ''[[Dravet's syndrome]]'' Severe myoclonic epilepsy of infancy (SMEI).<br /> This very rare syndrome is delimitated from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose’s myoclonic-astatic epilepsy. <br /> Onset in first year of life. Symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases, but familial cases are exceptionnal. From: [http://www.dravet.com www.dravet.com]<br /> <br /> * ''[[Benign focal epilepsies of childhood]]''<br /> The most common syndromes comprising the benign focal epilepsies of childhood include Benign Childhood Epilepsy with Centro-Temporal Spikes (or benign rolandic epilepsy), and Benign Childhood Epilepsy with Occipital Paroxysms. <br /> Benign rolandic epilepsy begins in children between the ages of 3 and 16 years. Apart from their seizure disorder, these patients are otherwise normal. <br /> Seizures typically occur at night, and are brief, focal motor events affecting facial and pharyngeal muscles, though may be generalized convulsions as well. <br /> Focal seizures may be less frequently reported than more obvious generalized seizures. Between seizures, patients have a stereotyped EEG pattern that includes di- or triphasic sharp waves over the central-midtemporal (Rolandic) regions. <br /> Prognosis is quite good overall with seizures disappearing by adolescence. <br /> There is no consensus on the first line treatment, however most cases respond well to most [[anticonvulsant]]s. <br /> <br /> * ''[[Juvenile myoclonic epilepsy]]'' (JME)<br /> begins in patients aged 8 to 20 years. These patients have normal IQ and are otherwise neurologically intact. JME is thought to be genetic, though that is not to say that JME will show in immediate family members. The seizures are morning myoclonic jerks often with generalized tonic-clonic seizures that occur just after waking. 'Petit mal' or absence seizures are less common in cases of JME, but are known to occur more often in young girls.<br /> EEG readings reveal generalized spikes with 4-6 Hz spike wave discharges and multiple spike discharges. Interestingly, these patients are often first diagnosed when they have their first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams). Alcohol is a major contributing factor and those with severe JME should monitor their intake of units. <br /> [[Valproic acid]] is the first line treatment, whereas carbamazepine can actually worsen symptoms. This condition is lifelong, thus patients must be taught appropriate sleep hygiene to prevent generalized tonic-clonic seizures. The severity of JME varies from person to person - some will experience full blown tonic-clonic seizures regularly, others will suffer only under sufficient stress from lack of sleep and intoxication.<br /> <br /> * ''[[Temporal lobe epilepsy]]'' is the most common epilepsy of adults. In most cases, the epileptogenic region is found in the medial temporal structures (e.g., the hippocampus, amygdala, and parahippocampal gyrus). Seizures begin in late childhood and adolescence. There is an association with febrile seizures in childhood, and some studies have shown herpes simplex virus (HSV) DNA in these regions, suggesting that perhaps this epilepsy has an infectious etiology. <br /> Most of these patients have complex partial seizures sometimes preceded by an [[Aura (symptom)|aura]], and some TLE patients also suffer from secondary generalised [[tonic-clonic seizures]]. <br /> If the patient does not respond sufficiently to medical treatment, surgery may be considered.<br /> <br /> * ''[[Fetal alcohol syndrome]]'' <br /> (FAS) is caused by prenatal [[alcohol]] exposure and results in [[central nervous system]] (CNS) damage. Seizure disorders due to prenatal alcohol exposure are one of several possible criteria for diagnosing FASD; however, any seizure disorder due to postnatal insult does not qualify as a diagnostic criterion for FASD.<ref>Astley, S.J. (2004). ''Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code''. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn.</ref><br /> * ''[[Frontal lobe epilepsy]]''<br /> * ''[[Lennox-Gastaut syndrome]]''<br /> * ''Occipital lobe epilepsy''<br /> <br /> ==References==<br /> {{reflist|2}}<br /> {{WH}}<br /> {{WS}}<br /> [[Category:Needs overview]]<br /> [[Category:Neurological disorders]]<br /> [[Category:Neurology]]<br /> [[Category:Epilepsy]]<br /> [[Category:Pediatrics]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Primary care]]</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161696 Neurology 2015-09-23T23:59:29Z

<p>Avinash R Sagi: </p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]], and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * [[Behavioral neurology|Behavioral/cognitive syndromes]]<br /> * [[Headache|Headache disorders]] such as [[migraine]], [[cluster headache]], and [[tension headache]] <br /> * [[Seizure|Seizure]] disorders<br /> * [[Neurodegenerative disorder|Neurodegenerative disorders]] including <br /> :* [[Alzheimer's disease]]<br /> :* [[Parkinson's disease]] <br /> :* [[Huntington's disease]]<br /> :* [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]])<br /> * [[Cerebrovascular disease]] such as <br /> :* [[Transient ischemic attack]]<br /> :* [[Stroke]]<br /> * [[Sleep disorder|Sleep disorders]]<br /> * [[Cerebral palsy|Cerebral palsy]] <br /> * [[Infection|Infections]] of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), and spinal cord ([[myelitis]])<br /> * [[Infections|Infections]] of the peripheral nervous system<br /> * [[Neoplasm|Neoplasms]] - [[tumors]] of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * [[Movement disorder|Movement disorders]] such as <br /> :* [[Parkinson's disease]] <br /> :* [[Huntington's disease]]<br /> :* [[Hemiballismus]] <br /> :* [[Tic disorder]]<br /> :* Gilles de la [[Tourette syndrome]]<br /> * [[Demyelinating disease|Demyelinating diseases]] of the <br /> :* [[Central nervous system]] such as [[multiple sclerosis]] <br /> :* [[Peripheral nervous system]] such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * [[Spinal cord|Spinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], and malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]), and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]], and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor, and [[coma]]<br /> * [[communication disorder|Speech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of post secondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes, and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines have created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers have increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]], and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots. (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161695 Neurology 2015-09-23T23:56:47Z

<p>Avinash R Sagi: </p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> <br /> <br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]], and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * [[Behavioral neurology|Behavioral/cognitive syndromes]]<br /> * [[Headache|Headache disorders]] such as [[migraine]], [[cluster headache]], and [[tension headache]] <br /> * [[Seizure|Seizure]] disorders<br /> * [[Neurodegenerative disorder|Neurodegenerative disorders]] including <br /> :* [[Alzheimer's disease]]<br /> :* [[Parkinson's disease]] <br /> :* [[Huntington's disease]]<br /> :* [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]])<br /> * Cerebrovascular disease, such as <br /> :* [[Transient ischemic attack]]<br /> :* [[Stroke]]<br /> * [[Sleep disorder|Sleep disorders]]<br /> * [[Cerebral palsy|Cerebral palsy]] <br /> * [[Infection|Infections]] of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]])<br /> * [[Infections|Infections]] of the peripheral nervous system<br /> * [[Neoplasm|Neoplasms]] - [[tumors]] of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * [[Movement disorder|Movement disorders]] such as <br /> :* [[Parkinson's disease]] <br /> :* [[Huntington's disease]]<br /> :* [[Hemiballismus]] <br /> :* [[Tic disorder]]<br /> :* Gilles de la [[Tourette syndrome]]<br /> * [[Demyelinating disease|Demyelinating diseases]] of the <br /> :* [[Central nervous system]] such as [[multiple sclerosis]] <br /> :* [[Peripheral nervous system]] such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * [[Spinal cord|Spinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], and malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]), and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]], and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor, and [[coma]]<br /> * [[communication disorder|Speech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of post secondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes, and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines have created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers have increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]], and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots. (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161692 Neurology 2015-09-23T23:14:08Z

<p>Avinash R Sagi: </p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> <br /> <br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]] and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * [[Behavioral neurology|Behavioral/cognitive syndromes]]<br /> * [[Headache|Headache disorders]] such as [[migraine]], [[cluster headache]], and [[tension headache]] <br /> * [[Seizure|Seizure]] disorders<br /> * [[Neurodegenerative disorder|Neurodegenerative disorders]], including [[Alzheimer's disease]], [[Parkinson's disease]], [[Huntington's disease]], and [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]]). <br /> * Cerebrovascular disease, such as [[transient ischemic attack]], and [[stroke]].<br /> * [[Sleep disorder|Sleep disorders]]<br /> * [[Cerebral palsy|Cerebral palsy]] <br /> * [[Infection|Infections]] of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]])<br /> * [[Infections|Infections]] of the peripheral nervous system<br /> * [[Neoplasm|Neoplasms]] - [[tumors]] of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * [[Movement disorder|Movement disorders]] such as [[Parkinson's disease]], [[Huntington's disease]], [[hemiballismus]], [[tic disorder]], and Gilles de la [[Tourette syndrome]]<br /> * [[Demyelinating disease|Demyelinating diseases]] of the central nervous system, such as [[multiple sclerosis]] and of the [[peripheral nervous system]], such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * [[Spinal cord|Spinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]), and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]], and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor, and [[coma]]<br /> * [[communication disorder|Speech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> <br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]] and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> <br /> [[bn:স্নায়ুবিদ্যা]]<br /> [[bs:Neurologija]]<br /> [[bg:Неврология]]<br /> [[ca:Neurologia]]<br /> [[cs:Neurologie]]<br /> [[da:Neuromedicin]]<br /> [[de:Neurologie]]<br /> [[el:Νευρολογία]]<br /> [[es:Neurología]]<br /> [[eo:Neŭrologio]]<br /> [[eu:Neurologia]]<br /> [[fa:عصب‌شناسی]]<br /> [[fr:Neurologie]]<br /> [[ga:Néareolaíocht]]<br /> [[hr:Neurologija]]<br /> [[id:Neurologi]]<br /> [[it:Neurologia]]<br /> [[he:נוירולוגיה]]<br /> [[ku:Neurologî]]<br /> [[lt:Neurologija]]<br /> [[hu:Neurológia]]<br /> [[nl:Neurologie]]<br /> [[ne:स्नायुशास्त्र]]<br /> [[ja:神経学]]<br /> [[no:Nevrologi]]<br /> [[nn:Nevrologi]]<br /> [[pl:Neurologia]]<br /> [[pt:Neurologia]]<br /> [[ro:Neurologie]]<br /> [[ru:Неврология]]<br /> [[simple:Neurology]]<br /> [[sr:Неурологија]]<br /> [[fi:Neurologia]]<br /> [[sv:Neurologi]]<br /> [[tr:Nöroloji]]<br /> [[ur:اعصابیات]]<br /> [[zh:神經學]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161689 Neurology 2015-09-23T23:11:42Z

<p>Avinash R Sagi: </p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> <br /> <br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]] and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * [[Behavioral neurology|Behavioral/cognitive syndromes]]<br /> * [[Headache|Headache disorders]] such as [[migraine]], [[cluster headache]], and [[tension headache]] <br /> * [[Seizure|Seizure]] disorders<br /> * [[Neurodegenerative disorder|Neurodegenerative disorders]], including [[Alzheimer's disease]], [[Parkinson's disease]], [[Huntington's disease]], and [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]]). <br /> * Cerebrovascular disease, such as [[transient ischemic attack]], and [[stroke]].<br /> * [[Sleep disorder|Sleep disorders]]<br /> * [[Cerebral palsy|Cerebral palsy]] <br /> * [[Infection|Infections]] of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]])<br /> * [[Infections|Infections]] of the peripheral nervous system<br /> * [[Neoplasm|Neoplasms]] - [[tumors]] of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * [[Movement disorder|Movement disorders]] such as [[Parkinson's disease]], [[Huntington's disease]], [[hemiballismus]], [[tic disorder]], and Gilles de la [[Tourette syndrome]]<br /> * [[Demyelinating disease|Demyelinating diseases]] of the central nervous system, such as [[multiple sclerosis]], and of the [[peripheral nervous system]], such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * [[Spinal cord|Spinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]), and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]], and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor, and [[coma]]<br /> * [[communication disorder|Speech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> <br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]] and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> <br /> [[bn:স্নায়ুবিদ্যা]]<br /> [[bs:Neurologija]]<br /> [[bg:Неврология]]<br /> [[ca:Neurologia]]<br /> [[cs:Neurologie]]<br /> [[da:Neuromedicin]]<br /> [[de:Neurologie]]<br /> [[el:Νευρολογία]]<br /> [[es:Neurología]]<br /> [[eo:Neŭrologio]]<br /> [[eu:Neurologia]]<br /> [[fa:عصب‌شناسی]]<br /> [[fr:Neurologie]]<br /> [[ga:Néareolaíocht]]<br /> [[hr:Neurologija]]<br /> [[id:Neurologi]]<br /> [[it:Neurologia]]<br /> [[he:נוירולוגיה]]<br /> [[ku:Neurologî]]<br /> [[lt:Neurologija]]<br /> [[hu:Neurológia]]<br /> [[nl:Neurologie]]<br /> [[ne:स्नायुशास्त्र]]<br /> [[ja:神経学]]<br /> [[no:Nevrologi]]<br /> [[nn:Nevrologi]]<br /> [[pl:Neurologia]]<br /> [[pt:Neurologia]]<br /> [[ro:Neurologie]]<br /> [[ru:Неврология]]<br /> [[simple:Neurology]]<br /> [[sr:Неурологија]]<br /> [[fi:Neurologia]]<br /> [[sv:Neurologi]]<br /> [[tr:Nöroloji]]<br /> [[ur:اعصابیات]]<br /> [[zh:神經學]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161682 Neurology 2015-09-23T21:51:50Z

<p>Avinash R Sagi: </p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> <br /> <br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]] and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * [[Behavioral neurology|Behavioral/cognitive syndromes]]<br /> * [[Headache|Headache disorders]] such as [[migraine]], [[cluster headache]] and [[tension headache]] <br /> * [[Seizure|Seizure]] disorders<br /> * [[Neurodegenerative disorder|Neurodegenerative disorders]], including [[Alzheimer's disease]], [[Parkinson's disease]], [[Huntington's disease]], and [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]]). <br /> * Cerebrovascular disease, such as [[transient ischemic attack]] and [[stroke]].<br /> * [[Sleep disorder|Sleep disorders]]<br /> * [[Cerebral palsy|Cerebral palsy]] <br /> * [[Infection|Infections]] of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]])<br /> * [[Infections|Infections]] of the peripheral nervous system<br /> * [[Neoplasm|Neoplasms]] - [[tumors]] of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * [[Movement disorder|Movement disorders]] such as [[Parkinson's disease]], [[Huntington's disease]], [[hemiballismus]], [[tic disorder]], and Gilles de la [[Tourette syndrome]]<br /> * [[Demyelinating disease|Demyelinating diseases]] of the central nervous system, such as [[multiple sclerosis]], and of the [[peripheral nervous system]], such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * [[Spinal cord|Spinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]) and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]] and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor and [[coma]]<br /> * [[communication disorder|Speech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> <br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]] and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> <br /> [[bn:স্নায়ুবিদ্যা]]<br /> [[bs:Neurologija]]<br /> [[bg:Неврология]]<br /> [[ca:Neurologia]]<br /> [[cs:Neurologie]]<br /> [[da:Neuromedicin]]<br /> [[de:Neurologie]]<br /> [[el:Νευρολογία]]<br /> [[es:Neurología]]<br /> [[eo:Neŭrologio]]<br /> [[eu:Neurologia]]<br /> [[fa:عصب‌شناسی]]<br /> [[fr:Neurologie]]<br /> [[ga:Néareolaíocht]]<br /> [[hr:Neurologija]]<br /> [[id:Neurologi]]<br /> [[it:Neurologia]]<br /> [[he:נוירולוגיה]]<br /> [[ku:Neurologî]]<br /> [[lt:Neurologija]]<br /> [[hu:Neurológia]]<br /> [[nl:Neurologie]]<br /> [[ne:स्नायुशास्त्र]]<br /> [[ja:神経学]]<br /> [[no:Nevrologi]]<br /> [[nn:Nevrologi]]<br /> [[pl:Neurologia]]<br /> [[pt:Neurologia]]<br /> [[ro:Neurologie]]<br /> [[ru:Неврология]]<br /> [[simple:Neurology]]<br /> [[sr:Неурологија]]<br /> [[fi:Neurologia]]<br /> [[sv:Neurologi]]<br /> [[tr:Nöroloji]]<br /> [[ur:اعصابیات]]<br /> [[zh:神經學]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161681 Neurology 2015-09-23T21:47:04Z

<p>Avinash R Sagi: </p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> <br /> <br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]] and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * [[Behavioral neurology|Behavioral/cognitive syndromes]]<br /> * [[Headache|Headache disorders]] such as [[migraine]], [[cluster headache]] and [[tension headache]] <br /> * [[Seizure|Seizure]] disorders<br /> * [[Neurodegenerative disorder|Neurodegenerative disorder]]s, including [[Alzheimer's disease]], [[Parkinson's disease]], [[Huntington's disease]], and [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]]). <br /> * Cerebrovascular disease, such as [[transient ischemic attack]] and [[stroke]].<br /> * S[[sleep disorder|leep disorder]]s<br /> * C[[cerebral palsy|erebral palsy]] <br /> * I[[infection|nfection]]s of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]])<br /> * I[[infections|nfections]] of the peripheral nervous system<br /> * N[[neoplasm|eoplasm]]s - [[tumor]]s of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * M[[movement disorder|ovement disorder]]s such as [[Parkinson's disease]], [[Huntington's disease]], [[hemiballismus]], [[tic disorder]], and Gilles de la [[Tourette syndrome]]<br /> * D[[demyelinating disease|emyelinating disease]]s of the central nervous system, such as [[multiple sclerosis]], and of the [[peripheral nervous system]], such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * S[[spinal cord|pinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]) and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]] and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor and [[coma]]<br /> * S[[communication disorder|peech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> <br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]] and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> <br /> [[bn:স্নায়ুবিদ্যা]]<br /> [[bs:Neurologija]]<br /> [[bg:Неврология]]<br /> [[ca:Neurologia]]<br /> [[cs:Neurologie]]<br /> [[da:Neuromedicin]]<br /> [[de:Neurologie]]<br /> [[el:Νευρολογία]]<br /> [[es:Neurología]]<br /> [[eo:Neŭrologio]]<br /> [[eu:Neurologia]]<br /> [[fa:عصب‌شناسی]]<br /> [[fr:Neurologie]]<br /> [[ga:Néareolaíocht]]<br /> [[hr:Neurologija]]<br /> [[id:Neurologi]]<br /> [[it:Neurologia]]<br /> [[he:נוירולוגיה]]<br /> [[ku:Neurologî]]<br /> [[lt:Neurologija]]<br /> [[hu:Neurológia]]<br /> [[nl:Neurologie]]<br /> [[ne:स्नायुशास्त्र]]<br /> [[ja:神経学]]<br /> [[no:Nevrologi]]<br /> [[nn:Nevrologi]]<br /> [[pl:Neurologia]]<br /> [[pt:Neurologia]]<br /> [[ro:Neurologie]]<br /> [[ru:Неврология]]<br /> [[simple:Neurology]]<br /> [[sr:Неурологија]]<br /> [[fi:Neurologia]]<br /> [[sv:Neurologi]]<br /> [[tr:Nöroloji]]<br /> [[ur:اعصابیات]]<br /> [[zh:神經學]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Neurology&diff=1161680 Neurology 2015-09-23T21:43:42Z

<p>Avinash R Sagi: Capitalization</p> <hr /> <div>{{SI}}<br /> {{CMG}}<br /> <br /> <br /> <br /> <br /> '''Neurology''' is a [[medical]] speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system|autonomic nervous systems]], including their coverings, blood vessels, and<br /> all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]] and [[translational research]]. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects of one of neurology's subdisciplines.<br /> <br /> ==Field of work==<br /> '''Neurological disorders''' are disorders that affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]].<br /> <br /> Major conditions include:<br /> * B[[behavioral neurology|ehavioral/cognitive syndromes]]<br /> * H[[headache|eadache disorders]] such as [[migraine]], [[cluster headache]] and [[tension headache]] <br /> * S[[seizure|eizure]] disorders<br /> * N[[neurodegenerative disorder|eurodegenerative disorder]]s, including [[Alzheimer's disease]], [[Parkinson's disease]], [[Huntington's disease]], and [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]]). <br /> * Cerebrovascular disease, such as [[transient ischemic attack]] and [[stroke]].<br /> * S[[sleep disorder|leep disorder]]s<br /> * C[[cerebral palsy|erebral palsy]] <br /> * I[[infection|nfection]]s of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]])<br /> * I[[infections|nfections]] of the peripheral nervous system<br /> * N[[neoplasm|eoplasm]]s - [[tumor]]s of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]])<br /> * M[[movement disorder|ovement disorder]]s such as [[Parkinson's disease]], [[Huntington's disease]], [[hemiballismus]], [[tic disorder]], and Gilles de la [[Tourette syndrome]]<br /> * D[[demyelinating disease|emyelinating disease]]s of the central nervous system, such as [[multiple sclerosis]], and of the [[peripheral nervous system]], such as [[Guillain-Barré syndrome]] and [[chronic inflammatory demyelinating polyneuropathy]] (CIDP)<br /> * S[[spinal cord|pinal cord]] disorders - [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], malformations (e.g., myelocele, meningomyelocele, tethered cord) <br /> * Disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]) and [[neuromuscular junction]]s<br /> * Traumatic injuries to the [[brain]], [[spinal cord]] and peripheral [[nerve]]s<br /> * Altered mental status, [[encephalopathy]], stupor and [[coma]]<br /> * S[[communication disorder|peech and language disorders]]<br /> <br /> == Educational requirements ==<br /> A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.<br /> <br /> Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.<br /> <br /> Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.<br /> <br /> == Testing examinations ==<br /> <br /> During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.<br /> <br /> ==Clinical tasks==<br /> ===General caseload===<br /> Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a [[neurosurgeon]], an [[interventional neuroradiologist]], or a [[neurointerventionalist]]. In some countries, additional legal responsibilities of a neurologist may include making a finding of [[brain death]] when it is suspected that a [[patient]] is [[deceased]]. Neurologists frequently care for people with hereditary ([[gene|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases.<br /> <br /> ===Overlapping areas===<br /> There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequela]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of [[JCAHO]] stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system [[infectious disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Similarly, most cases of [[sciatica]] and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age.<br /> <br /> [[Clinical_neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological_assessment|evaluate]] [[brain]]-[[Human_behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical_medicine_and_rehabilitation|rehabilitation]] strategies, documenting [[cognitive]] strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal [[aging]] or tracking the progression of a [[dementia]]).<br /> <br /> ===Relationship to clinical neurophysiology===<br /> In some countries, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]] and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).<br /> <br /> ===Overlap with psychiatry===<br /> {{see|Psychoneuroimmunology|Neuropsychiatry}}<br /> <br /> Although many [[mental illness]]es are believed to be neurological disorders affecting the [[central nervous system]], traditionally they are classified separately, and treated by [[psychiatrists]]. In a 2002 review article in the [[American Journal of Psychiatry]], Professor Joseph B. Martin, Dean of [[Harvard Medical School]] and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)<br /> <br /> There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|depression]], depression and [[dementia]] associated with [[Parkinson's disease]], mood and cognitive dysfunctions in [[Alzheimer's disease]], to name a few. Hence, there is no sharp distinction between neurology and [[psychiatry]] on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on [[neurosciences]] - aided by the tremendous advances in [[genetics]] and [[neuroimaging]] recently.)<br /> <br /> == References ==<br /> <references/><br /> <br /> ==External links==<br /> <br /> * [http://www.efns.org European Federation of Neurological Societies]<br /> * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology]<br /> * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)]<br /> * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial<br /> * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] <br /> * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines - Neurology]<br /> *[http://www.neurologia.com/ Revista de neurologia] <br /> <br /> {{Medicine}}<br /> {{Neuroscience-footer}}<br /> <br /> <br /> [[Category:Neurology]]<br /> [[Category:Subjects taught in medical school]]<br /> <br /> <br /> [[bn:স্নায়ুবিদ্যা]]<br /> [[bs:Neurologija]]<br /> [[bg:Неврология]]<br /> [[ca:Neurologia]]<br /> [[cs:Neurologie]]<br /> [[da:Neuromedicin]]<br /> [[de:Neurologie]]<br /> [[el:Νευρολογία]]<br /> [[es:Neurología]]<br /> [[eo:Neŭrologio]]<br /> [[eu:Neurologia]]<br /> [[fa:عصب‌شناسی]]<br /> [[fr:Neurologie]]<br /> [[ga:Néareolaíocht]]<br /> [[hr:Neurologija]]<br /> [[id:Neurologi]]<br /> [[it:Neurologia]]<br /> [[he:נוירולוגיה]]<br /> [[ku:Neurologî]]<br /> [[lt:Neurologija]]<br /> [[hu:Neurológia]]<br /> [[nl:Neurologie]]<br /> [[ne:स्नायुशास्त्र]]<br /> [[ja:神経学]]<br /> [[no:Nevrologi]]<br /> [[nn:Nevrologi]]<br /> [[pl:Neurologia]]<br /> [[pt:Neurologia]]<br /> [[ro:Neurologie]]<br /> [[ru:Неврология]]<br /> [[simple:Neurology]]<br /> [[sr:Неурологија]]<br /> [[fi:Neurologia]]<br /> [[sv:Neurologi]]<br /> [[tr:Nöroloji]]<br /> [[ur:اعصابیات]]<br /> [[zh:神經學]]<br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=Cysticercosis_medical_therapy&diff=1161408 Cysticercosis medical therapy 2015-09-23T18:56:15Z

<p>Avinash R Sagi: </p> <hr /> <div>__NOTOC__<br /> {{Cysticercosis}}<br /> {{CMG}}<br /> <br /> ==Overview==<br /> Cysticercosis is generally treated with combination of both anti parasitic drugs and anti inflammatory drugs. Symptomatic treatment is the mainstay therapy for neurocysticercosis. Surgerical removal sometimes necessary to treat Ophthalmic Cysticercosis and Subcutaneous Cysticercosis.<br /> <br /> ==Medical Therapy==<br /> ===Neurocysticercosis===<br /> Neurocysticercosis most often presents as [[headache]]s and acute onset [[seizure]]s, thus the immediate mainstay of therapy is [[anticonvulsant]] medications. Once the seizures have been brought under control, [[antihelminthic]] treatments may be undertaken. The decision to treat with [[antiparasitic therapy]] is complex and based on the stage and number of cysts present, their location, and the patient's specific clinical presentation.<ref>{{cite journal|title=New developments in the management of neurocysticercosis|doi=10.1086/597758|year=2009|author=White, Jr., A. Clinton|journal=The Journal of Infectious Diseases|volume=199|pages=1261|pmid=19358667|issue=9}}</ref> Antiparasitic treatment should be given in combination with [[corticosteroids]] and anticonvulsants to reduce inflammation surrounding the cysts and lower the risk of seizures. [[Albendazole]] is generally preferable over [[praziquantel]] due to its lower cost and fewer drug interactions.<ref name="nine">Dimitrios K. Matthaiou, Georgios Panos, Eleni S. Adamidi,Matthew E. Falagas “Albendazole versus Praziquantel in the Treatment of Neurocysticercosis: A Meta-analysis of Comparative Trials” PLoS Negl Trop Dis. 2008 March; 2(3): e194</ref> Asymptomatic cysts, such as those discovered incidentally on neuroimaging done for another reason, may never lead to symptomatic disease and in many cases do not require therapy. Calcified cysts have already died and [[Involution_(medicine)|involuted]]. Further antiparasitic therapy will be of no benefit.<br /> ===Ophthalmic cysticercosis===<br /> In ophthalmic disease, surgical removal is necessary for cysts within the [[eye]] itself while antihelminth drugs with [[steroid]]s alone might be sufficient to treat cysts outside globe.Treatment recommendations for subcutaneous cysticercosis includes surgery, [[praziquantel]] and [[albendazole]].<br /> ===Subcutaneous cysticercosis===<br /> In general, subcutaneous disease does not need specific therapy. Painful or bothersome cysts can be surgically excised.<br /> <br /> ===Antimicrobial Regimen===<br /> <br /> ====Neurocysticercosis====<br /> :* '''Neurocysticercosis treatment'''<br /> ::* 1. '''Parenchymal neurocysticercosis'''<br /> :::* 1.1 '''Single lesions'''<ref name="pmid12364377">{{cite journal| author=García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D et al.| title=Current consensus guidelines for treatment of neurocysticercosis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 747-56 | pmid=12364377 | doi= | pmc=PMC126865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364377 }} </ref><br /> ::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid for 3-8 days {{and}} [[Prednisone]] 1 mg/kg/day PO qid for 8-10 days followed by a taper<br /> :::* 1.2 '''Multiple cysts'''<br /> ::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid for 8-15 days and high-dose steroids<br /> ::::* Preferred regimen: [[Praziquantel]] 50 mg/kg/day PO tid {{and}} [[Albendazole]] 15 mg/kg/day PO bid <br /> :::* 1.3 '''Cysticercal encephalitis''' <ref name="pmid12364377">{{cite journal| author=García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D et al.| title=Current consensus guidelines for treatment of neurocysticercosis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 747-56 | pmid=12364377 | doi= | pmc=PMC126865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364377 }} </ref><br /> ::::* Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy<br /> :::* 1.4 '''Calcified cysts ''' <br /> ::::* Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic. Seizures in these patients should be treated with antiepileptic therapy. <br /> ::* 2. '''Extraparenchymal NCC'''<br /> :::* 2.1 '''Subarachnoid cysts'''<br /> ::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid for 28 days {{and}} ([[Prednisone]] up to 60 mg/day PO {{or}} [[Dexamethasone]] (up to 24 mg/day)) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent <br /> :::* 2.2 '''Giant cysts'''<br /> ::::* Giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or without mannitol).<br /> :::* 2.3 ''' Intraventricular cysts''' <br /> ::::* Emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt<br /> ::::* Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci<br /> :::* 2.4 ''' Ocular cysticercosis'''<br /> ::::* Surgical excision is warranted in the setting of intraocular cysts<br /> ::::* Cysticercal involvement of the extraocular muscles should be managed with albendazole and corticosteroids.<br /> :::* 2.5 '''Spinal cysticercosis'''<br /> ::::* Medical therapy with corticosteroids and antiparasitic drugs<br /> <br /> ====Contraindicated medications====<br /> {{MedCondContrAbs|MedCond = Ocular cysticercosis|Praziquantel}}<br /> <br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Needs content]]<br /> [[Category:Infectious disease]]<br /> [[Category:Disease]]<br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=User:Avinash_R_Sagi&diff=972659 User:Avinash R Sagi 2014-05-22T02:07:36Z

<p>Avinash R Sagi: </p> <hr /> <div><br /> '''AVINASH RAO SAGI'''<br /> <br /> Contact: ASagi@som.umaryland.edu<br /> <br /> <br /> ==Current Position==<br /> <br /> <br /> <br /> * Wikidoc.org - Associate Editor-In-Chief.<br /> <br /> * Post Doctoral Research Fellow - Department of Neurology/School of Medicine, University of Maryland.<br /> <br /> <br /> ==Education==<br /> <br /> <br /> * M.B.B.S (Bachelor of Medicine & Bachelor of Surgery)- Kakatiya Medical College, NTR University of Health Sciences, Andhra Pradesh,India.<br /> <br /> * ECFMG(Educational Commission for Foreign Medical Graduate) certified.<br /> <br /> <br /> <br /> ==Research Experience==<br /> <br /> <br /> <br /> * Currently working on project titled- Administration of Nicotinamide Mono Nucleotide (NMN) Prevents and Treats Diabetic Peripheral Neuropathy.<br /> <br /> * Presented a paper as First Author on Clinical Profile and Management of LRTI in Children - Department of Pediatrics, Mahatma Gandhi Memorial Hospital, Andhra Pradesh,India.</div>

Avinash R Sagi https://www.wikidoc.org/index.php?title=User:Avinash_R_Sagi&diff=972462 User:Avinash R Sagi 2014-05-21T04:56:21Z

<p>Avinash R Sagi: Created page with " '''AVINASH RAO SAGI''' Contact: ASagi@som.umaryland.edu <font size="+1.5">Current Position</font> ---- * Wikidoc.org - Associate Editor-I..."</p> <hr /> <div><br /> '''AVINASH RAO SAGI'''<br /> <br /> Contact: ASagi@som.umaryland.edu<br /> <br /> <br /> <font size="+1.5">Current Position</font><br /> <br /> ---- <br /> <br /> * Wikidoc.org - Associate Editor-In-Chief.<br /> <br /> * Post Doctoral Research Fellow - Department of Neurology/School of Medicine, University of Maryland.<br /> <br /> <br /> <font size="+1.5">Education</font><br /> ----<br /> <br /> * M.B.B.S (Bachelor of Medicine & Bachelor of Surgery)- Kakatiya Medical College, NTR University of Health Sciences, Andhra Pradesh,India.<br /> <br /> * ECFMG(Educational Commission for Foreign Medical Graduate) certified.<br /> <br /> <br /> <br /> <font size="+1.5">Research Experience</font><br /> <br /> ----<br /> <br /> * Currently working on project titled- Administration of Nicotinamide Mono Nucleotide (NMN) Prevents and Treats Diabetic Peripheral Neuropathy.<br /> <br /> * Presented a paper as First Author on Clinical Profile and Management of LRTI in Children - Department of Pediatrics, Mahatma Gandhi Memorial Hospital, Andhra Pradesh,India.</div>

Avinash R Sagi