Appendix G: Abbreviations and glossary

Appendix G: Abbreviations and glossary

AED

Anti-epileptic drug

BECTS

Benign epilepsy with centrotemporal spikes

BNF

British national formulary

CT

Computed tomography

ECG

Electrocardiogram

EEG

Electroencephalogram

ESNs

Epilepsy specialist nurses

GTC

Generalised tonic–clonic

IGE

Idiopathic generalised epilepsy

IUD

Intrauterine device

JME

Juvenile myoclonic epilepsy

MRI

Magnetic resonance imaging

SPC

Summary of product characteristics

SUDEP

Sudden unexpected death in epilepsy

VNS

Vagus nerve stimulation

Unless otherwise stated, definitions are taken from 'Mosby's medical, nursing and allied health dictionary' 5th edition and supplemented by the text of the epilepsy full guideline published in 2004.

Absence seizure

A seizure characterised by behavioural arrest associated with generalised spike wave activity on EEG.

Adherence

The extent to which the person's behaviour matches the prescriber's recommendations. Adherence emphasises the need for agreement and that the patient is free to decide whether or not to adhere to the doctor's recommendation[27].

Adjunctive treatment

When a medication is added to a first-line AED for combination therapy.

Aetiology

The cause or origin of a disease or disorder as determined by medical diagnosis.

Anti-epileptic drug (AED)

Medication taken daily to prevent the recurrence of epileptic seizures. Refer to appendix E concerning the choice of drug, side effects and suitability to syndrome.

Atonic seizure

A generalised seizure characterised by sudden onset of loss of muscle tone.

Attack

An episode in the course of an illness.

Baseline

The initial set of measurements at the beginning of a study (after run-in period where applicable), with which subsequent results are compared.

Benign epilepsy with centrotemporal spikes (BECTS)

An epilepsy syndrome of childhood (5–14 years) characterised by focal motor and/or secondarily generalised seizures, the majority from sleep, in an otherwise normal individual, with centrotemporal spikes seen on EEG.

Carer

Someone other than a healthcare professional who is involved in caring for a person with a medical condition.

Childhood absence epilepsy

An epilepsy syndrome with an age of onset of 4–9 years, characterised by frequent absence seizures associated with 3 Hz spike wave activity on EEG.

Clinical presentation

The description of the history and presentation of the clinical condition to the assessing medical team.

Clinician

A healthcare professional providing direct patient care (for example, doctor, nurse or physiotherapist).

Comorbidity

Co-existence of more than one disease or an additional disease (other than that being studied or treated) in a person.

Concordance

This is a recent term, the meaning of which has changed. It was initially applied to the consultation process in which doctor and patient agree therapeutic decisions that incorporate their respective views, but now includes supporting patients in medicine-taking as well as communication when prescribing. Concordance reflects social values but does not address medicine-taking and may not lead to improved adherence[27].

Continuous spike and wave during slow sleep (CSWS)

An epilepsy syndrome with childhood onset, characterised by a plateau and regression of cognitive abilities associated with dramatic increase in spike wave activity in slow wave sleep (> 85% of slow sleep). There may be few seizures at presentation.

Convulsive status epilepticus

When a convulsive seizure continues for a prolonged period (longer than 5 minutes), or when convulsive seizures occur one after the other with no recovery between. Convulsive status epilepticus is an emergency and requires immediate medical attention.

Dosage

The prescribed amount of a drug to be taken, including the size and timing of the doses.

Dravet syndrome

Previously known as severe myoclonic epilepsy of infancy. An epilepsy syndrome with onset in infancy, characterised by initial prolonged, typically lateralised, febrile seizures, subsequent development of multiple seizure types including myoclonic, absence, focal and generalised tonic–clonic seizures, with developmental plateau or regression.

Electrocardiogram (ECG)

A test that records the heart's electrical activity.

Electroencephalogram (EEG)

An investigation that involves recording the electrical activity of the brain. Electrodes are attached to standardised points on the person's head with collodion. Recordings are usually taken across two points.

Epilepsy

A condition in which a person is prone to recurrent epileptic seizures.

Epilepsy syndrome

A distinctive disorder identifiable on the basis of a typical age of onset, seizure types, specific EEG characteristics, and often other features. Identification of epilepsy syndrome has implications for treatment, management and prognosis[28].

Epileptic seizure

A transient occurrence of signs and/or symptoms, the result of a primary change to the electrical activity (abnormally excessive or synchronous) in the brain[26].

Focal seizure

A seizure that originates within networks limited to one hemisphere, discretely localised or more widely distributed. Replaces the terms partial seizure and localisation-related seizure.

Generalised seizure

A seizure that originates in, and rapidly engages, bilaterally distributed networks. Such bilateral networks can include cortical and subcortical structures but do not necessarily include the entire cortex[26].

Generalised tonic–clonic (GTC) seizure

A seizure of sudden onset involving generalised stiffening and subsequent rhythmic jerking of the limbs, the result of rapid widespread engagement of bilateral cortical and subcortical networks in the brain.

Genetic (with reference to epilepsy)

The epilepsy is, as best as understood, the direct result of a known or presumed genetic defect(s) in which seizures are the core symptom of the disorder[26].

Ictal phenomenology

Description or history of ictal events (seizures).

Idiopathic

A syndrome that is only epilepsy, with no underlying structural brain lesion or other neurological signs or symptoms. These are presumed to be genetic in aetiology and are usually age dependent[26].

Idiopathic generalised epilepsy (IGE)

A well-defined group of disorders characterised by typical absences, myoclonic and generalised tonic–clonic seizures, alone or in varying combinations in otherwise normal individuals. The EEG is also characteristic, demonstrating a distinct pattern of generalised polyspike wave discharges and/or generalised spike wave. Presumed to have a genetic aetiology. The new classification of the ILAE (2010) suggests the terminology should change to 'genetic generalised epilepsy' (GGE).

Indication (specific)

The defined use of a technology as licensed by the Medicines and Healthcare products Regulatory Agency (MHRA).

Infantile spasms

A specific seizure type presenting in the first year of life, most commonly between 3 and 9 months. Spasms are brief axial movements lasting 0.2–2 seconds, most commonly flexor in nature, involving flexion of the trunk with extension of the upper and lower limbs. They are occasionally referred to as 'salaam seizures'.

Intervention

Healthcare action intended to benefit the patient, for example, drug treatment, surgical procedure or psychological therapy.

Juvenile absence epilepsy

An epilepsy syndrome with an age of onset of 9–13 years characterised by absence seizures, associated with 3–4 Hz spike wave on EEG. Generalised tonic–clonic seizures may occur.

Juvenile myoclonic epilepsy (JME)

An epilepsy syndrome with an age of onset of 5–20+ years (peak 10–16 years) characterised by myoclonic seizures that most commonly occur soon after waking. Absence and generalised tonic–clonic seizures may occur in between 50 and 80% of people with JME. EEG demonstrates 3–6 Hz generalised polyspike and wave activity, with photosensitivity in more than 30% of people.

Ketogenic diet

A specific diet that is high in fat but low in carbohydrates and protein.

Landau–Kleffner syndrome (LKS)

A very rare epilepsy syndrome with an age of onset of 3–6 years characterised by loss of language (after a period of normal language development) associated with an epilepsy of centrotemporal origin, more specifically bitemporal spikes on EEG with enhancement in sleep or continuous spike and wave during slow sleep.

Late-onset childhood occipital epilepsy (Gastaut type)

Epilepsy with an age of onset in mid-childhood to adolescence with frequent brief seizures characterised by initial visual hallucinations, ictal blindness, vomiting and post-ictal headache. EEG typically shows interictal occipital spikes attenuated by eye opening.

Lennox–Gastaut syndrome

An epilepsy syndrome with an age of onset of 3–10 years characterised by multiple seizure types (including atonic, tonic, tonic–clonic and atypical absence seizures), cognitive impairment and specific EEG features of diffuse slow spike and wave (< 2 Hz) as well as paroxysmal fast activity (10 Hz or more) in sleep.

Monotherapy

Use of a single drug in treatment.

Myoclonic-astatic epilepsy (MAE)

Also known as Doose syndrome. An epilepsy syndrome with an age of onset of 18–60 months, characterised by different seizure types with myoclonic and myoclonic-astatic seizures seen in all, causing children to fall. The EEG shows generalised spike/polyspike and wave activity at 2–6 Hz.

Myoclonic seizures

Sudden brief (< 100 ms) and almost shock-like involuntary single or multiple jerks due to abnormal excessive or synchronous neuronal activity and associated with polyspikes on EEG.

Neurological deficit

A deficiency or impairment of the nervous system.

Non-convulsive status epilepticus

A change in mental status or behaviour from baseline, associated with continuous seizure activity on EEG, which is also seen to be a change from baseline.

Non-epileptic attack disorder (NEAD)

A disorder characterised by episodes of change in behaviour or movement, not caused by a primary change in electrical activity of the brain. Movements are varied, and the attacks can be difficult to differentiate from epileptic seizures. Refer to appendix A of the full guideline for the differentiation of epileptic attacks from NEAD and its subgroups.

Older people

For the purposes of this guideline, older people are defined as 65 years or older; however, this is based on the cut-off point in the majority of the literature.

Panayiotopoulos syndrome

Epilepsy syndrome presenting in early childhood (mean 4–7 years) with rare seizures that are prolonged. Characterised by autonomic features including vomiting, pallor and sweating followed by tonic eye deviation, impairment of consciousness with possible evolution into a secondarily generalised seizure. Prognosis is excellent and treatment often unnecessary.

Pharmacokinetics

The way in which a drug is processed by the body, influencing absorption, metabolism, distribution and excretion.

Polypharmacy

Multiple different drugs used in a patient's treatment, which could include AEDs.

Polytherapy

Two or more medications used in combination therapy. The guideline specifically refers to AEDs.

Prognosis

A probable course or outcome of a disease. Prognostic factors are patient or disease characteristics that influence the course of a disease. Good prognosis is associated with a low rate of undesirable outcomes; poor prognosis is associated with a high rate of undesirable outcomes.

Provocation techniques

Methods used to provoke seizures, such as hyperventilation, photic stimulation, sleep deprivation and withdrawal of medication.

Quality of life

A combination of a person's physical, mental and social wellbeing; not just the absence of disease.

Refractory status epilepticus

Continued status epilepticus despite treatment with two anticonvulsants in appropriate doses. This can occur in both convulsive and non-convulsive status epilepticus.

Secondarily generalised seizure

Now referred to as a 'focal seizure evolving to a bilateral convulsive seizure'[28].

Simple and complex partial epileptic seizures

These terms are no longer recommended. They have been generally replaced with the single word, 'focal'. Focal seizures should include a clear description of the impairment of consciousness[28].

Specialist (as used in this guideline)

For adults: a medical practitioner with training and expertise in epilepsy. For children and young people: a paediatrician with training and expertise in epilepsy.

Sudden unexpected (or unexplained) death in epilepsy (SUDEP)

Sudden, unexplained, witnessed or unwitnessed, non-traumatic and non-drowning death in people with epilepsy, with or without evidence for a seizure, and excluding documented status epilepticus, in which post-mortem examination does not reveal a toxicological or anatomic cause for death[29].

Syncope

A brief lapse in consciousness caused by transient reduction in blood flow to the brain. May be caused by many different factors, including emotional stress, vagal stimulation, vascular pooling in the legs, diaphoresis, or sudden change in environmental temperature or body position.

Tertiary epilepsy specialist

A tertiary epilepsy specialist is an adult or paediatric neurologist who devotes the majority of their working time to epilepsy, is working in a multidisciplinary tertiary referral centre with appropriate diagnostic and therapeutic resources, and is subject to regular peer review.

Tertiary service

Specialist care delivery unit, to which people may be referred from secondary care.

Tonic seizure

An epileptic seizure characterised by abrupt generalised muscle stiffening possibly causing a fall. The seizure usually lasts less than a minute and recovery is rapid.

Tonic–clonic seizure

An epileptic seizure characterised by initial generalised muscle stiffening, followed by rhythmical jerking of the limbs, usually lasting a few minutes. The person may bite their tongue and may be incontinent. They may feel confused or sleepy afterwards, and take a while to recover fully.



[27] National Collaborating Centre for Primary Care (2009) Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: Royal College of General Practitioners.

[28] Definition from the International League Against Epilepsy (ILAE) Task Force on Classification (2001).

[29] Provided by Nashef L (1997) Sudden unexpected death in epilepsy: terminology and definitions. Epilepsia 38: S20–2.

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