Talk:Epilepsy/GA1
GA Review edit
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Reviewer: Jfdwolff (talk · contribs) 21:27, 7 January 2014 (UTC)
- I will be reviewing this article. As previously, it will probably take a few days before I have passed comment(s) on each section. After the first cycle of comments/suggestions I may do another final readthrough before agreeing to GA status. JFW | T@lk 21:27, 7 January 2014 (UTC)
Happy to pass as GA. Well done James, another important article of dependable quality. JFW | T@lk 15:18, 26 January 2014 (UTC)
Introduction edit
Comments on the introduction: JFW | T@lk 22:12, 7 January 2014 (UTC)
- Done Most sections are represented (although not the very short ones, such as "prevention" and "other animals"), but I miss a summary of "society and culture". What key points should get into the intro?
- Done The discussion about the epidemiology might be too detailed to do justice to some of the distinctions. Why is epilepsy more common in the elderly, yet new diagnoses are made in childhood and young adulthood? This is obvious to those who are used to the epidemiology of chronic conditions, but for the casual reader it seems a bit counterintuitive.
Signs and symptoms edit
Comments on this section: JFW | T@lk 22:34, 7 January 2014 (UTC)
- Done The subsection "Seizures" is rather brief, and needs to mention some important subtypes (Tonic–clonic seizure, Partial seizure) and phases (e.g. tonic followed by clonic phase). Currently there is no mention of vocalising at the onset of a GTCS; anyone who has ever witnessed a seizure might read this article and wonder what causes that.
- I had all of this at epileptic seizure, may be good to have hear aswell and added. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:44, 10 January 2014 (UTC)
- Done There is a pressing need to mention the Postictal state, as it is of immense diagnostic relevance in the distinction from syncope.
- Done Todd's paresis often frightens the hell out of bystanders (and the patient themselves) with concern of acute stroke or brain damage.
- Done It bears pointing out that someone having a generalised seizure is not responsive to external stimuli (of diagnostic relevance in the distinction with PNES)
- Done I would suggest merging the "Physical" subsection into the "Seizures" subsection
- Done I wonder if it might be reasonable to merge "psychosocial" and "associated conditions", as the conditions mentioned are in similar diagnostic domains.
- Done Is there a freely available video of someone having a seizure that we could include?
- I could have gotten some last week. Had two people come in with active seizures. One was an amazing partial seizure. Just one side twitching and awake. Not sure what you think of the video above. There is this video [1] and I could ask if they would be willing to release. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:16, 10 January 2014 (UTC)
Causes edit
Comments on this section: JFW | T@lk 22:34, 7 January 2014 (UTC)
- Done Might it be reasonable to list the monogenic causes of epilepsy that cause 1-2%? Or would that be a huge list of very rare conditions?
- Done "In herpes simplex encephalitis the risk of a seizure is around 50%." Are we talking about the acute phase or about sequelae?
- Done "[t]hose who drink six drinks per day have a two and a half fold increase in risk". For the lay reader, the distinction between Unit of alcohol and glass/cup is not clear; perhaps this needs rephrasing.
- Done Out of curiosity, how does malnutrition cause epilepsy?
- Done It might be useful to point out that identifying the epilepsy syndrome is relevant with regards to prognosis and treatment decisions (e.g. valproate for myoclonic epilepsy)
Mechanism edit
Comments: JFW | T@lk 22:57, 12 January 2014 (UTC)
- Done Opening sentence "due to problems within the brain" is very broad and might suggest that everyone with epilepsy has a structural or functional "brain problem" (which to laypeople is almost synonymous with cognitive impairment). Rephrase possible?
- Done "Failure of the blood-brain barrier [...]" - at the risk of making the section too long, how does this predispose to epileptogenic activity?
- Done Do we need to make reference to the kindling model? Or perhaps not at all?
Diagnosis edit
Overall a strong section. Just some bits: JFW | T@lk 22:57, 12 January 2014 (UTC)
- Done "Routine antiseizure medical levels in the blood are not required in adults or children." I think this is confusing. The reader probably thinks this section is about new diagnosis of a seizure disorder. At this point, most will not have been commenced on anticonvulsants yet. Perhaps the recommendation should be moved to a discussion about pharmacotherapy.
- Done "An electroencephalogram (EEG) is only recommended for those who likely had an epileptic seizure" - for the purposes of this article, what does this sentence serve to exclude?
- Done "Approximately one in five people seen at epilepsy clinics have PNES" - I have repeatedly heard that people with epilepsy are disproportiately at risk for PNES. It might be worth alluding to this if supported by sources.
Management edit
Comments: JFW | T@lk 22:57, 12 January 2014 (UTC)
- Done "airway management" - I suspect most readers won't know what's implied by those two words
- Done In "First aid", I would suggest completing the paragraph with a very brief discussion of the critical care management of status epilepticus (a concept that should be introduced in this section). I agree that there is substantial overlap with epileptic seizure.
- Done In "medications", I am somewhat surprised at the need to use the Chin reference. Is there no direct source in the WHO document repository about this? Alternatively, does Newton cover this somewhere?
- Done In "alternative medicine", would it be an idea to move the claims about exercise therapy to "Other", considering the fact that this has a reasonable evidence base?
Prognosis edit
Comments: JFW | T@lk 22:57, 12 January 2014 (UTC)
- Done The figure of 80% in the opening sentence clashes with the 70% figure used elsewhere in the article.
Epidemiology edit
No comments. JFW | T@lk 22:57, 12 January 2014 (UTC)
History edit
No comments. Strong section! JFW | T@lk 22:57, 12 January 2014 (UTC)
Society and culture edit
Done Stigma: it might be worth merging the comments on Tanzania from the "history" section into this section. JFW | T@lk 22:57, 12 January 2014 (UTC)
Research edit
Done The possible treatments seem cobbled together from a number of sources, without any explanation as to why they might be beneficial. Any idea whether this could be improved? JFW | T@lk 22:57, 12 January 2014 (UTC)