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  • Published: 03 May 2018
  • Orrin Devinsky 1 ,
  • Annamaria Vezzani 2 ,
  • Terence J. O'Brien 3 , 4 , 5 ,
  • Nathalie Jette 6 ,
  • Ingrid E. Scheffer 7 , 8 , 9 ,
  • Marco de Curtis 10 &
  • Piero Perucca 3 , 4 , 5  

Nature Reviews Disease Primers volume  4 , Article number:  18024 ( 2018 ) Cite this article

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  • Therapeutics

Epilepsy affects all age groups and is one of the most common and most disabling neurological disorders. The accurate diagnosis of seizures is essential as some patients will be misdiagnosed with epilepsy, whereas others will receive an incorrect diagnosis. Indeed, errors in diagnosis are common, and many patients fail to receive the correct treatment, which often has severe consequences. Although many patients have seizure control using a single medication, others require multiple medications, resective surgery, neuromodulation devices or dietary therapies. In addition, one-third of patients will continue to have uncontrolled seizures. Epilepsy can substantially impair quality of life owing to seizures, comorbid mood and psychiatric disorders, cognitive deficits and adverse effects of medications. In addition, seizures can be fatal owing to direct effects on autonomic and arousal functions or owing to indirect effects such as drowning and other accidents. Deciphering the pathophysiology of epilepsy has advanced the understanding of the cellular and molecular events initiated by pathogenetic insults that transform normal circuits into epileptic circuits (epileptogenesis) and the mechanisms that generate seizures (ictogenesis). The discovery of >500 genes associated with epilepsy has led to new animal models, more precise diagnoses and, in some cases, targeted therapies.

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Departments of Neurology, Neuroscience, Neurosurgery and Psychiatry, NYU School of Medicine, New York, NY, USA

Orrin Devinsky

Department of Neuroscience, Laboratory of Experimental Neurology, IRCCS ‘Mario Negri’ Institute for Pharmacological Research, Milan, Italy

Annamaria Vezzani

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia

Terence J. O'Brien & Piero Perucca

Department of Neurology, Alfred Health, Melbourne, Victoria, Australia

Departments of Neurology and Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia

Department of Neurology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Nathalie Jette

Department of Medicine, Epilepsy Research Centre, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia

Ingrid E. Scheffer

The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia

Department of Paediatrics, and Department of Neurology, The University of Melbourne, The Royal Children's Hospital, Melbourne, Victoria, Australia

Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

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Introduction (O.D. and I.E.S.); Epidemiology (N.J.); Mechanisms/pathophysiology (A.V., M.d.C. and I.E.S.); Diagnosis, screening and prevention (P.P. and I.E.S.); Management (T.J.O.B.); Quality of life (O.D.); Outlook (I.E.S. and O.D.); and Overview of Primer (O.D.).

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O.D. has received research funding from the US NIH, GW Pharmaceuticals, Novartis and PTC Pharmaceuticals. He has equity in Egg Rock Holdings, Empatica, Engage Therapeutics, Pairnomix, Rettco and Tilray. He is the Principal Investigator for the North American SUDEP Registry and the SUDC Registry and Research Collaborative. He currently receives research funding from NIH and the US Centers for Disease Control and Prevention. He consults for the Center for Discovery. A.V. has received consultancy fees from UCB Pharma and research grants from Ovid, Pfizer and Takeda. T.J.O.B. has received research funding from Eisai, the National Health and Medical Research Council of Australia, the NIH, the Royal Melbourne Hospital Neuroscience Foundation and UCB Pharma. N.J. currently receives research funding from Alberta Health, the Canadian Institute of Health Research and the NIH, and is an associate editor of Epilepsia and serves on the editorial board of Neurology . I.E.S. has served on scientific advisory boards for BioMarin, Eisai, GlaxoSmithKline, Nutricia and UCB Pharma, sits on the editorial boards of Epileptic Disorders and Neurology and might accrue future revenue on a pending patent. I.E.S. has also received speaker honoraria from Athena Diagnostics, Eisai, GlaxoSmithKline, Transgenomics and UCB Pharma, has received funding for travel from Athena Diagnostics, Biocodex, BioMarin, Eisai, GlaxoSmithKline and UCB Pharma, and has received research support from the American Epilepsy Society, the Australian Research Council, CURE, the Health Research Council of New Zealand, the March of Dimes, the National Health and Medical Research Council of Australia, the NIH, the US Department of Defense Autism Spectrum Disorder Research Program, and Perpetual Charitable Trustees. P.P. has received honoraria from Eisai. All other authors declare no competing interests.

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Supplementary box 1.

Epilepsy syndromes by age of seizure onset. (PDF 88 kb)

Supplementary Table 1

Precision therapies. (PDF 124 kb)

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Devinsky, O., Vezzani, A., O'Brien, T. et al. Epilepsy. Nat Rev Dis Primers 4 , 18024 (2018). https://doi.org/10.1038/nrdp.2018.24

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Clinical characteristics and impact of comorbidities on the prognosis of senile epilepsy in Southwest China: a retrospective cohort study

Schisandrin b, a dual positive allosteric modulator of gabaa and glycine receptors, alleviates seizures in multiple mouse models.

Acta Pharmacologica Sinica (2024)

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State of the art and challenges in epilepsy—a narrative review.

epilepsy research paper introduction

1. Introduction

2. definition and terminology.

  • At least two unprovoked (or reflex) seizures occurring more than 24 h apart;
  • An unprovoked (or reflex) seizure and the likelihood of subsequent seizures similar to the overall risk of recurrence (at least 60%—accompanied by clinical, electrical-electroencephalogram (EEG), or neuroimaging changes) after two unprovoked seizures occurring within the next 10 years;
  • Diagnosis of epilepsy syndrome [ 5 ].

3. Etiology

4. clinical aspects, 5. diagnostic of epilepsy, 6. evolution, complication, and prognostic, 7. healthcare of people with epilepsy.

  • Wear a helmet when cycling or horseback riding;
  • No unsupervised swimming;
  • It is advisable to use the shower, not the bathtub;
  • Water temperature control of the hot water heater to reduce the risk of scalding;
  • Use a microwave oven, not a stove;
  • Avoid locking the toilet or bedroom door;
  • The height of the bed should be small in order to avoid possible post-crash injuries;
  • It is preferable to use an epilepsy safety pillow (made to reduce the risk of suffocation if sitting face down);
  • Be careful of high stairs;
  • Beware of driving rules for patients with epilepsy;
  • Administration of medication according to the scheme-continuum.

8. Treatment of Epilepsy—Principles of the Current Status

  • Epilepsy characteristics: seizure type, seizure frequency, specific epilepsy syndrome;
  • Patient characteristics: gender, age, comorbidities, pregnancy, allergies, current and previous medication;
  • Drug characteristics: efficacy, adverse reactions, drug interactions, half-life, titration, risk of teratogenicity, interaction with oral contraceptives, liquid/solid form;
  • Socio-economic characteristics: cost, availability, personal choice.

9. Drug-Resistant Epilepsy

  • Mesial temporal lobe epilepsy or neocortical epilepsy;
  • Lesional epilepsy due to focal structural pathology (low-grade glioma, cavernous malformation);
  • Nonlesional focal epilepsy.

10. Conclusions

Author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Focal OnsetGeneralized OnsetUnknown Onset
AwareImpaired Awareness

Automatisms
Atonic
Clonic
Epileptic spasms
Hyperkinetic
Myoclonic
Tonic


Autonomic
Behavior arrest
Cognitive
Emotional
Sensory

Tonic-clonic
Clonic
Tonic
Myoclonic
Myoclonic-tonic-clonic
Myoclonic-atonic
Atonic
Epileptic Spasms

Typical
Atypical
Myoclonic
Eylied myoclonia


Tonic-clonic
Epileptic spasms


Behavior arrest
Focal to bilateral tonic-clonic Unclassified
GeneticStructuralMetabolicImmuneInfectious
].
].
].
].
].
].
Test Result

EEG helps us to complete the diagnosis of epilepsy, choose appropriate therapy, monitor response to treatment, and determine candidates for antiepileptic drug withdrawal and surgical localization.
Focal spikes or sharp waves with associated slowing of the electrical activity in the area of the spikes.

Video-EEG recording is useful and indicated in patients with suspected psychogenic seizures, for epilepsy classification, and especially in those with pharmacoresistant focal epilepsy, possible candidates for epilepsy surgery. It is also helpful in intensive care units in the evaluation of encephalopathies and non-convulsive status epilepticus.
Capturing seizure activity simultaneously on video recording and EEG; increased EEG sampling may reveal evidence of interictal abnormalities (spikes and sharp waves), which may make the diagnosis of focal seizures more likely.

Usually ordered in emergencies in patients presenting with a first seizure episode (37). It is useful for identifying acute causes of seizures but is less sensitive to smaller abnormalities often seen on MRI.
Structural lesions

Neuroimaging helps us to identify the underlying etiology of focal or generalized seizures and the location of the epileptogenic area and to determine the surgical location in focal pharmacoresistant epilepsies [ ].
The optimal MRI technique for patients with focal seizures is 3 Tesla studies with coronal, axial, and sagittal T1, T2, and FLAIR sections [ ]. The epilepsy protocol should also include a 3D T1 with a volumetric acquisition, which allows better assessment of cortical dysplasia or discrete focal lesions [ ]. FLAIR has a 97% accuracy in detecting abnormalities, especially temporal sclerosis [ , ].
Structural injuries (mesial
temporal sclerosis, neoplastic lesions, vascular malformations, and developmental lesions).

Part of the surgical evaluation of treatment drug-resistant focal epilepsy.
Ictal-hypermetabolic; interictal-hypometabolic
Extreme hypoglycemia or hyperglycemia can cause provoked focal seizures.

Genetic testing is increasingly available for a number of inherited syndromes but has variable clinical utility depending on the clinical and genetic heterogeneity of a syndrome [ , ].
ConditionDifferentiating Signs/Symptoms
Vasovagal syncope usually has prodromal sensations of dizziness, nausea, and diaphoresis, often caused by the change of position, physical exertion, Valsalva maneuvers, and strong emotional impact. The loss of consciousness is short-lived; if it persists, convulsive movements may occur, and confusion may arise between the diagnosis of syncope and epileptic seizure. Post-critical confusion and urinary incontinence are rare in this situation. Cardiogenic syncope is usually the result of bradyarrhythmia or tachyarrhythmia disorders [ ].
The clinical features depend on the duration of the ischemia, the territory of the vasculature affected, and the anatomical location. Transient ischemic attacks typically last from a few minutes to an hour, usually. Cerebrovascular disease is usually associated with negative signs such as muscle weakness, aphasia, and decreased visual acuity. Epileptic seizures are associated with positive signs in the ictal period but post ictally may have negative signs, confusing with stroke, in which situations-imaging and video-EEG clarify.
May have clinical similarities similar to an epileptic seizure, such as visual, sensory, or dyscognitive phenomena. However, the mechanism is different, and it is quite rare for an epileptic seizure to follow a migraine.
Dyskinesias, paroxysmal dystonia, or tremor can mimic a focal epileptic seizure. Normal EEG during these movements and carefully studied semiology differentiate the two pathologies.
Another easily confusing category is REM sleep disorders, parasomnias. Non-REM parasomnias involve confused behavior with or without vocalization and sleepwalking. Patients with REM sleep disorders often behave violently, dreaming that they are being attacked or chased, with the risk of injury during these episodes. Polysomnography is required to confirm the diagnosis.

Usually occurs in people older than 50 years.
Sudden onset of amnesia that lasts for several hours. Patients maintain alertness but are confused and ask questions repeatedly.
PNES can be distinguished by spontaneous closing and opening of the eyes, associated with volitional head movements of „yes-yes” or „no-no” and prominent thrusting of the pelvis [ ]. Correct diagnosis is usually based on the semiology of the event and the absence of an epileptiform EEG correlate.
The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

Manole, A.M.; Sirbu, C.A.; Mititelu, M.R.; Vasiliu, O.; Lorusso, L.; Sirbu, O.M.; Ionita Radu, F. State of the Art and Challenges in Epilepsy—A Narrative Review. J. Pers. Med. 2023 , 13 , 623. https://doi.org/10.3390/jpm13040623

Manole AM, Sirbu CA, Mititelu MR, Vasiliu O, Lorusso L, Sirbu OM, Ionita Radu F. State of the Art and Challenges in Epilepsy—A Narrative Review. Journal of Personalized Medicine . 2023; 13(4):623. https://doi.org/10.3390/jpm13040623

Manole, Aida Mihaela, Carmen Adella Sirbu, Mihaela Raluca Mititelu, Octavian Vasiliu, Lorenzo Lorusso, Octavian Mihai Sirbu, and Florentina Ionita Radu. 2023. "State of the Art and Challenges in Epilepsy—A Narrative Review" Journal of Personalized Medicine 13, no. 4: 623. https://doi.org/10.3390/jpm13040623

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epilepsy research paper introduction

epilepsy research paper introduction

Table of Contents | June, 2024  Vol. 14  No.1 | Next Issue |
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The inside experience of epilepsy: An essay about the importance of subjectivity

Affiliation.

  • 1 Danish Epilepsy Centre Filadelfia, Dianalund, Denmark; Programa de Pós-Graduação em Ciências Médicas, Universidad Federal de Santa Catarina, Florianópolis, SC, Brazil. Electronic address: [email protected].
  • PMID: 33531199
  • DOI: 10.1016/j.seizure.2021.01.006

This essay addresses three aspects of the inside experience of epilepsy, i) the high semiological significance of subjective seizure symptoms, ii) the therapeutic consequences, both positive and negative, of subjective seizure experiences, and iii) the importance of recognizing the patient as the 'inside expert' of epilepsy. Subjective symptoms are often not spontaneously reported but ignoring them may be associated with serious risks. They can be experienced as neutral, negative or positive, and this can have important consequences for therapy. Only patients have full and first-hand knowledge of subjective symptoms but an understanding of these symptoms and an adequate response to them requires expert assistance. The inside and outside views of seizures are different but of equal importance. To get the full picture, both are needed to supplement each other.

Keywords: Epilepsy surgery; Isolated aura; Patient-doctor relation; Psychoeducation; Seizure arrest; Seizure semiology.

Copyright © 2021 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

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  • Semiological seizure classification: before and after video-EEG monitoring of seizures. Hirfanoglu T, Serdaroglu A, Cansu A, Bilir E, Gucuyener K. Hirfanoglu T, et al. Pediatr Neurol. 2007 Apr;36(4):231-5. doi: 10.1016/j.pediatrneurol.2006.12.002. Pediatr Neurol. 2007. PMID: 17437905
  • Time to response and patient visibility during tonic-clonic seizures in the epilepsy monitoring unit. Malloy K, Cardenas D, Blackburn A, Whitmire L, Cavazos JE. Malloy K, et al. Epilepsy Behav. 2018 Dec;89:84-88. doi: 10.1016/j.yebeh.2018.09.012. Epub 2018 Oct 31. Epilepsy Behav. 2018. PMID: 30388666
  • Preoperative sensory aura predicts risk for seizure in temporal lobe epilepsy surgery. Arifin MT, Hanaya R, Bakhtiar Y, Bintoro AC, Iida K, Kurisu K, Arita K, Bunyamin J, Askoro R, Brillantika SP, Muttaqin Z. Arifin MT, et al. Epilepsy Behav. 2020 Oct;111:107255. doi: 10.1016/j.yebeh.2020.107255. Epub 2020 Jul 24. Epilepsy Behav. 2020. PMID: 32759061
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Technical reports are designed to quickly alert researchers to recent findings and developments in scientific and technical research. These reports are issued for a variety of purposes:

  • to communicate results or describe progress of a research project
  • to convey background information on an emerging or critical research topic
  • to provide lists of instructions or procedures for current practices
  • to determine the feasibility of a technology and recommend if research should be continued (and how to evaluate any further progress made)
  • to detail technical specifications (materials, functions, features, operation, market potential, etc.)

Technical reports first appeared in the early part of the 20th century. The U.S. Geological Survey (USGS) published a series of professional papers beginning in 1902, and the National Advisory Committee for Aeronautics (NACA) issued its first report in 1915. But, the format gained importance during World War II, emerged in the postwar era, and remains, to this day, a major tool for reporting progress in science and technology, as well as in education, business, and social sciences research. The names given to series of these publications vary, but are often such generic terms as "technical reports," "working papers," "research memoranda," "internal notes," "occasional papers," "discussion papers" or "gray (or grey) literature." In the physical and natural sciences, "technical report" seems to be the preferred designation. For reports dealing with business, education, and the social sciences, on the other hand, the terms "working paper," "occasional paper," and "memorandum" are often the designations of choice. Other, more specific types of technical reports include "preprints" and "reprints." Preprints generally are versions of papers issued by researchers before their final papers are published by commercial publishers. Preprints allow researchers to communicate their findings quickly, but usually have not been peer reviewed. Reprints are typically released to heighten awareness of the research being conducted in a particular field or at a single institution. The term, "technical report" encompasses all of these designations.

Since many of these publications are intended to provide just a temporary snapshot of current research in a particular field or topic, they may contain the some of following distinctions:

  • Rapid communication of new research results
  • Dissemination to a targeted audience.
  • Detailed methodologies, in order to facilitate review of research results by others
  • No peer review, though there is often another selection process for publication (grant, contract, or institutional affiliation)
  • Not published by typical commercial publishers (instead reports are issued or sponsored by government agencies, professional associations, societies, councils, foundations, laboratories, universities, etc.)
  • Corporate authorship, where present, is typically emphasized

Unfortunately, uncertain availability, limited print runs, and decentralized distribution patterns with little bibliographic information are also often characteristics of this literature.

The Federal Government issues many different types of technical reports. An overview of some of these can be found in a May 2001 GAO report, " Information Management: Dissemination of Technical Reports ." Government issued or sponsored reports contain an additional characteristic - they may be subject to distribution restrictions linked to their classification status. Although references to classified reports may be found in technical reports literature, the security status or limited distribution of reports may make them unavailable to the general public and to the Library as well, as the Library holds only titles in the public domain. Those interested in locating such materials can consult the U.S. Department of Justice's Freedom of Information Act  site for guidance in obtaining these reports.

To enable them to be identified and located, technical reports are assigned report codes by agencies or organizations involved in their production or distribution. These codes may be referred to as "accession numbers," "agency report series numbers," "contract numbers," "grant numbers" or by other names, and include dates and individual report numbers. Typically, reports are assigned multiple codes and these codes help to identify the sponsoring agency, the organization performing the research or the organization disseminating the report.  Most technical reports held by the Library of Congress are not cataloged, and, for these reports, one or more report codes is required for Library staff to check the collections for a report or to locate and retrieve it. For more information about the current Standard Technical Report Number format (STRN) see ANSI/NISO Z39.23- 1997 (S2015) Standard Technical Reports Number Format and Creation . 

Standards are specifications which define products, methods, processes or practices, and are known to have existed as early as 7000 B.C., when cylindrical stones were used as units of weight in Egypt. According to  Office of Management and Budget (OMB) Circular A-119 , as revised in 2016, the term "standard" or "technical standard" refers to:

  • common and repeated use of rules, conditions, guidelines or characteristics for products or related processes and production methods, and related management systems practices;
  • the definition of terms; classification of components; delineation of procedures; specification of dimensions, materials, performance, designs, or operations; measurement of quality and quantity in describing materials, processes, products, systems, services, or practices; test methods and sampling procedures; or descriptions of fit and measurements of size or strength; and
  • terminology, symbols, packaging, marking or labeling requirements as they apply to a product, process, or production method.

Technical standards are not "professional standards of personal conduct; or institutional codes of ethics." (p. 15).

Standards are typically generated by governments or by professional associations and organizations interested in or affected by the subject matter of particular standards. For example, U.S. government standards mandated by the  Fair Packaging & Labeling Act (FPLA)  have standardized the labeling required for packaging in which consumer commodities is sold. Standards set the basis for determining consistent and acceptable minimum levels of reliability and safety, and are adhered to either voluntarily or as mandated by law. For a more complete overview, see the NIST report  " The ABC's of Standards Activities " by Maureen A. Breitenberg (2009).

The Library of Congress standards collection includes military and other federal standards, industry standards, and a few older international standards from Russia, China, and South Africa. Material from the collection is available in various formats, including digital, print, and microform materials. The majority of the Library's standards collection held in the Science Section's Technical Reports and Standards Collection. The collection remains largely uncatalogued, and as a result, most items from this collection are not discoverable in the Library's online catalog. Inquires on Library holdings can be sent to the Science Section using the Science and Technical Reports Ask-a-Librarian form . Some standards, however, are housed in the Library's general collections and discoverable by searching the  online catalog -- the ASTM standards are one example. Other standards are in custody of appropriate specialized research centers, such as the Law Library , which maintains  OSHA standards and some building codes.

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: Classification of drugs used in the therapy of epilepsies

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Cover of An Introduction to Epilepsy

An Introduction to Epilepsy

Editors: Edward B Bromfield , MD, José E Cavazos , MD, PhD, and Joseph I Sirven , MD.

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An Introduction to Epilepsy was developed by the Student & Resident Education Subcommittee of the American Epilepsy Society's Education Committee as an educational resource for students and faculty.

  • Collapse All
  • Contributors
  • Acknowledgments
  • I. Introduction
  • II. Neurophysiology of the Cerebral Cortex
  • III. Physiological Basis of the EEG
  • IV. Pathophysiology of Seizures: An Alteration in the Normal Balance of Inhibition and Excitation
  • I. Definitions and Epidemiology
  • II. Evaluation After the First Seizure
  • III. Treatment
  • IV. Non-Drug Treatments of Epilepsy
  • V. Epilepsy Surgery
  • VI. Status Epilepticus
  • VII. Neonatal Seizures
  • VIII. Selected Pediatric Epilepsy Syndromes
  • IX. Managing Pediatric Epilepsy
  • X. Nonepileptic Seizures and Imitators of Epilepsy
  • XI. Pregnancy and Epilepsy
  • XII. Driving and Epilepsy
  • Appendix E: Case Studies
  • II. Mechanisms of AED Activity
  • III. AED Pharmacokinetics
  • IV. Additional Pharmacokinetic and Pharmacodynamic Aspects of AEDs
  • V. Adverse Effects
  • Appendix A: Pediatric Case Study
  • I. Epilepsy Presurgical Evaluation
  • II. Surgical Treatment of Epilepsy
  • III. Vagus Nerve Stimulation as a Treatment for Epileptic Seizures
  • IV. Head Injury, Seizures, and Epilepsy

All content of An Introduction to Epilepsy , except where otherwise noted, is licensed under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • Cite this Page Bromfield EB, Cavazos JE, Sirven JI, editors. An Introduction to Epilepsy [Internet]. West Hartford (CT): American Epilepsy Society; 2006.

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  3. (PDF) A COMPREHENSIVE REVIEW ON EPILEPSY

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  4. Epilepsy: A Clinical Overview

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  5. New Trends and Most Promising Therapeutic Strategies for Epilepsy

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  6. Recent advances in epilepsy

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  10. State of the Art and Challenges in Epilepsy—A Narrative Review

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  11. Introduction to the epilepsy syndrome papers

    6 Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA. PMID: 35503711. DOI: 10.1111/epi.17262. No abstract available.

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  23. Introduction

    The names given to series of these publications vary, but are often such generic terms as "technical reports," "working papers," "research memoranda," "internal notes," "occasional papers," "discussion papers" or "gray (or grey) literature." In the physical and natural sciences, "technical report" seems to be the preferred designation.

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  25. An Introduction to Epilepsy

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