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  1. Home
  2. Books
  3. The Causes of Epilepsy
  • Cited by 33
Publisher:
Cambridge University Press
Online publication date:
March 2012
Print publication year:
2011
Online ISBN:
9780511921001
DOI:
https://doi.org/10.1017/CBO9780511921001
Subjects:
Neurology and Clinical Neuroscience, Medicine
Information

Book description

Causation is an aspect of epilepsy neglected in the scientific literature and in the conceptualization of epilepsy at a clinical and experimental level. It was to remedy this deficiency that this book was conceived. The book opens with a draft etiological classification that goes some way to filling the nosological void. The book is divided into four etiological categories: idiopathic, symptomatic, cryptogenic, and provoked epilepsies. Each chapter considers topics in a consistent fashion, dealing with the phenomenon of epilepsy in each etiology, including its epidemiology, clinical features and prognosis, and any specific aspects of treatment. The book is a comprehensive reference work, a catalogue of all important causes of epilepsy, and a clinical tool for all clinicians dealing with patients who have epilepsy. It is aimed at epileptologists and neurologists and provides a distillation of knowledge in a form that is helpful in the clinical setting.

Reviews

'… really very good. I am not aware of anything else that deals with the causes of epilepsy as succinctly and is as well organised and user friendly. This is the sort of book that one would dip into when faced with a particularly interesting or problematic case … should be on the bookshelf of everyone who investigates and manages people with epilepsy.'

Professor Martin J. Brodie - Director, Epilepsy Unit, Western Infirmary, Glasgow

'Most of the authors are world experts on the subjects, and I admire the energy and professional network required to assemble this impressive work … it will have a huge impact.'

Source: The Lancet Neurology

'… extremely comprehensive … fills a significant void in the epilepsy literature … The chapters are well written and address both basic pathogenic mechanisms and clinical diagnosis and management … This book fills a unique niche in the field of epileptology: it is the first to carefully and concisely address the varied etiologies. It is a very readable and comprehensive book that will be valued both by practising clinicians and by trainees and basic neuroscientists. It is an essential resource and should be on the bookshelf of any clinician caring for persons with epilepsy worldwide.'

Source: Epilepsy and Behavior

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Contents

Page 4 of 5

Contents
  • Chapter 81 - Rasmussen encephalitis and related conditions
    pp 573-578
  • View abstract

    Summary

    Head injuries may result from impact or shaking or a combination of these mechanisms, which act through translational or rotational forces. The classic presentation of non-accidental brain injury (NABI) in infants is the shaken baby syndrome (SBS), which is characterized by widespread parenchymal damage, diffuse axonal injury, subdural and/or subarachnoid hemorrhages, and retinal hemorrhages. Seizures occur more frequently in children with inflicted versus non-inflicted traumatic brain injury. Radiological imaging plays a crucial role in investigating NABI, in order to assess intracranial complications, guide clinical management, and provide documentary evidence for forensic investigation. Magnetic resonance imaging (MRI) detects hemorrhage in the sub acute stage (3-14 days) and demonstrates with high sensitivity early ischemic changes and diffuse axonal injury. Phenytoin has been considered the drug of choice for preventive treatment of early and late seizures while carbamazepine and valproate would be more suitable for the treatment of late seizures.
  • Chapter 82 - Systemic lupus erythematosus and other collagen vascular diseases
    pp 579-584
  • View abstract

    Summary

    Gliomas are neoplasms derived from glial cell precursors. Gliomas may present with one or a combination of neurological deficits, symptoms of mass effect and seizures, usually reflecting the anatomical location of the lesion. Seizures in the context of glioma appear to confer a significant prognostic benefit. Epileptic foci are believed to develop within the cortex surrounding tumors, since the lesions themselves have no electroencephalographic (EEG) activity and are not electrically excitable. Diagnosis of a space-occupying lesion as the cause of a seizure is made usually with the aid of cross-sectional imaging. Magnetic resonance imaging (MRI), with and without gadolinium contrast, is the investigation of choice, showing a higher sensitivity and specificity than computed tomography (CT) for detecting glioma. Fractionated focal radiotherapy is a key component of adjuvant treatment, especially in high-grade lesions. Chemotherapy with temozolomide has been shown to be of seizure benefit in approximately 50% of Grade 2 gliomas.
  • Chapter 84 - Psychiatric disorders
    pp 593-606
  • View abstract

    Summary

    The majority of tumors that present with epilepsy comprise a group of tumors that include dysembryoplastic neuroepithelial tumors (DNT), ganglioglioma, gangliocytoma, and the more recently described angiocentric glioma. This chapter focuses on these tumors and their management is predominantly focused on seizure control. The differential diagnosis includes other low-grade epilepsy-associated tumors, cortical dysplasia, and diffuse gliomas. The chapter discusses the lesions which are distinguished from the dysplastic gangliocytoma of the cerebellum and desmoplastic infantile ganglioglioma. Ganglioglioma accounts for up to 50% of all tumors in patients undergoing surgery for control of epilepsy and is the commonest tumor associated with chronic epilepsy. The goals of management are seizure control, confirmation of the radiological diagnosis, and control of tumor growth and progression. Angiocentric glioma is a low-grade cortical tumor associated with epilepsy. The differential diagnosis includes low-grade glioneuronal tumors, focal cortical dysplasia (FCD), and diffuse glioma.
  • Chapter 85 - Multiple sclerosis and other acquired demyelinating diseases
    pp 607-611
  • View abstract

    Summary

    Hypothalamic hamartomas (HH) are an uncommon human pathology resulting in a distinctive and often severe epilepsy syndrome, usually including gelastic (laughing) seizures. This chapter focus on HH associated with epilepsy. The gross anatomy of HH lesions determines the nature of their clinical symptoms. Epilepsy associated with HH is a progressive disease for the majority of patients, with development of multiple seizure types, and coincident deterioration in cognition and behavior. Antiepilepsy drugs (AEDs) are unsuccessful in managing seizures associated with HH, and eradication or complete disconnection of the HH is successful for controlling seizures, and may help ameliorate the comorbid problems with cognition and behavior. Treatment choice is guided by the individual circumstances of the case, including the clinical course of the disease and an assessment of the size and attachment of the HH.
  • Chapter 86 - Hydrocephalus and porencephaly
    pp 612-617
  • View abstract

    Summary

    This chapter discusses the etiology, diagnosis, and principles of management of epilepsy in patients diagnosed with meningiomas. It presents cases that demonstrate the broad spectrum of meningioma-related epileptogenesis and the challenges associated with their surgical management. In terms of the medical management of epilepsy related to meningiomas, the choice of antiepileptic drugs (AEDs) depends on various factors including age, drug-drug interactions, and comorbid conditions. Meningiomas along the convexities are often readily accessible and so surgical resection is often indicated for treatment of the underlying neoplasm. When cortical tissue is involved and cortical resection is anticipated, intraoperative electrocorticography (ECoG) may be performed to define the interictal irritative zone. Careful surgical technique during the initial tumor resection may help to prevent some of these cases, but when seizures occur or persist after surgery, and are not controlled by AEDs, the patient should be considered for further surgery to control the epilepsy.
  • Chapter 87 - Alzheimer disease and other neurodegenerative diseases
    pp 618-624
  • View abstract

    Summary

    This chapter addresses the topic of brain tumors as causes of epilepsy. It focuses on secondary brain tumors, commonly referred to as solid metastatic brain tumors, and neoplastic meningitis. Epileptic seizures in patients with cerebral metastatic disease are most likely multifactorial, however, a number of factors are considered to be contributing to the development and continuation of these seizures in a subgroup of individuals. Antiepileptic drugs are known to reduce the activity of chemotherapeutic drugs. The treatment of epilepsy in patients with secondary brain tumors should involve a multidisciplinary team that is knowledgeable about all the surgical, radiation, and therapeutic options in the management of these patients. Research needs to be focused on the best antiepileptic drug (AED) or drug combination to use in these patients so that new practice guidelines can be developed to improve patient care.
  • Chapter 88 - Introduction to the concept of provoked epilepsy
    pp 625-630
  • View abstract

    Summary

    Viral encephalitides include acute viral encephalitis, post-infectious encephalomyelitis, viral infections of the central nervous system (CNS), and chronic degenerative diseases. This chapter presents the diagnostic and clinical challenges that accompany the management of seizures following CNS infection by the herpes viruses, RNA viruses, enteroviruses, and arenaviruses. Fever, headache, lethargy, nausea, and non-specific flu-like symptoms are often the first clinical signs of infection, with subsequent symptoms of leptomeningeal irritation becoming prominent. Specific viruses can now be detected in the cerebrospinal fluid (CSF) using polymerase chain reaction (PCR) where previously specific viral diagnoses could only be made by brain biopsy. Patients should therefore be treated with acyclovir if the clinical suspicion is high pending final herpes simplex virus (HSV)-1 PCR results, and repeat CSF testing should be considered. Wider applications of PCR may help to determine individual risks for some of the more common viral agents.
  • Chapter 90 - The menstrual cycle and catamenial epilepsy
    pp 635-642
  • View abstract

    Summary

    This chapter discusses the burden and the changing epidemiology of acute bacterial meningitis (ABM) and the incidence of epilepsy following ABM and intracranial abscesses in children. It identifies the predictive factors, therapeutic implications, and prevention of ABM and consequent epilepsy in these conditions. Of the acquired causes, central nervous system (CNS) infections are common in childhood and include bacterial meningitis, viral encephalitis, and intracranial suppurative infections such as brain abscess, subdural empyema, and cranial epidural abscess. The changing epidemiology of bacterial meningitis and the emergence of antibiotic resistant strains of pneumococcal meningitis demand regional guidelines for initial empirical treatment of ABM based on the knowledge of regional epidemiologic factors. The effectiveness of administration of dexamethasone before the first effective parenteral antibiotic dose in reducing neurologic and/or audiologic sequelae in children with Haemophilus influenzae type B (HiB) meningitis has been demonstrated in several studies.
  • Chapter 91 - Sleep
    pp 643-649
  • View abstract

    Summary

    Bacterial meningitis is infection of the nervous system confined to the meninges and subarachnoid space. Cranial suppurative disorders include intracranial abscesses and subdural empyemas and, less commonly, epidural (extradural) empyemas. Pyogenic bacterial abscesses can be single or multiple. Acute symptomatic seizures due to neurological insults increase the risk for unprovoked seizures/epilepsy, this risk being less than the risk of a second seizure following an unprovoked seizure. Initial immediate investigations include lumbar puncture in the absence of evidence of raised intracranial pressure, blood cultures, and routine blood tests including inflammatory markers, before prompt empirical therapy. The burden of epilepsy due to bacterial meningitis can be reduced by early diagnosis and effective therapy of the meningitis, and reduction in rates of bacterial meningitis and thereby associated epilepsy though vaccinations, disease surveillance, and treatment of close contacts.
  • Chapter 92 - Metabolic and endocrine-induced seizures
    pp 650-654
  • View abstract

    Summary

    Plasmodium falciparum is the most severe form of malaria and is responsible for most of the neurological complications. The erythrocyte stages of P. falciparum are responsible for the acute symptoms and probably the development of epilepsy. The manifestations of severe P. falciparum malaria include coma, seizures, severe anemia, metabolic acidosis, and, in nonimmune individuals, renal impairment and pulmonary edema. Complex partial seizures are infrequently reported from the African children, but this may be caused by difficulties in describing the semiology in this patient group. Most patients who develop epilepsy following severe malaria respond to first-line antiepileptic drugs (AEDs), such as phenobarbital, phenytoin, and carbamazepine, used in resource-poor countries. The epilepsy following malaria is often associated with considerable comorbidity, particularly behavioral and neurocognitive impairment in children. The aminoquinolones, such as chloroquine and mefloquine, are contraindicated in patients with epilepsy, based upon a number of case reports.
  • Chapter 93 - Electrolyte and sugar disturbances
    pp 655-663
  • View abstract

    Summary

    Neurocysticercosis (NCC) is a major contributor to the burden of seizures in the world, and is also one of the few preventable causes of seizures and epilepsy. Infection is caused by ingestion of the eggs of the tapeworm, excreted with the feces of an infected human tapeworm carrier. The majority of cysticercosis cases are in older children and young adults, presenting as a single degenerating intraparenchymal lesion. Another particular clinical setting associated with seizures is the occurrence of perilesional edema around a dead, calcified parasite. The primary diagnostic approach when neurocysticercosis is suspected is the use of brain imaging. The differential diagnosis of a single brain enhancing lesion is problematic. Treatment of epilepsy secondary to NCC follows standard guidelines for the management of any other secondary epilepsies. Neurocysticercosis is rarely associated with refractory seizures, and first-line antiepileptic drugs (AEDs) usually achieve good seizure control.
  • Chapter 94 - Drug-induced seizures
    pp 664-673
  • View abstract

    Summary

    This chapter reviews some of the parasitic disorders including sparganosis, toxocariasis, onchocerciasis, schistosomiasis and paragonimiasis, which may involve the central nervous system (CNS) and for which an association with seizures and epilepsy has been described. It is important that neurologists across the globe are aware of the epidemiology, clinical manifestations, and treatment of the parasitic disorders. Although the association between epilepsy and parasitic diseases has been generally recognized, most research and literature concerning the association is related to infection with Taenia solium cysticercosis. When brain lesions are demonstrated on imaging studies of individuals presenting with seizures, histological examination of these lesions through biopsy provides proof of the causal association between the parasitic disorder and seizures. The effects of anthelminthic drugs and the role of antiepileptic drugs on the seizure outcome also need to be considered. The aim is to eradicate these disorders through scientifically established and properly legislated preventive measures.
  • Chapter 95 - Alcohol- and toxin-induced seizures
    pp 674-682
  • View abstract

    Summary

    This chapter presents the epidemiology, clinical features, diagnosis and principles of the management for tuberculosis. History of contact with and the presence of pulmonary tuberculosis on chest X-ray are more often found in children than in adults. Children less often complain of headache and more often have hydrocephalus. The tuberculin skin test and its immunological equivalent with blood, the interferon-gamma releasing assay (IGRA) which measures interferon-gamma release by T cells, both measure development of cell-mediated immunity after exposure to Mycobacterium tuberculosis. Neurotuberculosis is associated with an increased risk of epilepsy. Risk of epilepsy is higher if there were early seizures and particularly status epilepticus. The differential diagnosis includes all other causes of central nervous system (CNS) infection, bacterial meningitis, viral meningoencephalitis, cerebral malaria, fungal meningitis, and even non-infective causes. The first-line antiepileptic drugs (AEDs), phenytoin, carbamazepine, valproate, and phenobarbitone, are most widely used in developing countries.
  • Chapter 96 - How reflex mechanisms cause epilepsy
    pp 683-686
  • View abstract

    Summary

    This chapter presents epidemiology, type and etiology of seizures. It describes the electroencephalography among HIV-seropositive patients with seizures and magnitude and mechanisms of seizures for HIV infection. Intracranial focal lesions account for nearly half the neurological disorders in neuro-AIDS patients. The nature of these focal cerebral lesions can be broadly divided into two distinct groups: opportunistic infections and non-infective lesions. Clinicians faced with the task of controlling seizures in HIV-seropositive patients must consider a number of potential drug-disease and drug-drug interactions when selecting antiepileptic drugs (AEDs) therapy in the face of limited data. HIV-seropositive patients are likely to be receiving multiple medications both for HIV and for prophylaxis against various opportunistic infections, and sometimes for the treatment of opportunistic infections. Antiepileptic and antiretroviral drugs have the potential for interacting through multiple mechanisms including competition for protein binding, enhanced or reduced liver metabolism, and increased viral replication.
  • Chapter 97 - Visual stimuli, photosensitivity, and photosensitive epilepsy
    pp 687-694
  • View abstract

    Summary

    This chapter focuses on the emerging and less common viruses that cause encephalitis and seizures. It presents emerging encephalitides such as Japanese encephalitis virus, West Nile virus, Nipah virus, enterovirus 71, dengue virus, human herpesvirus 6, Chandipura virus and Monkeypox virus. The chapter discusses the other uncommon encephalitides such as rabies, Tick-borne encephalitis, LaCrosse encephalitis, St. Louis encephalitis, Western equine encephalitis, Eastern equine encephalitis and Murray Valley encephalitis. Most viral infections of the central nervous system cause acute brain parenchymal inflammation with perivascular lymphocytic and mononuclear cell cuffing and infiltration, ballooning and death of neurons leading to subsequent gliosis. Tick-borne encephalitis virus first infects the Langerhans cells before invading the lymphoid and reticulo endothelial system, and finally causes inflammation not just in the brain, but also in the spinal cord and the leptomeninges. The Venezuelan and Eastern equine viruses, Nipah and Hendra viruses cause widespread vasculitic changes and microvascular infarcts.
  • Chapter 98 - Startle-induced (and other sensory-induced) epilepsy
    pp 695-699
  • View abstract

    Summary

    This chapter presents the diagnostic tests and principles of management for intracerebral hemorrhage (ICH), subdural hematoma (SDH) and extradural hemorrhage (EDH). ICH is twice as common as subarachnoid hemorrhage (SAH) and more likely to result in death or major disability. Cerebrovascular disease (CVD) is the most commonly identified antecedent of epilepsy in adults, accounting for 11% of cases. Intracerebral hemorrhage is the most lethal form of stroke and is a medical emergency. Prompt imaging studies are required because clinical presentation alone is insufficient to differentiate ICH from stroke due to other causes. Scanning with computed tomography (CT) and magnetic resonance imaging (MRI) are first-choice options. Catheter-directed or minimally invasive endoscopic surgery for clot evacuation using tissue-type plasminogen activator may hold promise in selected patients. Retrospective studies of small numbers of patients conclude that the routine use of prophylactic anticonvulsants is of no benefit after clipping or coil embolization.
  • Chapter 100 - Auditory-induced epilepsy
    pp 704-708
  • View abstract

    Summary

    Stroke is a killer and causes long-term disability. It is among the most frequent causes of death in adults and children across the globe. Risk factors include age, hypertension, and hypercholesterolemia. Hematologic disorders such as sickle-cell disease and coagulopathies put patients at risk for stroke. The initiating event for ischemic stroke is one of three pathophysiologic occurrences resulting in the interruption of oxygen and glucose delivery to brain cells. Presenting symptoms in children may include nausea, vomiting, headache, and seizures instead of, or in addition to, those described for adults. Electroencephalogram (EEG) and imaging studies are standard diagnostic tools for both cerebrovascular disease and epilepsy. Patients were treated with phenytoin, carbamazepine, or valproate and 75% of patients were reported to have seizures controlled, although that is not defined by the authors as seizure-free.
  • Chapter 101 - Focal reflex seizures – with emphasis on seizures triggered by eating
    pp 709-712
  • View abstract

    Summary

    This chapter presents the definition, epidemiology, diagnosis and principles of management for arteriovenous malformations (AVMs). The primary goal of AVM management is to assess the overall risk of the patient, and then develop a management plan that minimizes risks, i.e., deciding whether obliteration or observation is safest. The primary goal of obliterative AVM treatment by any modality is the prevention of hemorrhage. The epileptogenicity resulting from a hemorrhage and from hemosiderin deposition has been documented. Treatment of AVMs, with surgery, radiation, embolization, or a combination of these, can cause new seizures in some patients with AVMs, albeit with a risk which is much smaller than the risk of the AVM itself causing seizures. While the primary goal of AVM treatment is the prevention of hemorrhage, several retrospective series have also demonstrated a benefit in seizure outcome with AVM treatment with surgery, radiation, embolization, or multimodality treatment.
  • Chapter 102 - Hot-water epilepsy
    pp 713-719
  • View abstract

    Summary

    This chapter discusses the demographic data, pathological characteristics and pathophysiological mechanisms of epilepsy in Cavernous malformations (CMs). It presents genetic aspects, clinical features, diagnostic tools and therapeutic options for CMs. CMs are characterized by low-flow sinusoidal vessels lined by thin endothelial walls with no obvious feeding arteries or venous drainage. For an optimal therapeutic approach it is mandatory to understand the epilepsy inducing mechanisms associated with CMs. Numerous studies of magnetoencephalography (MEG) in medically intractable epilepsy have shown that MEG can detect interictal and ictal epileptiform activity. The role in diagnosis and the history of imaging techniques such as cerebral angiography, computed tomography (CT), and magnetic resonance imaging (MRI) as well as the radiological characteristics of CM have been extensively reviewed in recent literature. The optimal management of CMs presenting with epileptic seizures is still a matter of debate.
  • Chapter 103 - Reflex epilepsy with higher-level processing
    pp 720-722
  • View abstract

    Summary

    This chapter presents a brief description of some uncommon vascular disorders that can characteristically cause epilepsy and/or seizures. The epilepsy is usually not the main clinical problem. In cases with moyamoya syndrome, the prognosis depends upon identification and treatment of the underlying cause of the condition. A seizure, which results in recategorization as eclampsia, may occur before, during, and after delivery. The cerebral vascular changes most commonly occur in the posterior circulation and have features such as hypertensive encephalopathy, including cerebral edema. Thrombosis of the cerebral venous system is less common than in the arterial system. The autoimmune state, characterized by the presence of antiphospholipid antibodies, may cause thrombosis both in arteries and in veins. The isolated angiitis is probably an inflammatory reaction caused by a variety of disorders, such as infections, but also cerebral amyloid angiopathy. Treatment of the arteritis includes corticosteroids, often in combination with other immunosupressive drugs.
  • Chapter 104 - Introduction – how status epilepticus is caused
    pp 723-729
  • View abstract

    Summary

    This chapter presents the definition, epidemiology, pathology, physiology, clinical features, diagnostic tests and principles of management for Rasmussen encephalitis (RE). The histopathological properties of RE are non-specific and are suggestive of chronic multifocal encephalitis. Rasmussen hypothesized a viral etiology, based on the constituents of the immune reaction in the brain such as lymphocyte infiltration and microglial nodules. Magnetic resonance imaging (MRI) of the brain shows progressive hemiatrophy of variable degree in the involved cerebral hemisphere. Fluorodeoxyglucose positron emission tomography (PET) studies showed large areas of hypometabolism which were confined to the affected hemisphere. An early surgery seems to be favored in view of the progressive neurologic devastation and dementia that may directly result from the catastrophic epilepsy. The late complications of the early surgical techniques, including superficial hemosiderosis and hydrocephalus, have been largely overcome by the introduction of disconnective procedures such as functional hemispherectomy and hemispherotomy.
  • Chapter 106 - The causes of convulsive status epilepticus in adults
    pp 735-744
  • View abstract

    Summary

    Systemic lupus erythematosus (SLE) is the most common collagen vascular disease associated with epilepsy. Various autoantibodies have been implicated in the pathogenesis of neuropsychiatric SLE. Neuropsychiatric involvement is one of the most common clinical features of SLE, with a variable incidence reported between 15% and 75% in adults and between 20% and 85% in children. In SLE, the risk of disease is influenced by complex genetic and environmental contributions: for example, alleles including HLA-DRB1, IRF5, and STAT4 are established susceptibility genes. The diagnosis of SLE is generally a clinical one, supported by laboratory tests. With regard to neurologic involvement, radiologic techniques may be extremely helpful. In the first pediatric SLE (pSLE) study all five children who received either azathioprine or cyclophosphamide in addition to prednisone had a good recovery, while two out of 11 patients treated with prednisone alone died and three other patients had residual neurological defects.
  • Chapter 107 - Uncommon causes of status epilepticus
    pp 745-751
  • View abstract

    Summary

    This chapter talks about Hashimoto encephalopathy and the treatment-responsive encephalopathies associated with antibodies to neuronal antigens. Epilepsy has also been associated with the inflammatory bowel diseases (ulcerative colitis, Crohn disease, and celiac disease), although this association is more contentious. The chapter discusses the clinical features and treatment options for limbic encephalitis (LE) and the association of LE with epilepsy. Hu/ANNA-1, Ma-2, collapsin-response-mediator protein, amphiphysin and glutamic acid decarboxylase are intracellular antigens associated with LE. Voltage-gated potassium channels, N-methyl-D-aspartate receptor are extracellular antigens associated with LE. Accepted medical treatments for surface-antigen-related LE are high-dose steroids, plasma exchange, and/or intravenous immunoglobulin (IVIG), which are sometimes given in combination. The index disease for autoimmune thyroiditis group of immune-mediated epilepsy syndromes is the entity known as Hashimoto encephalopathy or steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT). The chapter also discusses the management of inflammatory bowel disease (IBD) and SREAT.
  • Chapter 108 - Causes of non-convulsive status epilepticus in adults
    pp 752-758
  • View abstract

    Summary

    The causal conditions for psychiatric disorders include: stress, depression, illicit psychoactive drug misuse, psychotropic medication (antidepressants and antipsychotics), autistic spectrum disorders, Tourette syndrome and attention deficit hyperactivity disorder (ADHD). This chapter discusses the treatment and diagnostic options for these conditions. A variety of commonly used recreational drugs can act either directly or indirectly to cause seizures. In the UK these include opioids, stimulants (cocaine, amphetamine, methylenedioxymethamphetamine), marijuana, benzodiazepines, barbiturates, club drugs (phencyclidine and ketamine), hallucinogens, and inhalants. The core features of autism and related disorders (ASD) are qualitative abnormalities in reciprocal social interactions, patterns of communication, and a restricted stereotyped repetitive repertoire of interests and activities. Attention deficit hyperactivity disorder is a childhood-onset illness characterized by severe inattention, hyperactivity, and impulsivity. Diagnosis of ADHD is clinical and based upon fulfilling the DSM-IV criteria.

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