Talk:Epilepsy/GA1

GA Review

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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)
  • Good work on the recommendations below. I am doing a final readthrough and gentle copyedit that I will hopefully complete tomorrow. I'm not expecting any major issues and will probably pass GA within the next 24h. JFW | T@lk 22:33, 25 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

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?

Added a couple of sentences on driving. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:49, 9 January 2014 (UTC)

•  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.

Clarified Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:59, 9 January 2014 (UTC)

Signs and symptoms

There is this

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 Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:12, 10 January 2014 (UTC)

•  Done Todd's paresis often frightens the hell out of bystanders (and the patient themselves) with concern of acute stroke or brain damage.

Added a bit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:47, 10 January 2014 (UTC)

•  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. Many with PNES act as if they are not conscious which can make it tricky. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 10 January 2014 (UTC)

•  Done I would suggest merging the "Physical" subsection into the "Seizures" subsection

Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:14, 10 January 2014 (UTC)

•  Done I wonder if it might be reasonable to merge "psychosocial" and "associated conditions", as the conditions mentioned are in similar diagnostic domains.

Agree. Good idea. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:14, 10 January 2014 (UTC)

•  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)

Neither of the videos have English lettering or commentary, which makes them a bit less ideal. Still, with an appropriate caption the video above might be okay. JFW | T@lk 21:16, 12 January 2014 (UTC)

Causes

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?

There are more than 200. [2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:57, 10 January 2014 (UTC)

Wow. If none are particularly common then perhaps we can leave it there. JFW | T@lk 21:16, 12 January 2014 (UTC)

•  Done "In herpes simplex encephalitis the risk of a seizure is around 50%." Are we talking about the acute phase or about sequelae?

That was acutely. There is a high risk of epilepsy afterwards. Have clarified. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:12, 10 January 2014 (UTC)

•  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.

Okay changed to units of alcohol and linked. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:50, 10 January 2014 (UTC)

•  Done Out of curiosity, how does malnutrition cause epilepsy?

A risk factor. It is unclear if it is a direct cause. Have clarified. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:22, 10 January 2014 (UTC)

•  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)

Pointed it out in the treatment section that treatment is based partly on the epilepsy syndrome. Should I mention it in both places? Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:24, 10 January 2014 (UTC)

Perhaps, but will leave it in your hands. JFW | T@lk 21:16, 12 January 2014 (UTC)

Mechanism

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?

Rephrase to what? All cases there is a structural or functional problem. This is to separate it from a "mental disorder" which does not any obvious issues.Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:37, 23 January 2014 (UTC)

•  Done "Failure of the blood-brain barrier [...]" - at the risk of making the section too long, how does this predispose to epileptogenic activity?

Clarified. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:39, 23 January 2014 (UTC)

•  Done Do we need to make reference to the kindling model? Or perhaps not at all?

Added to the research section. It is controversial other than in creating an animal model of epilepsy.Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:50, 23 January 2014 (UTC)

Diagnosis

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.

Good point. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:51, 23 January 2014 (UTC)

•  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?

It is important as part of a differential diagnosis / work-up. If a person obviously has syncope a EEG is potentially harmful due to the risk of false positives. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:53, 23 January 2014 (UTC)

I've rephrased a little bit to emphasise the importance of pre-test probability. JFW | T@lk 22:07, 25 January 2014 (UTC)

•  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.

Added. It is about 10% of those with PNES have epilpsy aswell. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:03, 23 January 2014 (UTC)

Management

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

Good point. Linked and clarified. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:24, 23 January 2014 (UTC)

Looks much better. JFW | T@lk 22:07, 25 January 2014 (UTC)

•  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.

I think that should be sufficient. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:24, 23 January 2014 (UTC)

•  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?

Have added a second ref from the WHO bulliten. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:24, 23 January 2014 (UTC)

Good. Hope you don't mind that I've removed Chin, as the other sources are (much) stronger. JFW | T@lk 22:07, 25 January 2014 (UTC)

•  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?

Good point. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:31, 23 January 2014 (UTC)

Prognosis

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.

The 80% claim is for generalized with the 70% claim is overall. Will clarify. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:33, 23 January 2014 (UTC)

Epidemiology

No comments. JFW | T@lk 22:57, 12 January 2014 (UTC)

History

No comments. Strong section! JFW | T@lk 22:57, 12 January 2014 (UTC)

Society and culture

 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)

Okay Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:41, 23 January 2014 (UTC)

Research

 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)

Organized in same order as the article.Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:42, 23 January 2014 (UTC)

Other animals

No comments. JFW | T@lk 22:57, 12 January 2014 (UTC)