Hormone Replacement Therapy in Women with Epilepsy

Abstract

According to the WHO 50 million people suffer from epilepsy; 80% of them live in resource poor countries (WHO, 2001). In these settings, classification of seizures in view of adequate treatment has been difficult due to lack of diagnostic tools such as electroencephalograms (EEG) and imaging. Drawing from a vast working experience of many years in neurology in developing countries, the authors developed a classification system for seizures suitable for local circumstances. Considering clinical, diagnostic, prognostic and therapeutic needs, we adjusted the International Classification of Epileptic Seizures (ICES) and opted for a simple-structured, easy-to-understand classification of epileptic seizures which is still in accordance with the ICES and in fact shares many similarities with the ILAE version of guidelines for epidemiologic studies on epilepsy (ILAE 1981, ILAE 1993. EEG and neuroimaging are normally not available in developing countries, thus the diagnosis is based on clinical symptomatology alone. We suggest the following classification: 1) Generalised types of seizures:Generalised seizures within a specific age range: primary generalised seizures that start within a specific age group (mainly between 6 and 25 years). There is no obvious cause for the seizures, brain damage is absent. There may however be a positive family history, suggesting a possible genetic background. Seizures of this group may also be termed idiopathic generalised epilepsies.Generalised seizures outside a specific age range: primary generalised seizures that lie outside the specific age range of most of the idiopathic generalised epilepsies, but have no focal start and no clinical signs of brain damage. There may be a cause which cannot be diagnosed with the currently available ancillary means, thus these seizures may be termed "cryptogenic". 2) Partial types of seizures:Generalised seizures with diffuse brain damage: clinically seizures start in a generalised way, however, diffuse brain damage is obvious, which is the major difference when compared to group 1. Causes are mainly due to static encephalopathies. All age groups can be affected, but there tends to be a shift to the younger ages.Generalised seizures with focal signs: secondary generalised seizures with a focal start or clear unilateral seizures but without major brain damage. There may be developmental delay, subtle signs of brain damage and/or focal neurology. Causes are often due to progressive encephalopathies. All age groups can be affected.Complex partial seizures: as defined by the ILAE (ILAE 1981).Simple partial seizures: as defined by the ILAE (ILAE 1981). 3) Other types of seizures:Two different seizure types: the patient has more than one type of seizure. Possible combinations are simple partial or complex partial seizures with any of the generalised seizures of group 2 or generalised seizures of group 1 and pseudoseizures.Unclassified epileptic seizures: include all those seizures that cannot be classified because of incomplete data.The first diagnostic gro...