Definition of epilepsy: significance of its revision on clinical neurophysiological basis to improve prognosis and quality of life of patients with epilepsy.

摘要

Epilepsy is currently defined as a condition characterized by recurrent (two or more) unprovoked or spontaneous seizures. This definition instills a sense of fear and anxiety in patients with epilepsy owing to the spontaneity and un-predictability of the attacks and which contribute to unwarranted false perceptions about the disorder and its associated risks.An epileptic attack is generally the result of excitatory versus inhibitory influences in the epileptic zone and its surround. Many factors have been found to exercise significant influence on either of the two processes that can eventually determine the occurrence of the attack(s). Eggers [1 ] has also argued that all seizures are provoked in temporal lobe epilepsy, the commonest form of epilepsy. Further, a number of studies have reported high (62-90%) incidence of existence and self-perception of precipitants in patients with epilepsy [2-5]. In one study [4], 52% of the study-group attempted to avoid the precipitant(s) and 47% could even succeed in arresting their seizure sometimes. In the same study, 15% could even self-induce their attacks. The ability to abort and self-induce a seizure opens up a new interesting potential dimension of body-mind-body interactive circuitry operating in epilepsy, which however is a field for further exploration. The prevalence of seizure precipitants could be still higher than reported due to unidentifiable nature of the precipitant itself or due to the inability of identification by the patients owing to lack of awareness, very infrequent attacks and other factors pertaining to the patients' perceiving ability.