Question 1 of 10

    Epilepsy (Seizure Disorder)

    Spike-waves[1]

    Epilepsy is a brain disorder characterized by an enduring predisposition to generate epileptic seizures, the consequences of this condition and the occurrence of at least one seizure. Seizures can be classified as being partial-onset seizures and generalized-onset seizures.

    This disease is caused by the following process: endocrine.

    Presentation

    The symptoms of epilepsy usually vary on the basis of underlying pathology. Seizure is the only symptom which is present in all types of epilepsy. However, the associated symptoms may differ on the type of seizures.

    Impairment or loss of consciousness is usually a feature of complex partial seizures. The level of consciousness is not affected in simple partial seizures. Atonic and tonic seizures often make the patient fall down.

    Skin
    Flushing
    • Postural Phonatory Vocalization arrest of speech With somatosensory or special sensory symptoms Simple hallucinations Somatosensory Visual Auditory Olfactory Gustatory Vertiginous With autonomic symptoms or signs Epigastric sensations, pallor, sweating, flushing[clevelandclinicmeded.com]
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  • urogenital
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  • psychiatrical
    Visual Hallucination
    • They may include strange sensations, visual hallucinations, emotional changes, muscle spasms, convulsions, and a variety of other symptoms, depending on where in the brain the seizures originate.[medicinenet.com]
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  • cardiovascular
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  • musculoskeletal
    Muscle Twitch
    • These seizures produce muscle twitches, convulsions and loss of consciousness.[faculty.washington.edu]
    • Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes.[healthline.com]
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  • gastrointestinal
    Abdominal Pain
    • pain, headache, mood changes, rash, hirsutism, and gingival hyperplasia Gabapentin 300-900 300 mg/day at 24-hr intervals Neurocognitive effects, weight gain, mood changes, dry mouth, periorbital edema, myalgias Lacosamide 100 100 mg/day at 1-wk intervals[clevelandclinicmeded.com]
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  • respiratoric
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  • neurologic
    Seizure
    • […] first-line for generalized seizures with lamotrigine being second-line. [63] In those with absence seizures, ethosuximide or valproate are recommended; valproate is particularly effective in myoclonic seizures and tonic or atonic seizures. [63] If seizures[en.wikipedia.org]
    • Focal dyscognitive seizures (complex partial seizures).[mayoclinic.org]
    • These types of seizures are called provoked seizures.[aurorahealthcare.org]
    • Most seizures do not cause brain damage, but ongoing uncontrolled seizures may cause brain damage.[ninds.nih.gov]
    Confusion
    • During these seizures a person can be confused and consciousness is impaired.[healthychildren.org]
    • Partial-onset seizure symptoms can include: Shaking/stiffening of one side of the body Confusion, inability to speak Staring spells Sensory disturbances Tongue biting, drooling or foaming at the mouth Uncontrollable screaming[aurorahealthcare.org]
    • This can be even more confusing, because strokes can sometimes cause seizures .[verywell.com]
    • Others cause confusion and staring spells.[aarp.org]
    • Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness.[mayoclinic.org]
    Dizziness
    • Nervous system problems : APTIOM may cause problems that can affect your nervous system, including dizziness, sleepiness, vision problems, trouble concentrating, and difficulties with coordination and balance.[aptiom.com]
    • In some cases, people know they are about to have a seizure because they see or hear something, or feel dizzy, nauseous, or "strange."[faculty.washington.edu]
    • These medicines may cause side effects, including fatigue, dizziness, skin rash, or problems with your memory, coordination, or speech.[familydoctor.org]
    • Many people experience a sensory change or sensation, such as a tingling or dizziness, immediately before a grand mal seizure.[radiologyinfo.org]
    • Most side effects of anticonvulsants are relatively minor, including fatigue, dizziness, difficulty thinking, or mood problems, French said.[livescience.com]
    Aura
    • This is called an aura .[faculty.washington.edu]
    • There are many different types of auras which people may experience, yet while there is a great variety, aura's tend to be the same for an individual person from seizure to seizure.[verywell.com]
    • How to Tell if Your Dog is Going to Have a Seizure Signs of an impending seizure may include a period of warning, an altered mental state where the animal will experience what is called an aura or focal onset.[petmd.com]
    • This is called an aura.[health.pa.gov]
    Staring Spells
    • Partial-onset seizure symptoms can include: Shaking/stiffening of one side of the body Confusion, inability to speak Staring spells Sensory disturbances Tongue biting, drooling or foaming at the mouth Uncontrollable screaming[aurorahealthcare.org]
    • In other cases, seizures cause only a period of confusion, a staring spell or muscle spasms.[familydoctor.org]
    • Others cause confusion and staring spells.[aarp.org]
    • Spontaneous, temporary symptoms such as confusion, muscle jerks, staring spells, loss of awareness and disturbances in mood and mental functions can occur during seizures.[livescience.com]
    • Also, there was no significant reduction in nonconvulsive seizures, which are essentially brief staring spells in which a person is unaware of his or her surroundings for several seconds.[scientificamerican.com]
    Drop Attack
    • Lennox-Gestaut syndrome or other epilepsies with drop attacks.[neurosurgery.ucla.edu]
    • The seizures that respond best to callosotomy are sudden falls or "drop attacks" with injury to the patient.[massgeneral.org]
    • Corpus callosotomy can end drop attacks and other generalized seizures.[medicinenet.com]
    • attack can be, among many others, an atonic seizure . [83] Children may have behaviors that are easily mistaken for epileptic seizures but are not.[en.wikipedia.org]
    Night Terrors
    • Examples include: Breath holding Fainting (syncope) Facial or body twitching (myoclonus) Sleep disorders ( night terrors , sleepwalking, and cataplexy) They may occur just once or may recur over a limited time period.[healthychildren.org]
    • In pediatric patients, the differential also includes breath-holding spells, pallid infantile syncope, tics, night terrors, somnambulism, and long QT syndrome. 8 As soon as epileptic seizures are diagnosed, the next step is to determine the epileptic[clevelandclinicmeded.com]
    • These include breath-holding spells , bed wetting , night terrors , tics and shudder attacks . [83] Gastroesophageal reflux may cause arching of the back and twisting of the head to the side in infants, which may be mistaken for tonic-clonic seizures.[en.wikipedia.org]
    Febrile Convulsions
    • If your child has had a febrile convulsion , some parents may try controlling the fever using acetaminophen and sponging.[healthychildren.org]
    Stupor
    • […] sedative effects Phenytoin Generalized and partial seizures Cytochrome P-450 inducer Pregabalin Partial seizures Minimal drug interactions Tiagabine Partial seizures High protein binding; no enzyme induction or inhibition; may precipitate spike-wave stupor[clevelandclinicmeded.com]
    Involuntary Movements
    • It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized), and are sometimes accompanied by loss of consciousness and control of bowel or[who.int]
    Disturbance of Consciousness
    • Focal epilepsy, also called partial epilepsy, is a disorder in which seizures are preceded by an isolated disturbance such as a twitching of a part of the body, a particular sensation or feeling, or some other disturbance in consciousness.[my.clevelandclinic.org]
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  • Entire body system
    Falling
    • Tonic seizures cause a stiffening of the muscles in your back, arms and legs, and may cause you to fall to the ground.[aurorahealthcare.org]
    • These conditions include: narcolepsy , a condition which causes a person to become too sleepy, or have "sleep attacks" where they fall asleep at inappropriate times insomnia, or the inability to sleep.[neurology.duke.edu]
    • Atonic seizure - This seizure is characterized by the loss of muscle tone and causes a person to fall down.[faculty.washington.edu]
    • If a friend has a seizure, he or she may fall down and begin to shake.[health.pa.gov]
    Cerebral Palsy
    • DONATE CLOTHES TO HELP END EPILEPSY Epilepsy affects more people than multiple sclerosis, cerebral palsy, muscular dystrophy and Parkinson’s combined – yet receives fewer federal research dollars per patient than each of these.[endepilepsy.org]
    • More people suffer from epilepsy than with Parkinson's disease, cerebral palsy, multiple sclerosis and muscular dystrophy combined.[health.pa.gov]
    • This brain damage can result in epilepsy or cerebral palsy.[mayoclinic.org]
    • About 20 percent of seizures in children are due to cerebral palsy or other neurological abnormalities.[medicinenet.com]
    • palsy Mental disabilities Seizures occurring within days after head injury Family history of epilepsy or fever-related seizures Alzheimer's disease (late in the illness) Lengthy fever-related (febrile) seizures Alcohol or drug abuse A doctor makes his[aans.org]
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  • Jaw & Teeth
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  • Workup

    Before the diagnosis of epilepsy is made, the following investigations are used to rule out infections or metabolic causes of seizures.

    • Blood Chemistry Panel
    • Serum urea, creatinine and electrolytes
    • Random blood sugar
    • Serum calcium and magnesium
    • Liver function tests
    • Lumbar puncture

    Other investigations that will help diagnose epilepsy include the following.

    • Electroencephalography: Electroencephalography may help establish and characterize the type of epilepsy by demonstrating abnormal electrical activity in the brain.
    • Compuerized Tomography (CT) or Magnetic Resonance Imaging (MRI) scan: CT or MRI brain scanning is often useful in defining or excluding structural causes for seizures e.g. tumors and infections.
    • Position Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT): PET and SPECT are also used to evaluate certain patients of seizures who do not respond to medical therapy.

    Test Results

    EEG
    Seizure Activity
    • These seizure activities generally last between 30 and 90 seconds.[petmd.com]
    • Keeping good notes and records about your seizure activity will give your physician a better understanding about how epilepsy affects you and what treatments might be most effective.[health.pa.gov]
    • In a study entitled "Does co-morbid ADHD predispose to seizure activity in children?"[mayo.edu]
    • The rapid spread of seizure activity in the brain means the seizures are often convulsive.[neurosurgery.ucla.edu]
    • In some cases, this can stop seizure activity.[healthline.com]
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  • Treatment

    Immediate care of seizures:

    Little can be done for a person having a major seizure. Supportive treatment includes first aid, maintenance of airway, provision of oxygen and administration of intravenous anticonvulsants.

    Anti-convulsant drug therapy:

    If the cause of epilepsy is treatable promptly, drug therapy is not necessary. Drug therapy is required when the cause is not immediately treatable and and the patient is at a risk of having further seizures. There are various anticonvulsant drugs with different mechanism of actions. They can be divided into the following large groups [6]. 

    • Sodium channels e.g. phenytoin, carbamazepine etc
    • GABA-A receptor enhancers e.g. phenobarbital
    • T-calcium channel blockers e.g. valproate
    • Carbonic anhydrase inhibitors e.g. zonisamide
    • Blockers of unique binding sites e.g. gabapentin

    Surgical choices

    The type of epilepsy surgery depends on the location in the brain causing the seizures. Anterior temporal lobectomy is the most common surgical choice in adults [7]. In children, the surgical choices include corpus callosotomy and hemispherectomy [8] [9].

    Prognosis

    If epilepsy is properly controlled via medications, the lifespan of the patients is completely normal.

    Even without treatment, sudden death in the patients suffering from epilepsy is very uncommon. Those suffering from tonic-clonic seizures may suffer from accidents and traumas. Mortality is also higher in the patients whose seizures are associated with loss of consciousness.

    Complications

    Absence Seizure
    • Generalized seizure warning signs and symptoms can include: Whole-body convulsions Whole-body jerks Staring spells Common types of generalized seizures include: Absence seizures , previously known as petit mal seizures, often occur in children.[aurorahealthcare.org]
    • Absence seizures (also called petit mal seizures) - These seizures may not always be recognized as seizures at first.[verywell.com]
    • Absence seizure is another type of generalised seizure.[news-medical.net]
    • Absence seizure ("petit mal" seizure) — Your child will lose awareness and stare blankly for a few seconds.[ucsfbenioffchildrens.org]
    Night Terrors
    • Examples include: Breath holding Fainting (syncope) Facial or body twitching (myoclonus) Sleep disorders ( night terrors , sleepwalking, and cataplexy) They may occur just once or may recur over a limited time period.[healthychildren.org]
    • In pediatric patients, the differential also includes breath-holding spells, pallid infantile syncope, tics, night terrors, somnambulism, and long QT syndrome. 8 As soon as epileptic seizures are diagnosed, the next step is to determine the epileptic[clevelandclinicmeded.com]
    • These include breath-holding spells , bed wetting , night terrors , tics and shudder attacks . [83] Gastroesophageal reflux may cause arching of the back and twisting of the head to the side in infants, which may be mistaken for tonic-clonic seizures.[en.wikipedia.org]
    Febrile Convulsions
    • If your child has had a febrile convulsion , some parents may try controlling the fever using acetaminophen and sponging.[healthychildren.org]
    Syncope
    • Other times, fainting or "syncope," may be mistaken for a seizure.[emedicinehealth.com]
    • Examples include: Breath holding Fainting (syncope) Facial or body twitching (myoclonus) Sleep disorders ( night terrors , sleepwalking, and cataplexy) They may occur just once or may recur over a limited time period.[healthychildren.org]
    • Disorders that can be confused with epilepsy include migraine, syncope, transient ischemic attacks, nonepileptic events (pseudoseizures), movement disorders, Menière's disease, and rage attacks.[clevelandclinicmeded.com]
    • "Value of serum prolactin in the management of syncope" .[en.wikipedia.org]
    Status Epilepticus
    • Status Epilepticus in Dogs Status epilepticus, or epilepsy , is a neurological disorder that causes dogs to have sudden, uncontrolled and recurring seizures.[petmd.com]
    • People in status epilepticus do not always have severe convulsive seizures.[medicinenet.com]
    • People with status epilepticus have an increased risk of permanent brain damage and death.[mayoclinic.org]
    • Status epilepticus - This seizure is characterized by frequent, long-lasting seizures without regaining consciousness between attacks.[faculty.washington.edu]
    • Serious risks include: Fetal harm in pregnant women who have epileptic seizures Status epilepticus, a condition in which seizures last longer than five minutes Sudden unexpected death in epilepsy (SUDEP), a rare fatal outcome that may be caused by changes[everydayhealth.com]
    Sleep Deprivation
    • Repeat EEGs after sleep deprivation can increase the chance of finding an abnormality.[my.clevelandclinic.org]
    • Certain activation procedures such as sleep deprivation, photic stimulation, and hyperventilation can improve the detection of epileptiform activity as can obtaining more prolonged EEG recordings.[clevelandclinicmeded.com]
    • The following factors may increase the risk of seizures in people predisposed to seizures: Stress Sleep deprivation or fatigue Insufficient food intake Alcohol use or drug abuse Failure to take prescribed anticonvulsant medications About half of the people[aans.org]
    • Sleep deprivation in particular is a universal and powerful trigger of seizures.[medicinenet.com]
    • Seizure triggers (eg, stress, sleep deprivation, alcohol, menses) should be indicated.[uptodate.com]
    Cerebral Palsy
    • DONATE CLOTHES TO HELP END EPILEPSY Epilepsy affects more people than multiple sclerosis, cerebral palsy, muscular dystrophy and Parkinson’s combined – yet receives fewer federal research dollars per patient than each of these.[endepilepsy.org]
    • More people suffer from epilepsy than with Parkinson's disease, cerebral palsy, multiple sclerosis and muscular dystrophy combined.[health.pa.gov]
    • This brain damage can result in epilepsy or cerebral palsy.[mayoclinic.org]
    • About 20 percent of seizures in children are due to cerebral palsy or other neurological abnormalities.[medicinenet.com]
    • palsy Mental disabilities Seizures occurring within days after head injury Family history of epilepsy or fever-related seizures Alzheimer's disease (late in the illness) Lengthy fever-related (febrile) seizures Alcohol or drug abuse A doctor makes his[aans.org]
    Postictal State
    • After the shaking has stopped it may take 10–30 minutes for the person to return to normal; this period is called the " postictal state " or "postictal phase."[en.wikipedia.org]
    Complex Partial Seizures
    • These may be simple partial seizures or complex partial seizures.[news-medical.net]
    • Focal dyscognitive seizures (complex partial seizures).[mayoclinic.org]
    • They're called complex partial seizures if the person becomes unconscious or experiences altered awareness.[everydayhealth.com]
    • Complex partial seizures are the most common.[health.pa.gov]
    • Common Focal Seizures: Focal seizures (previously called complex partial seizures) involve abnormal electrical activity in one part of the brain.[healthychildren.org]
    Temporal Lobe Epilepsy
    • Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy.[fusfoundation.org]
    • Among the types of epilepsy that respond to surgery: back to top Mesial temporal lobe epilepsy: Seizures usually start in childhood.[neurosurgery.ucla.edu]
    • The introduction of MRI-based hippocampal volumetry in patients with temporal lobe epilepsy by Clifford R.[mayo.edu]
    • Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome with focal seizures.[medicinenet.com]
    Complex Partial Seizure
    • These may be simple partial seizures or complex partial seizures.[news-medical.net]
    • Focal dyscognitive seizures (complex partial seizures).[mayoclinic.org]
    • They're called complex partial seizures if the person becomes unconscious or experiences altered awareness.[everydayhealth.com]
    • Complex partial seizures are the most common.[health.pa.gov]
    • Common Focal Seizures: Focal seizures (previously called complex partial seizures) involve abnormal electrical activity in one part of the brain.[healthychildren.org]
    Apnea
    • While most people will experience short-term insomnia at one point or another, some people experience persistent insomnia that lasts for weeks or months. sleep apnea, a condition caused when breathing is interrupted during sleep restless legs syndrome[neurology.duke.edu]
    • Some adverse effects of the VNS include coughing, hoarse voice, bradycardia, and exacerbation of sleep apnea.[clevelandclinicmeded.com]
    Hallucinations
    • For example, a partial seizure may cause changes in emotions, or to the senses (for example, hallucinations, numbness, tingling, or other changes to vision, taste, smell, touch, or hearing).[familydoctor.org]
    • […] findings suggest focal onset Simple Partial Seizures Consciousness not impaired With motor symptoms Focal motor Focal motor march (Jacksonian) Versive Postural Phonatory Vocalization arrest of speech With somatosensory or special sensory symptoms Simple hallucinations[clevelandclinicmeded.com]
    • One drug gave him hand tremors, another made him a zombie and a third made him hallucinate, thinking that bugs and worms were crawling out of his skin.[nytimes.com]
    • Focal seizure symptoms include unusual feelings or sensations that can take many forms, such as sudden and unexplainable emotions, nausea , or hallucinations .[medicinenet.com]

    Etiology

    The etiology of epilepsy varies with age group.

    In neonates, developmental insufficiency or brain injury are the most common causes for the development of epilepsy.

    In the infantile age group, the principal congenital malformations, perinatal injury and metabolic disorders are the principal causes of epilepsy.

    In children and adolescents, epilepsy usually results from genetic causes.

    In adults, in addition to genetic causes, cerebral neoplasms, drugs, alcohol withdrawal, brain trauma, stroke, infection and surgery are the predisposing conditions that lead to the development of epilepsy.

    The genetic syndromes that cause seizures include Angelman syndrome, Rett syndrome, Pitt Hopkin’s syndrome, tuberous sclerosis, Prader Willi syndrome and Struge Weber syndrome [1][2].

    Causes

    Sleep Deprivation
    • Repeat EEGs after sleep deprivation can increase the chance of finding an abnormality.[my.clevelandclinic.org]
    • Certain activation procedures such as sleep deprivation, photic stimulation, and hyperventilation can improve the detection of epileptiform activity as can obtaining more prolonged EEG recordings.[clevelandclinicmeded.com]
    • The following factors may increase the risk of seizures in people predisposed to seizures: Stress Sleep deprivation or fatigue Insufficient food intake Alcohol use or drug abuse Failure to take prescribed anticonvulsant medications About half of the people[aans.org]
    • Sleep deprivation in particular is a universal and powerful trigger of seizures.[medicinenet.com]
    • Seizure triggers (eg, stress, sleep deprivation, alcohol, menses) should be indicated.[uptodate.com]

    Epidemiology

    The annual incidence of epilepsy in Minnesota was demonstrated by a study to be around a 100 cases per 100,000 persons aged between 0 to 1 years; 40 cases per 100,000 persons aged 38 to 40 years and 140 cases per 100,000 persons aged 79-80 years.

    Overall, the total incidence of epilepsy is 3400 per 100,000 men (3.4%) and 2800 per 100,000 women (2.8%) by the age of 75 years [3].

    Sex distribution
    Age distribution

    Pathophysiology

    Seizures result from a sudden imbalance between the excitatory and inhibitory mechanisms in the brain [4].

    Partial seizures are those in which the seizure activity is restricted to one part of the cerebrum; i.e. the focus of increased electrical activity is in one hemisphere.

    On the other hand, in generalized seizures, diffuse regions of both the hemispheres are involved simultaneously and sunchronously.

    If any seizure remains for 60 minutes, irreversible brain damage occurs. Cell death occurs from excessively increased metabolic demands of the continuously discharging neurons.

    Prevention

    Since the cause of epilepsy is not exactly known, it is not possible to prevent it. However, head injury being the most important cause, if avoided can prevent the development of epilepsy [10]. Wearing seat belts, following traffic rules and avoiding accidents is helpful in reducing the risk of head trauma.
    Epileptics sensitive to alcohol must prevent alcohol intake.

    Summary

    A seizure or convulsion is a paroxysmal involuntary disturbance of brain function that may be manifested as an impairment or loss of consciousness, abnormal motor activity, behavioral abnormalities, sensory disturbances or autonomic dysfunction.
    Epilepsy is defined as a brain disorder that is characterized by recurrent seizures unrelated to fever or to an acute cerebral etiology.

    Patient Information

    Epilepsy is a group of disorders characterized by seizures in association with loss of consciousness and psychic abnormalities. The patients of epilepsy may belong to any age group. Early diagnosis and proper management of the disease improves the outcome. Treatment may be done through anti-seizure drugs or brain surgery.

    Other symptoms

    Toxocariasis
    • […] tapeworm , which can result in neurocysticercosis , is the cause of up to half of epilepsy cases in areas of the world where the parasite is common. [49] Epilepsy may also occur after other brain infections such as cerebral malaria , toxoplasmosis , and toxocariasis[en.wikipedia.org]

    Self-assessment

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    References

    1. Steffenburg U, Hagberg G, Hagberg B. Epilepsy in a representative series of Rett syndrome. Acta paediatrica. Jan 2001;90(1):34-39.
    2. Whalen S, Heron D, Gaillon T, et al. Novel comprehensive diagnostic strategy in Pitt-Hopkins syndrome: clinical score and further delineation of the TCF4 mutational spectrum. Human mutation. Jan 2012;33(1):64-72.
    3. Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clinic proceedings. Jun 1996;71(6):576-586.
    4. Engelborghs S, D'Hooge R, De Deyn PP. Pathophysiology of epilepsy. Acta neurologica Belgica. Dec 2000;100(4):201-213.
    5. Tharyan P. Prolactin levels in epilepsy. The Journal of the Association of Physicians of India. Jun 1991;39(6):505-506.
    6. Goldenberg MM. Overview of drugs used for epilepsy and seizures: etiology, diagnosis, and treatment. P & T : a peer-reviewed journal for formulary management. Jul 2010;35(7):392-415.
    7. Matsuura M. Indication for anterior temporal lobectomy in patients with temporal lobe epilepsy and psychopathology. Epilepsia. 2000;41 Suppl 9:39-42.
    8. Gonzalez-Martinez JA, Gupta A, Kotagal P, et al. Hemispherectomy for catastrophic epilepsy in infants. Epilepsia. Sep 2005;46(9):1518-1525.
    9. Rahimi SY, Park YD, Witcher MR, Lee KH, Marrufo M, Lee MR. Corpus callosotomy for treatment of pediatric epilepsy in the modern era. Pediatric neurosurgery. 2007;43(3):202-208.
    10. Pitkanen A, Bolkvadze T. Head Trauma and Epilepsy. In: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, eds. Jasper's Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD)2012.

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