الفهرس 
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Abstract
ilepsy is one of the most common serious neurological disorders affecting about 65 million people globally. It affects 1% of the population by age 20 and 3% of the population by age 75.It is more common in males than females with the overall difference being small. Most of those with the disease (80%) are in the developing world .
Epilepsy is not necessarily life-long, and is considered to be resolved if a person has been seizure-free for the last 10 years, with at least the last 5 year off ant seizure medicines, or when that person has passed the age of an age-dependent epilepsy syndrome. Studies providing detailed knowledge of seizure recurrence risk are few, so most diagnoses of epilepsy will of necessity still be made by documentation of two unprovoked seizures so epilepsy can be defined by any of the following conditions:
1. At least two unprovoked (or reflex) seizures occurring >24 h apart.
2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years.
3. Diagnosis of an epilepsy syndrome.
Epilepsy has many classification some of them classify seizures according to their phenomenological origin, types and
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conscious level and others classify according to age and severity beside the classification of epilepsy syndromes.
There are a lot of theories to explain causes of epilepsy which is most probably amulti-theoritical disease.there is the theory of Neurotransmitters which depends mainly on the excess glutamate which is the most stimulatory neurotransmitter and decreased GABA which is the most inhibitory neurotransmitter in brain.there is also disturbed sodium, potassium and calcium channel function beside autoimmune theory , tropical and inflammatory causes which depend on infection and finally hormonal disturbance and its role in epilepsy.
Diagnosis of epilepsy is a collaperative clinical issue depending on clinical and investigation measures so the first thing to do is the assessment of mental state which is very important although frequently underrated. The testing of electrolyte, blood glucose and calcium levels is important to rule out problems with these as causes. An electrocardiogram can rule out problems with the rhythm of the heart. A lumbar puncture may be useful to diagnose a central nervous system infection but is not routinely needed. In children additional tests may be required such as urine biochemistry and blood testing looking for metabolic disorders. Electroencephalography has played crucial role in diagnosis of epilepsy. Electroencephalography is greatly improved as a reliable method of diagnosis.
Epilepsy as a disease has multiple effects on patient life it not only a matter of occurring of seizures it affects all the aspects of the
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patient life. Epilepsy affects physical, mental and behavioral functions and is associated with higher risk of premature death due to traumatic brain injury; Status epileptics, suicide, pneumonia and sudden death, and it account for 1.4% of all years of life lost. Psychiatric disorders frequently affect 32% and 41% patients with epilepsy.
Since treatment of epilepsy is long-term and medication adherence is crucial for treatment success, drug tolerability is a major issue. AEDs can cause various adverse effects, and this is an important factor to consider when selecting therapy. Although most AEDs can cause common CNS side effects (dizziness and drowsiness), some agents are more tolerable compared to others. Impaired cognition is one major concern for many patients and family members. In general, newer agents like gabapentin and levetiracetam appear to have the least effects on cognition and may be better options.
AEDs may also cause different dermatologic reactions. Phenytoin can cause skin rash. Rare, fatal skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported with most agents, but appear to be more common with carbamazepine, valproic acid, phenytoin, phenobarbital, and lamotrigine
A number of agents can affect the liver. Carbamazepine, phenytoin, and valproic acid can cause elevations in liver enzymes and thus should be avoided in patients with liver disease. Although
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these agents have also been known to cause hepatotoxicity, more severe liver problems are rare.
Suicidal behavior or ideation has been reported in numerous studies evaluating the use of AEDs for epilepsy and psychiatric conditions. Due to the potential risk, a black box warning has been added to the labeling of all AEDs, and distribution of medication guides is required. It is generally recommended to monitor patients on AEDs for any new or worsening thoughts of suicidal behavior
Many studies have compared the efficacy of new AEDs with that of older agents. Although the newer agents do not show superior efficacy when compared to older drugs, some have proven to be ―no inferior.‖ Second-generation anti-seizure drugs (ASDs) that have undergone head-to-head trials with older agents confirming similar efficacy and equal or better tolerability in focal epilepsy include: levetiracetam, lamotrigine, oxcarbazepine, topiramate, and zonisamide. Oxcarbazepine has demonstrated equivalent efficacy in comparison to carbamazepine, valproic acid, and phenytoin. Topiramate (100 mg and 200 mg) has demonstrated equivalent efficacy and safety when compared with 600 mg twice-daily carbamazepine for partial seizures, as well as with 1, 250 mg valproic acid for idiopathic generalized seizures.
Non-pharmacological treatment of epilepsy includes ketogenic diet, Transcranial Magnetic Stimulation, vagal nerve stimulation, deep brain stimulation, surgery and electroconvulsive therapy. Alternative
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therapies include techniques such as yoga, acupuncture, chiropractic, massage therapy, EEG biofeedback, aromatherapy, homeopathy, herbal remedies (traditional Chinese medicine).Most people with epilepsy need to take antiepileptic medication to control their seizures and alternative therapies are more often complementary
Nonpharmacological treatment of epilepsy is considered safer than pharmacological treatment but unfortunately less effective although it shows promising antiseizure effects, especially ketogenic diet and transcranial magnetic stimulation.
Current therapies are largely unsatisfactory, as they suppress seizures, but do not affect the underlying cause beside its multiple side effects and the narrow spectrum of some