Talk:Epilepsy

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Signs and symptomes[edit]

Epilepsy is characterized by a long-term risk of recurrent seizures This statement is not entirely true and the reference to the article is a narrative review. The review as per me does not say anything about increased long term risk of recurrent seizure as being a " characteristic of seizure. (Drsoumyadeepb (talk) 17:58, 16 October 2014 (UTC))

I guess you meant "characteristic of epilepsy". This sentence makes no sense in the section signs and symptoms anyway. Jophiel 12:38, 17 October 2014 (UTC)

Lead section[edit]

Drsoumyadeepb It would be helpful you provide some comments here on the talk page when you contribute since this article is being discussed intensively at the moment. Jophiel 12:38, 17 October 2014 (UTC)

Will do Jophiel . I hope the same applies for all editors (Drsoumyadeepb (talk) 13:52, 17 October 2014 (UTC))
All animals are equal, but some animals are more equal than others. If you feel discriminated here with respect to editing you should address it right away. Jophiel 00:42, 18 October 2014 (UTC)

Genetics meta-analysis[edit]

doi:10.1016/S1474-4422(14)70171-1, pointing at SCN1A and the new PCDH7 loci for all epilepsy as well as (for generalised epilepsy) a locus at 2p16.1 suggesting either VRK2 or FANCL. Nothing much for focal epilepsy. JFW | T@lk 22:37, 19 August 2014 (UTC)

Classification[edit]

I don't dispute the edits by Jophiel 123 (talk · contribs) but I was wondering if there was a way of turning the addition into prose. JFW | T@lk 21:33, 20 September 2014 (UTC)

Agree Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:46, 22 September 2014 (UTC)

Edit[edit]

Have reverted the following [1] as

1) there was issues with the ref formatting changes 2) video EEG should be discussed in the overview of diagnosis 3) IMO "While figuring out a specific epileptic syndrome is often attempted, it is not always possible" is a better summary than " In addition an epileptic syndrome can sometimes be figured out (mostly in children)" Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:46, 22 September 2014 (UTC)

2) Do not agree. Mentioning types of EEG (e.g. long term/video EEG) is arbitrary. Also types of neuroimaging (e.g. MRI) could be mentioned. Content should be matched with "EEG": "perform the EEG while the affected individual is sleeping or sleep deprived" basically means long term/vido EEG. An uninformed reader may consider it as two different things.
3) Agree. Jophiel 123 (talk) 09:16, 23 September 2014 (UTC)
2) We discuss the types of neuro imaging under neuroimaging. We just mention that "Video and EEG monitoring may be useful in difficult cases" Not sure what the issue is? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:37, 23 September 2014 (UTC)
2) We discuss the types of neuro imaging under neuroimaging so we should discuss the types of EEG unter EEG. Jophiel 123 (talk) 20:55, 23 September 2014 (UTC)

Epilepsy syndromes[edit]

This are both causes and diagnosis. We should have a brief overview in both areas (as we did) IMO. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:10, 23 September 2014 (UTC)

Some syndromes may have specific causes, but on the whole I would want to separate the two.
Perhaps Jophiel 123 can comment over here first before making extensive edits to this article. JFW | T@lk 08:08, 23 September 2014 (UTC)
Agree. We should change the wording for clarification since the term syndrome is vague.
Proposal: There is a number of epileptic syndromes of genetic origin often linked to a metabolic and/or neurodevelopmental disorder[1] Some epilepsy syndromes with onset in childhood which were traditionally grouped by age of onset, type of seizures and characteristic pattern on an electroencephalogram e.g. benign rolandic epilepsy (2.8 per 100,000), childhood absence epilepsy (0.8 per 100,000) and juvenile myoclonic epilepsy (0.7 per 100,000). Many of them have also turned out to be of genetic or presumed genetic origin.[2][3] Syndromes traditionally classified as "genetic" because of chromosome aberrancies are also associated with epilepsy.[4]. Febrile seizures and benign neonatal seizures are not forms of epilepsy.[5]
and add this to the bottom of "classification":
In general clinical practice the term "epilepsy syndrome" is commonly used synonymously to diseases of the 1989 classification like "temporal lobe epilepsy". This usage is not recommended any more in accordance with the 2011 classification. Jophiel 123 (talk) 09:16, 23 September 2014 (UTC)
We have two issue:
1) Where should we put this information in the article?
2) What wording should we use?
The proposed wording is more complicated than the existing wording. We should use shorter sentence as much as possible.
This is not a very good source http://www.epilepsysociety.org.uk/childhood-epilepsy-syndromes
Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:44, 23 September 2014 (UTC)
There was a redundant word in my proposal (onset in childhood "which"). The wording may be more complicated but delivers the fact that "syndrome" is used inconsistently for different things (the reader may have stumbled across elsewhere). The fact that different definitions are being used needs (also) to be adressed (and not be put aside using a very general wording). Refinements considering this issue are welcome of course. The sentences of the proposal are not longer than in the existing version (the examples for childhood epilepsies can be put in a seperate sentence). Reference can be replaced. Jophiel 123 (talk) 11:37, 23 September 2014 (UTC)
Some syndromes are due to an unknown cause per "Additionally there are groups with specific constellations of symptoms, those due to specific metabolic or structural causes, and those of unknown cause.[5]" Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:48, 23 September 2014 (UTC)
will rethink. Jophiel 123 (talk) 20:55, 23 September 2014 (UTC)
Expanded. Syndromes are a traditional way of classifying epilepsies. It matches partly with the modern classification of epilepsies. Since the latter is in the section diagnosis the former better fits into this section as well. Causes were always what people were looking for. Little knowledge though was available about the causes when the syndromes were named, thus its categorization is mainly based on clinical features. This is another reason why the focus should not be on causes i.e. it better fits into diagnosis section. In literature syndromes are also usually referred to as diagnoses (not causes).Jophiel 123 (talk) 00:21, 5 October 2014 (UTC)
As many cases are unknown (60%), having a bit about the epilepsy syndromes under causes is useful. Else I guess we could have an unknown subheading where we discuss the syndrome that are of unknown cause. And then discuss the syndromes of known cause under genetics. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:56, 5 October 2014 (UTC)
see below. Jophiel 123 (talk) 02:58, 5 October 2014 (UTC)

I have problems with some of this text[edit]

  1. You begin with " When scientific knowledge was less profound, epilepsies were categorized into syndromes by clinical features, i.e. by age of seizure onset, specific seizure types and EEG characteristics" and then you reference the most recent 2012 NICE document to insult them on it. The ref say "classification (database) of the etiologies of epilepsy is proposed".[2] It does not say it has been accepted.
  2. Why repeat this material "Between 1 and 10% of those with Down syndrome and 90% of those with Angelman syndrome have epilepsy" exactly word for word when it is already in the genetics section?
  3. Syndromes are a "cause" of epilepsy. With the cause of many syndrome being unknown. Some believe them to be genetic but this does not make them so. It could also be exposure during pregnancy etc. Thus I disagree currently with your moving of this section.
  4. Another issue is some of the wording is a little to complex. Terms like phakomatoses need to be clarified.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:36, 5 October 2014 (UTC)

  1. ^ Kullmann DM (2002). "Genetics of epilepsy.". J Neurol Neurosurg Psychiatry 73 (Suppl 2): II32–5. doi:10.1136/jnnp.73.suppl_2.ii32. PMC 1765606. PMID 12536158. 
  2. ^ a b c Neligan, A; Hauser, WA; Sander, JW (2012). "The epidemiology of the epilepsies.". Handbook of clinical neurology 107: 113–33. doi:10.1016/B978-0-444-52898-8.00006-9. PMID 22938966. 
  3. ^ "childhood epilepsy syndromes". Epilepsy society. Retrieved 2014-09-22. 
  4. ^ a b Bhalla, D.; Godet, B.; Druet-Cabanac, M.; Preux, PM. (Jun 2011). "Etiologies of epilepsy: a comprehensive review.". Expert Rev Neurother 11 (6): 861–76. doi:10.1586/ern.11.51. PMID 21651333. 
  5. ^ a b c d National Institute for Health and Clinical Excellence (January 2012). "Chapter 9: Classification of seizures and epilepsy syndromes". The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Clinical Guideline Centre. pp. 119–129. 
  6. ^ a b c d e Shorvon SD (2011). "The etiologic classification of epilepsy". Epilepsia 52 (6): 1052–1057. doi:10.1111/j.1528-1167.2011.03041.x. 
  7. ^ a b . International league against epilepsy https://www.epilepsydiagnosis.org/syndrome/epilepsy-syndrome-groupoverview.html. Retrieved 2014-10-06.  Missing or empty |title= (help)
  8. ^ Nordli DR jr (2012). "Epileptic encephalopathies in infants and children". J Clin Neurophysiol 29 (5): 420-4. doi:10.1097/WNP.0b013e31826bd961. PMID 23027099. 
  9. ^ a b Pandolfo M (2013). "Pediatric epilepsy genetics". Curr Opin Neurol 26 (2): 137-45. doi:10.1097/WCO.0b013e32835f19da. PMID 23449174. 
  10. ^ Heinzen EL, Depondt C, Cavalleri GL, Ruzzo EK, Walley NM, Need AC, Ge D, He M, Cirulli ET, Zhao Q, Cronin KD, Gumbs CE, Campbell CR, Hong LK, Maia JM, Shianna KV, McCormack M, Radtke RA, O'Conner GD, Mikati MA, Gallentine WB, Husain AM, Sinha SR, Chinthapalli K, Puranam RS, McNamara JO, Ottman R, Sisodiya SM, Delanty N, Goldstein DB (2012). "Exome sequencing followed by large-scale genotyping failed to identify single rare variants of large effect in "idiopathic" generalized epilepsy". Am J Hum Genet 91: 293–302. PMC 3415540. PMID 22863189. 
  11. ^ Thomas RH, Berkovic SF (2014). "The hidden genetics of epilepsy-a clinically important new paradigm". Nat Rev Neurol 10 (5): 283-92. doi:10.1038/nrneurol.2014.62. PMID 24733163. 
  12. ^ a b "De novo mutations in epileptic encephalopathies". Nature 501 (7466): 217-21. 2013. doi:10.1038/nature12439. PMC 3773011. PMID 23934111. 
Have moved this text more or less to the lead of this article Epilepsy syndromes as a compromise. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 5 October 2014 (UTC)
Agree. Still need to solve the issue "syndrome is a cause" (see below). Jophiel 123 (talk) 02:58, 5 October 2014 (UTC)
After having had a second look on the issue I would suggest do keep the content about syndromes here because it basically is about epilepsy. The introductory part of the other article should be kept short. Jophiel 123 (talk) 13:49, 6 October 2014 (UTC)
---
1. I cited the 2011 proposed classification as reference for the sentence "The current conception of categorizing epilepsies focuses on the underlying causes". The proposal of a database was mentioned in the original paper in which the classification was published but is a different issue. Furthermore, I wanted to express that the classification into clinical epilepsy syndromes has its origins in times, where knowledge was less profound. However, its still useful. Probably my wording was a little unintelligent, would you give alternatives?
2. I missed removing it from the genetic section (see 3.)
3. The problem is that the 2011 ILAE classification is somewhat inconsistent: In examples for epilepsies you can find obivious causes for instance hippocampal sclerosis. But you can also find full-fledged diagnoses like "photosensitive epilepsy". You would not say that "photosensitive epilepsy" is the cause of epilepsy, it IS (the diagnose) of epilepsy. This is also the case in the epilepsy syndromes (clinical syndromes with seizures as the major feature): You would not say benign rolandic epilepsy is the cause, it IS (the diagnose of) epilepsy (thus included in its name). Another example: Dravet syndrome is not the cause of epilepsy, it IS (the diagnose) of epilepsy. The cause is a single gene (de-novo) mutation. So the epilepsy syndromes belong to the section diagnosis because they are diagnoses. Other clinical syndromes in which seizures are NOT the major feature, e.g. angelman syndrome are indeed causes (of epilepsy), but they are not "epilepsy syndromes". However, in the article these should be mentioned in "syndromes" (not genetics) to emphasize the difference which is not obvious right away. And the title of the section is syndromes so with regarding to this issue its fits in well. Jophiel 123 (talk) 02:24, 5 October 2014 (UTC)
Lets ask for a third opinion from User:Jfdwolff. Will also check with ILAE. We often use "cause" in a looser sense her on Wikipedia than the more strict term "etiology". We often include risk factors and any disease or disorder associated with the condition in question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:21, 5 October 2014 (UTC)
The epilepsy syndrome IMO are both a cause and a type of epilepsy. The acquired epilepsies are also in the epilepsy classification. We mention the acquired types in both spots and thus we should discuss the epilepsy syndromes in both spots such as we do within the classification section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:14, 5 October 2014 (UTC)
May I ask you be a little more responsive to my arguments? How can benign rolandic epilepsy be the cause of benign rolandic epilepsy? Quote ILAE: "Such syndromes have a typical age of seizure onset, specific seizure types and EEG characteristics and often other features which when taken together allow the specific epilepsy syndrome diagnosis. Jophiel 123 (talk) 09:37, 5 October 2014 (UTC)
Benign rolandic epilepsy can be a "cause" of epilepsy yes. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:35, 5 October 2014 (UTC)
Jmh849 Jophiel 123 I've been worried that these new additions come very close to WP:NOR. You simply cannot displace an international consensus document with a weaker secondary source. Many seizure subtypes are idiopathic, and the treatment is determined mainly by subtype and not by (suspected) cause. In that sense, we need to be clear that the cause might be unknown. The discussion has been provoked mainly because of WP:MEDMOS constraints - the template currently doesn't really have a way to list "classification" in the way this article needs it.
I can have a closer look tomorrow or Tuesday. JFW | T@lk 06:40, 5 October 2014 (UTC)
Jfdwolff I am aware of WP:NOR. Which document are you referring to when you say "displace an international consensus document with a weaker secondary source". I far as I can see I did not displace any document. I expanded the content on syndromes. I gave secondary references for all statements. I did refer to one article of primary literature but for the example of epileptic encephalopathies and Dravet syndrome but stated that this is recent research data.
What do you mean by "Many seizure subtypes are idiopathic, and the treatment is determined mainly by subtype and not by (suspected) cause. In that sense, we need to be clear that the cause might be unknown." I fully agree. Concerning syndromes I stated that these can have a variety of causes and clinical features.
You said "The discussion has been provoked... the template currently doesn't really have a way to list "classification" in the way this article needs it". What do you think the right way would be? Jophiel 123 (talk) 09:37, 5 October 2014 (UTC)
Would it be reasonable to move the discussion about the challenged content to the talk page of the article about epilepsy syndromes since the content moved to that article? Jophiel 123 (talk) 10:18, 5 October 2014 (UTC)
We should not move the discussion that has been written here. But if you want to discuss further changing the content on epilepsy syndromes we can discuss it their. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:45, 5 October 2014 (UTC)
see above. Jophiel 123 (talk) 13:49, 6 October 2014 (UTC)
Jfdwolff Got the point (was focused on the syndromes subsection only). The very good reference "National Institute for Health and Clinical Excellence (January 2012)" (NICE 2012) was indeed displaced from the section classification.
  • The section was poor before and mixed classification of epilepsies and classification of seizures. NICE 2012 was cited for the classification of seizures ("seizure types are organized by whether the source of the seizure is localized (focal seizures) or distributed (generalized seizures) within the brain.") which moved to the article epileptic seizures. The reference was not cited for the classification of epilepsies so its not WP:NOR
  • It can be discussed if the current ILAE 2011 classification (later but weaker) should be used instead of NICE 2012 (earlier but stronger, not including the ILAE 2011 classification because it was probably published after editorial deadline). This could be justified with the following argument:
The only evidence for classifying epilepsies given in NICE 2012 is the classification of epilepsies of ILAE (of 2004) (evidence grade IV). It is stated: "At present the established classification system is undergoing review and current proposals have the status of ‘work in progress'" (the latest, of 2010, given in full detail). It is more than likely that NICE would have taken ILEA 2011 (not 'in progress') into account for the classification of eplepsies if published some months earlier
  • In NICE 2012 causes are genetic, structural/metabolic and unknown cause (as adopted from ILAE 2010). Syndromes are not referred to as causes but diagnoses. The quoted ILAE defintions are very good, we should consider use them in the section causes.Jophiel 123 (talk) 18:17, 5 October 2014 (UTC)

How are epilepsy syndromes categorised[edit]

IMO "The current conception of categorizing epilepsies focuses on the underlying causes." is a little overly strong. Especially as we have this 2013 textbook which states "An epilepsy syndrome is empirically identified and does not imply a common etiology" [3]

When you state "When scientific knowledge was less profound, epilepsies were categorized" implies that they are no longer categorized by clinical features. Somehow I doubt this is true and refs to support that epilepsy syndromes are no longer categorized by clinical features have not been provided that I can see.

I do agree that cause is one way they are categorized. But it does not appear to be the universally accepted or used method. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:12, 5 October 2014 (UTC)

The wording ('when scientifc knowledge was less profound') is not good, agree. Needs improvement. The overall classification of epilepsies is more and more focusing on causes. Syndromes were traditionally identified, as you said, empirically, i.e. by clinical features. The syndrome 'classification' exists in parallel to the modern classification, and I guess, will be historic in 10 years. Jophiel 123 (talk) 10:11, 6 October 2014 (UTC)

Diagnosis[edit]

EEG and Imaging should be put one level higher unter "diagnostic tests". Jophiel 123 (talk) 09:16, 23 September 2014 (UTC)

Moved it earlier if that is what you meant. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:34, 23 September 2014 (UTC)
We need a section "diagnostic tests" because "eeg" (and the others tests) is not the same level of abstraction as the other topics unter "diagnosis". An electrocardiogram is not a lab test anway. Subsections EEG, Neuroimaging, Lab tests, other (as a list with bullets)Jophiel 123 (talk) 11:37, 23 September 2014 (UTC)
Sure merged Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:35, 23 September 2014 (UTC)

Refs[edit]

This addition needs a ref "Attacks of the movment disorder Paroxysmal dyskinesia may be taken for epileptic seizures. The cause of a drop attack can be, among many others, an atonic seizure." Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:32, 23 September 2014 (UTC)

Sure, added. Jophiel 123 (talk) 20:55, 23 September 2014 (UTC)

Mechanism[edit]

The articles "epilepsy" and "seizures" are interdenpedent. There is no "mechanism" of epilepsy - there are causes of the disease and a pathophysiology of seizures. "Mechanism" should only be covered in the article "seizures" and should not just be copied here 1. to avoid conceptual confusion (seizure is not epilepsy) and 2. to avoid error-prone redundancies. Jophiel 123 (talk) 12:59, 23 September 2014 (UTC)

The mechanisms of seizures are the same as the mechanisms of epilepsy to a large part and IMO should be covered in both. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:29, 23 September 2014 (UTC)
When explaning the mechanism of a car you would not say "four-stroke internal combustion engines have four basic steps that repeat with every two revolutions of the engine:..:". You would mention the engine (and possibly its type) as an essential component of the car and refer to the article "internal combustion engine" where its mechanism is explained in detail. Car-engine is a relationship just like epilepsy-seizure. "Mechanism" belongs to the other article because it the mechanism of a seizure (and not of epilepsy). In addition details about seizures "signs and symptoms#seizures" needs to be much shorter and reference the article "seizures". Also first aid belong to the article "seizure" and should be mentioned under "medication" with one sentence or two. Jophiel 123 (talk) 20:55, 23 September 2014 (UTC)
The mechanism of seizures is a guy part of the mechanisms of epilepsy. Same with descriptions of the seizures themselves. If this article was excessively long I would agree with splitting this out, but it is not. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:45, 25 September 2014 (UTC)
I agree that seizures are an integral feature of epilepsy. But I gave an example why "mechanism of epilepsy" and "mechanism of seizure" are different things, because they are not on the same level of abstraction. "Mechanism of seizure" is the pathophysiology of a seizure (whats going on during a seizure) but you cannot put it on the same level with "mechanism of epilepsy" (whatever the difference may be) because this would mean seizure IS epilepsy. The causes of epilepsy may be to a certain extent overlap with the causes of seizures, though, e.g. brain damage. May we compromise and integrate "mechanism" into the section "signs and symptoms#seizures", it would fit well as the introductory part. Jophiel 123 (talk) 10:31, 2 October 2014 (UTC)
Yes it is the underlying mechanism of seizures that occur during epilepsy. I do not see an issue with were it is. Do not think we should move this content into signs and symptoms.
We could add further details about the mechanisms of epilepsy generally if you have refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:01, 3 October 2014 (UTC)
We cannot add further details about the mechanisms of epilepsy because we do not agree on what this mechanism is supposed to be (in contrast to the mechanism of seizure). It would help solve the issue if you provided some reasons for your arguments and respond to my objections. In particular it is the question why you think mechanism of epilepsy is the same as mechanism of seizure without implying logically that epilepsy is the same as seizure. Jophiel 123 (talk) 09:02, 3 October 2014 (UTC)
The mechanisms of epilepsy of course includes the mechanism of seizures as epilepsy is a broader term than includes seizures as part of it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:38, 3 October 2014 (UTC)
What elements of "mechanism of epilepsy" exist beyond "mechanism of seizure". Can you give examples? Jophiel 123 (talk) 01:00, 5 October 2014 (UTC)
While, for example why do seizures occur in Rolandic epilepsy or Lennox-Gastaut syndrome? These are mechanistic details beyond simply the mechanism of a individual seizure. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:51, 5 October 2014 (UTC)
What is then the difference between the mechanistic details and the causes? Jophiel 123 (talk) 02:27, 5 October 2014 (UTC)
Mechanistic details are pathophysiology. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:49, 5 October 2014 (UTC)
How would you explain the difference between the pathophysiology of epilepsy as opposed to the pathophysiology of seizure? If the latter is part of the former there must be some difference otherwise it would be the same. Could you maybe give an example for "mechanistic details beyond simply the mechanism of a individual seizure"? Jophiel 123 (talk) 09:47, 5 October 2014 (UTC)
We give a brief overview of the pathophysiology of conditions in our article of said conditions. Do you deny that the pathophysiology of seizures is also part of the pathophysiology of epilepsy? Uptodate discuses both together.[4] We could eventually create a page called Mechanisms of seizures and epilepsy and expand on details their. Than have main templates from that section in both these articles.
With respect to what is only about epilepsy "epilepsy suggests an enduring alteration of brain function that facilitates seizure recurrence" Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:41, 5 October 2014 (UTC)
I fully agree with the statement that seizures are (integral) part of epilepsy because without seizures there is no epilepsy. With regard to the pathophysiology I am not sure about the defintions. Concerning the 'pathophysiology of seizure' it seems obvious: Because a seizure is defined as "a brief episode of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain" its about what going on electrically. However, epilepsy is defined "as an enduring alteration of brain function that facilitates seizure recurrence". What is then the difference between the 'cause of epilepsy' (for instance a single gene mutation) and the 'pathophysiology' (for instance ...?) Jophiel 123 (talk) 18:35, 5 October 2014 (UTC)
The pathophysiology is the mechanisms that take the causes and turn them into the symptoms of the disease. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:52, 5 October 2014 (UTC)
What would that mechanisms be? There is nothing between causes of epilepsy and pathophysiology of seizure. See also below (Improvements and reverts). Jophiel 123 (talk) 13:55, 6 October 2014 (UTC)

"There is no "mechanism" of epilepsy - there are causes of the disease and a pathophysiology of seizures. " Can you please give a reference to back your statement. (from a peer-reviews publication backed by data and is NOT an opinion piece. ) I feel this is just an opinion being impressed on . Please cite evidence. Also I wonder how can there be any pathology with "no mechanism" .Trying to separate seizures and epilepsy looks pretty naive to me. Please cite evidence. (Drsoumyadeepb (talk) 18:06, 16 October 2014 (UTC))

Causes[edit]

We should not give a(nother) definition of epilepsy here because covered elsewhere. Added general sentence for introduction mentioning also ion channel defects which should be covered in more detail. The term "secondary" (of what? what is "primary" then?) should be replaced by "acquired" as opposed to genetic (or "idiopathic"). WHO good for rough epidemiologic data, not a good source for nomenclature issues, contradicting ILAE classfication. Removed third reference for "60% unknown cause" because reference does not contain such data. Jophiel 123 (talk) 14:12, 24 September 2014 (UTC)

We discuss the ion channel genes in the section on genetics thus moved their.
Agree acquired is a much better term than secondary
Have simplified wording slightly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:30, 25 September 2014 (UTC)

Management[edit]

Seizure dogs: Seizure RESPONSE dog is not equal to seizure ALERT dog. Existing sentence mixes both. Added content, adjusted existing sentence. Jophiel 123 (talk) 21:14, 1 October 2014 (UTC)

Yes agree. We should be using secondary sources though, not primary source per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:18, 1 October 2014 (UTC)
The cited reference is from a major neurology journal and not secondary (it is a case study) i.e. it is not more appropriate than the others. Quote: "In this report we describe a dog that warns of psychogenic nonepileptiform events (PNES) and critically examine the SAD literature." Examination of literature is integral part of primary literature and its existence does not qualify the respective article for "secondary" literature. Both terms "seizure response dog" and "seizure alert dog" are given in the publication. The latter term should be avoid in general because its questionable. Jophiel 123 (talk) 22:13, 1 October 2014 (UTC)
Which source do you refer to? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:15, 1 October 2014 (UTC)
Pubmed describes this [5] as a review. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:22, 1 October 2014 (UTC)
The quote "In this report we describe a dog..." ist from the source: "Doherty, MJ; Haltiner, AM (2007) Wag the dog..." (https://www.ncbi.nlm.nih.gov/pubmed/19715180). The source may be desribed as a "review" by pubmed but the article is a case study. The magazine "Neurology" calls it a " Clinical/Scientific Note" (neither a full-fledged article nor a review). The other given reference "Di Vito et. al (2010): A seizure response dog..." (https://www.ncbi.nlm.nih.gov/pubmed/17242343) also lists the existing literature about seizure dogs and discusses it.Jophiel 123 (talk) 10:04, 2 October 2014 (UTC)
Yes their is not really any good overview articles on the topic. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:02, 3 October 2014 (UTC)
I think we agree on the poor quality of evidence. But I object on keeping the current statement "Some claim that seizure dogs, a form of service dog, can predict seizures. Evidence for this, however, is poor". The term "seizure response dogs" is used consistently in literature synonymously to "seizure dog", meaning a dog demonstrating behaviour during or after a seizure of its owner. Such abilitiy is not questioned in literature. Some organizations train and supply service dogs specifically trained for this purpose. Some do claim that some dogs can specifically (trained to) sense an impending epileptic seizure (discriminating it from a psychogenic seizure) and this ability is questioned in the currently cited source and other sources. In literature the term "seizure dog" does not refers to alerting dogs.
-> It is not claimed that seizure dogs predict seizures because the term refers to resonding dogs. Also this sentence wrongly puts the focus on skepticism. The benefit of response dogs is not questioned in literature; cited sources for this are more recent than the one currenty cited an not inferior in quality. We should mention in this article what is not questionable (responding behaviour) instead of what is (alerting behaviour). Jophiel 123 (talk) 09:58, 3 October 2014 (UTC)
Sure we can just refer to dogs without the term seizure response dog when we mention the ability to predict. Do you think that is fair? Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:41, 3 October 2014 (UTC)
Agree (Some dogs, also referred to as seizure dogs, may help during or after a seizure. It is not clear if dogs have the ability to predict seizures before they occur.) Jophiel 123 (talk) 00:54, 5 October 2014 (UTC)

Improvements and reverts[edit]

I am so glad a neurologist has finally started working on this article, and so disappointed that their improvements are being reverted. Please James, that's no way to work. I appreciate that you and Jfdwolff are feeling somewhat possessive towards something you worked on but really, you need to let go. This article as of 15 September, before recent edits, was not good. I'm sorry to say. It reads like an article about epilepsy by someone who doesn't really understand epilepsy. At a fundamental level. The statement made in the talk above by Jophiel 123 at 02:24, 5 October 2014 about the various classifications cause/diagnosis is absolutely correct. The responses by James, I'm sorry, reflect both a rigidity about so-called MEDMOS sections [an ongoing problem] and, frankly, just not getting it. Saying "Benign rolandic epilepsy can be a "cause" of epilepsy yes." is to me just an admission of being out of one's depth and I'm surprised Jophiel is being so patient. JFW claims the added text appears OR, but on the basis of sourcing used rather than whether the text actually is OR. More familiarity with the literature and subject would not lead you to make such a remark.

The later comment by Jophiel "There is no "mechanism" of epilepsy" is so true. The reply "The mechanisms of seizures are the same as the mechanisms of epilepsy to a large part and IMO should be covered in both" is just so wrong. I fully agree with Jophiel that discussing the causes of epilepsy is about the why that person has "an enduring alteration of brain function that facilitates seizure recurrence" and absolutely not why one particular type of seizure occurred.

Please can I suggest you let Jophiel have a go at the wheel of the car. Would you act this way to edits made by GrahamColm on a virus article? Epilepsy needs a good bit of work and this is a wiki so we can do that. And there will be times when the text might be a bit rough, repeats stuff, contains over-complex prose. I highly respect Jmh649 and Jfdwolff as Wikipedians and physicians and defenders of MEDRS standards, but a bit of humility might be in order. And please chuck MEDMOS in the bin if it is getting in the way of writing this article how it needs to be written.

As Jophiel notes, our understanding of epilepsy is evolving and far from mature. At various points in the history some terminology has been favoured and then discarded later as ideas develop. Our crude attempts to label aspects of epilepsy (seizure types, syndromes, drugs) can almost be held up as a classic example of evolving thought rather than a solid understanding of the universe. This topic is quite unlike nearly any other disease topic (possibly Cancer is most similar).

-- Colin°Talk 20:45, 5 October 2014 (UTC)

Colin you are more than welcome to insult me all you wish. We obviously disagree regarding whether or not articles should have a consistent structure as you have previously made clear.
Using terminology like "others have underlying inherited metabolic diseases, chromosomal abnormalities, phakomatoses, or malformations of cortical development" without any clarification is inappropriate when we are trying to write for a general audience.
You are arguing that their are no underlying mechanisms / pathophysiology to epilepsy? What about Volume 1 of Epilepsy: A Comprehensive Textbook? [6] There is a section on mechanisms of epilepstogenesis and epileptogenicity of which seizure mechanisms is a subsection.
That epilepsy syndromes are not "causes" of epilepsy in the common usage of the term is an interesting discussion. We have this book called "causes of epilepsy" [7] that has a chapter on epilepsy syndromes. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:50, 5 October 2014 (UTC)
Hello Colin, good to have you on board here. I'm very happy to collaborate with Jophiel, but this is not an issue of WP:OWN for me (I have made minimal personal contributions to this article). We are clearly finding a way to present the current nomenclature in a way that everyone finds useful.
Secondary epilepsy (e.g. in the context of neurocysticercosis or tuberous sclerosis) is easy. Primary epilepsy by definition requires descriptive labeling until more is understood about the causes (e.g. polymorphisms, see the Lancet Neurol paper I posted).
I think that large-scale changes to this article should ideally be discussed here on the talk page before being introduced. I also think that we might need to deviate from WP:MEDMOS if required, but with the least element of surprise from everyone. JFW | T@lk 00:52, 6 October 2014 (UTC)
I am extremely disappointed that James has reverted once again in 24 hours the excellent improvements made to this article. On the grounds that they haven't been presented here for discussion first. Is the best you can come up with that the word "phakomatoses" is unexplained? This is a wiki, for crying out loud, fix it. Don't revert it. There's clear OWNership going on here. Let's consider that between November 2013 and January 2014 James and others made a huge number of edits to this article, transforming it beyond recognition. Now please here is the talk page for that period. Where were those changes discussed, reviewed, picked over for minor issues? Nowhere. James will know I am a champion of making complex subjects readble by a lay audience. I've worked with many expert editors to help them refine their prose. Not once have I reverted several paragraphs of text because I didn't understand a single word. Througout that, I was humble enough to appreciate having an expert on board. Please James, you are so defensive here that you are just arguing for arguing sake. Take your claim "You are arguing that their are no underlying mechanisms / pathophysiology to epilepsy?" No I didn't argue that. James, when your discussion is picking holes in what the other person wrote on Talk rather than engaging with them to understand what their issue is they are trying to get across, then it is really time to go take a break. There are important "levels of abstraction" issues to consider here, as Jophiel has tried to explain. I don't see how a book called "Causes of epilepsy" having a chapter on syndromes somehow explains your misunderstanding that syndrome names are causes. The book also has a chapter on provoked epilepsy (are we to think hot water, or reading, causes epilepsy) and a chapter on status epilepticus (is that a cause too?).
James, what you take for insults you should happily agree with. You are not a neurologist. The best times I've had on Wikipedia is when working with real experts in their field to help them write great articles. I've learned a lot from them and I hope they enjoyed the experience. If you'd appreciate that, then you'd undo your second revert and work with Jophiel to resolve the relatively minor issues with the added text. And both you and JFW need to appreciate this is a wiki and we do not post up every change on talk for endless discussion until the penny drops. That's fine for hugely contentious articles like autism but this is basic uncontroversial stuff here and progress will be greatly impeded by that approach. -- Colin°Talk 08:04, 6 October 2014 (UTC)
Interesting that you consider all these changes excellent while a number of use find some of them concerning. Comments by Jophiel 123 here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:08, 6 October 2014 (UTC)
James, stop playing games. The so-called concerns you've raised are minor. -- Colin°Talk 21:14, 6 October 2014 (UTC)
I think this article need improvents on the conceptual level in the first step. For example in the beginning the section about classification mixed epilepsy and seizures. The reason was that the underlying concepts were apparently not clear.
I understand that some editors keep core articles on medical topics on a level to meet certain quality criteria. This is good because some inappropriate words about very serious health issues can mislead people. Someone may be emotionally upset because a diagnose was made on him and in this state of confusion he may even commit suicide when reading here that the supposed disease has no cure.
I think my edits were not imposing a danger to the general public. Most of them, I guess, were rather on a very conceptual level. However, getting into discussions here revealed that the perspective on the article, and possibly on medical issues, at least on epilepsy, is very different.
Argumentation should be about reasons, in the end its logic. I have tried to illustrate with concrete examples and analogies what I think is a proper way to explain points of view. However, I feel that my arguments were often met on the level of opinion. My impression is that, at least concerning this article, there seems to be an attitude to keeping what exists. I am not sure if this meets with Wiki policies.
I do agree that large-scale changes to this article should ideally be discussed here. But even small scale changes lead to discussions that apparently cannot be solved. The defintion of epilepsy is 'static' (its about the mere existence of something, i.e. a predispostion or having had two seizures before), so there cannot be a 'dynamic' mechanism. However, to have such a long discussion about issues that are basically not magic lets questions arise for me. I suggest that editors focus on their respective topics and work synergistic. Someone who works on a variety of medical of article has a different approach than a specialist. I do agree that articles should have a consistent structure but this should be flexible if the disease entity does not match the structure (multiple sclerosis is multpile sclerosis but epilepsy is not seizure). Jophiel 123 (talk) 09:49, 6 October 2014 (UTC)
Thank-you. I agree, the additional text on syndromes was utterly uncontroversial and quite necessary explanation of where we are in terms of undstanding/classifying these conditions. I really don't understand why it has been met with the hostility of twice being reverted. Any minor issues with it can be tweaked and refined as we do on a wiki. I repeat my question, James, would you act this way on one of Graham's article's. Would you feel insulted if someone pointed out your misunderstanding of the aspects of viral replication? When I say there are problems here "at a fundamental level" I don't mean that those writing it have no clue. I mean that the fundamental issue of what the article on epilepsy should cover vs articles on seizure or specific syndromes, seizure types or medications. It comes to the heart of what "epilepsy" is. And it is really unlike nearly any other medical condition, hence my problems with trying to fit it into the same structure as diabetes or Parkinson's disease. Some people prefer to talk of "the epilepsies", though possibly that may give more importance to epilepsy syndromes than to conditions that feature epilepsy as only one aspect. Can we please leave the revert button for when someone has wrecked the article or made such a huge blunder that they are in danger of seriously misleading our readers. -- Colin°Talk 10:03, 6 October 2014 (UTC)
Would it be feasible for Jmh849 to consider working hand in hand with me and allow that I focus on the conceptual framework and substantial additions of content and you on the important formal quality criteria for a medical article, allowing some flexibility and having in mind that the article is for the general public and health care professionals as well? Could we agree on giving constructive feedback instead of reverting changes that are not perfect but reasonable and compliant with Wiki policies? Jophiel 123 (talk) 14:44, 6 October 2014 (UTC)
We appear to be coming at this from different angles. Stating that "The current conception of categorizing epilepsies focuses on the underlying causes" might be theoretically true. It however is an ivory tower approach to these condition.
What is more clinically relevant is how epilepsy syndromes are ACTUALLY categorized. This actual categorization is not due to these practitioners having "less profound" "scientific knowledge". It is due to the constraints of reality and actually having patients one needs to treat. Making the prediction that in 10 years everyone will be diagnosing all these condition based on genetic analysis is all well and good and that all syndromes are really genetic deep down. I will believe it when I see it.
I have agreed with many of User:Jophiel 123 changes as some have been excellent. I have; however, disagreed with others and per Wikipedia policy we should WP:BRD.
Some of the disagreements have occurred around WP:MEDMOS. Yes I agree that having a general outline is not always perfect. But I disagree with User:Colin position that we should not follow it at all or that small discrepancies need to be hammered on indefinitely. Yes there are trade off and some of these require editor judgement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:40, 6 October 2014 (UTC)
James, don't put words in my mouth. My position is not that we should not follow MEDMOS at all. MEDMOS has makes it quite clear that section headings and article organisation should be made appropriately for the article -- this is an aspect of MEDMOS that you repeatedly and wilfully choose to ignore. Any section headings and orders are merely suggestions. You alone on Wikipedia seem to think they are policy. I've no idea what you mean about "small discrepancies need to be hammered on indefinitely". In terms of how our categorisation system for epilepsy has evolved, could we please have a sourced-based discussion. Hyperbole like "all syndromes are really genetic deep down", which is nobody's position, is not helpful. -- Colin°Talk 21:14, 6 October 2014 (UTC)
Based on what was said and was changed in the article recently, I thought it could be be appropriate to move the (new) content about syndromes back here from the article about syndromes, so I boldly did. The new wording of the first paragraph should meet the major criticism, it's close to the ILAE statement on syndromes. Some terms do still need clarification, but they are not necessarily inappropriate. We do not only write for the general audience but also for health care professionals, so specific terminology cannot just be replaced but, if too specific, needs to be explained (as I did e.g. with de-novo mutations), also other articles can be referenced. The content is not perfect but not that bad to revert the changes. Suggestions for improvements very welcome. Jophiel 123 (talk) 21:55, 6 October 2014 (UTC)

Well since the heated discussion last night, and plea from Graham below, what has happened? Jophiel stated that following from discussions here, he would move the syndromes text from from the Epilepsy syndromes article back to the Epilepsy article. And also stated he would remove the mechanism section from epilepsy, which is a duplicate of content in Epileptic seizure. It is worth noting that on 15 September this article had one short paragraph on syndromes, which is a major topic in "Epilepsy" (forming an entire section of my epilepsy textbook, not just a chapter or two). I had hoped we might be able to work on that expanded text collaboratively to refine what information is included here. Often text grows in size before being polished. But before I could even read what was written, James removed a big chunk of it and put it back into epilepsy syndromes. And since we now have the same text in two articles, James had to copy-edit both of them. And as for Mechanism? Well I think this article does need to cover aspects of the "neurobiology of epilepsy", as my textbook puts it, which includes some background on neuronal excitability and control, on epileptogenesis and some overview of what is believed to be faulty in various forms of epilepsy. What it doesn't need is just a copy/paste of what Epileptic seizure says. But, no, James reverted the removal of the Mechanism section, restoring pretty much the exact same text as is in the other article.

In my very limited free time, I have better things to do than analyse the diffs between two editors playing revert-tennis. I literally cannot keep up with the hundreds of words of text that have flowed in and out of this article in just one day. It would be difficult for me, with my lack of medical knowledge and limited access to sources, even if people were playing nicely. Jophiel, I hope you have more patience than me and can offer your expertise to improve this article. James has a 30-hour day when the rest of us mortals were given 24. His heart is in the right place, even if his head gets in the way. With regret, I'm unwatching. -- Colin°Talk 20:31, 7 October 2014 (UTC)

I copyedited partly due to concern raised here regarding paraphrasing. And partly as an effort to simplify the content in question.
The article epilepsy syndromes is a subarticle of this one. Thus per Wikipedia:Splitting one expects a summary of it to occur here with the majority of the content in the subarticle.
Per "mechanisms of seizures and epilepsy" we have many sources that discuss them such as this textbook chapter Basic Mechanisms Underlying Siezures and Epilepsy, Uptodate Pathophysiology of seizures and epilepsy], and others [8] [9]. While am happy to see this expanded / changed simply removing it to replace it with nothing I disagree with. Simply stating that epilepsy does not have mechanisms (unclear if that is the argument even) is refuted by the sources I have provided. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:59, 7 October 2014 (UTC)
1 Copyediting because of paraphrasing: Agree of course, sentence was not to meant be the final version.
2 Syndromes in a separate article: Do not agree, as said before. Did not get your reasons for doing it so far.
3 For the conceptual issues it does not really help to cite sources. You may cite one source, I may cite another. It is all about the valid definition and applying reason. Currently epilepsy is defined by having had two seizures, thus it's a definition of an abstract thing. Example: A group is defined by having two members. But the common (concrete) properties of the members, which give rise to grouping them, are by no means inherited or transferred to the (abstract) group. Thus, logically there cannot be something like a mechanism of epilepsy because abstract things cannot have a mechanism. For something to have a mechanism you need a concrete definition, like in the case of seizures. Thus, with respect to what I said, all mechanistic details belong to seizure.
However, the conception of epilepsy is also different to other diseases, in that there are a variety of (increasingly identified) underlying causes, which are disease entities by themselves and as such having different pathophysiologies. So you cannot refer to the pathopyhsiology of epilepsy (because of what I said above), but you can of course refer to the pathophysiology of the respective underlying disease. So when grouping these pathophysiologies you would group them in the same way as you group causes, for instance: inherited genetics / single gene -> ion channelopathy. Thus, pathophysiology directly belongs to the cause, so we should keep it there, the section about causes need to be extended anyway.
So, when referring to pathophysiology, you could either mean the pathophysiology of seizure or the pathophysiology of an underlying disease, there is no such thing as the pathophysiology of epilepsy. The definition of epilepsy was changed from "enduring predisposition" (with connotation on the predisposition and the mechanism) to "having had two seizures" exactly because of this. Jophiel 123 (talk) 16:59, 9 October 2014 (UTC)
1) Great
2) A summary of syndromes is here with greater detail in a separate article. This is how we usually arrange content. We could add another paragraph here if you wish but this article should be an overview with greater detail in the subarticle.
3) Sort of and sort of not. Many other high quality sources do describe a pathophysiology of epilepsy and seizures. I agree the two are closely related. We should eventually have an article called Mechanisms of seizures and epilepsy with a "main" template in the seizure and the epilepsy article. We could try a RfC if you see this as a huge issue. It is really just editorial judgement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:20, 10 October 2014 (UTC)
2. What I contributed is supposed to be the summary. What was in the article about the syndromes before, i.e. details about every single syndrome, should be kept there (and would need some revision). You have been referring to BRD, I would kindly ask you follow the rules as well. I added content, you moved it somewhere else, I moved it back - then its time to discuss before reverting it again. Of course we can discuss about the wording and why I think this content must not be moved to a separate article. You keep insisting on your opinion without really explaining your reasons. Saying "this is how we do it" means this is how you think it should be done and is an opinion, not an argument. As in 3. this is editorial judgement - and at this point we would need to discuss.
3. This is editorial judgement, I agree, and, as in 2., we would need to discuss, this matter that cannot be solved by citing sources. You did not refute my argument. You could have said: "Well, you are definitely right in what you said, however I would favor to have a section pathophysiology because ..., and we should put the following content..." But you didn't. You stay on the level on opinon.
James, this is not the way it's gonna work. I made some reasonable contributions and I would love to make some more, but you need to give some space for me to build this article as well. Let me also take responsibility. Other editors addressed this before, thanks Colin and GrahamColm. Follow the rules as you expect from others to do, tolerate this article being a little rough around the edges from time to time, step back a little and let me do. When (repetitively) at the argument level you do not have a response, concede. Do not delegate responsibility to others (let's have a second opinion, we can make a RfC) before you provided substantial arguments. Jophiel 123 (talk) 09:31, 10 October 2014 (UTC)
The article on epilepsy syndromes should also have a lead that summarizes the topic. Thus having the content their aswell I do not see as an issue
Typically it is a new edit that needs consensus to change what was their previously.
I have provided a bunch of references showing that mechanisms are commonly discussed when it comes to epilepsy. You have declined to address this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:37, 11 October 2014 (UTC)
The lead of the article on the syndromes needs to be shorter. Syndromes are just cases of epilepsy, there is nothing really special to them, so the main content belongs here. As I said it needs to be adjusted with the content of the section causes. Needs some work to integrate both aspects. Let's have a look at it again with the next revision of this section. OK?
This discussion about mechanism has become a little too theoretical, I guess. It's true that I did not decline your arguments with respect to the references you gave, I just had the impression if I had done so , you would have said in the end again "but the references say so" without really refuting my argument. A good article is not generated by a bunch of sources but by in-depth understanding, reason and editorial judgement, so giving references "where say also say so" is not really a response. When we have some content about mechanisms (that are not the mechanism of seizure) we can see where it fits best. OK?
For the future I would ask you to consider reverting only when necessary i.e. when an edit is really detrimental. When reverting, be sure to indicate your reasons (quote from article on WP:EW) -- just saying 'I have a problem' is an opinion but not a reason. It would also help you being more responsive on my arguments, saying "I do not see an issue" (as you did three times already) is inappropriate; again, please provide good reasons for your opinons and concede a point when you have no response (WP:EQ). I do not have to tell you that new edits do not need consensus right away, because for this article it would mean I have to ask you for permission before I edit, but this does not comply with (WP:OWN). Jophiel 123 (talk) 14:22, 11 October 2014 (UTC)

Ketogenic diet[edit]

The article currently says:

A ketogenic diet (high-fat, low-carbohydrate, adequate-protein) appears to decrease the number of seizures by half in about 30–40% of children.[89] About 10% manage to stay on the diet for a few years, 30% had constipation, and other adverse effects were common.[89] Less radical diets were easier to tolerate and may be effective.

This is inadequate in many ways. Not least because it cites one of the worst Cochrane reviews I have ever read. See Talk:Ketogenic diet for discussion on that paper. The prose above is simply awful. "appears to decrease" -- why "appears"? And no it doesn't do that "in about 30–40% of children" because very, very few children with epilepsy are put on the diet. So nobody really knows, in this currently age, what percentage of children with epilepsy would show an improvement and to what degree. This is a section on management, so we need to explain why a doctor would put a patient on this diet. Hint: there's a consensus paper with some recommendations. Why children? The last two sentences are written in a passive past tense. Makes you think nobody uses the diet any more, or that constipation and other adverse effects were only common in the past but perhaps not now?? It confuses the tiny features that a study notes (some patients get constipation, physician tweaks the diet, patient no longer has constipation, almost never a reason to discontinue the diet) with things that really are important to summarise in a big-topic article like this. The "other adverse effects" is wishy washy language. Are they bad (like dying of liver failure or going blind, like happens rarely with some very useful drugs) or debilitating (like being sleepy or dull), short term or long term (bone and stature issues). Really, I'd expect this section to discuss the role this diet plays in modern treatment of epilepsy, not just reiterate some facts and figures. -- Colin°Talk 21:01, 5 October 2014 (UTC)

So what do you want to change it to?
So why did I use the term "appears". While none of the trials were blinded. The authors of the paper use the term "These studies suggest" so as to paraphrase appears seems like a good enough word.
The passage links to the good article that you have written, so people should be able to leave this really crappy article and find something better without to much difficulty. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:51, 5 October 2014 (UTC)
Actually, the more I look at those few sentences, the more I am concerned about the rest of the article. The KD text is overly concerned about trials and the data from those trials. That's not why people read the Management section on Epilepsy. In addition, this gives all the hallmarks of an article produced by cobbling together indepdendent reviews, rather than using sources that deal with, say, epilepsy management as a whole. There are really far too many sources used in this article. Here's the problem with using a dud review that is concerned only with trial data: you overemphasise the wrong things. Consider that most children started on the KD have already tried numerous drugs, perhaps six in various mono and polytherapy attempts. They may have been through investigation for (and rejected from) surgergy. Often epilepsy is only one of the problems they face. So tell me, should you try a random therapy X for this child, what are the chances that the child will still be on it in 3 years. The evidence says that trying a new drug at this point is highly unlikely to strike gold. What percentage, even, of those children are alive in 3 years? I'm willing to guess that the figures for "still on after 3 years" aren't any better for individual drugs at this stage, than for the KD. Then consider the "constipation, and other adverse effects were common" claim. Is "constipation" the most significant issue with this diet (it isn't)? Is saying "other adverse effects were common" providing the reader with any useful information at all?
Wrt "appears", the text is once again confusing the analsysis of statistical results with plain English needed for "Management". The KD does not "appear" to reduce seizure frequence or even to eliminate seizures in a useful number of patients. It actually does. This isn't homeopathy or spirit healing. The only uncertainty is the 30-40% figure, which is only meaninful figure when one knows the context -- what population group is actually tried on the diet. The article gives the impression this is "children" when in fact it is very sick children with refractory epilepsy. I will revise the text when I get some time. But I raise this as an example of what can go wrong if you cite random review papers on a subject you aren't familiar with. -- Colin°Talk 08:33, 6 October 2014 (UTC)
Always good to finish all comments with a personal insult. This is interesting as I requested your input in writing this article. Yes I realize that you dislike this Cochrane review. But it is hardly a "random" paper. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:13, 6 October 2014 (UTC)
James, if you want to play the bully [10][11], then grow some thicker skin. If you want to actually collaborate on this article then I suggest you stop fighting all edits that don't have Jmh649's name attached. BRD is not policy nor even a guideline, nor is it the methodology you and others used when completely rewriting this article last winter. -- Colin°Talk 21:24, 6 October 2014 (UTC)
Good thing I do have thick skin because editing with you require it.
Concerns were not addressed. You simply restored it. You are free to join the discussion but maybe take some time to read the discussion. Reading WP:CIVILITY may also be useful.Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:27, 6 October 2014 (UTC)
Your concerns were minor. The added text was better than what we had, and in a better place. There is no requirement that all text added must be fully polished on talk before insertion. Wholesale reverts of good-faith improvements is not policy. Reading Wikipedia:Editing policy may be useful. You refused to explain why you are treating the edits by Jophiel 123 differently to those made by other editors here. Despite the heat on this talk page, the only person editing disruptively on the article is you. -- Colin°Talk 21:50, 6 October 2014 (UTC)
Please forgive me for poking my nose in. I have been following this discussion after my name was linked earlier. As you all know, I know nothing about epilepsy, but I do understand how Wikipedia works. Looking at the article history, I was shocked to see James' reverts of the edits of a relative newcomer and an established and respected editor. I get the impression – and I hope I am mistaken – that James considers "his" Good Articles to be off limits to new editors. I don't see any incivility on Colin's part, just a well argued case as to why the article needs improving. I am pleased that Jophiel has not taken umbrage and has generously offered to collaborate. Many other editors would have left us after such a cold reception. I am in full agreement with Colin, particularly when he suggests offering the driving seat to another editor. We have nothing to lose, and I suspect much to gain. So please let's not resort to reminding us all about Wikipedia policies, guidelines and essays that we all already know, but focus on the reason why we are engaged in this discussion – to improve the article. I am keen to see what Jophiel has to offer – I think it will valuable. Lastly, James I think you need to sit back and reflect, some of your responses are unbecoming. Graham Colm (talk) 22:21, 6 October 2014 (UTC)
This talk page has become a little disordered anyway so I'll give a little final response on "mechanism" right here.
I do agree that there is a chain between the cause of epilepsy and seizures. For example a singe gene defect results in expression of an altered protein, which is turn may constitute (part of) an ion channel, resulting in an disequilibrium of ions with change in membrane potential. Some enduring abnormal neuronal activity is probably generated in the neurons that express the channel protein. There is no term for these aspects of the causal chain, you may well call it mechanism, pathophysiology or epileptogensis, but this is not the term used. Even the term "predisposition" is not really good. For a reason the definition "enduring predisposition" was replaced by "having had two seizures". So, because on a molecular level the above mentioned aspects are heterogeneous as causes are, these aspect is usually subsumed under causes.
I think it would be good to get to a solution concerning the issue now, otherwise we will have the same discussion without a result some time later again. After all what was being said (and not said) I feel I can remove the section "mechanism", which is copied one to one from the the article about seizures. Reasons have been discussed. It is justified to deviate from a common structure of articles here because the situation in epilepsy is different. If someone wants to revert it back it would be very helpful to provide some substantial arguments before.
Major issues with regard to concept and methodology of this article have been mentioned. Quite an effort will be necessary to make this article a featured article one day. For now I feel a little tired since I have been involved here way beyond my available time and energy. I hope the investment was worth it an we can, after a little break, work productively in future. Jophiel 123 (talk) 09:19, 7 October 2014 (UTC)

Psychosocial vs comorbid[edit]

The Psychosocial section is currently a sub-section of "Signs and symptoms". None of the things in this section are signs or symptoms of epilepsy. Some of them are comorbid such as autism. A few, such as depression or anxiety may follow from untreated epilepsy or even from medication, but I would be interested if any direct link has ever been made between an epilepsy and a psychological outcome, or whether they are pecululiar to epilepsy vs any other disabling chronic condition. Correlation vs causation and all that. Is there a causitive link or diagnositc utility to these?

The sentence "Learning difficulties are common in those with the condition, and especially among children with epilepsy." This is wrong in two ways. Firstly, I should say the source reference here is inadequate. A 600+ page book is not a suitable specific reference. Please give chapter and (where the chapter is more than a few pages) page number. The first problem is that the source puts this the other way round. Epilepsy is more frequent among those with learning difficulties. And the frequency goes up with the severity of the learning difficulties. In fact the source says "Many children with epilepsy do not have associated learning disabilities" and indicates some particular syndromes where LD are common. This is important. In many cases the learning difficulties and the epilepsy are due to the same underlying disease. Identifying learning difficulties as being purely a consequence of the epilepsy itself is are more difficult job and deserves a more complex text. The second mistake is the classic one of thinking children are a special group. Do the learning difficulties disappear on adulthood? No, the linking of the two is a consequence of when epilepsy is frequently discovered and the urgency of treating learning problems in children. -- Colin°Talk 11:42, 6 October 2014 (UTC)

You mean giving the chapter and page numbers is not enough? That the National Institute for Health and Clinical Excellence is not a good reference
Here is the ref "National Institute for Health and Clinical Excellence (January 2012). "Chapter 1: Introduction". The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Clinical Guideline Centre. pp. 21–28."
There is no claim that the seizures are the cause of the learning problems. And this text "Learning difficulties are common in those with the condition" does not restrict the association just to children or imply that they disappear after they grow up like you seem to raise concern of here "The second mistake is the classic one of thinking children are a special group. Do the learning difficulties disappear on adulthood? No" Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:21, 6 October 2014 (UTC)
My apologies, I did not see the page numbers and located relevant text in the chapter "Children, young people and adults with learning disabilities and epilepsy". My point about confusing co-morbidity with signs and symptoms stands. Putting these into the section on the signs and symptoms of epilepsy does indeed make the claim that epilepsy is the cause. There are definitely times when epilepsy itself, and medication for epilepsy, can be blamed on developmental and psychological issues, but that needs a more considered source and article text than one can draw from the introduction section of a clinical guideline. Comorbidity is an important topic to discuss, perhaps in the Epidemiology section. -- Colin°Talk
Feel free. We could move this to prognosis, etc. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:39, 6 October 2014 (UTC)

Strangeness[edit]

  • So why was the {{Main|Epilepsy syndromes}} deleted [12]
  • And why all the text here removed
  • This is article here is supposed to be a brief summary here with the subarticle going into greater depth / complexity. These edits achieve that exact opposite. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:02, 6 October 2014 (UTC)
Missed to replace it with "see also". Done.
Some content was deleted because the new replaced it, basically saying the same in more detail. Is something missing in particular?
As mentioned before I think the content belongs here (again). The reason is that syndromes are just cases of epilepsies, classified in a different manner. Having two articles won't be helpful with respect to the understanding of epilepsy. To stick with the car: Categorize them by the number of doors - they are still cars.
There is overlap with the section "causes", it needs some more work to adjust it. Jophiel 123 (talk) 22:29, 6 October 2014 (UTC)
Have simplified the text and moved some of it to the subpage Epilepsy syndromes Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:55, 7 October 2014 (UTC)

Paraphrasing[edit]

This text was added in this edit[13]

"Whilst organizing cases of epilepsy by their underlying etiology is very important, they may also be organized into epilepsy syndromes by reliably identified common clinical features. These include typical age of seizure onset, specific seizure types and EEG characteristics and others. The diagnose of an epilepsy syndrome is useful as it provides information on which underlying etiologies should be considered and which anti-seizure medication might be most useful."

source says [14]

"Whilst conceptualizing epilepsies by their underlying etiology is very important, epilepsies may also be organized (by reliably identified common clinical and electrical characteristics) into epilepsy syndromes. Such syndromes have a typical age of seizure onset, specific seizure types and EEG characteristics and often other features which when taken together allow the specific epilepsy syndrome diagnosis. The identification of an epilepsy syndrome is useful as it provides information on which underlying etiologies should be considered and which anti-seizure medication(s) might be most useful."

IMO this paraphrasing was a little too close. I have paraphrased it further. Additionally User:Jophiel 123 if you wrote the original text at https://www.epilepsydiagnosis.org/ all we need is acknowledgement that you own the text and give release of it under a CC BY SA license. Best Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:06, 7 October 2014 (UTC)

I am in discussion with the ILAE about releasing this content under an open license. As far as I am aware they have not done so yet. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:12, 7 October 2014 (UTC)
This week's Dispatches: Wikipedia:Wikipedia Signpost/2014-10-01/Dispatches "Let's get serious about plagiarism" is worth reading. Few people understand that citing one's source is not sufficient to avoid plagiarism, which is not uncommon in academic papers including, ehem, nicking text from Wikipedia. Even if the source text was under e.g. CC BY-SA, we'd have to be careful how it was inserted so that the edit summary made quite clear the original authorship. Even then I'm not entirely sure that is sufficient attribution, given that the author's name wouldn't appear in the PDF generated form of this page. Someone else might know. Regardless of whether text is public domain or under a free licence, we should aim to write in our own words. Exceptions are where we use in-text attribution of some form, such as clearly repeating a definition from ILAE. -- Colin°Talk 19:04, 7 October 2014 (UTC)

Should the article on epilepsy have a mechanisms section?[edit]

The article on epilepsy has long had a section on mechanism (otherwise known as psychopathology). This is one of the recommended sections per WP:MEDMOS. There have been a number of attempts to remove this section such as here [15] for reasons that are not exactly clear to me.Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:15, 11 October 2014 (UTC)

Support[edit]

  • Support inclusion. Happy to see wording of this section adjusted. However, we have many sources that discuss this aspect of epilepsy. It is often done in relation to seizures as the two are closely related. We see many major textbooks that have chapters on the subject such as this one [16]. Further textbooks can be seen here [17]. Additionally google scholar pulls up a few thousand title with the term [18] and we see UpToDate has an article on pathophysiology of seizures and epilepsy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:15, 11 October 2014 (UTC)
  • Support. I don't want readers to come to this article and not find an explanation about why we think people with epilepsy experience seizures. A degree of overlap with Epileptic seizure is inevitable and should be encouraged. JFW | T@lk 07:44, 12 October 2014 (UTC)
  • Support As you say it is inevitable. Frankly I don't understand this odd distinction between the diagnosis and symptoms that is being made to oppose this. -- CFCF 🍌 (email) 13:11, 15 October 2014 (UTC)
Well, perhaps if you read the discussion below you might understand. Please, unless you understand both sides of a discussion, you cannot come to a conclusion. Frankly, I've no idea what you are talking about wrt "distinction between the diagnosis and symptoms" which is nothing to do with why this article should not have a top level Mechanism section. See the analogy with Blindness below. -- Colin°Talk 14:20, 15 October 2014 (UTC)
I should have put it differently. The separation of diagnosis and events leading to diagnosis is incorrect. -- CFCF 🍌 (email) 15:33, 15 October 2014 (UTC)
Em, we're discussing whether the article should have a top level Mechanism section. What have "diagnosis" and "events leading to diagnosis" got to do with it? -- Colin°Talk
I think he might be in the wrong article. Jophiel 18:31, 15 October 2014 (UTC)
No, what we are doing is making a difference between the diagnosis of epilepsy, and the events - seizures. Even if mechanisms are varied they are meaningful to mention, especially where any similarities lie. As for blindness, it is possible that a well sourced and well written mechanisms section could cover things the causes section would not. By explaining underlying physiology it would be possible to clarify the pathophysiology more than is done. That article is of low quality and should not be used as a guide. -- CFCF 🍌 (email) 05:17, 16 October 2014 (UTC)
  • Support I have read this talk page from top to bottom, and looked at the various versions of text in this article and others, and the text proposed on this talk page. After looking at it all, I think that there is adequate sources to write a section titled mechanism per the WP:MOSMED. The most compelling reason is that it would be most useful to reader to have this separate section. One of the reasons that Wikipedia is a popular reference is that the content is very accessible. Part of what makes the content accessible is that the material is organized in a manner so the students and other people who are not knowledgeable about the topic can find it. Students are asked to understand the mechanisms (or pathophysiology) of diseases and conditions including epilepsy. Locating it in a separate section is is much easier for the general reader and student than if the content is mixed together with other sections. I fully support and expect there to be multiple mechanisms in the section because from reading the rest of the article it clear that there are multiple types of epilepsy. Sydney Poore/FloNight♥♥♥♥ 18:23, 15 October 2014 (UTC)
FloNight Could you briefly explain with your own words, just give some sentences, what these mechanism could be? Jophiel 18:31, 15 October 2014 (UTC)
Thank you for reading the whole page. You are right that a student will want to understand the mechanism of this disease called epilepsy. We must disappointment on both fronts. For epilepsy is not one disease but a group of diseases who's only common aspect is recurrent seizures, and even these seizures can be very unrelated. Secondly we must disappoint them that there is not one mechanism behind these diseases. The current article text does not do that and misleads the reader. The first thing any discussion on mechanism does, in a textbook say, is divide the discussion by cause. And we already have a cause section. There is nothing common we can say about mechanisms in epilepsy. It does not make for efficient or logical article structure. -- Colin°Talk 18:46, 15 October 2014 (UTC)
  • Support this is a standard section and we do have a mission to be encyclopedic here. This includes a 'mechanism' section on the basic pathogenesis of a disease, or the putative understanding thereof. --Tom (LT) (talk) 00:24, 16 October 2014 (UTC)
    • Tom (LT), can you tell me what the mechanism is (or is purported to be)? I've asked below, and so far neither the splitters nor the mergers have been able to answer my question. WhatamIdoing (talk) 00:46, 16 October 2014 (UTC)
      That's a great question, WhatamIdoing. I and I am sure many others wish there was more clarity on this, as the end therapeutic implications would be very positive. I do however feel that it is encyclopedic to have a section covering some of the current understanding of the topic. --Tom (LT) (talk) 00:52, 16 October 2014 (UTC)
      We have this textbook called Jasper's Basic Mechanisms of the Epilepsies. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:04, 16 October 2014 (UTC)
      Sure, we can cite that. We can cite page 466, in which they directly say that the mechanism is (a) "probably multifactorial" and (b) "of unknown nature". Or page 470, "Their [all the different forms of epilepsy] underlying mechanism remains unknown". If you look at individual ones, rather than epilepsy as a whole, at least you can give small hints about whether it's likely structural or genetic. WhatamIdoing (talk) 03:49, 16 October 2014 (UTC)
      Yes we do something similar in a lot of article. We could say their are like a number of mechanisms and the exact specifics are unknown. Than discuss some of the hypothesis which apply to some of the more common types and the details regarding seizures which are more clear. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:15, 16 October 2014 (UTC)

      Yes WAID I think even that sort of general breakdown of the categories of mechanism should be in there. In the case that there are many things that could be said, see if the 80/20 rule applies, cover the basics for the most common/highest impact ones, leave the details to a subarticle. I can't imagine why this would be objectionable. Zad68 04:23, 16 October 2014 (UTC)

      Because nobody appears to be able to say what the "basics" are, or what the "most common" or "highest impact" mechanisms are. This seems to be a fight over whether to have a section titled ==Mechanism== when nobody has any idea what sentences could legitimately go under it.
      I looked through the long book that James recommended there. My impression is that the answers, depending significantly on the type, are "maybe it's structural, but we don't actually know", "maybe it's genetic, but we don't actually know", and "we have absolutely no idea at all, sorry". (This, by the way, should form the basis of a ==Classification== system, because the book says that this three-part best-guess system is the basis for the WHO's classification of epilepsy.) I was not able to find an agreed-upon mechanism for even a single subtype, and all the general statements amount to "we don't know". I'm starting to think that we need things called "sentences" and "paragraphs" with "encyclopedic content" before we try to decide what the section heading should be called. WhatamIdoing (talk) 05:31, 16 October 2014 (UTC)
      The basics include: a large number of causes (some known and some unknown) result in an increased risk of synchronized neuronal activity. When this synchronized neuronal activity occurs a seizure results. The location of the discharge in the brain determines the type of seizure.
      This increased risk occurs due to a number of mechanisms, some known and others unknown. Some include a decrease in inhibitory neuronal mechanisms due to changes in ion channels or injury to inhibitor neurons. Others include an increase in excitatory circuits due to changes in neural networks. These mechanisms are more clearly defined in secondary epilepsies. Many primary epilepsies are believed to result from gene mutations that effect the same mechanisms (ie decreased inhibitory neuronal mechanisms). There are lots of sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:50, 16 October 2014 (UTC)
      James There are causes rendering the brain susceptible to seizures by decrease of inhibition or increase of excitation - but this decrease and increase is the fundamental mechanism of any neuronal networking, not specific to pathology. How, for example, do you explain epileptic EEG patterns in persons, who never have seizures. Or, how does it come, that in some persons with seizures there are no interictal discharges whilst in others there a lot? Jophiel 09:52, 16 October 2014 (UTC)
      WhatamIdoing I fully agree - we need some content first before we try to decide what the section heading should be called - or if we need a section at all. Jophiel 09:58, 16 October 2014 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── James, what you wrote does not mean anything. Here's what you wrote:

The basics [mechanisms] include: a large number of causes (some known and some unknown) result in an increased risk of synchronized neuronal activity. When this synchronized neuronal activity occurs a seizure results. The location of the discharge in the brain determines the type of seizure.

This increased risk occurs due to a number of mechanisms, some known and others unknown. Some include a decrease in inhibitory neuronal mechanisms due to changes in ion channels or injury to inhibitor neurons. Others include an increase in excitatory circuits due to changes in neural networks. These mechanisms are more clearly defined in secondary epilepsies. Many primary epilepsies are believed to result from gene mutations that effect the same mechanisms (ie decreased inhibitory neuronal mechanisms).

Here's what you wrote, only translated into plain English:

There are a large number of causes of epilepsy (some known and some unknown). Epilepsy results in a risk of seizures. When a seizure happens, a seizure results. The location of the seizure in the brain determines the type of seizure.

The increased risk of seizures occurs due to a number of mechanisms, some known and others unknown. Some mechanisms for having seizures include a decrease in inhibitory neuronal mechanisms due to changes in ion channels or injury to inhibitor neurons. Others include an increase in excitatory circuits due to changes in neural networks. These seizure mechanisms are more clearly defined in secondary epilepsies. The cause [NB: this is not the mechanism] of primary epilepsies is believed to be genetic mutations that increase the risk of seizures in similar ways.

Most of that is either repetitive, or tautological, or both. "A seizure is caused by <medicalese that is a synonym for seizure> is not an explanation. The alleged mechanism is not explained. How exactly is physical brain trauma supposed to cause changes to some ion channels on neurons? "Blunt force trauma shakes ion channels out of their holes and breaks their timing belt, causing the mistimed firing that is a seizure" would be a mechanism. "We measured some changes to an ion channel, so maybe that's an isolated piece of the puzzle" is not a mechanism for how one develops epilepsy in the first place. (Ion channel changes could also be the result of the brain trying to stop seizures, or the new damage caused by the seizure itself. The fact that it exists doesn't mean that it's part of the how-to-get-epilepsy-to-begin-with process.) WhatamIdoing (talk) 15:45, 16 October 2014 (UTC)

Whether a physiological explanation of what a seizure is accounts to "medicalese" is not subject of a counterargument. The physiological background might not explain why seizures occur in the first place (cause), but rather how they occur (mechanisms), which is profoundly relevant to the article. -- CFCF 🍌 (email) 13:25, 17 October 2014 (UTC)
CFCF, it doesn't even matter if it's written in medicalese. "A seizure is caused by <a plain English definition of seizure>" would still not be an explanation of what causes a seizure. Imagine if I wrote "Falling down is caused by falling down". It's nonsense in plain English, and it's nonsense in fancy academic language, too. "Falling down is suddenly and involuntarily moving from an erect position to a prone one"; falling down is not caused by suddenly and involuntarily moving from an erect position to a prone one". What James wrote about the "cause" of seizures is only a definition of what seizures "are". WhatamIdoing (talk) 16:21, 17 October 2014 (UTC)
User:WhatamIdoing I think you'll find that isn't the definition of a seizure, but rather the pathophysiology. A few dictionary definitions: "A sudden attack, spasm, or convulsion, as in epilepsy or another disorder." (American Heritage Dictionary of the English Language. This one includes some physiology, but doesn't give it as a definition, but rather a cause: A sudden episode of transient neurologic symptoms such as involuntary muscle movements, sensory disturbances and altered consciousness. A seizure is caused by abnormal electrical activity in the brain, which is often diagnosed on an electroencephalogram. (American Heritage Science Dictionary). And these are only googled, I didn't have time to look into medical dictionaries. -- CFCF 🍌 (email) 16:48, 17 October 2014 (UTC)
I believe that you will find that the technical definition differs from the layman's understanding. PMID 11580774 appears to be the current technical definition, and it is "manifestation(s) of epileptic (excessive and/or hypersynchronous) usually self-limited activity of neurones in the brain". Sources like PMID 18627792 speak of "asymptomatic seizures" (this study recorded six of them), which wouldn't be possible under the dictionary definition. WhatamIdoing (talk) 19:04, 17 October 2014 (UTC)
  • Support per principle of least astonishment. If there is no one "mechanism" or even no single underlying thing because many things with similar presentations get lumped into the "epilepsy" bucket, then explain that and provide a general overview of the range of relevant topics. The article needs to have this. Zad68 02:36, 16 October 2014 (UTC)
    • Zad68, I haven't seen any justification for this section beyond that some med students, mistakenly still thinking epilepsy is one disease because they haven't gone on their neurology 101 course yet, might look for it. A general reader doesn't go looking for a mechanism section so would not be astonished to find it missing. Just as nobody goes looking for a mechanism section in the blindness article and nobody is astonished to find it missing. Indeed, I would be astonished to find it. More people understand that blindness is not one disease and the causes and mechanisms of blindness are manifold and separate, but ignorance is not a reason why epilepsy should be structured the same way as polio or diabetes. -- Colin°Talk 07:15, 16 October 2014 (UTC)
      • Wikipedia health article are the voice of the reliable sources on the topic. I checked sources before participating in this discussion and saw that the mechanisms or pathophysiology of epilepsy is discussed in a wide variety of reliable references. If they do it, then we can and should, too. Giving a concise overview of topics in an organized way is the awesome service the Wikipedia provides. There is no good reason not to do it on this article, too. Sydney Poore/FloNight♥♥♥♥ 15:12, 16 October 2014 (UTC)
        • You keep saying I read the whole page, I read the sources. But on the level of new arguments which could help solve the issue you have not yet made a contribution. An RfC is not a voting system. Jophiel 11:03, 17 October 2014 (UTC)

Oppose[edit]

  • Oppose Come on, let us stop this. This is all hypothetical. We do not have any content so far to put in a section 'pathophysiology'. Once we have plenty of content I think we will see where it fits best. My major issue is rather on James' conduct as editor acting in a way as he was the owner of this article, repeatedly refusing to discuss fairly. With respect to pathopysiology (mechanism), for those interested, my argmuments were:
The content currently in the section 'mechanism' is just a one-to-one copy from the article about epileptic seizures, this just does not makes sense because epilepsy is not the same as seizure.
Currently epilepsy is defined by having had two seizures [19], thus it's a definition of an abstract thing. Example: A group is defined by having two members. But the common (concrete) properties of the members, which give rise to grouping them, are by no means inherited or transferred to the (abstract) group. Thus, logically there cannot be something like a mechanism of epilepsy because abstract things cannot have a mechanism. For something to have a mechanism you need a concrete definition, like in the case of seizures. Thus, all mechanistic details belong to seizure.
However, the conception of epilepsy is also different to other diseases, in that there are a variety of (increasingly identified) underlying causes, which are disease entities by themselves and as such having different pathophysiologies. So you cannot refer to the pathopyhsiology of epilepsy (because of what I said above), but you can of course refer to the pathophysiology of the respective underlying disease. So when grouping these pathophysiologies you would group them in the same way as you group causes, for instance: inherited genetics / single gene -> ion channelopathy. Thus, pathophysiology directly belongs to the cause, so we should keep it there, the section about causes need to be extended anyway.
Summary: When referring to pathophysiology, you could either mean the pathophysiology of seizure or the pathophysiology of an underlying disease, there is no such thing as 'the' pathophysiology of epilepsy. The ILAE definition of epilepsy was changed from "enduring predisposition" (with connotation on the predisposition and the mechanism) to "having had two seizures" exactly because of this.
Having said all this: To have a separate article about the mechanisms of seizures and epilepsy make even less sense than to have a section here.
James said: Source XY is talking about a mechanism of seizures and epilepsy. I responded to this, that a good article is not generated by a bunch of sources but by in-depth understanding, reason and editorial judgement, so giving references "where they say so" is not an appropriate response to my arguments. In the end it's up to the arguments of the editors to decide to use the concepts of a source or not, but my arguments were not refuted. Jophiel 123 (talk) 10:43, 12 October 2014 (UTC)
If you disagree with the current format of the section you will need to come up with an alternative before completely removing content that has some use for the average reader. I think it needs to mention both the underlying disease and how this leads to individual seizures. JFW | T@lk 19:59, 12 October 2014 (UTC)
The current section wouldn't be so disagreeable if it wasn't a copy/paste of what is in epileptic seizure. The fact that the text is identical apart from some copyediting is surely a warning sign of maintenance issues and a fundamental lack of understanding over what the different role each article plays on Wikipedia. Because we are not discussing verifiable facts here, or medical opinions, but simply the best way of presenting two related but distinct topics to the reader on Wikipedia. To claim the content was "removed" is somewhat disingenuous, since it is still present in the correct place: epileptic seizure. You will be aware that James is also edit warring over content related to epilepsy syndromes and whether that content should be here or in the epilepsy syndromes daughter article. Are you going to berate James for removing "content that has some use for the average reader" when he took a scythe to the syndromes section? Moving text around, or ensuring whole paragraphs aren't merely repeats is not "removal" but quite a normal process in editing. I will note that before James started editing the article, it looked like this -- the section (called Pathophysiology) was nothing great I will readily admit, but it was at least focused on Epilepsy rather than seizures. Jfdwolff, if one decides, say, that the best way to present mechanisms of epilepsy to the reader is alongside the discussion of each form of epilepsy, then it is inevitable that text based on the old approach may be removed before text based on the new approach is fully available. Our Editing policy fully encourages making changes that leave the article less than perfect -- Wikipedia is and always has been a work in progress. You will recall that before Jophiel turned up on the 15th September, this article had one very short paragraph on syndromes and James is actively blocking the development of that section. How is one expected to make significant improvements in structure, proportion and location if every single edit is subject to His Lordship's Consent and immediate revert? -- Colin°Talk
The epilepsy syndrome section is not the topic of this thread. And fixing plagiarism is not blocking developing. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:49, 12 October 2014 (UTC)
  • Oppose unless and until someone can identify the contents of the proposed section, and can demonstrate that said contents are actual mechanisms (not causes) for epilepsy (not seizures). Ideally, said content would be more than "we don't know" and not cause-specific. Sentences first, section headings later. WhatamIdoing (talk) 15:48, 16 October 2014 (UTC)
IMHO, we are massively over thinking this topic. A section that explains the mechanisms of epilepsy appears in a variety of sources. Readers expect to see it. Students will be asked to write about it. And professionals want to see a quick reference type explanation. It is a kind of original research for us to discard the contents of the reliable sources because we don't like that they can't give one clear mechanism for all people that have what is called "epilepsy". Sydney Poore/FloNight♥♥♥♥ 20:31, 16 October 2014 (UTC)
FloNight I wonder why you keep saying "we" don't need to think about that so much. "You" apparently don't need it. You did not contribute any new arguments here and, with regard to the "reliable sources", you refrained from giving an answer to the question what the content is roughly supposed to be. Jophiel 10:49, 17 October 2014 (UTC)
WhatamIdoing I made a new proposal [20] - but which does not really meet the ideal :-) Jophiel 10:49, 17 October 2014 (UTC)
  • Oppose Colin has not checked here but he opposes (as everybody knows). Jophiel 08:14, 17 October 2014 (UTC)
You have already opposed and you do not get to oppose for someone else. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:26, 17 October 2014 (UTC)

Discuss[edit]

  • From the RFC intro, I gather that the argument for including is the mechanism section that it's been there for a long time and the section is part of WP:MEDMOS. However, I'm not clear on the reasons for removing the mechanisms section. There are a whole lot of words up above there and I'm sure the reasons are in there somewhere but I'm feeling lazy so I don't want to read it all. Can someone provide the tl;dr version of the reasons why the mechanism section should be removed? Thanks. Ca2james (talk) 02:14, 12 October 2014 (UTC)
  • I'm not sure that this RFC is going to produce really useful information. It seems to me that what goes in the article matters much more than whether there is a section with a given name. WhatamIdoing (talk) 02:08, 13 October 2014 (UTC)
    • I agree that the content is more important than the title of the section, but I also think that the way that an article is organized is part of what makes it accessible to the reader. Having a consistent place to find content is pretty important for a someone who is not too knowledgeable about a topic such as students, or even a busy professional who is skimming as a Wikipedia text as quick reference. It is not absolutely necessary for all article to be organized in an identical way, there needs to be a strong reason to not use the WP:MOSMED for anything longer than a start article, especially a Good or FA. Sydney Poore/FloNight♥♥♥♥ 18:35, 15 October 2014 (UTC)
      • FloNight, do you realise I wrote much of MEDMOS, including the "suggested" sections part (though I built on what was there in earlier efforts). Those sections were just a very rough guess and the MEDMOS text makes it abundantly clear they do not apply to all diseases (which epilepsy is not -- it is a group of diseases). Articles should use sections appropriate to the topic. That's what MEDMOS says. -- Colin°Talk 18:49, 15 October 2014 (UTC)
        • I'm familiar with WP policy. My reasoning stands that I think a separate Mechanisms section is the best approach to use on this article. One reason is because the consistency of where to find information is an important aspect of what makes Wikipedia an useful reference. And in this instance, I've also given other reasons in other places on this page. I spent a good bit of time reading all of the discussions on this talk page considering whether there was a good reason to remove the Mechanisms section from article. I've stated my opinion and I don't want to have to argue with you about it until the cows come home. :-) Sydney Poore/FloNight♥♥♥♥ 22:05, 15 October 2014 (UTC)
  • Sometimes I find it not easy to follow all the threads here, but just to get you right (including what you said in other places here): Your argument is consistent structure among different articles which results in better accessability for the reader, right? You said further, that there are "adequate sources to write a section" so you probably had a glimpse into them. May I ask you if you got an idea for yourself what the content of the section "mechanism" could roughly be (or not be)? That would be important to know, maybe we missed something. Jophiel 22:51, 15 October 2014 (UTC)

Stop[edit]

Can I remind everyone that we don't vote on Wikipedia. Also, you are voting on the wrong thing. Which is one reason we don't vote on Wikipedia. We are supposed to discuss article content, engage with other editors, and strive towards consensus. This is not happening here, which is why I believe there is not a content issue, but a behavioural issue with one editor.

The "Mechanism" section that was removed was identical to the one on Epileptic seizure. Clearly Wikipedia does not need two identical sections when one article is on individual seizures (which are acute events that may occur outside of epilepsy) and the other is on epilepsy as a chronic condition. Now there are various ways in which epilepsy is believed to occur but these are really quite heterogeneous. What causes epilepsy in Dravet syndrome vs Tuberous sclerosis vs stroke, vs cysticercosis? There is no one mechanism, and any discussion of such is intimately tied up in Cause, which is another section. Much of our understanding of these mechanisms is speculation as we don't really understand the structures of the brain that well -- and a seizure requires more than just one neuron. Whenever one constructs an article on Wikipedia, one must consider the whole topic. What works for headache or polio may not work for epilepsy. Let's quote the relevant section from MEDMOS:

The following lists of suggested sections are intended to help structure a new article or when an existing article requires a substantial rewrite. Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition. Do not discourage potential readers by placing a highly technical section near the start of your article.

Note the comment on "simply to fit these guidelines". When I wrote those guidelines, I was aware that some editors might take the suggestions and rigidly apply them to articles where they don't fit. Sadly, despite clear text in MEDMOS, the editor who started this RFC is imposing those mere suggestions upon articles where they don't work. A recent example of disruptive editing "per MEDMOS" can be found at Ketogenic diet where a carefully planned order of sections was ripped up in order to fit a perceived rule that doesn't exist.

What does Epilepsy need then? Well it certainly doesn't need a copy/paste of the text in epileptic seizure, which is what it had and which is what was removed. Is the "mechanism" best handled per cause, per syndrome? I don't know but how to handle this is something to discuss, not vote on. That's way too simplistic and frankly just set up here in order for one editor to get his way. Sometimes, in order to make progress on an article one has to say "You know, that approach was wrong. We need to go about this a different way". Removing the "wrong approach" of having a single "mechanism" section is pretty harmless (since the information is already in another article) and leaves us the opportunity to fill the gap in a different way. Now two editors may disagree on what is the best approach, but they should be assuming good faith and considering whether the alternative approach is reasonable, even if you don't think it optimal. Sometimes you have to run with the other guy's suggestions for a while just to see how they turn out. This is a wiki, so if an alternative approach turns out to be awkward then we can easily try again. No harm done.

But if you look above, you see no assumption of good faith and reasonable edits being reverted as though made by a vandal or POV pusher, and the only approach acceptable is the one James approves. James says "Typically it is a new edit that needs consensus to change what was their previously" (and he has promised on his talk page (now deleted) that he will continue to revert changes to sourced text that have not gained his consent). This is the complete opposite to policy. Such a timid approach is occasionally necessary on highly controversial, high traffic and already featured-status articles like autism, but absolutely harmful on a straightforward, very low edit-traffic and very average article we have here. Wikipedia values change over status quo.

Our Editing policy encourages editors to improve content. To be bold. The avoid reverting if at all possible. It does not require every edit be vetted by the article owner. Since James is stubbornly refusing to engage with other editors on this page, and is actively discouraging consensus-forming through his reverts and his refusal to respond to valid points made by other editors, I propose James be temporary banned from this article until such time as he understands our Editing policy applies to him. An RFC full of "Support because MEDMOS says we should have this section" !votes is not how we write articles. -- Colin°Talk 08:52, 12 October 2014 (UTC)

Ah while you are certainly allowed to have your POV Colin. This is not really the place to propose a topic ban of another editor but you I believe know that. As I have stated a few times, yes the mechanism of seizures and epilepsy are closely related. This does not mean that they should only be discussed on a single page. This is similar to how pictures are allowed to be used on more than a single article. Additionally as I have suggested a couple of times it would be reasonable to have a sub article called Mechanisms of seizures and epilepsy and I have been considering starting one for a while.
This supposed recent disruption as you call it is from Sept 22nd.[21] It took you exactly 5 minutes to revert it [22] after which you left a less than pleasant message on my talk page [23].
Votes is one way of addressing decisions that depend on editorial judgement, for example should the Rorschach inkblot contain an image of the inkblots or not was decided by vote after extensive discussion had occured. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:13, 12 October 2014 (UTC)
I couldn't put it better than Jophiel has in the Oppose section above. But then, I'm not a neurologist and neither is James. Consider the mechanism that allows us to talk and whether this is the same as the mechanism that makes humans want to communicate by talking. Does it make sense to create one article on that? Sure there are common concepts that may require explaining here as well as the other article, but no need for 100% copy/paste. There's no comparison between copy/paste of entire sections of text and using a picture more than once. Please try to use an analogy that works. As for voting, well sorry James, but that's just more evidence that right now you've forgotten how Wikipedia works. James, can you even conceive that it might be possible to discuss the mechanisms in sections concerning syndromes and other related causes, rather than having a standalone section. Is there no universe where that's a rational choice, even if it isn't your choice? -- Colin°Talk 11:20, 12 October 2014 (UTC)

It is an interesting idea that one should be a "neurologist" to write about epilepsy on Wikipedia. And that editors should use their own deductive reasoning to decide what articles contain rather than following the sources. In my opinion Wikipedia is about verifiability not Truth. If Jophiel's suggest is as obvious as you make it sound he should not have any issue getting support from the wider community of editors. By the way discussing references is exactly how one resolves disputes on Wikipedia.Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:32, 12 October 2014 (UTC)

I think it does not matter if someone is a neurologist or not. But verifiability alone does not create a good article. I implicitly cited a source, it's the current ILEA definition on epilepsy (which is also part of this article). So in the end it is editorial judgement which source should be used and why. If editors do not agree right away it needs to be discussed with reasoning. Once (not before) this is done and still no consensus is achieved an RfC can be used to solve it. Jophiel 123 (talk) 14:21, 12 October 2014 (UTC)
My comment about Jophiel's claimed qualifications apply to his good explanation above. As James knows, even a lay person can write a complex neurology article. However, to take it beyond a basic level, and to ensure it contains no misunderstandings, one needs to have some fire in one's belly for the subject and to consult with the experts. My own neurology article had several reviews by a world-class expert on the topic. James, I suggest you have a word with Jimbo about your "Wikipedia is about verifiability not Truth." claim. That old myth has long since been discredited for the bankrupt soundbite it is. There is far more to article building than verifiability, and a good article is more than just the accumulation of facts drawn from distinct review papers.
It is interesting to note that this RFC is opened to discuss two options, one of which the proposer claims to not understand: "for reasons that are not exactly clear to me". There are several possibilities here. James is incompetent to understand the reasons presented, Jophiel is incompetent in his explanations of his reasons, Jophiel is an internet troll whose explanation defies all rational logic, or James and Jophiel have yet to communicate effectively. I favour the last option, given that both people seem bright and don't show any trollish symptoms. So the question here, is if James has yet to fully understand why he is edit warring to preserve his version of the article, why should anyone joining this RFC have sufficient information in which to contribute. This isn't a content dispute at all. It about an editor who has repeatedly reverted rational changes he disagrees with and has so dug himself into a hole that he can't admit the other guy even has a point, even if yet to be convinced that point is carries sufficient weight. It's why we don't vote -- both sides just end up polarising the situation in order to "win". James is only interested in winning, and has tried to recruit a mob. -- Colin°Talk 15:46, 12 October 2014 (UTC)
Colin this is not the place to attack individual editors. You need to stop commenting on editors and instead comment on content. Also you need to stop trying to make claims for me.
With respect to the Mechanism section it was my impression that Jophiel felt this article should not have one. I did not see his concern as being that the one here is similar to the one at the seizure article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:47, 12 October 2014 (UTC)

A bit of a clean start[edit]

I am a bit disappointed that this article has become a bit of a battleground, and I think we all need to decide where we want to go with this. I think Jophiel 123 has a number of valid points that arise from the observation that we were not covering the epilepsy syndromes clearly enough. This may inevitably have been result of James and myself being generalists and Jophiel a specialist (but I am only speculating). We certainly need to cover that, and we need to include the relevant pathophysiological features into the "Mechanism" section also. We do however also need to include some basic information about the key symptom of epilepsy, which is seizures; inevitably there will be some overlap with the epileptic seizure article that also discusses all other (including provoked and non-epileptic) seizures.

This page is going nowhere unless we can agree that we are all trying, from differing perspectives, to ensure that this is a high-quality article. I have asked Jophiel about his/her current priorities with this article, and I would like to ask the same of Jmh649 and Colin. JFW | T@lk 22:02, 12 October 2014 (UTC)

I think we should have a clean start not with regard to the content of this article but with regard to communication.
  • Reverting only when necessary i.e. when an edit is really detrimental
  • When reverting, good reasons needs to be indicated
  • Issues are always to be discussed by reasoning. An opinion is not a reason.
  • If someone has no response to an argument, he/she should concede
  • This article is not owned by anyone
This is all covered in the policies etc. but maybe it helps we agree here again on it. Jophiel 123 (talk) 22:35, 12 October 2014 (UTC)
The situation we are in is 1) you do not feel I have any good reason to justify keeping the mechanism section 2) I do not feel you have any good reason to justify removing the mechanism section.
I believe your removing it is detrimental, you appear to believe my keeping it is determinantal
You appear to consider my position opinion and yours reasoned, I consider your position opinion and mine reasoned
We both appear to think the other should concede
Colin appear to feel that I should leave the article to you. I am of the impression that neither you nor Colin are taking the concerns I have raised seriously. Though you have addressed some of them in your later edits.
Typically when this sort of issue occurs my position is that one should get a wider number of opinions. One mechanism is a RfC. Yourself and Colin appear to be against this mechanism. Instead there appear to be a wish to frame this as a user conduct issue on my part rather than a content issue (ie should this article have a section on mechanisms?)
Now Jophiel I welcome you here and am happy to work with you. If we cannot agree that we are to be guided by the references we will likely struggle.
Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:08, 12 October 2014 (UTC)
Assuming we agree on the above mentioned rules and we want to start from scratch, may I ask you explain your following points of view with your own words:
  • Is there something else beyond the pathophysiology of seizure and the pathophysiology of the underlying diseases causing epilepsy?
  • If yes, can you please specify. If no, why do you think the pathophysiology of the underlying diseases does not fit into the section on causes?
  • Do you think epilepsy syndromes are different from other cases of epilepsy. If yes, can you please specify. Jophiel 123 (talk) 07:41, 13 October 2014 (UTC)
Yup there is epileptogenesis / kindling. Why should the underlying pathophysiology be split out rather than added to the causes section? While doing so keeps the causes section simpler with the more technical biochemistry / discussion of neural circuits in the mechanism section. It is also a better place to discuss the underlying mechanics of a seizure.
As an example we know that serious head trauma can cause epilepsy. This epilepsy however may not begin until years later. What is the underlying processes that link the head injury (cause) to epilepsy? While that underlying process is the pathophysiology. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:40, 13 October 2014 (UTC)
Epileptogenesis is largely concerned with why epilepsy forms after an event (such as brain trauma) and less so with e.g. genetic conditions, though the term may still be used. The kindling model is just that, a model, which isn't applicable to all forms of epilpesy. This aspect of epilepsy is probably the hardest to write for a general audience. The full details how current theories can be explained in each article on epilepsy syndrome or significant cause. It is hard to see how we can write here more than a brief overview indicating the variety of mechanisms, as well as briefly explaining the "mechanics of a seizure". Such can be an introduction to or a sub-section of Cause. A top-level section on Mechanism is just grouping this aspect the wrong way up -- one can't give a decent explanation of any mechanism outside of the particular cause it applies to. -- Colin°Talk 14:28, 13 October 2014 (UTC)

Jfdwolff, thanks for trying to make a new start. However, you can see from above that the underlying problem has not been resolved: James owns the article. Jophiel's suggested way of working should be unarguable: it is what our WP:Editing policy requries of every editor. Yet James refuses to accept that. My earlier suggestion that James "let Jophiel have a go at the wheel of the car" is not the same as "Colin appear to feel that I should leave the article to you." I have no more wish to see Jophiel own the article than James or Jfdwolff or myself. I would like to see someone other than James being able to make an edit that survives more than 12 hours! Honestly, if I am to contribute at all to improving the article, edits have to take place over a period of days and absolutely no edit warring, and an assumption of good faith. This RFC should not have been necessary, and asked the wrong question anyway.

James repeats that we need to be "guided by the references", as though some of us disagree. Unfortunately there are no references called "How to compose a Wikipedia article on the subject of epilpesy". James has above claimed that the mere presence of a chapter in a book on epilepsy is sufficient evidence that his approach to the article is the one and only way. James repeats the old "verifiability, not truth" myth, which was often misinterpreted. Verification is a necessary requirement for inclusion but it is not a sufficient requirement for inclusion. Our sources are not hyperlinked encyclopeadia. They can, if we examine enough of them [not just a smattering of reviews], guide us as to the weight we should apply to a topic, but they don't tell us how to order or name our sections, they don't tell us the One True Way to group information, they don't tell us how to balance the inclusion of material in the main aritcle vs daughter articles. How do we determine such things? Well we can speculate as to what might be the best approach, we can examine the current approach to see if it is working for us, and, since this is a wiki, we can experiment with a different approach to see if it leads somewhere better.

James above comments that he has some views and Jophiel has others. They can't get to agree. He argues, wrongly, that all change to the article must gain consensus before being applied. Therefore, we have a stalemate and the article in the state James wants it. James has said on his talk page that, wrt to me, he has "come to realize that we may have a fairly different idea around how Wikipedia does and should work". Well from what I see here, James has peculiar ideas on our Editing policy and rules on Ownership of articles, Please do not bite the newcomers, Assume good faith, Disruptive editing and Etiquette.

We will only succeed if our communication and behaviour follows a different path. I don't actually believe that our differences about content strategy are unsurmountable. It needs communication where editors attempt to understand and appreciate the other's suggestions and ideas, rather than a battleground where one only defends ones own position while rubishing the other. An environment where edits are made and stick. Where new text is improved rather than deleted.

I think James needs some time to cool off before he can work sucessfully with anyone on this article. I have suggested that Jophiel work on another article for a while, but what he works on is his choice. If James won't work constructively with others, following actual Wikipedia policies and guidelines rather than his own interpretation, then I repeat my request to topic ban him for a period. It's his choice -- will his response to this be further attacks on others, or a serious reflection on how he has behaved so badly that a longtime wikifriend is asking for him to be topic banned? -- Colin°Talk 12:03, 13 October 2014 (UTC)

I had hoped that this thread would get us back "on topic" rather than quoting rules at each other. I am of the view that we need to explain to the average reader why people with epilepsy get seizures (in the most basic, electrical terms) and perhaps something about triggers and seizure threshold. Therefore, removing the "Mechanism" section entirely seems counterintuitive, at least from the perspective of a reason. Simply copying parts of other articles is probably not the solution. I think we need to focus on resolving this disagreement, and less about attitudes and personalities. Perhaps we can agree on an outline for a new mechanism section. JFW | T@lk 18:08, 13 October 2014 (UTC)
I don't think anyone disagrees that the causes of epilepsy need to be covered alone with some of the possible mechanisms. But there's a fundamental disagreement that this needs to be a top-level section separate from Causes. While the need for this top-level section is in dispute, and an unresolved RFC opened on it, James continues to fill it with copy/paste from other articles. I guess he has assumed he was "won" the RFC and that his rules that anyone must discuss and gain consensus prior to editing does not apply to him. Jfdwolff, I would deeply like to have an honest discussion about our approach to this article without mentioning anyone's behaviour, but is this possible while one person continues to behave as owner? -- Colin°Talk
This article must not be edited in sections on dispute. James, Colin responded to your arguments on epileptogenesis and kindling and you just do not respond any more and start rewriting the article? It appears you take it a little too easy. Don't you think there could in fact be some issues on your conduct? Why should people spend so much time trying to tell you this? Doing so now makes it even worse.
With regard to all that has been said so far, there should be a paragraph in the lead section mentioning that there is no single pathophysiology of epilepsy. The pathophysiology of the respective diseases will fit into the causes section. Even if it seems counterintuitive not to have a section on mechanism - that's due to the fact that epilepsy's is different to other diseases i.e. it's concept is counterintuitive - but we cannot help it by adding a section. This concept is exactly what needs to be understood, thus explain it in the lead section. Jophiel 123 (talk) 19:49, 13 October 2014 (UTC)
Seriously, JFW, you recommend to focus less about attitudes and personalities. James is now even more behaving unfairly. This IS (and has been) a matter of attitude. Jophiel 123 (talk) 20:03, 13 October 2014 (UTC)
Jophiel 123 Now that James has made changes to the "Mechanism" section to give more information on epileptogenesis, perhaps you could make the changes that you believe are required. If you get reverted, you are entitled to an explanation on the talk page.
I support the existence of separate "causes" and "mechanism" sections. They are not the same. A cause is a sine qua non for the development of a condition, while the mechanism is the pathway by which the numerous of causes of epilepsy lead to a propensity to seizures. To compare, dengue fever is caused by a virus but the mechanism by which it causes disease can be discussed in a separate section. JFW | T@lk 22:44, 13 October 2014 (UTC)
The term epileptogenesis will not really resolve our difficulties in common understanding (nor will a section "mechanism"). As Colin mentioned before, the term is largely concerned with why epilepsy forms after an event (such as brain trauma). It means rendering the brain susceptible to seizures (not necessarily epilepsy). Epileptogenic changes in the brain may already be present but not yet resulting in seizures, maybe only the threshhold for seizures will be lower than in a normal brain, the affected person may just have one seizure, or develop recurring seizures one day (i.e. the affected person may not be diagnosed epilepsy but epileptogenesis is "going on"). There is quite some content in the article on post-traumatic epilepsy. I do not know, 1. if this term should be used for other possible mechanisms, 2. if other mechanism are known at all, 3. if there is a difference between short-term and long-term mechanisms (as far as I understand this is possible). What I am saying is, that epileptogenesis does not even necessarily mean generation of seizures but making the brain susceptible to seizures. So it may possibly better fit into the article on seizures (or just into the article on post-traumatic epilepsy or post-traumatic seizures. As I said, currently I would favor to have just an explanatory paragraph in the lead section and no section on mechanism.
I suggest (see below) we raise an inventory first, let's see what we have at all, scattered in different articles, then we can see how to arrange all the knowledge. Jophiel 20:00, 14 October 2014 (UTC)
I've just read Jophiel's paragraph above after adding my response to the "Propose added to mechanisms the following" section. As I said there, I'm not convinced we need to describe this word at all. I'm sure that when discussing symptomatic causes such as stroke, or a brain lesion, we have the opportunity to mention theories about how those events lead on to epilepsy in some people and not others and what if anything we can do to prevent that. These are both things that I as a reader would want to know from an article on epilepsy. Currently I'm not told, but am repeatedly given the definition of a word I can barely pronounce. -- Colin°Talk 20:10, 14 October 2014 (UTC)

Questions for you[edit]

Can I get a few (I hope) basic questions answered, just for my own knowledge?

  1. Do we actually know how a person develops epilepsy (i.e., how you can become a person who has epileptic seizures)?
  2. If we know how this happens, is that knowledge at the solid level of "we know how people become infected with a pathogen" or at the more complicated level of "we mostly know how most people develop heart disease" or at the baffling level of "we really have no idea at all how some of these cancers get started"?
  3. If we know how it happens, is the mechanism the same for everyone with epilepsy, or at least similar, or is it sort of like cancer, i.e., different types of cancer probably have different causes and different types of epilepsy probably have different causes?

From the comments above, it looks to me like we know the mechanics of the seizures themselves. But so far I'm thinking the answers to my three questions are:

  1. No, not really.
  2. Closer to "baffling" than anything else (although, like cancers, we have lots of as-yet unproven hypotheses).
  3. Probably different causes (but see #1: nobody knows).

Is my impression approximately correct? WhatamIdoing (talk) 17:13, 13 October 2014 (UTC)

I'm no doctor but here's my best effort. In answering the third, it complicates the first two. I'll quote from my "Epilepsy: A Comprehensive Textbook 2nd Ed, Engel & Pedley". Page 505 says "Many different types of human epilepsy exist, and these reflect a variety of underlying fundamental neuronal mechanisms. Even with a given epileptic disorder, there are many components parts for which unique mechanisms can be identified." Page 495 says "Most of our views concerning the fundamental neuronal mechanisms of epileptic phenomena derive from investigations carried out on experimental animal models" and goes on to indicate how this is less than ideal. Coming back to #1. Page 217 says "What can be said at present about the fundamental mechanisms of different forms of epilepsy? In partial epilepsy, it appears that areas of hyperexcitability are associated with some form of brain of synaptic reorganization that occurs after brain injury. ... Neurons within epileptic areas in these structures undergo synchronous and paroxysmal depolarizations, and fire bursts of action potentials. .. Why such events occur at all, and why they occur at any specific point in time remains unknown. After all, even in the most severely affected individuals with epilepsy, seizures occur only intermittently. ... Primary generalizes seizures present a different set of challenges... no focal target for detailed examination... many ... are the result of genetic alternations in CNS function, several of which are currently being unravelled." We can, however, reliably induce seizures in animals and know how to give animals epilepsy either though procedures or genetic alternation. Some genetic conditions are so severe that epilepsy is inevitable, whereas in others we don't know why some get it and others don't or why it may be more severe or even what kind of seizures they will develop. Some adult-onset epilepsies, that can be treated with surgery, are better studied. But we can neither reliably predict whether someone with a brain lesion, say, will get epilepsy, never mind when any individual will have a seizure.
What is interesting is whether the answers to those questions you raise are to be found in the article? Are the answers I gave above contained in the article? Does our current Mechanism section have a clear scope, with an introduction, development of ideas and comprehensive summary of the topic?
Any comprehensive epilepsy textbook has to be a complete self-contained work. It will contain material that we, as a hyperlinked encyclopaedia for the general reader, might wish to include elsewhere or to simplify considerably. In order to discuss mechanisms of epilepsy, it may spend considerable time talking about neurons, excitability, brain networks, different parts of the brain, animal models, gene expression and so on. In the above 3000-page textbook, nearly 300 pages are on "The Neurobiology of Epilepsy" but only a dozen of those on the chapter "Basic mechanisms of epilepsy". Another book I have, the Oxford Specialist Handbook in Neurology series "Epilepsy", has a one of it's dozen chapters on "Mechanisms of epilepsy". Which initially sounds like support for having a top-level section. But if I break down that chapter, you'll see it what it contains:
  • Basic functional anatomy
  • Basic physiology
  • Basic neurochemistry
  • Mechanisms of epileptogenesis
  • Experimental models of epilepsy
  • Genetics and epilepsy
  • Causes of human epilepsy [this is just a list]
  • Pathology of epilepsy
There is overlap here with our Causes section,and with topics we can only really touch on here but must leave to other articles. And you can see from the quotes in the bigger textbook above, one can't really begin to be specific about mechanisms unless one is concerned with focal (partial) epilepsy or generalised, and even then it changes with cause. Can we do much more than wave our hands about and talk about excitability in a vague way? What's currently written in the Mechanism is very confusing, with repetition and a random selection of factoids drawn from separate reviews or even !! an elementary clinical medicine textbook. While this hodge-podge is often what arises on Wikipedia from the random edits inflicted upon it, I don't recommend that as an approach to serious article development. I'm yet to be convinced that what we need to say here can't be reasonably done within the Causes section, while also attempting to answer WhatamIdoing's questions in the article. -- Colin°Talk 19:19, 13 October 2014 (UTC)
One could technically combine all mechanism sections under the cause heading as mechanisms can sort of be conceived as causes. Epilepsy is not unique in this respect.
With respect to WAIDs question we do know some about the processes that lead to epilepsy but agree they are not as clear as in many infections. And yes their are a number of possible processes. We also know some about the mechanism that results in the most dramatic symptoms of epilepsy which are their seizures. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:17, 14 October 2014 (UTC)
Mechanism and cause appear to be distinct concepts here, as they are in many other cases. For given problem, such as "falling down", the mechanisms are going to be things like "leg collapsed under weight" or "center of gravity tipped past tolerance". The actual cause will be different: weak muscles, broken bones, or vertigo. I think that model is more relevant than infectious disease model, in which the cause is "got infected" and the mechanism is "what happens when you have this pathogen in your body".
If Cause A happens works though Mechanism A, and Cause B is Mechanism B, and Cause C goes with Mechanism C, then the reader would probably get more benefit from sections about ==A== and ==B== and ==C== than from ==Scrambled causes== and ==Mixed-up mechanisms== sections.
If, as Colin's explanation above suggests, the real mechanism for epilepsy (that is, what changes in the brain to make it have recurring epileptic seizures) is "we don't know", then an honest, accurate, and neutral ==Mechanisms== section is going to be a fairly brief statement that sounds a lot like "We don't know what the actual mechanisms are". WhatamIdoing (talk) 21:09, 14 October 2014 (UTC)
Saying "we don't know" isn't fair. There is quite a lot of stuff people know (though often at such a low level that this article couldn't even begin to explain them) and quite a lot of accepted theory for some causes. Possibly the reason "molecular and cellular levels" get mentioned below is because it is at that level that lots of scientists are working -- because it is too hard to study the structures in a living human brain (the Streetlight effect). -- Colin°Talk 22:10, 14 October 2014 (UTC)
The answer to your original question is another question: "which epilepsy". But that doesn't stop it being an absolutely valid question. So one of the things this article must do is explain that different epilepsies not only have different causes but the mechanisms that follow and lead to epilepsy are different. The scientists try to answer your first question by giving animals epilepsy and studying that. But of course that only answers the question: how does a cat who we have injected a poisonous substance into his brain develop epilepsy? And then people must speculate as to how relevant that animal model is to certain human epilepsies. Again, this issue with experiments should be mentioned in the article. Perhaps in Research, but perhaps also briefly in Cause if we need to admit to why our understanding is limited. -- Colin°Talk 22:16, 14 October 2014 (UTC)

Propose added to mechanisms the following[edit]

I propose adding the following which would look like [24] " Epilepsy occurs when the brain contains changes that increases the risk of seizures. There are a number of mechanisms by which this occurs. Epileptogenesis is one process by which a normal brain develops epilepsy.[1] The process, which is gradual, occurs in symptomatic epilepsy, in which seizures are caused by an identifiable lesion in the brain.[2] It results from acute brain insults such as physical trauma to the brain, stroke, or infection. Epileptogenesis is a series of events that occur between the event that causes epilepsy and the first spontaneous seizure.[3] In epileptogenesis, an array of events occur on molecular and cellular levels that cause neurons to fire in a hypersynchronous manner, resulting in seizures.[4]"

Peoples thoughts Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:32, 13 October 2014 (UTC)

  1. ^ McNamara JO, Huang YZ, Leonard AS (October 2006). "Molecular signaling mechanisms underlying epileptogenesis". Sci. STKE 2006 (356): re12. doi:10.1126/stke.3562006re12. PMID 17033045. 
  2. ^ Herman ST (January 2006). "Clinical trials for prevention of epileptogenesis". Epilepsy Res. 68 (1): 35–8. doi:10.1016/j.eplepsyres.2005.09.015. PMID 16377141. 
  3. ^ Bertram E (2007). "The relevance of kindling for human epilepsy". Epilepsia 48 (Supplement 2): 65–74. doi:10.1111/j.1528-1167.2007.01068.x. PMID 17571354. 
  4. ^ Armijo JA, Valdizán EM, De Las Cuevas I, Cuadrado A (2002). "Advances in the physiopathology of epileptogenesis: Molecular aspects". Rev Neurol (in Spanish; Castilian) 34 (5): 409–29. PMID 12040510. 

My thoughts:

  • "brain contains changes" is rather vague. Are these changes at a chemical level; cellular level; structural level; focal or global; do they involve independent areas or the communication network between areas; etc.
  • An increased risk of seizures isn't sufficient to cause epilepsy unless those seizures actually occur and recur. Concepts of seizure threshold may be useful here.
  • "There are a number of mechanisms by which this occurs". This is where cause and mechanism become confused. Typically, when one thinks of cause, we consider the necessary event or events without which the illness would not occur. A stroke may be the cause of someone's epilepsy, but not everyone who has a stroke gets epilepsy. But the mechanism by which that previously normal brain becomes epileptic cannot begin without the initial damage. So "mechanism" isn't really the whole story of how a brain changes for the worse. Which is why it is so difficult to discuss this in isolation of specific kinds of causes.
  • "Epileptogenesis is one process by which a normal brain develops epilepsy". It isn't "one process". It is "the process". That's its dictionary definition.
  • "The process, which is gradual, occurs in symptomatic epilepsy, in which seizures are caused by an identifiable lesion in the brain." True, but I have less often seen it used when discussing how other e.g. genetic conditions produce epilepsy. The process is certainly better studied in the cases of trauma, where also prediction and prevention is an important clinical benefit of any research. But perhaps my uncertainty of when this jargon term is used isn't really important to the reader. Do they need to know this word at all? It isn't used elsewhere in the article. It sounds like the sort of term that could better appear in parenthesis, so the reader can learn it if they wish, but knows that it isn't essential knowledge. The process can be described when we discuss symptomatic epilepsies, rather than in a Mechanism section.
  • "It results from acute brain insults such as physical trauma to the brain, stroke, or infection." What is the "it" that "results"? If we are still talking about epileptogenesis then it "follows" but doesn't "result from". Also this sentence is wrong. A brain lesion may have no identifiable traumatic event.
  • "Epileptogenesis is a series of events that occur between the event that causes epilepsy and the first spontaneous seizure" is this just another definition that adds nothing to the earlier "process" definition. Also, it says "events" as though discrete things happen with a gap in between them. Is that really what happens, or is this "gradual" process one that evolves over time.
  • "In epileptogenesis, an array of events occur on molecular and cellular levels that cause neurons to fire in a hypersynchronous manner, resulting in seizures" is just another definition that essentially repeats the line before. And I think it is wrong, because the changes are not just (or even necessarily) at the molecular or cellular level but often involve the network of systems in the brain. While the process does ultimately cause a seizure, it also causes recurring seizures, which is the necessary requirement for epilepsy rather than just post-traumatic seizure, say. And neurons firing in a hypersynchronous manner do not "result in seizures" -- that is a seizure. This isn't nit-picking, as writers we absolutely have to be correct in our language usage.
  • The proposed text has some repetition with the existing sentence later in the section: "These secondary epilepsies occur through processes known as epileptogenesis.", a sentence which makes no sense because the preceding text isn't talking about "secondary epilepsies".

But the biggest problem I have with the proposed text is that it doesn't actually answer the question: given a particular causative event or misfortune of how one was made, how does one go on to develop epilepsy? And to what degree is science confident about that? The answer, of course, depends greatly on the cause. But even in the case focused on in the text above (symptomatic epilepsy following trauma or detected brain lesion), the proposed text does not actually say anything about what occurs. It just repeatedly defines a jargon term.

We don't build an article or a section by just adding some facts or a series of definitions. And why so many sources to achieve multiple definitions of the same term? If we are writing section X I'd want to read chapters and articles on X as a whole and am quite likely to find sufficient information in those to source text for a high level subject like Epilepsy. That's the only way to determine the weight and to get an idea of how other people present a topic. A paper dealing with epileptogenesis at the molecular level, as cited above, really isn't a good source for answering the bigger question "What does our reader need to know about this topic". -- Colin°Talk 20:04, 14 October 2014 (UTC)

I'm looking at Colin's notes, and perhaps this would be a reasonable first revision in (almost) plain English:

"Molecular and cellular changes to the brain cause epilepsy.[4] The gradual process of developing these neurological changes is called epileptogenesis.[1]

These changes occasionally cause neurons to fire in a hyper-synchronous manner. This hyper-synchronous firing of neurons is called a seizure.[4]"

The numbers are the same as Doc James' original; I think I've kept them with their content. I've removed "It may be caused by acute brain injuries, such as physical trauma, stroke, or infection" because that's ==Causes==, not ==How the original cause results in epilepsy== (mechanism).
Does anyone have any complaints about this? WhatamIdoing (talk) 21:26, 14 October 2014 (UTC)
Yes. It is not answering the question. To pick just one cause of sake of argument, what is the mechanism that follows a lesion or trauma in part of the brain and develops into epilepsy? Giving it a long name is neither sufficient or helpful to the general reader. Or another, what is the mechanism in childhood absence epilepsy? It is more than just molecular and cellular changes. As already noted, the term epileptogenesis is not widely used to describe non-symptomatic forms of epilepsy. The second two sentences are so basic I'd expect the lead to have dealt with that. We're in a "I wouldn't start from here" situation with this section. -- Colin°Talk 22:00, 14 October 2014 (UTC)
Further, wrt to "Molecular and cellular changes", I note above this might be arising from where research is occurring rather than a proper picture of what happens in epilepsy. Put simply: cells do not have seizures or get epilepsy; brains do. -- Colin°Talk 22:35, 14 October 2014 (UTC)
I think it's useful to define relevant terms, so that readers (a) can click through to those articles and (b) know what those mean, if they happen to encounter them elsewhere.
I agree that it doesn't answer the question, but so far as I can tell, the answer to the question was not present in the original text that Doc James proposed. When stripped down to plain English, it (so far) amounts to a bit of handwaving at "molecules" and "cells", plus a pair of definitions. It's like saying "Molecular and cellular changes cause cancer. The process of developing cancer is called carcinogenesis." It's basically true, but it's not at all satisfying if you want to know how someone actually develops epilepsy. WhatamIdoing (talk) 23:16, 14 October 2014 (UTC)
Exactly. There are different ways to define jargon for the reader: explicitly, implicitly and parenthetically. The latter is one I favour for terms the article does not use and where knowledge of the term really isn't important to understand the whole topic. In other words, "(epileptogenesis)" may appear somewhere in the text where the process is actually discussed and explained. But we wouldn't consider that repeatedly defining that term was a priority for the article, and actually makes the article appear more difficult to read, because the reader gets the impression they need to learn it. And wrt my analogy below, we can substitute "visual loss" for "seizures". I really don't think there is an epilepsy mechanism shared between childhood absense seizures and focal epilepsy due to a tumour, and though both produce seizures, which have some hypersynchronous neuronal firing going on, they are different kinds of seizures affecting different parts and extents of the brain. -- Colin°Talk 07:44, 15 October 2014 (UTC)
Agree. There should be a consistent terminology in all articles of the "world of epilepsy". Jophiel 11:12, 15 October 2014 (UTC)

User:WhatamIdoing I think this is reasonable. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:26, 15 October 2014 (UTC)

Jmh649, just be be clear, you are saying that the boxed text above is a reasonabe Mechanism section? Text that WAID admits is "not at all satisfying" and "not answering the question" a Mechanism section is supposed to answer. -- Colin°Talk
I think it is a reasonable to start by defining some terminology. By indicating that the mechanism of epilepsy involved the brain and not something else. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:38, 15 October 2014 (UTC)
James, which part of "there is no mechanism [singular] of epilepsy [singular]" are you having problems understanding? And yes it involves the brain, well duh. Here I was in the middle ages and thought an excess of bile might be involved. -- Colin°Talk 12:57, 15 October 2014 (UTC)

If you guys are going to keep edit warring over whether to include this content (NB: Jophiel, I do not recommend that you join their little outburst of edit-warring), may I encourage you to edit-war over the plain-English version instead of the repetitive-medicalese version? WhatamIdoing (talk) 21:46, 15 October 2014 (UTC)

Blindness[edit]

Ok, I've found an analogous topic that I hope can put to bed this idea that Mechanism should be a top level section or that we can say much about the "mechanism of epilepsy" [note the double singular]. Blindness does not have a mechanism. There are many causes, each with their own mechanisms. Can we move on now? -- Colin°Talk 22:40, 14 October 2014 (UTC)

An example[edit]

I'm actually shocked that some people have suggested that perhaps blindness could benefit from a mechanism section and the only reason it doesn't have one is that it is just a C-class article. Let's take what James proposed above and convert it for blindness.

Blindness occurs when the visual system contains changes that prevent vision. Visual loss is one process by which a normal visual system fails. The process, which is gradual, occurs in symptomatic blindness, in which visual loss is caused by an identifiable trauma to the eye. It results from acute eye insults such as physical trauma to the eye or infection. Visual loss is a series of events that occur between the event that causes blindness and significant loss of vision. In visual loss, an array of events occur on molecular and cellular levels that prevent photons hitting the eye from resulting in an image in the brain.

If you want that sort of crap in this article, then vote for a mechanism section. -- Colin°Talk 07:24, 16 October 2014 (UTC)

Alternative proposal to close the case[edit]

Good analogy. With regard to all that has been said so far, I suggest removing the section "mechanism" and change the (introductory) wording of the lead section (improvements welcome, references to be added):

Epilepsy is a disease characterized by recurring epileptic seizures without an immediate provoking cause. Seizures are the result of excessive and abnormal cortical nerve cell activity in the brain; the outward effect can vary from brief and nearly undetectable to long periods of vigorous shaking. Cases of epilepsy are often referred to in the plural form, 'the epilepsies'.
There are a variety of underlying causes that give rise to epilepsy, genetic and acquired, many of them disease entities by themselves. Thus, the processes rendering the brain susceptible to seizures are heterogeneous. In post-traumatic epilepsy this process is also referred to as epileptogenesis.
Depending on the causes, the spectrum of clinical presentation in epilepsy ranges from no obvious other signs or symptoms to complex syndromes with severe physical and intellectual disabilities. Some well characterized syndromes whose major feature is recurrring seizures are referred to as 'epilepsy sydromes'. If seizures are less prominent the diagnose epilepsy is made in addition to others.
Epilepsy is commonly diagnosed when two unprovoked seizures occur at least 24 hours apart. The diagnostic process typically involves ruling out other conditions that might cause similar symptoms, and figuring out whether any immediate provoking cause, for instance meningitis, are present. Neuroimaging, EEG and lab tests are usually applied to achieve this.
Classification of cases of epilepsy traditionally focuses on clinical features. With increasing scientific knowledge the concepts of classification have been gradually shifting towards the underlying causes. Currently both systems are used in parallel.
... Jophiel 11:03, 15 October 2014 (UTC)
We have a proposal here regarding the keeping / removing of the mechanisms section Talk:Epilepsy#Should_the_article_on_epilepsy_have_a_mechanisms_section.3F. I still do not see justification to remove this section or consensus to do so and thus oppose it removal. Just because a C class articles does not have a mechanism section means little. The mechanism of seizures is also a mechanism of epilepsy.
Not sure if the proposal is to replace the current 4 paragraphs of the lead with these 5 paragraphs? Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:20, 15 October 2014 (UTC)
Lead supposed to continue with ..."Seizures are controllable with medication in about 70% of cases." Jophiel 11:25, 15 October 2014 (UTC)
Per WP:LEAD the lead is to be 3 or 4 paragraphs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:45, 15 October 2014 (UTC)

Having written this the question arises how many sources to be cited. I suggest only a few, not over-referencing again. The content above is very general. I would add three or four references with regard to definition, diagnosis and classification. Does this sound reasonable? Jophiel 11:21, 15 October 2014 (UTC)

This is missing a lot of important information. References in the lead are perfectly appropriate. At this point in time dose not look like an improvement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:23, 15 October 2014 (UTC)
Often we try to write the article body text and then summarise for the lead using mostly the same sources. Attempting a lead-rewrite is I think overambitious in the current climate. I do like some of what you have written, but agree that it misses some things like epidemiology and treatment, etc. We try to keep the lead to around four paragraphs or so.
An alternative is to work on the Seizures and Causes sections and work in those details of mechanism as appropriate. This will demonstrably make Mechanism redundant.
JFW's comment that we should explain "why we think people with epilepsy experience seizures" is only half the story (the other more relevant half is why/how people develop an epilepsy) and can better be covered in the relevant cause/seizure-type topic elsewhere in the article. So, really, JFW's request can easily be met without having a top-level Mechanism section. Basically, our argument is that the information is better if structured differently. -- Colin°Talk 12:16, 15 October 2014 (UTC)
The sections on treatment and epidemiology are missing in the proposal because I just put the new parts of the lead here. The rest "Seizures are controllable with medication in about 70% of cases.... but most are able to return to driving after a period of time without seizures." was meant to be kept. I suggested the proposal here only to have a concrete alternative to the other proposal, i.e. mentioning epileptogenesis in the lead not to skip it (and also by the way taking in account was was said on syndromes before). Of course the lead can be concentrated to fewer paragraphs. Jophiel 13:57, 15 October 2014 (UTC)
There is an article on Causes of seizures. There are articles on post-traumatic epilepsy, post-traumatic seizures and on epileptogenesis - why not keep it there, and mention it in the article on the causes of seizures (and in the lead here)? Jophiel 14:13, 15 October 2014 (UTC)

Jmh649, by "Just because a C class articles does not have a mechanism section means little." I assume you are referring to my Blindness analogy. Are you seriously suggesting that the reason Blindness lacks a mechanism section (per the Holy MEDMOS) is because the article isn't an FA? -- Colin°Talk 13:00, 15 October 2014 (UTC)

I recommend against even trying to edit the lead. It's difficult to do well while you're still building the content, and it seems to escalate disputes. WhatamIdoing (talk) 21:52, 15 October 2014 (UTC)
I agree. I suggested the proposal here only to have a concrete alternative to the other proposal (mentioning epileptogenesis in the lead instead of in a separate section "mechanism"). Jophiel 22:58, 15 October 2014 (UTC)
I think a better way to handle this is in the lead of Causes. In a well written Causes section, the reader will be left in no doubt that the mechanisms of epilepsy are many and separate. -- Colin°Talk 07:28, 16 October 2014 (UTC)

Towards content[edit]

If we want to solve the issue we need to focus on content (and mine the sources):

The following sources were cited so far:

  • [25]: Major part about normal physiology. When it gets to the pathology: chapter IV. is called "Pathophysiology of Seizures'". With respect to the pathophysiology of seizures it says what is known about seizures. The section "Current Theories as to How Inhibition and Excitation Can Be Altered at the Network Level" is very short and vague, and finally it gives some information on epileptogenesis (which is the term used for remodeling after trauma - thus it refers to ONE specific cause)
  • [26]: A lot about normal physiology. When it gets to pathology the chapter is called focal epilepsy: Mesial temporal lobe epilepsy, i.e. it's about the mechanism is ONE specific cause (hippocampus sclerosis)
  • [27] starts with "Epileptic seizures typically involve excessive firing and synchronisation of neurons". With respect to epilepsy it focuses on the focal epilepsy involving the hippocampus, so it's limited to ONE specific cause. With respect to absence seizures it says "until recently there WAS a consensus on the mechanisms for the classic 3 per second spike-wave activity, which depended on synchronisation of the thalamus by rhythmic activity of networks of inhibitory neurons. ... Recent evidence ... suggests that the thalamic T current may not be critical." So, basically nothing is known.
  • [28]: A lot about normal physiology, some interesting experimental facts (alteration of ion channels in animal model), some of them related to specific causes. Far away from identifying a single mechanism, basically saying alteration of normal physiology.

Have a look here [29] The title of the book is "Jasper's Basic Mechanisms of the Epilepsies". Very interesting, basically all that is known on pathophysiology. If someone is able to extract A mechanism of epilepsy from it - I would be happy to read it here.

In addition I searched medline (terms pathophysiology/physiopathology/mechanism/s epilepsy/seizure) and, in each of the searches, had a short review of the latest (~200) sources. All limited to specific cases, types of epilepsy, animal models.

So, some is known about the normal physiology but not much about the (common) pathologic physiology. With respect to a section pathophysiology here I make this proposal (this includes some copy and paste, e.g. from [30] and [31], for illustration purposes and needs to be adjusted to avoid plagiarism, and references need to be added, wording not meant to be final): Jophiel 10:10, 17 October 2014 (UTC)

In epilepsy abnormal genetic, structural and metabolic alterations give rise to lowering the threshold for seizures. Transient factors then precipitate the individual event. It is unkonwn if common mechansims exist for all different causes of epilepsy, as research data is limited to animal models of certain cases. Seizure threshold is determined by excitability of neurons, which comprises the following factors:
Intrinsic factors
  • The type, number and distribution of voltage- and ligand-gated channels. Such channels determine the direction, degree, and rate of changes in the transmembrane potential, which in turn determine whether an action potential occurs. Voltage-gated sodium channels, for example, form the basis of the rapid depolarization constituting the action potential. Among ligand-gated channels, the GABA receptor complex mediates inflow of chloride ions which hyperpolarize the cell, forming the basis of neuronal inhibition, as described previously
  • Biochemical modification of receptors. For example, phosphorylation of the NMDA receptor increases permeability to Ca++, resulting in increased excitability.
  • Activation of second-messenger systems. Binding of norepinephrine to its alpha receptor, for example, activates cyclic GMP, in turn activating G-proteins which open K+ channels, thereby decreasing excitability.
  • Modulating gene expression, as by RNA editing. For example, editing a single base pair of mRNA encoding a specific glutamate receptor subunit can change the ion selectivity of the assembled channel.
Extrinsic factors
  • Changes in extracellular ion concentration due to variations in the volume of the extracellular space. For example, decreased extracellular volume leads to increased extracellular K+ concentration, resisting the outward movement of K+ ions needed to repolarize the cell, thereby effectively increasing excitability.
  • Remodeling of synaptic contacts. For example, movement of an afferent axon terminal closer to the target cell body increases the likelihood that inward ionic currents at the synapse will bring the target neuron to threshold. The coupling between the pre- and post-synaptic elements can be made more efficient by shortening of the spine neck. In addition, previous synaptic experience such as a brief burst of high frequency stimulation (e.g., long-term potentiation-LTP) also increases the efficacy of such synapses, increasing their excitability.
  • Modulating transmitter metabolism by glial cells. Excitability increases, for example, if glial metabolism or uptake of excitatory transmitters such as glutamate or ACh decreases.
Electroencephalographic spikes, generated by the synchronous discharges of a group of neurons, are a sign of reduced inhibition and widely accepted as diagnostically relevant for epilepsy, but it is unknown why they are strongly associated with spontaneous seizures.
On the cellular level focal spikes are believed to be a result of paroxysmal depolarization shift (PDS). Sustained neuronal depolarization mediated by an influx of calcium ions underlies a train of action potentials associated with sodium influx. Repolarization and usually hyperpolarization, mediated mainly by potassium, follow this sustained depolarization. The corresponding extracellular field, forming the basis of the surface EEG, shows a negative peak during calcium and sodium influx, falls back to and then below baseline during hyperpolarization, and finally returns gradually to baseline. In vivo neuronal networks in hippocampus and neocortex are critical to production of both interictal and ictal discharges.
Common anticonvulsants do not block interictal activity but reduce the frequence of seizures.

I think this article should also include an overview of the pathophysiology of seizures. But agree this is a step forwards. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:07, 17 October 2014 (UTC)

Agree, should include at least an overview. Added more content to the proposal. Looking at the current content on pathophysiology of seizures: it is a mix of details on seizures (In epileptic seizures, due to problems within the brain) and epilepsy (In epilepsy the resistance of excitatory neurons .... or These secondary epilepsies, occur through processes ...), needs to be revised as well. Jophiel 13:57, 17 October 2014 (UTC)
Okay ping me when you have the above paraphrased and refs are in place and I will be happy to provide feedback. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:00, 17 October 2014 (UTC)
Let us all talk about the content first before formal things get adjusted. That's what the proposal is about. Once we agree I get done the rest by myself. Jophiel 14:12, 17 October 2014 (UTC)
References are integral to Wikipedia and part of the discussion will include the refs used. 14:54, 17 October 2014 (UTC)
It's basically copy and paste from the mentioned (high quality) sources so everything will be properly referenced. Just assume it is. Does it sound like a reasonable proposal? Jophiel 16:15, 17 October 2014 (UTC)
It looks like it is going in the right direction. Keys to Wikipedia include references and paraphrasing using suitably simple English. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:16, 18 October 2014 (UTC)
Please let us not talk about the final wording and referencing but about the content. Everything will be referenced and paraphrased.
  • "Right direction" is vague - is something missing in particular? If yes, please specify. If not, this is going to be roughly the content of the section (a paragraph on seizures will be added)- can we get consensus on this? If no, please specifiy.
  • With regard to wording: The factors are about highly spezialized, concrete and specific details, you cannot "translate" terms like "transmembrane potential", "remodeling of synaptic contacts" or "activation of second-messenger systems" without having verbiage at the end. However the introductory paragraphs should be (as in the proposal) kept simple. Jophiel 10:11, 18 October 2014 (UTC)
What is missing IS the paraphrasing and the sources. These are not extraneous things that one adds on latter. Is the proposal to add this to overview of seizures that is already present? Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:56, 18 October 2014 (UTC)
I think we are getting back to the point where you say "an article is about verifiability only". Verifiability is essential but not sufficient to generate content of quality. The editor is required to select sources, mine the sources properly and apply them with reasoning. The sources are mentioned above, by the way. The proposal is to replace the current (poor) content (which still exists as a one-to-one copy in the article on seizures). As mentioned, a paragraph on seizures will be added. Why do you repeatedly refuse to talk about content? Jophiel 15:24, 18 October 2014 (UTC)
Why has the article been changed in the section of dispute? The current version really is not an improvement. As mentioned above, the content mixes pathophysiology of seizures and epilepsy and really needs fundamental revision. Jophiel 17:49, 17 October 2014 (UTC)
Not sure. You mean these changes? [32] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:16, 18 October 2014 (UTC)
[33] was supposed to "make the locus of this discussion a bit clearer", I don't understand why this is not done here on the talk page but in the article. Jophiel 10:11, 18 October 2014 (UTC)
There's no rule against editing a page during a discussion. In fact, WP:BRD (expect people to throw that at you a lot, and expect them to have no idea what it's actual contents are) encourages it, if you believe that it has the potential to get a "stuck" dispute moving again.
In this case, I created that section in an effort to make the actual dispute clearer, and thereby (I hope) to get people to quit saying "Of course we need a section on the mechanism of seizures! Every source has a section on the mechanism of seizures!" when the question we're actually asking is, whether we should have a section on the mechanism of epilepsy itself, where epilepsy is not a synonym for seizures (as you already know). WhatamIdoing (talk) 14:45, 18 October 2014 (UTC)
I hope it'll serve this purpose. Jophiel 15:11, 18 October 2014 (UTC)

Arguments for/against a section mechanism/pathophysiology[edit]

This discussion is getting a little confusing. Can we have an overview? (for everybody to edit). Jophiel 13:45, 15 October 2014 (UTC)

Pro Con
  • There is some knowledge on post-traumatic processes (epileptogenesis)
  • The pathophysiology of seizure is part of the pathophysiology of epilepsy
  • Reader finds the same structure as in other articles on diseases
  • References referring to "pathophysiology of epilepsy"
  • Analogy with "Cancer#Pathophysiology" (many causes with many mechanisms for many diseases)
  • Articles should use sections appropriate to the topic (that's what MEDMOS says)
  • Epilepsy is defined abstract (having had two seizures) - there can be no concrete mechanism
    • Pathophysiology of seizure only belongs to article on seizures
  • Processes rendering the brain susceptible to seizures are heterogeneous (as causes are)
    • What is known (epileptogenesis after brain trauma) belongs to causes section
    • References referring to "pathophysiology of epilepsy" relate to specific causes
  • Section misleads reader (there is no single pathophysiology as in other diseases)
  • Analogy with "blindness" (many causes, each with their own mechanisms)

Comments[edit]

The analogy with blindness is definitive for me. There is no single form of blindness just as there is no one epilepsy. In blindness there is visual loss; in epilepsy there are seizures. There are different kinds/extents of visual loss and there are different kinds of seizures. Nobody would even consider creating a top level section Mechanism for blindness. Consider:

  • Epilepsy due to a tumour that has focal seizures manifesting as olefactory sensory disturbance in an old man.
  • Childhood absense epilepsy that has generalised seizures with short loss of full consciousness in a young boy.
  • Massive congenital cortical malformation leading to frequent convulsive seizures in an infant.

These have different causes, different mechanisms for producing epilepsy, different mechanisms for producing seizures and different seizures. They are likely to be treated with different drugs and have radically different prognoses. They all come under the umbrella of "epilepsy" but are really quite different diseases. There is no one mechanism and there is no one epilepsy. This article is better structured by discussing mechanism alongside both cause and seizure type. -- Colin°Talk 14:45, 15 October 2014 (UTC)

I understand the point that you are making about there being different mechanisms for different forms of epilepsy. From my perspective that is a good reason to spell it out clearly in a separate section called Mechanisms. Concisely discussing the different mechanisms for the different forms of epilepsy makes it much easier for a reader to find that information than if it is spread out in different articles about epilepsy or mixed into dense text in another sections of this article. Sydney Poore/FloNight♥♥♥♥ 19:21, 15 October 2014 (UTC)
There are dozens of forms of epilepsy. Are you suggesting that as well as enumerating the common syndromes and causes in their own sections, we repeat that list just to explain how e.g. Childhood absense epilepsy might develop? Because it shares no mechanism with a symptomatic focal seizure. The current Mechanism section doesn't explain this or answer the question. To be honest, the general reader does not look for a "Mechanism" section, she looks for "Cause". Mechanism is of interest to medical students, and they need to be quickly corrected in their thinking of epilepsy as "a disease". Do you think blindness also should have a Mechanism section? (Most people are already aware that blindness is not a disease). That would repeat all the Causes but this time explain how cataracts form, how trachoma irritates the eye and so on. Would the reader thank us for repeating all that? In a major-topic article like this, we can probably only go into detail for some common types. Since the mechanism is the bridge between cause and seizures, we'd need to repeat the cause (e.g. genetic defect, tumour, malformation) and the seizure type (absence, focal, etc) while filling in the detail of what might occur in between. It would be utterly tedious. -- Colin°Talk 19:41, 15 October 2014 (UTC)
In addition to this the problem is, that epilepsy (unlike other diseases) is only defined as "having had two seizures" - thus it formally cannot have a mechanism, not one, not many. Seizures do, by definition, have a mechanisms (but this is the article on epilepsy, not seizures). Furthermore, as said before, the processes rendering the brain susceptible to seizures (of which little is known) are so specific to the causes that they should go into the causes section (of seizure or epilepsy). Of course you could write in the section on mechanism here: Pathophysiology of epilepsy does not exist, there is pathophysiology of seizures and pathophysiology of the underlying diseases. But this is probably not what you had in mind. Jophiel 19:57, 15 October 2014 (UTC)
Another pro is that there are many references that cover the topic. Here is 1200 pages of details [34]
That epilepsy is defined as two seizures or one seizure with a high risk of more we all agree. Thus the mechanism section here being so similar to the mechanism section on the seizure article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:03, 16 October 2014 (UTC)
When reading 'similar' the question arises for me: Ok, a lot in common, but what exactly is the difference? Jophiel 10:02, 16 October 2014 (UTC)
Jophiel, we can follow the reliable sources and do a fine job of writing a concise summary of the pathophysiology of epilepsy. We don't need to over think this. :-) Sydney Poore/FloNight♥♥♥♥ 15:40, 16 October 2014 (UTC)

Defining terminology[edit]

There is this quote by Aristoteles, that one should define terms before discussing (don't remember exactly). Some agreed that this would be good to do here as well. [35] [36] [37] Let's do it (for everybody to edit). Jophiel 15:01, 15 October 2014 (UTC)

Terminology

Pathophysiology

  • "the physiology of abnormal or diseased organisms or their parts; the functional changes associated with a disease or syndrome." [38]

Physiology

  • 1. "the branch of biology dealing with the functions and activities of living organisms and their parts. 2. the organic processes or functions in an organism or its parts." [39]
  • "The scientific study of an organism's vital functions, including growth and development, the absorption and processing of nutrients, the synthesis and distribution of proteins and other organic molecules, and the functioning of different tissues, organs, and other anatomic structures. Physiology studies the normal mechanical, physical, and biochemical processes of animals and plants." [40]

Epilepsy

  • "Epilepsy is a disease of the brain defined by any of the following conditions: At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart, ... [41]

Comments[edit]

The world of epilepsy[edit]

So far we have been in conflict on where to put the chair. But, to be honest, the building is not even done.

There are articles on epilepsy, epilepsy syndromes, epilepsy in children, post-traumatic epilepsy, focal epilepsy, generalized epilepsy, Idiopathic generalized epilepsy, epileptic seizure, reflex seizure, post-traumatic seizure, seizure types, epileptogenesis, kindling model, postictal state, partial seizure, focal seizure, absence seizure, tonic-clonic seizure, gene therapy for epilepsy, anticonvulsant, epilepsy surgery, Issues for people with epilepsy, epilepsy and employment, epilepsy and driving, and many more, for instance on single epilepsy syndromes.

There is an abundance of redundancy and inconsistency. I think we should make a concept on how to integrate all this at first: Which articles to keep, which to integrate into others, which to create. Maybe a separate article on pathophysiology would makes sense, I am not sure. Some questions will arise, for instance, which terminology to use and which defintions to refer to. Of course this will require some effort and it will take a long time, but I think it is worth it. What do you think, James, Colin, JFW? Jophiel 123 (talk) 14:18, 14 October 2014 (UTC)

For instance we could take the following steps

  1. locate what we have at all, in total, and write it down
  2. see/decide what content is missing (and what is redundant)
  3. decide what articles we deem necessary for covering all aspects of epilepsy/seizures
  4. adjust the content

Jophiel 20:09, 14 October 2014 (UTC)

I'm sure there are dozens more articles too, some perhaps created by students told to go off an create an article! I don't think I'd vote for any of the above to be deleted. Perhaps epilepsy in children is the least developed and probably best renamed to "paediatric epilepsy", say, in order to include infants and adolescents. Issues for people with epilepsy is a bit vague. It's really hard to get articles deleted on Wikipedia even if one thinks the topic is misguided or unnecessary. I wouldn't worry over much about fixing up the entire neurology department otherwise you'll never make progress on one. But one valid strategy is to take one sub article and work on that till you're happy with it and then bubble up a summary of that to the main one. Wikipedia will have redundancy and inconsistency and we just have to live with that. But I agree with your idea below of trying to produce an outline of what topics we should cover, even if not necessarily in this article or to the same depth. It is at this point you may discover I slow down :-) I'd like to read some... -- Colin°Talk 20:25, 14 October 2014 (UTC)

Reviewing the articles may reveal interesting facts and points of view, for instance the pathopyhsiology section in the article on post traumatic epilepsy, that may be considered when improving this article. Jophiel 20:49, 14 October 2014 (UTC)
I see epilepsy in children as perfectly appropriate. In common usage child refers to both infants and adolescents. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:25, 15 October 2014 (UTC)
There is also an article on causes of seizures. Jophiel 14:15, 15 October 2014 (UTC)

Content on seizures and epilepsy

pathophysiology

  • of epilepsy (traumatic) [42] [43]
  • of seizure [44]
  • aspects not (fully) covered: ...
  • questions: Do we need the term epileptogenesis and how is it defined? [45] [46] [47] [48]

epilepsy syndromes

consequences of seizures/epilepsy

  • driving
  • other
  • aspects not (fully) covered: pregnancy, ...
  • questions: ...

...

  • ...
  • ...

for everybody to edit

In out in out shake it all about[edit]

WTF? Did the RFC get closed and I missed it? Did the ongoing discussions above reach any kind of consensus? Did anyone even defend proposed text after my detailed critism of how bad it is? -- Colin°Talk 15:54, 15 October 2014 (UTC)

Nope. Don't know what's up with CFCF. Jophiel 18:35, 15 October 2014 (UTC)