There are many different types of epilepsies which may differ in some respects in their pot ential effect on licensing policy although they have a common thread of paroxysmal gross im pairment sepa- rated by periods of relative normality. Complex partial and gener- alized to nic \200\223clonic seizures (primary or secondary) are the types most commonly associated w ith crashes ( 14 ). These are completely incapacitating during the ictal phase and are asso ciated with a vari- able postictal period where the driver may remain incapacitated despite a partial return of consciousness. Involuntary motor move- ments during partial seizures h ave also been noted to contribute to crashes. Other forms are less commonly causes of crash es, with simple partial or uncomplicated myoclonic seizures where con- sciousness is preser ved being rarely involved. Psychogenic pseudo- seizures rarely occur in dangerous situation s and should not affect driving; however, it is not always possible to be sure whether the events really are psychogenic unless they can be captured during EEG monitoring ( 16 ). Lic ensing guidelines for patients with epi- lepsy therefore may require identi \201 cation of a speci \201 c epilepsy syn- drome and monitoring of treatment. Because the oversight of epilepsy by clinicians rests largely on evidence from the patient regarding the frequency o f seizures, it is important for doctors to assess the reliability of the history. Informati on from family mem- bers can be helpful in this regard. It is important to differentiate be tween the risk of having a seizure (whether behind the wheel or not) and the risk of having a crash. This is especially problematic as most licensing guidelines specify a \201 xed \201 t-free period and record- ing of this historical data is likely to be adversely affe cted by bias in histories given to clinicians ( 17 ). Objective evidence of seizure fre- qu ency and type may come from police reports, hospital records, or observations made during a dmissions for monitoring. Clinical evidence of brain imaging or EEG may be helpful in estab lishing a diagnosis and serum drug levels may be helpful in monitoring treatment. Video EEG monitoring extended over a period of a day or more is a useful aid to assessment in cases where the extent of seizure control is doubtful ( 18 ). Therapeutic measures in epilepsy cases may also have a bearing on \201 tness to drive eve n though seizures are controlled. Visual \201 eld defects resulting from epilepsy surgery or treatment with certain drugs such as vigabatrin may be severe enough to render a person un \201 t to drive ( 22 ). Many anticonvulsant drugs have undesirable side effects such a s sedation, confusion, incoordination, or other psychomotor effects that can affect driving ability. In most cases these are either transient, due to wrong dosing or may be avoided w ith a change of medication. It is important to keep these effects in mind when treating pat ients with epilepsy. Reporting of drivers with epilepsy or any other medical condi- tion to the driver licensing authority (Driver and Vehicle Licensing Agency in the UK) is a source of anxiety for many doctors. In some jurisdictions reporting is compulsory, which makes the decision easy, but there may be an adverse impact on the doctor \200\223patient relationship and the reliabili ty of the history of seizure control. This aspect of licensing policy involves a breach of con \201 dentiality and raises ethical and medico-legal questions which have been debated vociferously in the literature ( 23 \200\22325 ). In some jurisdic- tions doctors are prote cted from litigation by the driver if it can be shown that they acted in good faith when re porting. Regardless of whether reporting is compulsory, it is always good practice to dis- cuss the situation fully with the patient and attempt to explain the reasons why they shoul d not be driving. Doctors who deal with epileptic patients need to be familiar with local \201 tness to drive requirements ( 26 ) and should be proactive in counseling the patient regarding driving ( 27 ). Medical notes are documents which may be examined in court and th erefore all aspects of these discus- sions and decisions should be meticulously recorded. Medical standards for drivers with epilepsy are concerned with When a person is actually suffering a seizure, they are uncon- scious and technically incap able of controlling a motor vehicle. This has implications for criminal proceedings where i t is neces- sary to prove intent or negligence for certain acts such as culpable driving, v ehicular homicide, or similar offenses. If a person is inca- pacitated by a seizure or a po stictal state it can be argued that they were not actually in control of the vehicle or res ponsible for their actions. The question of automatism may also arise. Arguments can be mad e that negligence extends to driving with untreated or inadequately treated epilepsy or aft er a negligent decision not to the following aspects: \227\206 The existence of a prescribed seizure-free period. Periods vary with different ju risdictions and the evidence base for them may not be strong ( 28 ); however, as a general rule, the risk of a recur- rence is reduced as the seizure-free period increases ( 29 ) . \227\206 The type of seizures being experienced. In some jurisdictions a distinction is ma de regarding \200\230safe \200\231 seizures such as purely sen- sory phenomena or those oc curring in or from sleep which by their nature are not likely to disturb driving. The recur rence rate Table 37.1 Private licensing guidelines for drivers with epilepsy ( 31 ) Disorder Canada Australia UK USA New Zealand Sweden CMA (2006) Austroads (2006 and 2012) Drivers Medical Group, Swansea (2008) Utah Driver License Division (2006) Land Transportation Safety Authority (2002) Swedish National Road Administration (1999) Auras and minor epilepsy (absences) May drive if: \227\206 seizure pattern has been Not addressed If patient suffered an attack whilst awake \200\224 must desist from driving for minimum 1 year from date of attack before license may be issued. 3-year license issue is dependent o n patient being treatment compliant and if driving is unlikely to cause danger to the publi c. 70 license restored if seizure free for minimum 7 years (with medication if necessary) An unrestricted license may be issued if seizure or episode free for 5 years, without medic ation. OR seizure free for 3 \200\22312 months without medication or with medication but no side effects. Reviews are required 6-monthly, yearly, or 2-yearly. Speed, area, and time o f day restriction apply, depending on the length of time without seizures. 6-monthly review required Regarded as a partial epilepsy attack and treat as uncontrolled epilepsy. May resume drivin g after 1 year free of any epileptic seizures. Upon specialist advice this period may be re duced if further seizures are unlikely Not addressed stable for at least 12 months \227\206 no generalized seizures \227\206 neurologist gives approval \227\206 no impairm ent of cognition or consciousness \227\206 no head or eye deviation with seizures First, isolated epileptic seizure (prior to epilepsy diagnosis) Desist from driving for 3 months. Neurological assessment including EEG (awake and asleep) and appropriate imaging preferable Desist from driving for 6 months. This may be reduced on medical advice May resume driving until the age of 70 after 1 year free of any epileptic seizures. Medical opinion required before driving again. Special consideration may be given if a non-recurri ng cause of the seizure is clearly identi \201 ed Whilst under evaluation, a restricted license may be issued subject to medical advice May resume driving after 1 year free of any epileptic seizures. Upon specialist advice this period may be reduced if further seizures are unlikely License denied due to any of the following: \227\206 seizure in the last 2 years \227\206 EEG test and medical history show high risk of loss of consciousness C H A P T E R 3 7 l e g a l \227\206 no evidence of epileptiform activity on EEG. Exceptions may be made if a favorable prognosis is made, e.g. seizures are unlikely to reoc cur a s p e c t s o f Epilepsy diagnosis May resume driving after 6 months free of seizures and on medication. 12 months if seizures associated with altered awareness have occurred in last 2 years. GP conversant with partic ipant compliance. Person to be warned about the effects of fatigue and alcohol Conditional license granted if seizure free for 6 months. Annual review required If patient suffered an attack whilst awake \200\224 must desist from driving for minimum 1 year from date of attack before license may be issued. 3-year license will be issued until the age of 70 if the driver is seizure free for at least 7 years since the last attack wit h medication, if required. Exceptions can be made if the seizure occurs during an acute hea d injury or intracranial surgery An unrestricted license may be issued if seizure or episode free for 5 years, without medic ation. OR seizure free for 3 \200\22312 months without medication or with medication but no side effects. Reviews are required 6-monthly, yearly, or 2-yearly. Speed, area, and time o f day restriction apply, depending on the length of time without seizures. 6-monthly review required May resume driving after 1 year free of any epileptic seizures. Upon specialist advice this period may be reduced if further seizures are unlikely. License denied due to any of the following: \227\206 seizure in the last 2 years \227\206 EEG test and medical history show high risk of loss of consciousness e p i l e p s y a n d \227\206 no evidence of epileptiform activity on EEG. e p i l e p s y Exceptions may be made if a favorable prognosis is made, e.g. seizures are unlikely to reoc cur a n d d r i v i n g Continued 3 7 5 3 7 6 o x f o r d t e x t b o o k Table 37.1 (Continued) Disorder Canada Australia UK USA New Zealand Sweden CMA (2006) Austroads (2006 and 2012) Drivers Medical Group, Swansea (2008) Utah Driver License Division (2006 and 2012) Land Transportation Safety Authority (2002) Swedish National Road Administration (1999) o f e p i l e p s y Seizures while sleeping Drive after 1 year from initial seizure if drug levels are therapeutic Conditional license may be issued after 1 year seizure-free period since last seizure whils t awake If attack occurred whilst asleep, must desist from driving for minimum 1 year. If attacks o ccur for 3 years whilst asleep, and no attacks when awake then patient may be licensed. If attack when awake occurs, then as above. 3-year license issue is dependent on patient \200 \231s being treatment compliant and if driving is unlikely to cause danger to the public If seizures have occurred only whilst asleep over a period of 3 years or more and con \201 rmed by a medical report, the person may be issued with a license after a \200\230suitabl e interval \200\231 May resume driving after 1 year if no seizures whilst awake and seizure pattern upon waking or during sleep remains unchanged License denied due to any of the following: 1. Seizure in the last 2 years. 2. EEG test and medical history show high risk of loss of consciousness. 3. No evidence of epileptiform ac tivity on EEG a n d e p i l e p t i c s e i z u r e s Withdrawal of medication Desist from driving for 3 months after withdrawal or change of medication If seizures recur : can resume driving on resumption of previously effective medications. Resume driving afte r 3 months if seizure free Long-term withdrawal: patients can drive any class of vehicle af ter being seizure free for 5 years and if no epileptiform activity is recorded during a wak ing and sleep EEG obtained in the 6 months prior to driving Desist from driving during withdrawal period and for 3 months after this. On medical advice and with low risk of seizure, may not need to curtail driving Desist from driving during withdrawal period and for 6 months after this. Exceptions can be made depending on the physician \200\231s advice Person may qualify for a license, subject to medical report and after a corrective adjustme nt to medication has been made and a \200\230suitable interval \200\231 has elapsed A reduction in the requirement for a person to be seizure-free for 1 year prior to resuming driving may be considered if the seizure occurred whilst medication was being withdrawn or modi \201 ed under medical direction Exceptions to the requirement for a person to be seizure free in the previous 2 years may b e made if the seizures resulted from attempted withdrawal of medication on medical advice. The length of any post-seizure observation period may be speci \201 ed on a case-by-case b asis Epilepsy treated by surgery May resume driving after 1-year seizure-free period after surgery. May be reduced to 6 mont hs on neurologist advice Conditional license may be issued after 1 year seizure-free period after surgery Not addressed Not addressed Not addressed Not speci \201 cally addressed CHAPTER 37 legal aspects of epilepsy and epilepsy and driving 377 of awake seizures after some sleep-related seizures is usually low enough to allow licensin g in many jurisdictions ( 30 ). 14. Gastaut H , Zifkin BG . The risk of automobile accidents with seizures occurring while driving: relation to seizure type . Neurology 1987 ; 37 ( 10 ): 1613 \200\2231 6 . \227\206 Compliance with prescribed medication. 15. Hasegawa S , Kumagai K , Kaji S . Epilepsy and driving: a survey of automobile accident s attributed to seizure . Jpn J Psychiatry Neurol 1991 ; 45 ( 2 ): 327 \200\223 31 . \227\206 Compliance with behavioral measures. These may include restrictions on driving wh en tired or sleep deprived, or restric- tions to driving at certain times. 16. Specht U , Thorbecke R . Should patients with psychogenic nonepileptic seizures be allo wed to drive? Recommendations of German experts . Epilepsy Behav 2009 ; 16 ( 3 ): 547 \200 \223 50 . \227\206 Abstention from other drugs or alcohol which may precipitate 17. Beaussart M , Beaussart-Defaye J , Lamiaux JM , Grubar JC . Epileptic seizures or affect control of the condition. drivers \200\224 a study of 1,089 patients . Med Law 1997 ; 16 ( 2 ): 295 \200\223 306 . 18. Kamel JT , Christensen B , Odell MS , D \200\231Souza WJ , Cook MJ . Evaluating the use of prolonged video-EEG monitoring to assess future seizure risk and \201 tness to drive . Epilepsy & Behavior 2010 ; 19 ( 4 ): 608 \200\223 11 . \227\206 A much more stringent criterion is applied to commercial or heavy vehicle drivers with epilepsy. This is intended to ensure (within the limits of knowledge of the condition ) that drivers have a risk of a seizure no greater than that of the general population. 19. McSherry B . Epilepsy, automatism and culpable driving . Med Law 2002 ; 21 ( 1 ): 133 \200\223 53 . 20. Medical Research Council . Randomized study of antiepileptic drug As Table 37.1 illustrates, a variety of approaches is taken by dif- ferent licensing author ities and the speci \201 cs of licensing guidelines vary between different jurisdictions. withdrawal in patients in remission . Lancet 1991 ; 337 ( 8751 ): 1175 \200\223 80 . 21. B onnett LJ , Shukralla A , Tudur-Smith C , Williamson PR , Marson AG . Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: fu rther results from the MRC Antiepileptic Drug Withdrawal Study and a systematic review . J Neurol Neurosurg Psychiatry 2011; 82:1328 \200\22333 . References 1. Fenwick P . Automatism, medicine and the law . Psychol Med Monogr 22. Ray A , Pathak-Ray V , Walters R , Hat \201 eld R . Driving after epilepsy surgery: ef fects of visual \201 eld defects and epilepsy control: British Journal of Neurosurgery . Br J Neurosurg 2002 ; 16 ( 5 ): 456 \200\223 60 . Suppl 1990 ; 17 : 1 \200\223 27 . 2. Beran RG . Automatism: comparison of common law and civil law approaches \200\224 a sea rch for the optimal . J Law Med 2002 ; 10 ( 1 ): 61 \200\223 8 . 3. Marsh L , Krauss GL . Aggression and violence in patients with epilepsy . 23. Black AB , Lai NY . Epilepsy and driving in South Australia \200\224 an assessment of compulsory noti \201 cation . Med Law 1997 ; 16 ( 2 ): 253 \200\223 67 . Epilepsy Behav 2000 ; 1 ( 3 ): 160 \200\223 8 . 24. Black AB . Con \201 dentiality and driver licensing authorities . Med Law 4. Reuber M , Mackay RD . Epileptic automatisms in the criminal courts: 13 cases tried in E ngland and Wales between 1975 and 2001 . Epilepsia 2008 ; 49 ( 1 ): 138 \200\223 45 . 2003 ; 22 ( 2 ): 333 \200\223 43 . 25. Remillard GM , Zifkin BG , Andermann F . Epilepsy and motor vehicle driving \200\224 a symposium held in Quebec City, November 1998 . Can J Neurol Sci 2002 ; 29 ( 4 ): 315 \200 \223 25 . 5. Somerville ER , Black AB , Dunne JW . Driving to distraction \200\224 certi \201 catio n of \201 tness to drive with epilepsy . Med J Aust 2010 ; 192 ( 6 ): 342 \200\223 4 . 26. Vogtle LK , Martin R , Russell Foushee H , Edward Faught R . A comparison of physicians \200\231 attitudes and beliefs regarding driving for persons with epilepsy . Epilepsy Behav 2007 ; 10 ( 1 ): 55 \200\223 62 . 27. Shareef YS , McKinnon JH , Gauthier SM , Noe KH , Sirven JI , 6. Hansotia P , Broste SK . The effect of epilepsy or diabetes mellitus on the risk of auto mobile accidents . N Engl J Med 1991 ; 324 ( 1 ): 22 \200\223 6 . 7. Bener A , Murdoch JC , Achan NV , Karama AH , Sztriha L . The effect of Drazkowski JF . Counseling for driving restrictions in epilepsy and other causes of tempora ry impairment of consciousness: How are we doing? Epilepsy Behav 2009 ; 14 ( 3 ): 550 \200 \223 2 . epilepsy on road traf \201 c accidents and casualties . Seizure 1996 ; 5 ( 3 ): 215 \200 \2231 9 . 8. Taylor J , Chadwick D , Johnson T . Risk of accidents in drivers with 28. Drazkowski JF , Fisher RS , Sirven JI, Demaerschalk BM , Uber-Zak L , epilepsy . J Neurol Neurosurg Psychiatry 1996 ; 60 ( 6 ): 621 \200\223 7 . Hentz JG , et al . Seizure-related motor vehicle crashes in Arizona before and after reduci ng the driving restriction from 12 to 3 months . Mayo Clin Proc 2003 ; 78 ( 7 ): 819 \200 \223 25 . 9. Sillanpaa M , Shinnar S . Obtaining a driver \200\231s license and seizure relapse in patients with childhood-onset epilepsy . Neurology 2005 ; 64 ( 4 ): 680 \200 \223 6 . 29. Krauss GL , Krumholz A , Carter RC , Li G , Kaplan P . Risk factors for seizure-related motor vehicle crashes in patients with epilepsy . Neurology 1999 ; 52 ( 7 ): 1324 \200 \223 9 . 10. Elliott JO , Long L . Perceived risk, resources, and perceptions concerning driving and epilepsy: A patient perspective . Epilepsy Behav 2008 ; 13 ( 2 ): 38 1 \200\223 6 . 30. Thomas RH , King WH , Johnston JA , Smith PE . Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law . J Neurol Neurosurg Psychia try 2010 ; 81 ( 2 ): 130 \200\223 5 . 31. Charlton JL , Koppel S , Odell MS, Devlin A , La ngford J , O \200\231Hare M , et al . In \202 uence of chronic illness on crash involvemen t of motor vehicle drivers Report #300. In \202 uence of chronic illness on crash involvem ent of motor vehicle drivers Report #300 . Victoria : Monash University Accident Research C enter , 2010 . 11. Bautista RE , Wludyka P . Driving prevalence and factors associated with driving among patients with epilepsy . Epilepsy Behav 2006 ; 9 ( 4 ): 625 \200\223 31 . 12. Polychronopoulos P , Argyriou AA , Huliara V , Sirrou V , Gourzis P , Chroni E . Factor s associated with poor compliance of patients with epilepsy driving restrictions . Neurolog y 2006 ; 67 ( 5 ): 869 \200\223 71 . 13. Berkovic SF . Epilepsy syndromes: effects on cognition, performance and driving ability . Med Law 2001 ; 20 ( 4 ): 547 \200\223 51 . This page intentionally left blank Index benign familial infantile seizures (BFIS) 12 , 14 benign familial neonatal convulsions (BFN Cs) 78, 160; see also neonatal/infantile-onset epilepsy benign familial neonatal seizures ( BFNS) 12 , antidepressant drugs 208 , 214 \200\22315 , 215 , 216 , 347 antiepileptic drugs (AEDs) 148 , 255 \200\2237; see absence seizures 71 , 102, 254; see also childhood absence epilepsy; epilepsy with myoclonic absences; juvenile absence epilepsy also individual antiepilectics acute administration 136 \200\2237 , 136 , 139 children/adol escents 188 , 189 \200\22390 chronic epilepsy 253 \200\2238 , 254 early epilepsy 245 \200 \2237 , 246 , 247 \200\2238 elderly populations 204 , 204 \200\2235 , 205 , 206 \200\2237 , 208 emergency departments 340 \200\2231 infections, CNS 227 \200\2238 interactions 269 \200\22377 , 270 , 271 , 274 , 275 neonatal/infantile-onset epilepsy 169 \200\22370 neuroch emistry 32 \200\2233 postpartum period 154 post-stroke seizures 225 post-traumatic epilepsy 223 \200\2234 pregnancy 145 \200\22351 , 152 , 153 and psychiatric illness 214 \200\22316 , 216 remission 56 resistance 299 stopping after surgery 304 tumoural epilepsy 229 \200\223 31 , 231 13 \200\22314 , 132 , 172 absorption interactions, AEDs 269 acetylcholine 32 active epilepsy, de \201 nition 51 acut e drug administration (ADA) 136 \200\2237 , benign familial neonatal-infantile seizures (BFNIS) 12 , 14 , 132 benign idiopathic neonatal seizures 172 benign infantile seizures (non-familial) 74 , 75 be nign myoclonic epilepsy in infants 136 , 139 ADNFLE (autosomal dominant nocturnal frontal lobe epilepsy) 12 , 14 , 78 , 132 adolescence 73 , 77, 187 \200\22394, 248; see also (BMEI) 74 , 77 , 189 \200\22390 benign neonatal seizures (BNSs) 79 benign partial epilepsy 63 , 63 benzodiazepines 169 \200 \22370 , 136 , 136 , 340 BFIS (benign familial infantile seizures) 12 , 14 BFNIS (familial neonatal-infantile seizures) 12 , juvenile absence epilepsy ADTLE (autosomal dominant temporal lobe epilepsy) 12 , 14 \200\22316 , 132 AEDs. see antiepileptic drugs etiology 61 \200\2239 , 62 , 63 , 4 chronic epilepsy 257 cognitive functioning 369 de \201 nitions 51 \200\2232 elde rly populations 202 , 202 \200\2233 epileptic encephalopathy 179 extratemporal epilepsy 309 \200\22310 neonatal/infantile-onset epilepsy 165 \200\2237 , 168 14 , 132 BFNS (benign familial neonatal seizures) 12 , 13 \200\22314 , 132 , 172 BMEI (benign myoclonic epilepsy in infants) 74 , 77 , 189 \200\22390 biochemical testing 127 , 127 \200\2238 , 128 , 129 , antipsychotic drugs 212 \200\22313 , 215 \200\22316 , 216 antiquitin (ALDH7A1 ) gene 21 anx iety disorders 211 \200\22312 , 367 , 369 array-comparative genomic hybridization 130 , 131 biopsy 128 , 131 bipolar disorder 215 blood \200\223brain barrier 229 brain development, im pact of seizures 169 brain function, and sexual/emotional age, and remission 262 \200\2233; see also elderly populations age of onset, classi \201 cation 73 aggression 196 \200\2237 alcohol intake 68 , 135 algor ithm, status epilepticus treatment 344 alpha rhythm asymmetries 99 alpha -subunits, voltage -gated sodium (CGH) 21 ARX gene 11 , 12 , 16 aspartate neurotransmitters 31 atonic seizures 71 , 75 atypical absen ce/atonic/tonic seizures 254 \200\2235 auras 293 , 293 autism 196 autoimmune encephalitis 2 43 autosomal dominant nocturnal frontal lobe behavior 357 \200\2238 , 358 brain mapping 297 \200\2238 brain structure 292 , 293 , 296 , 298 , 308 , 309 , 314 brain t umors 66 \200\2237 , 202 , 203 , 221 , 228 \200\22333 , channels 14 229 , 232 , 233 alphaamino- 3-hydroxyl-5-methyl-4-isoxazole- breast milk, and AEDs 154 bumetanide 170 propionate (AMPA) receptors 28 alpha-methyl-L-tryptophan (AMT) 115 Alzheimer disease 203 am ino acid disorders 133 \200\2234 , 133 amplitude integrated EEG (aEEG) 164 amygdala, deep b rain stimulation 322 Angelman syndrome causality 64 \200\2235 genetics 133 learning disabil ity 196 epilepsy (ADNFLE) 12 , 14 , 78 , 132 autosomal dominant temporal lobe epilepsy CACNA1H gene 18 CAE. see childhood absence epilepsy calcium ions 3 \200\2236 , 7 carbamazep ine (ADTLE) 12 , 14 \200\22316 , 132 bacterial meningitis 226 , 228 barbiturate drugs 344 \200\2235 Bayley Scale of Infant Devel opment 150 behavior, emotional 357 \200\22366 , 358 \200\22363 behavioral disturbances 196 \200\2237 behavioral side effects, AEDs 150 \200\2231 , 188 behavioral therapy 135 , 139 be liefs 352 benign childhood epilepsy with centrotemporal breast milk 154 drug interactions 274 elderly populations 206 neurochemistry 33 \200\2234 p harmacology/clinical animal models, neurochemistry 29 \200\22330 , 31 anterior frontal lobe seizures, therapeutics 279 \200\22381 , 280 classi \201 cation 74 , 76 pregnancy 149 seizure exacerbation 255 tumoural epilepsy 229 anterior temporal lobectomy 191 antibiotics 347 spikes (BECTS) 74 , 75 , 264 index 380 surgery 295 , 295 \200\2237 , 296 EMA (epilepsy with myoclonic craniotomy 297 , 297 Creutzfeldt \200\223Jakob disease 203 cryptogenic epilepsy. see presum ed carbon monoxide poisoning 68 cardiac arrhythmias 345 cardiac effects, vagus nerve stimulati on 320 case ascertainment 52* catamenial epilepsy 135 causality. see etiology CDKL5 gene 11 , 12 , 16 central nervous system infections 67 , 221 , absences) 77 \200\2238 , 190 EME (early myoclonic epilepsy) 160; see also symptomatic seizures neonatal/infantile-onset epilepsy CVD (cerebrovascular disease) 52 , 67 \200\2238 , 202 , emergency departments (ED) 337 \200\22342 , 338 , 208 , 221 , 224 \200\2235 cytochrome P450 enzyme system 229 339 , 341 emotional behavior 357 \200\22366 , 358 \200\22363 employment 348 \200\22355 , 350 , 351 , 352 , 354 encephalitis 67 , 226 endocrine disorders 68 , 91 enzyme-inducing AEDs 273 \200 \2235, 274 ; see also deconditioning therapy 139 deep brain stimulation 320 \200\2233 , 322 de \201 nitions 51 226 \200\2238 , 227 , 228 cerebrospinal \202 uid (CSF) examination 128 , 130 chronic epilepsy 253 epilepsy syndrome 263 neonatal/infantile-onset epilepsy 159 polycystic ovarian syndrome 145 re \202 ex seizures/epilepsies 137 dentate gyrus pathology, TLE 46 \200\2238 dentato-rubropallido-luysian atrophy cerebrovascular disease (CVD)) 52 , 67 \200\2238 , 202 , carbamazepine; phenobarbital; phenytoin; primidone 202 , 208 , 221 , 224 \200\2235 CGH (comparative genomic hybridization) 21 childhood absence epilepsy (CAE) epidemiology 52 \200\2239 , 53 , 54 , 55 elderly populations 201 , 201 \200\2232 , 202 emergency departments 337 infections, CNS 226 post-stroke seizures 224 single seizures 262 tumoural epilepsy 228 classi \201 cation 74 , 77 neurogenetics 12 , 18 remission 263 treatment 190 (DRPLA) 64 , 132 depressive disorders 211 \200\22312 , 367 \200\2239 developmental course of epilepsy 370 de velopmental neurobiology 39 \200\22341 , childhood epilepsy syndromes 63 children classi \201 cation 73 differential diagnosis 91 \200\2232 early epilepsy 248 examination/h istory-taking 85 \200\2236 treatment 187 \200\22394 vagus nerve stimulation 319 epilepsy with continuous spike and waves 39 \200\22350 , 44 \200\2237 during slow wave sleep 180; see also slow sleep oscillation diagnosis accuracy 52 chronic epilepsy 257 criteria 72 elderly populations 203 , 203 \200\2234 , 204 emergency departments 337 \200\22340 , 338 , 339 learning disability and epilepsy 197 epilepsy with myoclonic absences (EMA) 77 \200\2238 , 190 epilepsy with myoclonic-astatic seizures chloride ions (Cl -) 4 chromosomal disorders 21 , 65 , 132 \200\2233 , 133 chronic epilepsy 253 \200\2239 , 254 , 255 , 256 , 258 classi \201 cations 71 \200\2234 , 71 \200\22380 (MAE) 77 epilepsy syndrome, de \201 nitions 263 epileptic encephalopathies 15 \200\22316 , 177 \200 \22385 , 179 diet 140 \200\2231 , 190 , 258 diffusion tensor imaging (DTI) 111 \200\22313 , 112 dissocia tive disorders 87 \200\2238 dopamine 32 Down syndrome 65 , 196 Dravet syndrome (severe myoc lonic epilepsy in classi \201 cation 74 , 78 \200\2239 neonatal/infantile-onset 172 neurogenetics 12 treatme nt 187 \200\2238 absences 74 chronic epilepsy 257 extratemporal epilepsy 307 neonatal/infantile-onset epilep sy 160 , 160 \200\2232 , epileptic seizure, de \201 nition 51 epileptic spasms, classi \201 cation 74 \200\2235 ep ileptogenic zone 292 , 292 \200\2233 , 307 \200\2239 episodic dyscontrol syndrome 196 \200 \2237 eslicarbazepine acetate 280 , 281 ethosuximide 154 , 280 , 281 \200\2232 European Epi lepsy Brain Bank 39 evolution, sexual/emotional behavior 357 examination 86; see also diagn osis extraoperative invasive recording 104 extratemporal epilepsy 307 \200\22315 , 309 , 31 1 , 312 , 161 post-stroke seizures 224 status epilepticus 343 infancy) 12 , 13 , 132 , 140 , 180 \200\2231 driving 373 \200\2237 , 375 \200\2236 DRPLA (dentato-rubropallido-luysian CLCN2 gene 18 clinical applications, neurochemistry 33 \200\2234 clinical trials, AEDs 256 clobazam 280 , 281 clonazepam 280 , 281 clonic seizures, classi \201 cation 71 , 74 CNS in fections 67 , 221 , 226 \200\2238 , 227 , 228 cognitive functioning 150 \200\2231, 188, 367 \200\22372, 368 , atrophy) 64 , 132 drug interactions 269 \200\22377, 270 , 271 , 274 , 275 ; see also antiepileptic drugs and other drug types by name DTI (diffusion tensor imaging) 111 \200\22313 , 112 313 , 314 early epilepsy 247 \200\2239 early infantile encephalopathy with burst 369 ; see also social cognition columnar organization, neocortex 42 combined oral contraceptive pills (COCPs) 146 \200\2237 , 275 , 275 facial emotions 360 , 360 familial epilepsies, classi \201 cation 74 , 78; see also suppression 172 early infantile epileptic encephalopathy (EIEE) 12 , 160; see also neonatal/infantile-onset epilepsy autosomal dominant epilepsies comorbidity, early epilepsy 248 \200\2239 comparative genomic hybridization familial lateral temporal lobe epilepsy 78 febrile seizures 15 , 18 , 79 felbamate 280 , 28 2 fetal valproate syndrome 153 \201 rst seizures 245 \200\2237 , 261 \200\2232 , 262 FLAI R images 110 \202 umazenil 115 fMRI (functional magnetic resonance early myoclonic encephalopathy 172 early myoclonic epilepsy (EME) 160; see also (CGH) 21 complex partial seizures, ILAE classi \201 cation 71 compliance, AED drug regimes 257 cons ciousness, temporary loss neonatal/infantile-onset epilepsy early-onset epileptic encephalopathies 11 early postoperative seizures 302 EEG-fMRI 117 , 1 17 \200\22318; see also (TLOC) 82 , 83 , 85 electroencephalography continuous spike and waves during slow wave sleep syndromes 180; see also slow sleep oscill ation imaging) 116 , 116 \200\22318 , 117 EEs. see epileptic encephalopathies elderly populations 201 , 201 \200\22310 , 202 \200\223 8 focal cortical dysplasia (FCD) 40 \200\2233 , 40 , 41 , 44 , 45 early epilepsy 248 vagus nerve stimulation 319 electrocardiography (ECG) 87 electroconvulsi ve therapy (ECT) 215 electrocorticography 104 , 104 electroencephalography (EEG) 95 \200 \223107 , 96 \200\223106 biomarkers 162 \200\2234 , 163 , 164 , 165 , 166 , 167 differentia l diagnosis 86 resective surgery 301 \200\2232 slow sleep oscillation 3 , 4 contraceptive pill 146 \200\2237 , 275 , 275 corpus callosotomy 191 , 330 \200\2232 , 331 c ortex, spike wave (SW) seizures 6 \200\2237 , 8 cortical dysplasia 65 , 65, 129, 132, 132 ; see also malformations of cortical development focal epilepsies 39 , 40 , 88 , 189 focal motor seizures, classi \201 cation 75 focal onse t epileptic seizures, classi \201 cation 73 , 75 cortical lesions 109 counseling focal seizures antiepileptic drugs 247 classi \201 cation 71 , 75 electroencephalogram 100 \200\2231 , 10 3 genetic 22 early epilepsy 249 pre-conception 151 folic acid 151 index 381 hypothermia 346 hypoventilation 345 IPOLE (idiopathic photosensitive occipital lobe Fragile X syndrome 65 , 196 frontal lobe epilepsies 74 , 76 frontal lobe pathology, cogniti ve epilepsy) 137 , 138 irritative zone 292 , 295 \200\2236 , 292 , 307 iso \202 urane 346 isolated seizures, clas si \201 cation 79 ictal functioning 368 aggression 196 differential diagnosis 86 , 87 EEG 100 \200\2233 , 103 , 163 \200\2234 , 164 , 167 , 312 mood/anxiety symptoms 211 , 211 \200\22312 psychosis 212 \200\22313 functional de \201 cit zone 292 , 292 \200\2233 , 307 functional imaging 113 \200\22321 , 114 \200\22320 juvenile absence epilepsy (JAE) classi \201 cation 74 , 77 remission 263 treatment 190 GABA (gamma-aminobutyric acid) 3 , 27 \200\22331 , 33 , 370 gabapentin ictal-onset zone 292 , 292 , 296 idiopathic childhood occipital epilepsy (ICOE), juvenile myoclonic epilepsy (JME) breast milk 154 elderly populations 206 pharmacology/clinical classi \201 cation 74 , 75 idiopathic epilepsies 11 \200\22318 etiology 51 , 61 \200\2233 , 62 de \201 nitions 61 ILAE classi \201 cation 72 neurogenetics 12 classi \201 cation 74 , 77 neurogenetics 12 remission 263 treatment 190 therapeutics 280 , 282 pregnancy 149 tumoural epilepsy 230 GABRG2 gene 18 gastrointestinal motility 346 generalized absence seizures, AEDs 254 general ized convulsive status epilepticus kainate receptors 28 K-complex, neurophysiology 3 ketamine 346 ketogenic diet 140 \200\2231 , 190 kidney disease 239 , 240 \200\2231 idiopathic focal epilepsies 74 , 75 , 188 idiopathic generalized epilepsies (IGEs) 62 , 62 \200\2233 , 63 children/adolescents, (GCSE) 343 \200\2238 , 344 , 347 treatment 189 \200\22390 generalized epilepsy with febrile seizures plus classi \201 cation 74 , 77 neurogenetics 16 \200\22318 remission 263 see also juvenile abs ence epilepsy; juvenile (GEFS +) 12 , 13 , 78 , 132 lacosamide 207 , 230 , 280 , 282 \200\2233 Lafora body disease 64 , 132 lamotrigine generalized seizures AEDs 247 \200\2238 classi \201 cation 73 , 74 EEG 101 \200\2233 ILAE classi \201 cation 71 breast milk 154 elderly populations 205 pharmacology/clinical therapeutics 283 pregnancy 14 7 , 149 myoclonic epilepsy idiopathic photosensitive occipital lobe epilepsy (IPOLE) 137 , 138 generalized tonic \200\223clonic seizures (GTCSs) ILAE (International League Against Epilepsy) 40 , 71 \200\2232 , 160 , 160 AEDs 253 \200\2234 classi \201 cation 77 EEG 102 \200\2233 , 103 therapy, non-pharmacologi cal 135 Landau \200\223Kleffner syndrome 180 language functions AEDs in pregnancy 150 \200\2231 fMRI 116 immunological diseases of the nervous system 68 genetics 11 \200\22326 , 12 , 14 \200\22317 , 19 , 20 , 128 \200\22334 , 132 , lateral temporal lobe epilepsy, immunological investigations 128 , 131 immunosuppression 345 \200\2236 incidence 52 \200 \2235 , 53 133 , 248 \200\2239 classi \201 cation 74 , 76 glial cells 1 , 2 , 4 \200\2236 , 5 , 6 , 7 glutamate neurotransmission 28 \200\2239 , 31 , 33 glycine neurotransmitters 31 \200\2232 lateralization of seizures 293 learning disability 195 \200\2239 , 198 legal aspects of epi lepsy 373 Lennox \200\223 Gastaut syndrome 1 elderly populations 202 neonatal/infantile-onset epilepsy 159 tumoural epilepsy 228 \200 \2239 hematological tests 127 , 127 \200\2238 , causality 63 , 64 epileptic encephalopathy 179 , 179 \200\22380 remission 264 individual patient needs 255 , 255 induction mechanisms/interactions, 129 , 130 head trauma 66 , 202 , 203 , 221 , 221 \200\2234 heavy metals 68 hemimegalencephaly 182 \200\2233 hemispherectomy 332 , 332 \200\2233 hepatic disease 239 , 241 \200\2232 high-freq uency oscillations (HFOs) 105 \200\2237 , 106 AEDs 271 \200\2235 , 274 , 275 levetiracetam infantile spasms 12 , 140, 177 \200\2239; see also West breast milk 154 elderly populations 205 , 207 pharmacology/clinical therapeutics 280 , syndrome infantile-onset epilepsy. see neonatal/infantile- onset epilepsy 283 \200\2234 infections, CNS 67 , 221 , 226 \200\2238 , 227 , 228 in \202 ammatory diseases of the nerv ous pregnancy 149 , 151 tumoural epilepsy 230 system 68 hippocampus lidocaine 346 lifestyle factors inhibition interactions, AEDs 271 , 271 \200\2233 intelligence quotient (IQ) 150 \200\2231 intensive care units 343 \200\2238 , 344 , 347 interictal deep brain stimulation 322 neurochemistry 28 \200\2239 neuropathology 43 \200\2238 , 46 , 4 7 sclerosis 66 , 369 transection 328 \200\22330 , 330 , 331 histological investigations 128 , 131 history-taking 82 , 84 \200\2236 , 85 hoarseness, vagus nerve stimulation 319 homeos tasis chronic epilepsy 258 elderly populations 208 linguistic features, differential diagnosis 85 , aggression 197 differential diagnosis 86 EEG 99 , 102 , 163 mood/anxiety symptoms 211 \200 \22312 psychosis 213 sexual/emotional behavior 362 \200\2233 intermediate frontal lobe seiz ures 74 , 76 intermittent explosive disorder 196 \200\2237 International League Against Epi lepsy 85 , 88 lissencephaly (LIS) 18 , 19 lithium 215 \200\22316 , 276 liver disease 239 , 241 \200\2232 liver transplantation 242 lobar epilepsies 74 , 75 localization of seizures 293 localizatio n rules, EEG 96 \200\2237 , 97 lysosomal storage disorders 133 , 134 elderly populations 204 peritumoural 229 hormonal effects, AEDs 145 \200\2236 Horsley, Victor 292 , 299 \200\223300 hot-water epilep sy (HWE) 137 , 138 , 139 human variome project 22 Huntington disease 203 hyperperfusion enc ephalopathy 243 hyperventilation 88 , 97 hypoglycaemia 68 , 91 hypotension 345 hypothalamic amenorrhea 145 \200\2236 (ILAE) 40 , 71 \200\2232 , 160 , 160 intracranial EEG 295 , 297 , 296 \200\2237 , 301 \200\2232 intractable epilepsy 258, 264; s ee also chronic MAE (epilepsy with myoclonic-astatic epilepsy seizures) 77 , 140 , 181 \200\2232 intraoperative electrocorticography 104 , 104 invasive EEG 104 investigations 127 \200\2233 4, 127 \200\22333 ; see also magnetic resonance imaging (MRI) 109 \200\22311 , 110 , 111 case studies 311 , 312 , 313 , 314 neonatal/infantile-onset epilepsy 169 diagnosis index 382 myoclonus epilepsy and ragged red \201 bres parasomnias, differential diagnosis 88 \200\2239 , 339 magnetic resonance imaging (MRI) (cont.) (MERRF) 132 resective surgery 300 surgery 294 , 294 vagus nerve stimulation 320 parietal lobe epilepsies 74 , 76 paroxysmal depolarizing shift (PDS) 3 , 28 paroxysmal dysk inesias (PDs) 89 \200\22390 paroxysmal neurological disorders, differential narcolepsy 89 NEAD (Neurodevelopmental Effects of Antiepileptic drugs) study 150 \200\2231 magnetic resonance spectroscopy (MRS) 31 , 118 \200\22319 , 119 necrosis 345 neocortical pathology, focal epilepsies 40 \200\2233 , 41 neocortical temporal lobe epilepsy 74 , 76 neonatal period, classi \201 cation 73 neonatal/infantile-onset epi lepsy 159 \200\22375 , 160 , diagnosis 82 magnetoencephalography (MEG) 119 \200\22321 , 301 major congenital malformations 148 , 148 \200\22350 , partial (focal, local) seizures 71 pathophysiology 152 , 153 malaria 226 malformations of cortical development (MCDs) 18 \200\22321, 19 , 20 , 39 , 40, 40 , 41 ; see also cortical dysplasia management epilepsy and systemic diseases 239 \200\22340 neonatal/infantile-onset epilepsy 167 \200 \2239 161 , 163 \200\2239 , 171 PBDs (peroxisome biogenesis neoplasm 66 \200\2237 , 221 , 228 \200\22333 , 229 , 232 , 233 neuroacanthocytosis 133 neur oanatomy 39 \200\22341 , 39 \200\22350 , 44 \200\2237 neurochemistry 27 \200\22337 neurocut aneous conditions 64 , 64 , 133 neurocysticercosis 226 , 228 neurodegenerative disease 202 , 203 Neurodevelopmental Effects of Antiepileptic disorders) 133 \200\2234 PCDH19 gene 15 \200\22316 PCOS (polycystic ovarian syndrome) 145 \200\2236 peri-ictal elderly populations 208 emergency departments 337 \200\22342 , 338 ,