Epilepsies And Epilepsy Syndromes

Certain epileptic disorders are characterized by specific clusters of signs and symptoms that are considered epileptic syndromes. Because most of these syndromes have numerous etiologies, few have been defined as specific diseases. Proposed in 1989, the current classification of the epilepsies subdivides epilepsies and epileptic syndromes into three categories based on clinical history, electroencephalographic manifestations, and etiology. '12' Localization-related epilepsies and syndromes are typified by seizures that originate from a localized cortical region. The generalized epilepsies and epilepsy syndromes are characterized by seizures with initial activation of neurons within both cerebral hemispheres.

The syndromes are further divided into idiopathic and symptomatic types. Idiopathic refers to syndromes that arise spontaneously without a known cause, presumably having a genetic basis. Most affected patients are of normal intelligence and have normal results on neurological examinations. Symptomatic denotes epilepsies with an identified cause such as mesial temporal sclerosis. The term cryptogenic describes syndromes that are presumed to be symptomatic but have no known etiology and that occur in patients with or without abnormalities on neurological examination. Epilepsies that are characterized by both partial and generalized seizures and focal and generalized epileptiform discharges, but without a clear predominance of one over the other, are classified as undetermined. The term lesional epilepsy refers to focal epilepsy in which a lesion is identified on neuroimaging studies that is the probable cause of seizures. Lesions include mesial temporal sclerosis, congenital malformations, neoplasms, vascular malformations, and ischemic insults. The distinction between lesional and nonlesional focal epilepsy is particularly important in patients being considered for epilepsy surgery. In this population, surgical outcome is dependent upon the completeness of resection of epileptogenic lesion, which is accomplished more readily when a well-defined structural abnormality is present.

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