Seizures and Epilepsy

  • Andrea E. Cavanna


Epileptic seizures are defined as the clinical manifestations of abnormal excessive or synchronous neuronal activity in the brain: transient alterations in consciousness and/or motor control. Epilepsy is a disease characterised by an enduring predisposition to generate recurrent epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. Although approximately 1 in 20 people may have a seizure during their lifetime, the prevalence of epilepsy is considerably lower, being around 0.5–1% for the general population. The cornerstone of the seizure classification system is the determination of whether the initial manifestations of the seizure are focal or generalised. Additionally, focal seizures are sub-grouped as those with motor and non-motor manifestations at the onset. Finally, the behavioural assessment of consciousness (operationally defined as the patient’s awareness of self and environment during a seizure) may be included in the classification of focal seizure types. Behavioural symptoms are commonly reported by patients with epilepsy, and the neuropsychiatric aspects of epilepsy can be classified according to their temporal relationship to epileptic seizures as ‘interictal’ and ‘ictal’ psychiatric disorders.


Awareness Classification Consciousness Epilepsy Seizure 

Suggested Reading


  1. Asadi-Pooya AA, Sperling MR. Antiepileptic drugs: a clinician’s manual. 2nd ed. New York: Oxford University Press; 2016.Google Scholar
  2. National Institute for Health and Care Excellence (NICE). Clinical guideline (CG137) epilepsies: diagnosis and management. NICE; 2012 (updated 2016).Google Scholar
  3. Panayiotopoulos CP, editor. Atlas of epilepsies. London: Springer; 2010.Google Scholar
  4. Patsalos PN, Bourgeois BFD. The epilepsy prescriber’s guide to antiepileptic drugs. 2nd ed. Cambridge: Cambridge University Press; 2013.CrossRefGoogle Scholar
  5. Shorvon S, Guerrini R, Cook M, Lhatoo SD, editors. Oxford textbook of epilepsy and epileptic seizures. Oxford: Oxford University Press; 2012.Google Scholar
  6. Shorvon SD, Perucca E, Engel J Jr, editors. The treatment of epilepsy. 4th ed. West Sussex: Wiley-Blackwell; 2015.Google Scholar
  7. Temkin O. The falling sickness: a history of epilepsy from the Greeks to the beginnings of modern neurology. 2nd ed. Baltimore: Johns Hopkins University Press; 1994. (reprinted from 1971).Google Scholar


  1. Adcock JE, Panayiotopoulos CP. Occipital lobe seizures and epilepsies. J Clin Neurophysiol. 2012;29:397–407.CrossRefPubMedGoogle Scholar
  2. Angus-Leppan H. First seizures in adults. Br Med J. 2014;348:g2470.CrossRefGoogle Scholar
  3. Bangar S, Shastri A, El-Sayeh H, Cavanna AE. Women with epilepsy: clinically relevant issues. Funct Neurol. 2016;31:127–34.PubMedPubMedCentralGoogle Scholar
  4. Beleza P, Pinho J. Frontal lobe epilepsy. J Clin Neurosci. 2011;18:593–600.CrossRefPubMedGoogle Scholar
  5. Blair RD. Temporal lobe epilepsy semiology. Epilepsy Res Treat. 2012;2012:751510.PubMedPubMedCentralGoogle Scholar
  6. Blumenfeld H, Meador KJ. Consciousness as a useful concept in epilepsy classification. Epilepsia. 2014;55:1145–50.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Blumenfeld H, Meador K, Jackson GD. The return of consciousness to epilepsy seizure classification. Epilepsia. 2015;56:345–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Brodie MJ. Antiepileptic drug therapy: the story so far. Seizure. 2010;19:650–5.CrossRefPubMedGoogle Scholar
  9. Chaudhary UJ, Duncan JS, Lemieux L. A dialogue with historical concepts of epilepsy from the Babylonians to Hughlings Jackson: persistent beliefs. Epilepsy Behav. 2011;21:109–14.CrossRefPubMedGoogle Scholar
  10. Cox JH, Seri S, Cavanna AE. Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures. Neuropsychiatr Dis Treat. 2014;10:2191–200.PubMedPubMedCentralGoogle Scholar
  11. Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol. 2016;15:1075–88.CrossRefGoogle Scholar
  12. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, Pringsheim T, Lorenzetti DL, Jetté N. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology. 2017;88:296–303.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Fisher RS. Redefining epilepsy. Curr Opin Neurol. 2015;28:130–5.CrossRefPubMedGoogle Scholar
  14. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J Jr, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshé SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475–82.CrossRefPubMedGoogle Scholar
  15. Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE, Schulze-Bonhage A, Somerville E, Sperling M, Yacubian EM, Zuberi SM. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58:531–42.CrossRefPubMedGoogle Scholar
  16. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58:522–30.CrossRefPubMedGoogle Scholar
  17. Golyala A, Kwan P. Drug development for refractory epilepsy: the past 25 years and beyond. Seizure. 2017;44:147–56.CrossRefPubMedGoogle Scholar
  18. Jetté N, Sander JW, Keezer MR. Surgical treatment for epilepsy: the potential gap between evidence and practice. Lancet Neurol. 2016;15:982–94.CrossRefPubMedGoogle Scholar
  19. Kennedy JD, Schuele SU. Neocortical temporal lobe epilepsy. J Clin Neurophysiol. 2012;29:366–70.CrossRefPubMedGoogle Scholar
  20. Kriegel MF, Roberts DW, Jobst BC. Orbitofrontal and insular epilepsy. J Clin Neurophysiol. 2012;29:385–91.CrossRefPubMedGoogle Scholar
  21. Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365:919–26.CrossRefPubMedGoogle Scholar
  22. Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, Resnick T, Benbadis SR. The consequences of refractory epilepsy and its treatment. Epilepsy Behav. 2014;37:59–70.CrossRefPubMedGoogle Scholar
  23. Lennox WG, Markham CH. The socio-psychological treatment of epilepsy. JAMA. 1953;152:1690–4.CrossRefGoogle Scholar
  24. McCorry DJP, Cavanna AE. New thoughts on first seizure. Clin Med. 2010;4:395–8.CrossRefGoogle Scholar
  25. Millett D. A history of seizures and epilepsies: from the falling disease to dysrhythmias of the brain. Handb Clin Neurol. 2010;95:387–400.CrossRefPubMedGoogle Scholar
  26. Mitchell JW, Seri S, Cavanna AE. Pharmacotherapeutic options for refractory and difficult-to-treat seizures. J Cent Nerv Syst Dis. 2012;4:105–15.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Panayiotopoulos CP. The new ILAE report on terminology and concepts for organization of epileptic seizures: a clinician’s critical view and contribution. Epilepsia. 2011;52:2155–60.CrossRefPubMedGoogle Scholar
  28. Perucca E, Tomson T. The pharmacological treatment of epilepsy in adults. Lancet Neurol. 2011;10:446–56.CrossRefPubMedGoogle Scholar
  29. Perven G, So NK. Epileptic auras: phenomenology and neurophysiology. Epileptic Disord. 2015;17:349–62.PubMedGoogle Scholar
  30. Rugg-Gunn FJ, Sander JW. Management of chronic epilepsy. Br Med J. 2012;345:e4576.CrossRefGoogle Scholar
  31. Salanova V. Parietal lobe epilepsy. J Clin Neurophysiol. 2012;29:392–6.CrossRefPubMedGoogle Scholar
  32. Santulli L, Coppola A, Balestrini S, Striano S. The challenges of treating epilepsy with 25 antiepileptic drugs. Pharmacol Res. 2016;107:211–9.CrossRefPubMedGoogle Scholar
  33. Sauro KM, Wiebe S, Dunkley C, Janszky J, Kumlien E, Moshé S, Nakasato N, Pedley TA, Perucca E, Senties H, Thomas SV, Wang Y, Wilmshurst J, Jetté N. The current state of epilepsy guidelines: a systematic review. Epilepsia. 2016;57:13–23.CrossRefPubMedGoogle Scholar
  34. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, Hirsch E, Jain S, Mathern GW, Moshé SL, Nordli DR, Perucca E, Tomson T, Wiebe S, Zhang YH, Zuberi SM. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58:512–21.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Schmidt D, Schachter SC. Drug treatment of epilepsy in adults. Br Med J. 2014;348:g254.CrossRefGoogle Scholar
  36. Schulze-Bonhage A. Brain stimulation as a neuromodulatory epilepsy therapy. Seizure. 2017;44:169–75.CrossRefPubMedGoogle Scholar
  37. Scott DF. The discovery of anti-epileptic drugs. J Hist Neurosci. 1992;1:111–8.CrossRefPubMedGoogle Scholar
  38. Shorvon SD. Drug treatment of epilepsy in the century of the ILAE: the first 50 years, 1909-1958. Epilepsia. 2009;50(Suppl3):69–92.CrossRefPubMedGoogle Scholar
  39. Shorvon SD. Drug treatment of epilepsy in the century of the ILAE: the second 50 years, 1959-2009. Epilepsia. 2009;50(Suppl3):93–130.CrossRefPubMedGoogle Scholar
  40. Smith PE. The bare essentials: epilepsy. Pract Neurol. 2008;8:195–202.CrossRefPubMedGoogle Scholar
  41. So EL. Interictal epileptiform discharges in persons without a history of seizures: what do they mean? J Clin Neurophysiol. 2010;27:229–38.CrossRefPubMedGoogle Scholar
  42. Stoyke C, Bilgin O, Noachtar S. Video atlas of lateralising and localising seizure phenomena. Epileptic Disord. 2011;13:113–24.PubMedGoogle Scholar
  43. Tatum WO 4th. Mesial temporal lobe epilepsy. J Clin Neurophysiol. 2012;29:356–65.CrossRefPubMedGoogle Scholar
  44. Unnwongse K, Wehner T, Foldvary-Schaefer N. Mesial frontal lobe epilepsy. J Clin Neurophysiol. 2012;29:371–8.CrossRefPubMedGoogle Scholar
  45. Vajda FJE, Eadie MJ, Perucca P, Mula M. The clinical pharmacology of traditional antiepileptic drugs. Epileptic Disord. 2014;16:395–408.PubMedGoogle Scholar
  46. Wilson SJ, Baxendale S. The new approach to classification: rethinking cognition and behavior in epilepsy. Epilepsy Behav. 2014;41:307–10.CrossRefPubMedGoogle Scholar
  47. Wolf P. Descriptions of clinical semiology of seizures in literature. Epileptic Disord. 2006;8:3–10.PubMedGoogle Scholar
  48. Wolf P. History of epilepsy: nosological concepts and classification. Epileptic Disord. 2014;16:261–9.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andrea E. Cavanna
    • 1
  1. 1.Dept of NeuropsychiatryUniversity of BirminghamBirminghamUnited Kingdom

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