**Meet the editor**

Mark D. Holmes MD is currently Professor of Neurology and Associate Director of the Regional Epilepsy Center at the University of Washington in Seattle, Washington, USA. He received his medical degree at the Ohio State University, medical internship at the Cleveland Clinic, neurology training at Letterman Army Medical Center in San Francisco, California, and fellowships in epileptology and clinical neurophysiology at the National Institutes of Health in Bethesda, Maryland. He is the author of numerous papers and book chapters on various aspects of epilepsy. His current research focuses on understanding the epileptic network through high density EEG recordings in combination with neuroimaging modalities.

Contents

**Preface VII**

Chapter 2 **Role of EEG in Epilepsy 15**

**Machines 29**

Chapter 1 **Brain Circuits Responsible for Seizure Generation, Propagation, and Control: Insights from Preclinical Research 1**

Boulenouar Mesraoua, Dirk Deleu, Hassan Al Hail, Gayane Melikyan

Manjari Tripathi and Man Mohan Mehendiratta

Chapter 3 **Nonlinear Epilepsy Forewarning by Support Vector**

W.S. Ashbee, L.M. Hively and J.T. McDonald

Chapter 5 **Juvenile Myoclonic Epilepsy — A Maturation Syndrome**

Chapter 7 **Vagus Nerve Stimulation Therapy for Epilepsy 139**

Chapter 8 **Neuromodulation Therapy: Nonmedical, Nonsurgical Treatment for Intractable Epilepsy 161**

Russell D. Pella, Lakshmi Mukundan and C. Akos Szabo

Chapter 4 **Juvenile Myoclonic Epilepsy: An Update 53**

and Heinz Gregor Wieser

Raidah Saleem AlBaradie

**Coming of Age 77**

Chapter 6 **Reflex Epilepsy 129**

Reese S. Terry Jr

Hyang Woon Lee

Patrick A. Forcelli and Karen Gale

## Contents

#### **Preface XI**


Hyang Woon Lee


Preface

infectious and degenerative etiologies.

Epilepsy is recognized as of one of the most common primary disorders of the brain. It af‐ fects all ages, from infancy to old age, and afflicts at least one person in fifty during the course of his or her lifetime. The eminent 19st century British neurologist, J. Hughlings Jack‐ son, conceived of an epileptic seizure as an abnormal, paroxysmal and excessive electrical discharge in cortical neurons. Today, nearly a century and a half later, modern neurologists agree that Jackson's formulation is essentially correct. Today, neurologists understand that epileptic seizures may be a final common pathway of virtually any one of the myriad proc‐ esses that can potentially result in brain injury, ranging from genetic, vascular, traumatic,

Just as the causes of epilepsy may be protean, so may be the clinical manifestations of epi‐ leptic seizures. The signs and symptoms of seizures are determined by the location of ictal origin, the distribution and spread of discharges within an epileptic network, and the dura‐ tion of the seizure. The spectrum of adverse effects on brain function that result from a seiz‐ ure is extensive. These may range from temporary aberration of motor or sensory function, to collapse, convulsive activity, and the complete loss of consciousness which transiently, but completely, robs the affected individual of his or her essential humanity. Particularly when mental status is impaired during seizures, the overall impact on quality of life may be profound, with deleterious effects on nearly all aspects of the patient's life. Despite the sig‐ nificant advances that have been made over the last several decades by basic scientists in understanding the fundamental nature of epileptic seizures, and by clinical researchers in improving diagnosis and treatment, at least one-third of affected subjects remain medically

Although the management of patients with epilepsy usually falls under the purview of neu‐ rologists or epileptologists, other specialists are frequently involved in epilepsy patient eval‐ uation and care as well, including neurosurgeons, neuropsychologists, neuroradiologists, psychiatrists, social workers, nurses, emergency physicians, and primary care providers, in‐ cluding obstetrician-gynecologists. In fact, nearly any health care provider who has direct patient contact will most likely, at some point, be involved with the assessment or treatment of patients with seizures. For this reason, widespread dissemination of knowledge regard‐

In this volume, an international group of recognized epilepsy researchers and clinicians has been assembled to discuss a variety of topics on epilepsy. The subject matter is diverse, and includes new concepts in brain circuitry involved in seizure generation, a discussion on re‐ flex epilepsy, updates on juvenile myoclonic epilepsy, the role of EEG in epilepsy evalua‐ tion, the novel possibility of seizure prediction from scalp EEG, the roles of vagus nerve

refractory. Epilepsy thus remains a major world-wide public health problem.

ing fundamental issues surrounding the patient with epilepsy is vitally important.

Chapter 11 **Quality of Life Issues in Epilepsy 225** Jane McCagh

#### Chapter 12 **Marriage of Epileptic Patients 241** Azra Alajbegovic, Jasminka Djelilović-Vranić, Salem Alajbegović and Lejla Alajbegović

## Preface

Chapter 9 **Psychogenic Non-Epileptic Spells 173**

Chapter 11 **Quality of Life Issues in Epilepsy 225**

Chapter 12 **Marriage of Epileptic Patients 241**

Jane McCagh

**VI** Contents

Lejla Alajbegović

Gavito, Richard Phenis and Daniel Cruz

Batool F. Kirmani, Diana Mungall Robinson, Jose Aceves, David

Chapter 10 **Psychogenic Non-Epileptic Seizures in a Surgical Epilepsy Unit: Experience and a Comprehensive Review 193**

> Lorena Vega-Zelaya, Marta Alvarez, Elena Ezquiaga, Jaime Nogeiras, María Toledo, Rafael G. Sola and Jesús Pastor

Azra Alajbegovic, Jasminka Djelilović-Vranić, Salem Alajbegović and

Epilepsy is recognized as of one of the most common primary disorders of the brain. It af‐ fects all ages, from infancy to old age, and afflicts at least one person in fifty during the course of his or her lifetime. The eminent 19st century British neurologist, J. Hughlings Jack‐ son, conceived of an epileptic seizure as an abnormal, paroxysmal and excessive electrical discharge in cortical neurons. Today, nearly a century and a half later, modern neurologists agree that Jackson's formulation is essentially correct. Today, neurologists understand that epileptic seizures may be a final common pathway of virtually any one of the myriad proc‐ esses that can potentially result in brain injury, ranging from genetic, vascular, traumatic, infectious and degenerative etiologies.

Just as the causes of epilepsy may be protean, so may be the clinical manifestations of epi‐ leptic seizures. The signs and symptoms of seizures are determined by the location of ictal origin, the distribution and spread of discharges within an epileptic network, and the dura‐ tion of the seizure. The spectrum of adverse effects on brain function that result from a seiz‐ ure is extensive. These may range from temporary aberration of motor or sensory function, to collapse, convulsive activity, and the complete loss of consciousness which transiently, but completely, robs the affected individual of his or her essential humanity. Particularly when mental status is impaired during seizures, the overall impact on quality of life may be profound, with deleterious effects on nearly all aspects of the patient's life. Despite the sig‐ nificant advances that have been made over the last several decades by basic scientists in understanding the fundamental nature of epileptic seizures, and by clinical researchers in improving diagnosis and treatment, at least one-third of affected subjects remain medically refractory. Epilepsy thus remains a major world-wide public health problem.

Although the management of patients with epilepsy usually falls under the purview of neu‐ rologists or epileptologists, other specialists are frequently involved in epilepsy patient eval‐ uation and care as well, including neurosurgeons, neuropsychologists, neuroradiologists, psychiatrists, social workers, nurses, emergency physicians, and primary care providers, in‐ cluding obstetrician-gynecologists. In fact, nearly any health care provider who has direct patient contact will most likely, at some point, be involved with the assessment or treatment of patients with seizures. For this reason, widespread dissemination of knowledge regard‐ ing fundamental issues surrounding the patient with epilepsy is vitally important.

In this volume, an international group of recognized epilepsy researchers and clinicians has been assembled to discuss a variety of topics on epilepsy. The subject matter is diverse, and includes new concepts in brain circuitry involved in seizure generation, a discussion on re‐ flex epilepsy, updates on juvenile myoclonic epilepsy, the role of EEG in epilepsy evalua‐ tion, the novel possibility of seizure prediction from scalp EEG, the roles of vagus nerve stimulation and other neuromodulatory therapies in epilepsy management, non-epileptic seizures, and, no less important to the individual, some of the psychosocial issues that con‐ front the patient and his or her family. This volume is not intended be a comprehensive overview of the field of epilepsy, but each discussion is focused and will be valuable to both investigators and practitioners.

#### **Mark D. Holmes MD**

**Chapter 1**

**Brain Circuits Responsible for Seizure Generation,**

**Propagation, and Control: Insights from Preclinical**

In the early 1870s, John Hughlings Jackson, the father of modern epileptology wrote, that a seizure is "a symptom, and implies only that there is an occasional, an excessive, and a disorderly discharge of nerve tissue" [1]. When one considers that he wrote this more than 50 years before the first human electroencephalographic recordings [2], his level of insight is quite remarkable. Indeed, his later definition of epilepsy as "the name for occasional, sudden, excessive, rapid, and local discharge of grey matter" [3] could be used without alteration today. There is a key difference between Jackson's two definitions: his later definition no longer included the concept of seizures as "disorderly". While seizures are a symptom of a disorder, the temporal pattern of signs and symptoms of seizures are far from disorderly or disorgan‐ ized; this was evident to Jackson in the march of seizure activity through somatosensory cortex [1,4]. Today, relying not only on seizure semiology, but also electroencephalographic, neuro‐ imaging, and animal models, we can without hesitation state that seizure activity does not spread randomly through the brain, but moves through anatomically constrained pathways

These pathways are the focus of this chapter; we will discuss specific brain networks that are capable of seizure generation, seizure propagation, and seizure suppression. From the

**2.** What is the importance of animal models for understanding seizures (with an emphasis

© 2014 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

perspective of preclinical research, we will emphasize several points:

on circuit-level manipulations and species-specific features)?

**1.** How do we identify seizure circuits?

**Research**

Patrick A. Forcelli and Karen Gale

http://dx.doi.org/10.5772/58584

**1. Introduction**

and networks.

Additional information is available at the end of the chapter

Regional Epilepsy Center Department of Neurology University of Washington Seattle, Washington, USA
