User talk:Wadewitz/Epilepsy collaboration page

First attempt

I made a first haphazard attempt at an outline, using WP:MEDMOS and the current article. Let me know what you think. Awadewit | talk 19:07, 14 November 2007 (UTC)

I think I'd like to change "Characteristics" to "Signs and symptoms". The former is generally used for disorders/conditions that are not always considered pathological (e.g., Asperger syndrome, Tourtette syndrome). We should describe the visible effects of various seizures, the effect on consciousness, auras, after-effects, etc. Signs also include characteristic EEGs for certain syndromes. My current thinking is that the Classification section should just be an overview and introduce the important keywords (partial/focal, generalised, symptomatic, idiopathic, etc) so that the reader can understand the symptoms and causes sections to come. If the classification goes into great detail on seizure types and epileptic syndromes, we will end up explaining everything at once. The Classification section often comes early because some understanding of types can influence the rest of the article (e.g., diabetes has two types). We've got to work out the best order and split for the sections so we don't get ahead of ourselves or repeat ourselves. I think there may be justification for keeping "Seizure types" and "Epileptic syndromes" (the latter being a better phrase than "seizure symptoms") as top-level sections, later in the article. I think that, along with seizure types, there should be an epileptic syndromes daughter article. We need to work out what level of detail to include here. Perhaps it would help to find out which are the most common, so we don't give undue weight to obscure stuff. Colin°^Talk 23:40, 19 November 2007 (UTC)

"Signs and symptoms" works for me. There is way too much vocab for this article! Ah! I think it is actually good to repeat it. The poor, overwhelmed reader will get another chance to take it all in. :) We should do so in increasing levels of detail, I think. I agree we can't list everything and I think listing the most common types of seizures makes sense. I like how you have been arranging the sources. If you could continue to do that, that would be fabulous. Just point me to what to read and I will read it. I just don't have time to search for things right now, but I can always pick up an article or two to read. :) Awadewit | talk 12:35, 25 November 2007 (UTC)

I'm glad the arrangement of section-specific sources seems helpful. I'm just gathering likely sources by running searches and picking what might be useful, after a brief scan of the text. My filter currently includes only those with free-online text since that makes it easier for me, but I'll have to go back with a wider filter to see if there are any essential sources that aren't free. Where possible, I'm picking out reviews of the literature or evidence rather than original research papers. One exception is the SANAD study on anticonvulsants, which looks like a seminal work that we should base text on (there is secondary commentary on those papers).

There is still lots of work to do gathering sources, organising the structure, and perhaps listing some points for inclusion. I don't plan to pick a section for rewrite any time soon. I've no particular recommendation for sources to read at present. Perhaps it is best to start with some of the general sources? Colin°^Talk 19:14, 25 November 2007 (UTC)

I was actually thinking that writing this article was shaping up to be really different than the others I've worked on. It might work better as segments. I was hoping that I wouldn't have to read everything first and then write. We'll see. I am trying to focus on the seizure types right now. Awadewit | talk 17:33, 27 November 2007 (UTC)

I'm continuing to locate suitable articles (mostly reviews) for use in this article. The journal Epilepsia is almost 100% free online from 1997 to 2006. I've been flicking through the table of contents from 2001 upward. A few months contain special editions that concentrate on one topic. September 2003 - Vol. 44 Issue s6 is of special importance since it could have been written for us as there are short articles on everything we might cover. Colin°^Talk 22:22, 3 December 2007 (UTC)

Seizure types

Ah! What a nightmare! I see you have laid out the two "systems" of classification here. Do you think we should pick one, use an amalgam, or not even try to discuss it in this article? Awadewit | talk 05:15, 19 November 2007 (UTC)

I believe the 1981 classification is still current wrt epidemiology, drug choice, and articles being published. A couple of recent books use the latest syndrome classifications. I'm interested to know what Engel's "Epilepsy: A Comprehensive Textbook 2nd Ed" contains: since Engel is the lead author of the ILAE classification task force. We should not use any "proposed" classification unless it has been widely accepted. Colin°^Talk 23:40, 19 November 2007 (UTC)

• I've always heard the 1981 system, but I'll check Engel, if you want me to. In the meantime, do you want to stick with the 1981 system? Awadewit | talk 12:36, 25 November 2007 (UTC)

• We would also need sources that clearly outline the 1981 system rather than sources that talk about the new one. Awadewit | talk 12:55, 25 November 2007 (UTC)

I've added the original 1981 source, if you have access to it. The 1981 hierarchy contains three top level "types", but the third type is an artefact of classification rather than a true type of seizure. Their comment: "Includes all seizures that cannot be classified because of inadequate or incomplete data and some that defy classification in hitherto described categories. This includes some neonatal seizures, e.g., rhythmic eye movements, chewing, and swimming movements." Many reproductions of the 1981 classification ignore this third category or mention it briefly in the text. They are admitting that when one classifies seizures, it isn't always possible to know which box to put it in (either due to inadequate data or because you are genuinely stumped). I suggest we ignore this "type" and focus on the main distinction: whether the onset is focal or generalized.

The latest ILAE classification introduces a new top level of "Self-limited" and "Continuous" seizure types. The latter are effectively forms of status epilepticus. I don't propose we give the distinction such prominence. We should mention (probably in the "status epilepticus" section) that most seizures are self-limited (they require no medication to stop them), however...

I think the current text in the "Seizure types" section is not bad (I wrote it a while ago :-) but could do with being polished and expanded. Worth noting that focal seizures may affect the senses or muscles, depending on what part of the brain is affected. Also, that an aura is a sensory focal seizure. Colin°^Talk 18:39, 25 November 2007 (UTC)

Terminology

Seizure disorder

• Stafstrom CE. It's Time to Eliminate the Term Seizure Disorder from Our Lexicon [letter]. Epilepsia. 2005 Mar;46(3):456–456. PMID 15730547.
• Engel J. Epilepsy and Seizure Disorder [letter]. Epilepsia. 2005 Aug;46(8):1333–1333. PMID 16060952.

Stafstrom's letter requests the term "Seizure Disorder" be dropped, regarding it as synonymously with "epilepsy" but inferior. Engel responds that it is not synonymous (it is wider in scope: "Epilepsy and Related Conditions Including Provoked, Isolated, and Nonepileptic Seizures") and as such has a place when discussing this wide scope. However, it is probably fair to say that neither would regard a diagnosis of "seizure disorder" as useful. I propose we don't use the phrase in this article, and certainly not in any way that indicates it might be regarded as equivalent to "epilepsy". Colin°^Talk 19:09, 19 November 2007 (UTC)

Just wanted to check. Now we have the sources in case anyone else asks, too. :) I see an excellent footnote here. Awadewit | talk 12:38, 25 November 2007 (UTC)

Our terms should mostly come from the ILAE. Their glossary was published:

• Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia. 2001 Sep;42(9):1212–8. PMID 11580774.

We need to use and define some words that will be unfamiliar to the reader; we can't avoid them all. Knowing some of these words is part of knowing about epilepsy, and being able to read the literature. I think our job is partly to help the reader expand their vocabulary. But we mustn't overload the reader or use unnecessary technical terms. Some words are so precisely defined, that we can't substitute alternatives. Here's a list of some problem words. Feel free to add or move about. Colin°^Talk 19:03, 25 November 2007 (UTC)

Words we need

• The names of the common seizure types. Including focal seizure; partial seizure; generalized seizure; absence seizures (Older term: petit mal); myoclonic seizures, clonic seizures, tonic seizures, tonic-clonic seizures (Older term: grand mal), atonic seizures. status epilepticus. The -onic words are particularly opaque to the reader.
• The words epilepsy, seizure, convulsion, fit.

Words we might need

• ictal; inter-ictal; provocant; febrile; hypsarrhythmia; paroxysm.

Words to avoid

Hard stuff

There are some sections/aspects that are particularly hard to understand and explain. We may need help with the following:

• The way neuronal activity leads to a seizure. Channels (calcium, sodium). GABA.
• How anticonvulsant therapies work: drugs, ketogenic diet, vagus nerve stimulator.
• EEG. What it measures, what it means.

Query: Anything that is not "evidence-based" should be excluded, should it not? Awadewit | talk 04:47, 19 November 2007 (UTC)

• I agree. Though surprisingly little of epilepsy's medical aspects are based on the best evidence. Colin°^Talk 21:07, 25 November 2007 (UTC)

I would be willing to lend a hand here. I am not a medical doctor, but working on the polio article gave me a pretty good idea about types of information and the depth that readers can understand (myself included!). After a draft has been prepared we could ask the MDs to have a look for accuracy. --DO11.10 (talk) 17:27, 27 November 2007 (UTC)

We certainly need all the help we can get! This is a huge topic, which sprawls over many pages and isn't very well-defined, I'm afraid. Any assistance you could provide would be much appreciated. We seem to be working at a very slow pace right now, though, as both of us are quite busy. But there are no deadlines on wikipedia, happily. I am trying to focus on the "seizure types" section right now. It's a morass. :) Awadewit | talk 17:31, 27 November 2007 (UTC)

• I've started dumping information/ideas/questions into the sections. Feel free to add your own. Please don't take anything I've said as "truth". Everything must be verified. The Mechanism parts are extremely complex and the scientists don't know all the answers. It might be best to work from the clinical, visible effects back down to the cellular level. At some point, the detail will be too hard to explain or understand. Colin°^Talk 23:11, 29 November 2007 (UTC)

Change of emphasis

To reduce/remove:

• The "Responding to a seizure" section is inappropriate. Some of seizure covers this. Needs to be rewritten to note encyclopaedic info only.
• The "Electrophysiology" is an essay/advert. We need to cover EEG but not all this.
• "Important investigators of epilepsy" should be removed. Some may be included in the History section.

To increase: Well, most of it...

• The article lacks a world view (esp. epidemiology and treatment).
• Need to discuss epilepsy in infants, children, adults and the elderly. They are all important and distinct patient-groups.
• History. This could easily become a daughter-article, there is so much to say.

Colin°^Talk 19:26, 25 November 2007 (UTC)

• I have an essay that I wrote a few years ago on the history of anti-convulsants somewhere. I'll try and find it. It might be a good starting point. Awadewit | talk 17:35, 27 November 2007 (UTC)

Citation style

I've hand-formatted the citations according to the Vancouver system (or International Committee of Medical Journal Editors Uniform Requirements for Manuscripts Submitted to Biomedical Journals) which seems to be the most appropriate for a medical article. It has the advantage of being identical to the format used by PubMed in its search results (once you remove the newlines and shorten the author list to six). I'd previously used the cite templates but have grown to dislike their inflexible and arbitrary results. At the end of the citation, I've included the PMID for journals at PubMed and ISBN for books. If the text is freely available online, then I've hyperlinked the article title, preferring the HTML version over the PDF version if there is a choice (the latter is more faithful to the original, but takes longer to download and usually lacks hyperlinks). If the source is available on a site that requires free registration, then I'll still include the link but mention this. If you need to pay to retrieve the article, then no link is supplied.

Is this OK, or do you have strong preferences for another style? Colin°^Talk 22:05, 25 November 2007 (UTC)

• I think we should use this. I usually use MLA, but that is more appropriate for literature and history articles. I don't really know this citation style, so until I learn it, perhaps you could fix my errors? Awadewit | talk 17:36, 27 November 2007 (UTC)