88 - Introduction to the concept of provoked epilepsy  pp. 625-630

Introduction to the concept of provoked epilepsy

By Simon D. Shorvon, Renzo Guerrini and Frederick Andermann

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The fact that seizures can be “provoked” has of course been long recognized. The precipitation by light was recorded by Pliny and by Apuleius, and by the nineteenth century, cases of epilepsy induced by stress, startle, sensory stimulation, shock, noise, sexual activity and masturbation, eating, reading, and music, for instance, were well recorded. Following Tissot (1770), most authorities for the next hundred years at least tended to divide the causes of epilepsy into two categories: (a) underlying causes (syn. predisposing causes), and (b) “exciting” or provoking causes (see Chapter 2). Exciting causes were often described in relation to reflex action, and these were systematically explored by Marshall Hall (who coined the term) (Hall 1850), Brown-Séquard, and Hughlings Jackson amongst others. Jackson described a number of provoked seizures, including one case in which seizures were induced by a tap on the head. Gowers (1885) described cases of epileptic seizures induced by “light, voluntary movement and sudden muscular tension.” In experimental animals, seizure provocation by touch was first demonstrated by Amantea (1921), by light by Clementi (1929), and by noise by Morgan and Morgan (1939). Pavlov's demonstration on conditional reflexes stimulated further research and Gastaut described conditioned-reflex epilepsy in 1956. Gastaut and his colleagues also made early studies of photic-induced seizures, and the first experiments in the photosensitive baboon, Papio papio, were made by Naquet in Gastaut's unit in 1956 (Beaumanoir 1995). In any book dealing with etiology, the provoking causes of seizures are important.

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