title: Quinceañera

text: Fifteenth-birthday celebrations were very popular in Cuba until the late 1970s. This practice partly entered Cuba via Spain, but the greatest influence was the French. The wealthy families who could afford to rent expensive dining rooms in private clubs or hotels of four and five stars held celebrations that were the precursors of , which they called . These celebrations usually took place in the house of the girl or the more spacious house of a relative.


title: Quinceañera

text: Another tradition, commonly found in Cuba, is to have 14 ladies and 14 escorts (sometimes 7 each) as a court. The escorts hold flowers (usually roses) and the ladies carry candles. As the dances the waltz with her father, she blows out one candle, then picks up one rose. This continues until she has blown out all the candles and picked up all the roses. The 14 candles blown out represent her 14 previous years, and with each she makes a wish. When the time comes to cut the cake, the will blow out her last candle, thus completing her 15 wishes. The flowers are given to her mother.


title: Quinceañera

text: In Colombia, the starts with the arrival of the teenage girl, accompanied by her father; she is received by her mother and other relatives and friends; father and daughter dance a waltz and other tunes. The birthday girl next dances with her brothers (if any) and their uncles and godparents. Then she performs the and the waltz with all members of the procession (then optional dances to other music, such as merengue or pop).


title: Quinceañera

text: For this occasion the teenager wears an evening dress in light colors or pastels, is dressed and made up slightly, and usually places a tiara in her hair and jewels on her neck and hands. All the guests dress in formal attire, including the teenager's peers.


title: Quinceañera

text: After the first dance, the teenager and her friends have a dance. Then the festival begins with music from live bands, some famous artists, DJs, food, drink, and at one late point of the night a is carried out, in which the attendants wear masks or funny wigs and make noise with whistles and rattles while fast-tempo music is played. It is optional to make some surprise dance performed by the birthday girl (alone or accompanied), and a dance that will give away her friends, cousins, and others.


title: Quinceañera

text: The custom's social significance is such that even poor families tend to spend lavishly on a daughter's . The event can cost as much as a year's wages, and many take up debt to be able to pay for it.


title: Quinceañera

text: In French Guiana and the French Caribbean, the celebration is known as . It follows a similar structure.


title: Quinceañera

text: In Mexico, the is adorned with elegant jewelry and makeup. By tradition, this was to be the first time she would wear makeup in public, but in the 21st century, girls start using makeup at an earlier age. The is also expected to wear a formal evening dress, traditionally a long, elegant ball gown chosen by the girl and most often, her mother, according to her favorite color and style.


title: Quinceañera

text: In the Mexican Catholic tradition, the celebration begins with a thanksgiving Mass. She arrives at church accompanied by her parents, godparents, and court of honor. The court of honor is a group of her chosen peers consisting of paired-off girls and boys, respectively known as (dames) and (chamberlains). Typically, the court consists of pairs ranging from 7 to 15 and . At this religious mass, a Rosary, or sometimes a necklace with a locket or pendant depicting Mexico's patron saint, the Virgin of Guadalupe, is presented to the teenager by her godparents, the necklace or rosary having been previously blessed by the priest. She is also awarded a tiara, which serves as a reminder that to her loved ones, especially her immediate family, the will always be a princess. Some also see it as denoting that she is a "princess" before God and the world. After this, the girl may leave her bouquet of flowers on the altar for the Virgin Mary.


title: Quinceañera

text: After the thanksgiving mass, guests gather for a celebratory reception where the events to honor the will take place, including giving gifts. This reception may be held at the 's home, at venues (such as dining halls, banquet halls, or casinos), or in some cases, in more public places, similar to a block party. During the reception, the birthday girl usually dances a traditional waltz with her father to a song chosen by both that speaks about the occasion and their relationship. Then her father passes her to the , her chosen escort, and afterward they continue the dance with the rest of her court of honor. Often this section of the celebration is previously practiced and/or choreographed, often weeks in advance, sometimes even with months of anticipation.


title: Quinceañera

text: The basic reception has six major parts with dances taking place while a traditional Mexican meal is served:


title: Quinceañera

text: Traditionally, Mexican girls could not dance in public until they turned 15, except at school dances or at family events. So the waltz with her is choreographed and elaborate to celebrate what was meant to be the 's first public dance.


title: Quinceañera

text: Some families may choose to add a ceremonial components to the celebration, depending on local customs. Among them are the ceremony of the Change of Shoes, in which a family member presents the with her first pair of high heel shoes; the Crowning ceremony, in which a close relative places a crown on her head; and (literally "ceremony of the last doll"), during which her father presents her with a doll usually wearing a dress similar to the . The ceremony of the last doll is based on a Maya tradition; it is related to the birthday girl's later giving up of the doll as she grows into womanhood.


title: Quinceañera

text: Once all symbolic gestures have taken place, the dinner is begun. At this point, the celebration reaches its peak; live musical groups begin playing music, keeping the guests entertained. The music is played while the guests dine, chat, mingle, and dance.


title: Quinceañera

text: The next morning the family and closest friends may also attend a special breakfast, especially if they are staying with the family. Sometimes what is known as a (re-warming) takes place in which any food not consumed during the event of the night before is warmed again for a brunch type event.


title: Quinceañera

text: The celebration of a quinceañera party is a strong tradition for the majority of Mexicans, especially among families of rural and low-socioeconomic origins; but it is common for girls of middle- and upper-socioeconomic class to dismiss the tradition as ("tacky"). In recent years, many girls, mostly from the Mexico City suburbs, tend to prefer a small party with their close family or friends, and ask for a paid vacation, instead of having their families invest a lot of money on a party.


title: Quinceañera

text: are growing in popularity in Spain, which sees frequent emigration from the countries of the former Spanish Empire. The demand has grown so much that Spanish event companies now specialize in organizing parties for Latin American communities across Spain, where events typically cost thousands of euros and guests number in the hundreds. According to Luisa Sánchez-Rivas, a Spanish sociolinguist who specializes in liminality, the parties are considered especially significant for Latin American immigrants in Spain as a way to protect and preserve their non-Spanish cultural identity. The concept has not caught on among Spaniards, although one company in Madrid that specializes in organized one for a girl from a Spanish family.


title: Quinceañera

text: While in most of the United States it is customary to celebrate a sweet sixteen, a is common in Puerto Rico and within Hispanic communities throughout the country. Quinceañeras were noted to be celebrated in the mid- to late 1970s in Los Angeles and San Diego and in the early 1980s in different parts of Texas. Though they may not have been widespread, many working-class families could afford because the and pitch in for the costs. In recent years, have gained popularity in the United States. Books and other publications about distributed in the United States increasingly include English versions to the original works in Spanish. This shows the increasing influence of Hispanic and Latino culture within the broader American culture. The increasing popularity of the celebration has begun to lead to an uptick in retailers and businesses catering directly to young Hispanic or Latina women.


title: Quinceañera

text: In the 21st century, many girls create their own celebrations. Whereas traditional dresses were formal and usually white or pink only, dress designs are now more varied. Also, instead of having the traditional seven and seven , the may pick all or all . Traditionally, girls were not allowed to dance in public until turning 15, but this taboo has also receded significantly. The ceremony of the Changing of the Shoes has also been modified. Instead of wearing slippers before ceremonially exchanging them for high heels, a girl may decide to wear shoes compatible with the color and style of her dress instead of donning the traditional slippers.


title: SMART criteria

text: S.M.A.R.T. is a mnemonic acronym, giving criteria to guide in the setting of goals and objectives that are assumed to give better results, for example in project management, employee-performance management and personal development. The term was first proposed by George T. Doran in the November 1981 issue of "Management Review". He suggested that goals should be SMART (specific, measurable, assignable, realistic and time-related).


title: SMART criteria

text: Since then, other variations of the acronym have been used, a commonly used version includes the alternative words: attainable, relevant, and timely. Additional letters have been added by some authors.


title: SMART criteria

text: Those who support the use of SMART objectives suggest they provide a clear road map for both the person setting the goal and the person evaluating their progress (e.g. employee and employer, or athlete and coach). The person setting the goal is said to gain a clear understanding of what needs to be delivered and the person evaluating can then assess the outcome based on defined criteria. SMART criteria are commonly associated with Peter Drucker's management by objectives concept.


title: SMART criteria

text: Often, the term "S.M.A.R.T. Goals" and "S.M.A.R.T. Objectives" are used. Although the acronym SMART generally stays the same, objectives and goals can differ. Goals are the distinct purpose that is to be anticipated from the assignment or project, while objectives, on the other hand, are the determined steps that will direct full completion of the project goals.


title: SMART criteria

text: The November 1981 issue of "Management Review" contained a paper by George T. Doran called "There's a S.M.A.R.T. way to write management's goals and objectives". It discussed the importance of objectives and the difficulty of setting them.


title: SMART criteria

text: Each letter in SMART refers to a different criterion for judging objectives. There is some variation in usage, but perhaps the most commonly used criteria today are:


title: SMART criteria

text: A review of the evidence on the SMART acronym to increase physical activity found that its use is not based on scientific theory, is not supported by evidence, and has potentially harmful effects. In contrast, a growing body of evidence suggests that non-specific and open-ended goals (e.g. "see how fast I can run 5km" or "see how far I can walk in 3 hours") may be more effective to increase physical activity.


title: Epilepsy

text: Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly such as broken bones or through causing accidents. In epilepsy, seizures tend to recur and may have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.


title: Epilepsy

text: The underlying mechanism of epileptic seizures is excessive and abnormal neuronal activity in the cortex of the brain which can be observed in the electroencephalogram (EEG) of an individual. The reason this occurs in most cases of epilepsy is unknown (idiopathic); some cases occur as the result of brain injury, stroke, brain tumors, infections of the brain, or birth defects through a process known as epileptogenesis. Known genetic mutations are directly linked to a small proportion of cases. The diagnosis involves ruling out other conditions that might cause similar symptoms, such as fainting, and determining if another cause of seizures is present, such as alcohol withdrawal or electrolyte problems. This may be partly done by imaging the brain and performing blood tests. Epilepsy can often be confirmed with an EEG, but a normal test does not rule out the condition.


title: Epilepsy

text: Epilepsy that occurs as a result of other issues may be preventable. Seizures are controllable with medication in about 69% of cases; inexpensive anti-seizure medications are often available. In those whose seizures do not respond to medication; surgery, neurostimulation or dietary changes may then be considered. Not all cases of epilepsy are lifelong, and many people improve to the point that treatment is no longer needed.


title: Epilepsy

text: , about 50 million people have epilepsy. Nearly 80% of cases occur in the developing world. In 2015, it resulted in 125,000 deaths, an increase from 112,000 in 1990. Epilepsy is more common in older people. In the developed world, onset of new cases occurs most frequently in babies and the elderly. In the developing world, onset is more common in older children and young adults due to differences in the frequency of the underlying causes. About 5–10% of people will have an unprovoked seizure by the age of 80, with the chance of experiencing a second seizure rising to between 40% and 50%. In many areas of the world, those with epilepsy either have restrictions placed on their ability to drive or are not permitted to drive until they are free of seizures for a specific length of time. The word "epilepsy" is from Ancient Greek ἐπιλαμβάνειν, "to seize, possess, or afflict".


title: Epilepsy

text: Epilepsy is characterized by a long-term risk of recurrent epileptic seizures. These seizures may present in several ways depending on the parts of the brain involved and the person's age.


title: Epilepsy

text: The most common type (60%) of seizures are convulsive which involve involuntary muscle contractions. Of these, one-third begin as generalized seizures from the start, affecting both hemispheres of the brain and impairing consciousness. Two-thirds begin as focal seizures (which affect one hemisphere of the brain) which may progress to generalized seizures. The remaining 40% of seizures are non-convulsive. An example of this type is the absence seizure, which presents as a decreased level of consciousness and usually lasts about 10 seconds.


title: Epilepsy

text: Certain experiences, known as auras often precede focal seizures. The seizures can include sensory (visual, hearing, or smell), psychic, autonomic, and motor phenomena depending on which part of the brain is involved. Muscle jerks may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a Jacksonian march. Automatisms may occur, which are non-consciously generated activities and mostly simple repetitive movements like smacking the lips or more complex activities such as attempts to pick up something.


title: Epilepsy

text: There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures. They all involve loss of consciousness and typically happen without warning.


title: Epilepsy

text: Tonic-clonic seizures occur with a contraction of the limbs followed by their extension and arching of the back which lasts 10–30 seconds (the tonic phase). A cry may be heard due to contraction of the chest muscles, followed by a shaking of the limbs in unison (clonic phase). Tonic seizures produce constant contractions of the muscles. A person often turns blue as breathing is stopped. In clonic seizures there is shaking of the limbs in unison. After the shaking has stopped it may take 10–30 minutes for the person to return to normal; this period is called the "postictal state" or "postictal phase." Loss of bowel or bladder control may occur during a seizure. People experiencing a seizure may bite their tongue, either the tip or on the sides; in tonic-clonic seizure, bites to the sides are more common. Tongue bites are also relatively common in psychogenic non-epileptic seizures.


title: Epilepsy

text: Myoclonic seizures involve very brief spasms of muscles in either a few areas or all over. These sometimes cause the person to fall, which can cause injury. Absence seizures can be subtle with only a slight turn of the head or eye blinking with impaired consciousness; typically, the person does not fall over and returns to normal right after it ends. Atonic seizures involve losing muscle activity for greater than one second, typically occurring on both sides of the body. Rarer seizure types can cause involuntary unnatural laughter (gelastic), crying (dyscrastic), or more complex experiences such as "déjà vu".


title: Epilepsy

text: About 6% of those with epilepsy have seizures that are often triggered by specific events and are known as reflex seizures. Those with reflex epilepsy have seizures that are only triggered by specific stimuli. Common triggers include flashing lights and sudden noises. In certain types of epilepsy, seizures happen more often during sleep, and in other types they occur almost only when sleeping.


title: Epilepsy

text: Patients with epilepsy may experience seizure clusters which may be broadly defined as an acute deterioration in seizure control. The prevalence of seizure clusters is uncertain given that studies have used different definitions to define them. However, estimates suggest that the prevalence may range from 5% to 50% of epilepsy patients. Refractory epilepsy patients who have a high seizure frequency are at the greatest risk for having seizure clusters. Seizure clusters are associated with increased healthcare utilization, worse quality of life, impaired psychosocial functioning, and possibly increased mortality. Benzodiazepines are used as an acute treatment for seizure clusters.


title: Epilepsy

text: After the active portion of a seizure (the ictal state) there is typically a period of recovery during which there is confusion, referred to as the postictal period, before a normal level of consciousness returns. It usually lasts 3 to 15 minutes but may last for hours. Other common symptoms include feeling tired, headache, difficulty speaking, and abnormal behavior. Psychosis after a seizure is relatively common, occurring in 6–10% of people. Often people do not remember what happened during this time. Localized weakness, known as Todd's paralysis, may also occur after a focal seizure. It would typically last for seconds to minutes but may rarely last for a day or two.


title: Epilepsy

text: Epilepsy can have adverse effects on social and psychological well-being. These effects may include social isolation, stigmatization, or disability. They may result in lower educational achievement and worse employment outcomes. Learning disabilities are common in those with the condition, and especially among children with epilepsy. The stigma of epilepsy can also affect the families of those with the disorder.


title: Epilepsy

text: Certain disorders occur more often in people with epilepsy, depending partly on the epilepsy syndrome present. These include depression, anxiety, obsessive–compulsive disorder (OCD), and migraine. Attention deficit hyperactivity disorder (ADHD) affects three to five times more children with epilepsy than children without the condition. ADHD and epilepsy have significant consequences on a child's behavioral, learning, and social development. Epilepsy is also more common in children with autism.


title: Epilepsy

text: Approximately, one-in-three people with epilepsy have a lifetime history of a psychiatric disorder. There are believed to be multiple causes for this including pathophysiological changes related to the epilepsy itself as well as adverse experiences related to living with epilepsy (e.g., stigma, discrimination). In addition, it is thought that the relationship between epilepsy and psychiatric disorders is not unilateral but rather bidirectional. For example, patients with depression have an increased risk for developing new-onset epilepsy.


title: Epilepsy

text: The presence of comorbid depression or anxiety in patients with epilepsy is associated with a poorer quality of life, increased mortality, increased healthcare utilization and a worse response to treatment (including surgical). Anxiety disorders and depression may explain more variability in quality of life than seizure type or frequency. There is evidence that both depression and anxiety disorders are underdiagnosed and undertreated in patients with epilepsy.


title: Epilepsy

text: Epilepsy can have both genetic and acquired causes, with the interaction of these factors in many cases. Established acquired causes include serious brain trauma, stroke, tumours, and brain problems resulting from a previous infection. In about 60% of cases, the cause is unknown. Epilepsies caused by genetic, congenital, or developmental conditions are more common among younger people, while brain tumors and strokes are more likely in older people.


title: Epilepsy

text: Seizures may also occur as a consequence of other health problems; if they occur right around a specific cause, such as a stroke, head injury, toxic ingestion, or metabolic problem, they are known as acute symptomatic seizures and are in the broader classification of seizure-related disorders rather than epilepsy itself.


title: Epilepsy

text: Genetics is believed to be involved in the majority of cases, either directly or indirectly. Some epilepsies are due to a single gene defect (1–2%); most are due to the interaction of multiple genes and environmental factors. Each of the single gene defects is rare, with more than 200 in all described. Most genes involved affect ion channels, either directly or indirectly. These include genes for ion channels themselves, enzymes, GABA, and G protein-coupled receptors.


title: Epilepsy

text: In identical twins, if one is affected, there is a 50–60% chance that the other will also be affected. In non-identical twins, the risk is 15%. These risks are greater in those with generalized rather than focal seizures. If both twins are affected, most of the time they have the same epileptic syndrome (70–90%). Other close relatives of a person with epilepsy have a risk five times that of the general population. Between 1 and 10% of those with Down syndrome and 90% of those with Angelman syndrome have epilepsy.


title: Epilepsy

text: Phakomatoses, also known as neurocutaneous disorders, are a group of multisystemic diseases that most prominently affect the skin and central nervous system. They are caused by defective development of the embryonic ectodermal tissue that is most often due to a single genetic mutation. The brain, as well as other neural tissue and the skin, are all derived from the ectoderm and thus defective development may result in epilepsy as well as other manifestations such as autism and intellectual disability. Some types of phakomatoses such as tuberous sclerosis complex and Sturge-Weber syndrome have a higher prevalence of epilepsy relative to others such as neurofibromatosis type 1.


title: Epilepsy

text: Tuberous sclerosis complex is an autosomal dominant disorder that is caused by mutations in either the TSC1 or TSC2 gene and it affects approximately 1 in 6,000-10,000 live births. These mutations result in the upregulation of the mechanistic target of rapamycin (mTOR) pathway which leads to the growth of tumors in many organs including the brain, skin, heart, eyes and kidneys. In addition, abnormal mTOR activity is believed to alter neural excitability. The prevalence of epilepsy is estimated to be 80-90%. The majority of cases of epilepsy present within the first 3 years of life and are medically refractory. Relatively recent developments for the treatment of epilepsy in TSC patients include mTOR inhibitors, cannabidiol and vigabatrin. Epilepsy surgery is often pursued.


title: Epilepsy

text: Sturge-Weber syndrome is caused by an activating somatic mutation in the GNAQ gene and it affects approximately 1 in 20,000-50,000 live births. The mutation results in vascular malformations affecting the brain, skin and eyes. The typical presentation includes a facial port-wine birthmark, ocular angiomas and cerebral vascular malformations which are most often unilateral but are bilateral in 15% of cases. The prevalence of epilepsy is 75-100% and is higher in those with bilateral involvement. Seizures typically occur within the first two years of life and are refractory in nearly half of cases. However, high rates of seizure freedom with surgery have been reported in as many as 83%.


title: Epilepsy

text: Neurofibromatosis type 1 is the most common phakomatoses and occurs in approximately 1 in 3,000 live births. It is caused by autosomal dominant mutations in the Neurofibromin 1 gene. Clinical manifestations are variable but may include hyperpigmented skin marks, hamartomas of the iris called Lisch nodules, neurofibromas, optic pathway gliomas and cognitive impairment. The prevalence of epilepsy is estimated to be 4-7%. Seizures are typically easier to control with anti-seizure medications relative to other phakomatoses but in some refractory cases surgery may need to be pursued.


title: Epilepsy

text: Epilepsy may occur as a result of several other conditions, including tumors, strokes, head trauma, previous infections of the central nervous system, genetic abnormalities, and as a result of brain damage around the time of birth. Of those with brain tumors, almost 30% have epilepsy, making them the cause of about 4% of cases. The risk is greatest for tumors in the temporal lobe and those that grow slowly. Other mass lesions such as cerebral cavernous malformations and arteriovenous malformations have risks as high as 4060%. Of those who have had a stroke, 6–10% develop epilepsy. Risk factors for post-stroke epilepsy include stroke severity, cortical involvement, hemorrhage and early seizures. Between 6 and 20% of epilepsy is believed to be due to head trauma. Mild brain injury increases the risk about two-fold while severe brain injury increases the risk seven-fold. In those who have experienced a high-powered gunshot wound to the head, the risk is about 50%.


title: Epilepsy

text: Some evidence links epilepsy and celiac disease and non-celiac gluten sensitivity, while other evidence does not. There appears to be a specific syndrome that includes coeliac disease, epilepsy, and calcifications in the brain. A 2012 review estimates that between 1% and 6% of people with epilepsy have coeliac disease while 1% of the general population has the condition.


title: Epilepsy

text: The risk of epilepsy following meningitis is less than 10%; it more commonly causes seizures during the infection itself. In herpes simplex encephalitis the risk of a seizure is around 50% with a high risk of epilepsy following (up to 25%). A form of an infection with the pork tapeworm (cysticercosis), in the brain, is known as neurocysticercosis, and is the cause of up to half of epilepsy cases in areas of the world where the parasite is common. Epilepsy may also occur after other brain infections such as cerebral malaria, toxoplasmosis, and toxocariasis. Chronic alcohol use increases the risk of epilepsy: those who drink six units of alcohol per day have a 2.5-fold increase in risk. Other risks include Alzheimer's disease, multiple sclerosis, tuberous sclerosis, and autoimmune encephalitis. Getting vaccinated does not increase the risk of epilepsy. Malnutrition is a risk factor seen mostly in the developing world, although it is unclear however if it is a direct cause or an association. People with cerebral palsy have an increased risk of epilepsy, with half of people with spastic quadriplegia and spastic hemiplegia having the disease.


title: Epilepsy

text: Normally brain electrical activity is non-synchronous, as large numbers of neurons do not normally fire at the same time, but rather fire in order as signals travel throughout the brain. Neuron activity is regulated by various factors both within the cell and the cellular environment. Factors within the neuron include the type, number and distribution of ion channels, changes to receptors and changes of gene expression. Factors around the neuron include ion concentrations, synaptic plasticity and regulation of transmitter breakdown by glial cells.


title: Epilepsy

text: The exact mechanism for epilepsy is unknown, but a little is known about its cellular and network mechanisms. However, it is unknown under which circumstances the brain shifts into the activity of a seizure with its excessive synchronization. Changes in MicroRNAs (miRNAs) levels seems to play a leading role. MicroRNAs (miRNAs) are a family of small non-coding RNAs that control the expression levels of multiple proteins by decreasing mRNA stability and translation, and could therefore be key regulatory mechanisms and therapeutic targets in epilepsy


title: Epilepsy

text: In epilepsy, the resistance of excitatory neurons to fire during this period is decreased. This may occur due to changes in ion channels or inhibitory neurons not functioning properly. This then results in a specific area from which seizures may develop, known as a "seizure focus". Another mechanism of epilepsy may be the up-regulation of excitatory circuits or down-regulation of inhibitory circuits following an injury to the brain. These secondary epilepsies occur through processes known as epileptogenesis. Failure of the blood–brain barrier may also be a causal mechanism as it would allow substances in the blood to enter the brain.


title: Epilepsy

text: There is evidence that epileptic seizures are usually not a random event. Seizures are often brought on by factors (also known as triggers) such as stress, excessive alcohol use, flickering light, or a lack of sleep, among others. The term seizure threshold is used to indicate the amount of stimulus necessary to bring about a seizure; this threshold is lowered in epilepsy.


title: Epilepsy

text: In epileptic seizures a group of neurons begin firing in an abnormal, excessive, and synchronized manner. This results in a wave of depolarization known as a paroxysmal depolarizing shift. Normally, after an excitatory neuron fires it becomes more resistant to firing for a period of time. This is due in part to the effect of inhibitory neurons, electrical changes within the excitatory neuron, and the negative effects of adenosine.


title: Epilepsy

text: Focal seizures begin in one area of the brain while generalized seizures begin in both hemispheres. Some types of seizures may change brain structure, while others appear to have little effect. Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.


title: Epilepsy

text: The seizures can be described on different scales, from the cellular level to the whole brain. These are several concomitant factor, which on different scale can "drive" the brain to pathological states and trigger a seizure.


title: Epilepsy

text: The diagnosis of epilepsy is typically made based on observation of the seizure onset and the underlying cause. An electroencephalogram (EEG) to look for abnormal patterns of brain waves and neuroimaging (CT scan or MRI) to look at the structure of the brain are also usually part of the initial investigations. While figuring out a specific epileptic syndrome is often attempted, it is not always possible. Video and EEG monitoring may be useful in difficult cases.


title: Epilepsy

text: Furthermore, epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past that age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.


title: Epilepsy

text: This 2014 definition of the International League Against Epilepsy is a clarification of the ILAE 2005 conceptual definition, according to which epilepsy is "a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure."


title: Epilepsy

text: It is, therefore, possible to outgrow epilepsy or to undergo treatment that causes epilepsy to be resolved, but with no guarantee that it will not return. In the definition, epilepsy is now called a disease, rather than a disorder. This was a decision of the executive committee of the ILAE, taken because the word "disorder," while perhaps having less stigma than does "disease," also does not express the degree of seriousness that epilepsy deserves.


title: Epilepsy

text: The definition is practical in nature and is designed for clinical use. In particular, it aims to clarify when an "enduring predisposition" according to the 2005 conceptual definition is present. Researchers, statistically minded epidemiologists, and other specialized groups may choose to use the older definition or a definition of their own devising. The ILAE considers doing so is perfectly allowable, so long as it is clear what definition is being used.


title: Epilepsy

text: In contrast to the classification of seizures which focuses on what happens during a seizure, the classification of epilepsies focuses on the underlying causes. When a person is admitted to hospital after an epileptic seizure the diagnostic workup results preferably in the seizure itself being classified (e.g. tonic-clonic) and in the underlying disease being identified (e.g. hippocampal sclerosis). The name of the diagnosis finally made depends on the available diagnostic results and the applied definitions and classifications (of seizures and epilepsies) and its respective terminology.


title: Epilepsy

text: The International League Against Epilepsy (ILAE) provided a classification of the epilepsies and epileptic syndromes in 1989 as follows:


title: Epilepsy

text: This classification was widely accepted but has also been criticized mainly because the underlying causes of epilepsy (which are a major determinant of clinical course and prognosis) were not covered in detail. In 2010 the ILAE Commission for Classification of the Epilepsies addressed this issue and divided epilepsies into three categories (genetic, structural/metabolic, unknown cause) that were refined in their 2011 recommendation into four categories and a number of subcategories reflecting recent technologic and scientific advances.


title: Epilepsy

text: Cases of epilepsy may be organized into epilepsy syndromes by the specific features that are present. These features include the age that seizure begin, the seizure types, EEG findings, among others. Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as what anti-seizure medication should be tried.


title: Epilepsy

text: The ability to categorize a case of epilepsy into a specific syndrome occurs more often with children since the onset of seizures is commonly early. Less serious examples are 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). Severe syndromes with diffuse brain dysfunction caused, at least partly, by some aspect of epilepsy, are also referred to as developmental and epileptic encephalopathies. These are associated with frequent seizures that are resistant to treatment and cognitive dysfunction, for instance Lennox–Gastaut syndrome (1-2% of all persons with epilepsy), Dravet syndrome(1: 15000-40000 worldwide), and West syndrome(1-9: 100000). Genetics is believed to play an important role in epilepsies by a number of mechanisms. Simple and complex modes of inheritance have been identified for some of them. However, extensive screening have failed to identify many single gene variants of large effect. More recent exome and genome sequencing studies have begun to reveal a number of de novo gene mutations that are responsible for some epileptic encephalopathies, including CHD2 and SYNGAP1 and DNM1, GABBR2, FASN and RYR3.


title: Epilepsy

text: Syndromes in which causes are not clearly identified are difficult to match with categories of the current classification of epilepsy. Categorization for these cases was made somewhat arbitrarily. The "idiopathic" (unknown cause) category of the 2011 classification includes syndromes in which the general clinical features and/or age specificity strongly point to a presumed genetic cause. Some childhood epilepsy syndromes are included in the unknown cause category in which the cause is presumed genetic, for instance benign rolandic epilepsy. Others are included in "symptomatic" despite a presumed genetic cause (in at least in some cases), for instance Lennox-Gastaut syndrome. Clinical syndromes in which epilepsy is not the main feature (e.g. Angelman syndrome) were categorized "symptomatic" but it was argued to include these within the category "idiopathic". Classification of epilepsies and particularly of epilepsy syndromes will change with advances in research.


title: Epilepsy

text: An electroencephalogram (EEG) can assist in showing brain activity suggestive of an increased risk of seizures. It is only recommended for those who are likely to have had an epileptic seizure on the basis of symptoms. In the diagnosis of epilepsy, electroencephalography may help distinguish the type of seizure or syndrome present. In children it is typically only needed after a second seizure unless specified by a specialist. It cannot be used to rule out the diagnosis and may be falsely positive in those without the disease. In certain situations it may be useful to perform the EEG while the affected individual is sleeping or sleep deprived.


title: Epilepsy

text: Diagnostic imaging by CT scan and MRI is recommended after a first non-febrile seizure to detect structural problems in and around the brain. MRI is generally a better imaging test except when bleeding is suspected, for which CT is more sensitive and more easily available. If someone attends the emergency room with a seizure but returns to normal quickly, imaging tests may be done at a later point. If a person has a previous diagnosis of epilepsy with previous imaging, repeating the imaging is usually not needed even if there are subsequent seizures.


title: Epilepsy

text: For adults, the testing of electrolyte, blood glucose and calcium levels is important to rule out problems with these as causes. An electrocardiogram can rule out problems with the rhythm of the heart. A lumbar puncture may be useful to diagnose a central nervous system infection but is not routinely needed. In children additional tests may be required such as urine biochemistry and blood testing looking for metabolic disorders. Together with EEG and neuroimaging, genetic testing is becoming one of the most important diagnostic technique for epilepsy, as a diagnosis might be achieved in a relevant proportion of cases with severe epilepsies, both in children and adults. For those with negative genetic testing, in some it might be important to repeat or re-analyze previous genetic studies after 2–3 years.


title: Epilepsy

text: A high blood prolactin level within the first 20 minutes following a seizure may be useful to help confirm an epileptic seizure as opposed to psychogenic non-epileptic seizure. Serum prolactin level is less useful for detecting focal seizures. If it is normal an epileptic seizure is still possible and a serum prolactin does not separate epileptic seizures from syncope. It is not recommended as a routine part of the diagnosis of epilepsy.


title: Epilepsy

text: Diagnosis of epilepsy can be difficult. A number of other conditions may present very similar signs and symptoms to seizures, including syncope, hyperventilation, migraines, narcolepsy, panic attacks and psychogenic non-epileptic seizures (PNES). In particular a syncope can be accompanied by a short episode of convulsions. Nocturnal frontal lobe epilepsy, often misdiagnosed as nightmares, was considered to be a parasomnia but later identified to be an epilepsy syndrome. Attacks of the movement disorder paroxysmal dyskinesia may be taken for epileptic seizures. The cause of a drop attack can be, among many others, an atonic seizure.


title: Epilepsy

text: Children may have behaviors that are easily mistaken for epileptic seizures but are not. These include breath-holding spells, bedwetting, night terrors, tics and shudder attacks. Gastroesophageal reflux may cause arching of the back and twisting of the head to the side in infants, which may be mistaken for tonic-clonic seizures.


title: Epilepsy

text: Misdiagnosis is frequent (occurring in about 5 to 30% of cases). Different studies showed that in many cases seizure-like attacks in apparent treatment-resistant epilepsy have a cardiovascular cause. Approximately 20% of the people seen at epilepsy clinics have PNES and of those who have PNES about 10% also have epilepsy; separating the two based on the seizure episode alone without further testing is often difficult.


title: Epilepsy

text: While many cases are not preventable, efforts to reduce head injuries, provide good care around the time of birth, and reduce environmental parasites such as the pork tapeworm may be effective. Efforts in one part of Central America to decrease rates of pork tapeworm resulted in a 50% decrease in new cases of epilepsy.


title: Epilepsy

text: Epilepsy can be dangerous when seizure occurs at certain times. The possibility of drowning and having car accident is higher. It is also dangerous when seizure occurs during pregnancy. Certain anti-epileptic medications increase the risk of birth defects. It is also found that people with epilepsy are more likely to have psychological problems. Other complications include aspiration pneumonia and difficulty learning.


title: Epilepsy

text: Epilepsy is usually treated with daily medication once a second seizure has occurred, while medication may be started after the first seizure in those at high risk for subsequent seizures. Supporting people's self management of their condition may be useful. In drug-resistant cases different management options may be looked at including a special diet, the implantation of a neurostimulator, or neurosurgery.


title: Epilepsy

text: Rolling people with an active tonic-clonic seizure onto their side and into the recovery position helps prevent fluids from getting into the lungs. Putting fingers, a bite block or tongue depressor in the mouth is not recommended as it might make the person vomit or result in the rescuer being bitten. Efforts should be taken to prevent further self-injury. Spinal precautions are generally not needed.


title: Epilepsy

text: If a seizure lasts longer than 5 minutes or if there are more than two seizures in an hour without a return to a normal level of consciousness between them, it is considered a medical emergency known as status epilepticus. This may require medical help to keep the airway open and protected; a nasopharyngeal airway may be useful for this. At home the recommended initial medication for seizure of a long duration is midazolam placed in the mouth. Diazepam may also be used rectally. In hospital, intravenous lorazepam is preferred. If two doses of benzodiazepines are not effective, other medications such as phenytoin are recommended. Convulsive status epilepticus that does not respond to initial treatment typically requires admission to the intensive care unit and treatment with stronger agents such as thiopentone or propofol.


title: Epilepsy

text: The mainstay treatment of epilepsy is anticonvulsant medications, possibly for the person's entire life. The choice of anticonvulsant is based on seizure type, epilepsy syndrome, other medications used, other health problems, and the person's age and lifestyle. A single medication is recommended initially; if this is not effective, switching to a single other medication is recommended. Two medications at once is recommended only if a single medication does not work. In about half, the first agent is effective; a second single agent helps in about 13% and a third or two agents at the same time may help an additional 4%. About 30% of people continue to have seizures despite anticonvulsant treatment.


title: Epilepsy

text: There are a number of medications available including phenytoin, carbamazepine and valproate. Evidence suggests that phenytoin, carbamazepine, and valproate may be equally effective in both focal and generalized seizures. Controlled release carbamazepine appears to work as well as immediate release carbamazepine, and may have fewer side effects. Recently, "Nux vomica" and "Cicuta virosa" have been shown to produce significant anti-epileptic effects and no side effects. This could prove to be very helpful for a large segment of population. In the United Kingdom, carbamazepine or lamotrigine are recommended as first-line treatment for focal seizures, with levetiracetam and valproate as second-line due to issues of cost and side effects. Valproate is recommended first-line for generalized seizures with lamotrigine being second-line. In those with absence seizures, ethosuximide or valproate are recommended; valproate is particularly effective in myoclonic seizures and tonic or atonic seizures. If seizures are well-controlled on a particular treatment, it is not usually necessary to routinely check the medication levels in the blood.


title: Epilepsy

text: The least expensive anticonvulsant is phenobarbital at around US$5 a year. The World Health Organization gives it a first-line recommendation in the developing world and it is commonly used there. Access however may be difficult as some countries label it as a controlled drug.


title: Epilepsy

text: Adverse effects from medications are reported in 10 to 90% of people, depending on how and from whom the data is collected. Most adverse effects are dose-related and mild. Some examples include mood changes, sleepiness, or an unsteadiness in gait. Certain medications have side effects that are not related to dose such as rashes, liver toxicity, or suppression of the bone marrow. Up to a quarter of people stop treatment due to adverse effects. Some medications are associated with birth defects when used in pregnancy. Many of the common used medications, such as valproate, phenytoin, carbamazepine, phenobarbital, and gabapentin have been reported to cause increased risk of birth defects, especially when used during the first trimester. Despite this, treatment is often continued once effective, because the risk of untreated epilepsy is believed to be greater than the risk of the medications. Among the antiepileptic medications, levetiracetam and lamotrigine seem to carry the lowest risk of causing birth defects.


title: Epilepsy

text: Slowly stopping medications may be reasonable in some people who do not have a seizure for two to four years; however, around a third of people have a recurrence, most often during the first six months. Stopping is possible in about 70% of children and 60% of adults. Measuring medication levels is not generally needed in those whose seizures are well controlled.


title: Epilepsy

text: Epilepsy surgery may be an option for people with focal seizures that remain a problem despite other treatments. These other treatments include at least a trial of two or three medications. The goal of surgery is total control of seizures and this may be achieved in 60–70% of cases. Common procedures include cutting out the hippocampus via an anterior temporal lobe resection, removal of tumors, and removing parts of the neocortex. Some procedures such as a corpus callosotomy are attempted in an effort to decrease the number of seizures rather than cure the condition. Following surgery, medications may be slowly withdrawn in many cases.


title: Epilepsy

text: Neurostimulation via neuro-cybernetic prosthesis implantation, may be another option in those who are not candidates for surgery, providing chronic, pulsatile electrical stimulation of specific nerve or brain regions, alongside standard care. Three types have been used in those who do not respond to medications: vagus nerve stimulation (VNS), anterior thalamic stimulation, and closed-loop responsive stimulation.


title: Epilepsy

text: Non-pharmacological modulation of neurotransmitters via high-level VNS (h-VNS) may reduce seizure frequency in children and adults who do not respond to medical and/or surgical therapy, when compared with low-level VNS (l-VNS). In a 2022 Cochrane review of 4 randomised controlled trials, with moderate certainty of evidence, people receiving h-VNS treatment were 73% more likely (13% more likely to 164% more likely) to experience a reduction in seizure frequency by at least 50% (the minimum threshold defined for individual clinical response). Potentially 249 (163 to 380) per 1000 people with drug-resistant epilepsy may achieve a 50% reduction in seizures following h-VNS, benefiting an additional 105 per 1000 people compared with l-VNS.


title: Epilepsy

text: This outcome was limited by the number of studies available, and the quality of one trial in particular, wherein 3 people received l-VNS in error. A sensitivity analysis suggested that the best case scenario was that the likelihood of clinical response to h-VNS may be 91% (27% to 189%) higher than those receiving l-VNS. In the worst-case scenario, the likelihood of clinical response to h-VNS was still 61% higher (7% higher to 143% higher) than l-VNS.


title: Epilepsy

text: Despite the potential benefit for h-VNS treatment, the Cochrane review also found that the risk of several adverse-effects was greater than those receiving l-VNS. There was moderate certainty of evidence that voice alteration or hoarseness risk may be 2.17(1.49 to 3.17) fold higher than people receiving l-VNS. Dyspnoea risk was also 2.45 (1.07 to 5.60) times that of l-VNS receipients, although the low number of events and studies meant that the certainty of evidence was low. The risk of rebound-withdrawal symptoms, coughing, pain and paraesthesia was unclear.


title: Epilepsy

text: There is promising evidence that a ketogenic diet (high-fat, low-carbohydrate, adequate-protein) decreases the number of seizures and eliminates seizures in some; however, further research is necessary. It is a reasonable option in those who have epilepsy that is not improved with medications and for whom surgery is not an option. About 10% stay on the diet for a few years due to issues of effectiveness and tolerability. Side effects include stomach and intestinal problems in 30%, and there are long-term concerns about heart disease. Less radical diets are easier to tolerate and may be effective. It is unclear why this diet works. In people with coeliac disease or non-celiac gluten sensitivity and occipital calcifications, a gluten-free diet may decrease the frequency of seizures.


title: Epilepsy

text: Avoidance therapy consists of minimizing or eliminating triggers. For example, those who are sensitive to light may have success with using a small television, avoiding video games, or wearing dark glasses. Operant-based biofeedback based on the EEG waves has some support in those who do not respond to medications. Psychological methods should not, however, be used to replace medications.


title: Epilepsy

text: Exercise has been proposed as possibly useful for preventing seizures, with some data to support this claim. Some dogs, commonly 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.


title: Epilepsy

text: There is moderate-quality evidence supporting the use of psychological interventions along with other treatments in epilepsy. This can improve quality of life, enhance emotional wellbeing, and reduce fatigue in adults and adolescents. Psychological interventions may also improve seizure control for some individuals by promoting self-management and adherence.


title: Epilepsy

text: As an add-on therapy in those who are not well controlled with other medications, cannabidiol appears to be useful in some children. In 2018 the FDA approved this product for Lennox–Gastaut syndrome and Dravet syndrome.


title: Epilepsy

text: There are a few studies on the use of dexamethasone for the successful treatment of drug-resistant seizures in both adults and children


title: Epilepsy

text: In women of childbearing age, use of antiepileptic drugs is a major concern balancing possible side effects on the fetus against risk from uncontrolled seizures. Use of AEDs entail teratogenic effects including intrauterine growth retardation, major congenital malformations and developmental (neurocognitive) and behavioral issues, that need to be discussed with the patient at the time of starting the AEDs and before they plan pregnancy. Most women with epilepsy receive safe and effective treatment and have normal children, however risks exist. The International League Against Epilepsy created a task force on women and epilepsy which published consensus recommendations to guide therapy decisions until more definitive evidence is available in the future.


title: Epilepsy

text: Alternative medicine, including acupuncture, routine vitamins, and yoga, have no reliable evidence to support their use in epilepsy. Melatonin, , is insufficiently supported by evidence. The trials were of poor methodological quality and it was not possible to draw any definitive conclusions.


title: Epilepsy

text: Several supplements (with varied reliabilities of evidence) have been reported to be helpful for drug-resistant epilepsy. These include high-dose Omega-3, berberine, Manuka honey, Reishi and Lion's Mane mushrooms, curcumin, vitamin E, coenzyme Q-10, and resveratrol. The reason these can work(in theory) is that they reduce inflammation or oxidative stress, two of the major mechanism contributing to epilepsy.


title: Epilepsy

text: Epilepsy cannot usually be cured, but medication can control seizures effectively in about 70% of cases. Of those with generalized seizures, more than 80% can be well controlled with medications while this is true in only 50% of people with focal seizures. One predictor of long-term outcome is the number of seizures that occur in the first six months. Other factors increasing the risk of a poor outcome include little response to the initial treatment, generalized seizures, a family history of epilepsy, psychiatric problems, and waves on the EEG representing generalized epileptiform activity. In the developing world, 75% of people are either untreated or not appropriately treated. In Africa, 90% do not get treatment. This is partly related to appropriate medications not being available or being too expensive.


title: Epilepsy

text: People with epilepsy are at an increased risk of death. This increase is between 1.6 and 4.1 fold greater than that of the general population. The greatest increase in mortality from epilepsy is among the elderly. Those with epilepsy due to an unknown cause have little increased risk.


title: Epilepsy

text: Mortality is often related to: the underlying cause of the seizures, status epilepticus, suicide, trauma, and sudden unexpected death in epilepsy (SUDEP). Death from status epilepticus is primarily due to an underlying problem rather than missing doses of medications. The risk of suicide is between 2 and 6 times higher in those with epilepsy; the cause of this is unclear. SUDEP appears to be partly related to the frequency of generalized tonic-clonic seizures and accounts for about 15% of epilepsy-related deaths; it is unclear how to decrease its risk.


title: Epilepsy

text: In the United Kingdom, it is estimated that 40–60% of deaths are possibly preventable. In the developing world, many deaths are due to untreated epilepsy leading to falls or status epilepticus.


title: Epilepsy

text: Epilepsy is one of the most common serious neurological disorders affecting about 39 million people . It affects 1% of the population by age 20 and 3% of the population by age 75. It is more common in males than females with the overall difference being small. Most of those with the disorder (80%) are in low income populations or the developing world.


title: Epilepsy

text: The estimated prevalence of active epilepsy () is in the range 3–10 per 1,000, with active epilepsy defined as someone with epilepsy who has had a least one unprovoked seizure in the last five years. Epilepsy begins each year in 40–70 per 100,000 in developed countries and 80–140 per 100,000 in developing countries. Poverty is a risk and includes both being from a poor country and being poor relative to others within one's country. In the developed world epilepsy most commonly starts either in the young or in the old. In the developing world its onset is more common in older children and young adults due to the higher rates of trauma and infectious diseases. In developed countries the number of cases a year has decreased in children and increased among the elderly between the 1970s and 2003. This has been attributed partly to better survival following strokes in the elderly.


title: Epilepsy

text: The oldest medical records show that epilepsy has been affecting people at least since the beginning of recorded history. Throughout ancient history, the disease was thought to be a spiritual condition. The world's oldest description of an epileptic seizure comes from a text in Akkadian (a language used in ancient Mesopotamia) and was written around 2000 BC. The person described in the text was diagnosed as being under the influence of a moon god, and underwent an exorcism. Epileptic seizures are listed in the Code of Hammurabi () as reason for which a purchased slave may be returned for a refund, and the Edwin Smith Papyrus () describes cases of individuals with epileptic convulsions.


title: Epilepsy

text: The oldest known detailed record of the disease itself is in the "Sakikku", a Babylonian cuneiform medical text from 10671046 BC. This text gives signs and symptoms, details treatment and likely outcomes, and describes many features of the different seizure types. As the Babylonians had no biomedical understanding of the nature of disease, they attributed the seizures to possession by evil spirits and called for treating the condition through spiritual means. Around 900 BC, Punarvasu Atreya described epilepsy as loss of consciousness; this definition was carried forward into the Ayurvedic text of Charaka Samhita (about 400 BC).


title: Epilepsy

text: The ancient Greeks had contradictory views of the disease. They thought of epilepsy as a form of spiritual possession, but also associated the condition with genius and the divine. One of the names they gave to it was the "sacred disease" (ἠ ἱερὰ νόσος). Epilepsy appears within Greek mythology: it is associated with the Moon goddesses Selene and Artemis, who afflicted those who upset them. The Greeks thought that important figures such as Julius Caesar and Hercules had the disease. The notable exception to this divine and spiritual view was that of the school of Hippocrates. In the fifth century BC, Hippocrates rejected the idea that the disease was caused by spirits. In his landmark work "On the Sacred Disease", he proposed that epilepsy was not divine in origin and instead was a medically treatable problem originating in the brain. He accused those of attributing a sacred cause to the disease of spreading ignorance through a belief in superstitious magic. Hippocrates proposed that heredity was important as a cause, described worse outcomes if the disease presents at an early age, and made note of the physical characteristics as well as the social shame associated with it. Instead of referring to it as the "sacred disease", he used the term "great disease", giving rise to the modern term "grand mal", used for tonic–clonic seizures. Despite his work detailing the physical origins of the disease, his view was not accepted at the time. Evil spirits continued to be blamed until at least the 17th century.


title: Epilepsy

text: In Ancient Rome people did not eat or drink with the same pottery as that used by someone who was affected. People of the time would spit on their chest believing that this would keep the problem from affecting them. According to Apuleius and other ancient physicians, in order to detect epilepsy, it was common to light a piece of "gagates", whose smoke would trigger the seizure. Occasionally a spinning potter's wheel was used, perhaps a reference to photosensitive epilepsy.


title: Epilepsy

text: In most cultures, persons with epilepsy have been stigmatized, shunned, or even imprisoned. As late as in the second half of the 20th century, in Tanzania and other parts of Africa epilepsy was associated with possession by evil spirits, witchcraft, or poisoning and was believed by many to be contagious. In the Salpêtrière, the birthplace of modern neurology, Jean-Martin Charcot found people with epilepsy side by side with the mentally ill, those with chronic syphilis, and the criminally insane. In ancient Rome, epilepsy was known as the "morbus comitialis" ('disease of the assembly hall') and was seen as a curse from the gods. In northern Italy, epilepsy was once traditionally known as Saint Valentine's malady. In at least the 1840s in the United States of America, epilepsy was known as the "falling sickness" or "the falling fits", and was considered a form of medical insanity. Around the same time period, epilepsy was known in France as the "haut-mal" ('high evil'), "mal-de terre" ('earthen sickness'), "mal de Saint Jean" ('Saint John's sickness'), "mal des enfans" ('child sickness'), and "mal-caduc" ('obsolete sickness'). Patients of epilepsy in France were also known as "tombeurs", or 'people who fall', due to the seizures and loss of consciousness in an epileptic episode.


title: Epilepsy

text: In the mid-19th century, the first effective anti-seizure medication, bromide, was introduced. The first modern treatment, phenobarbital, was developed in 1912, with phenytoin coming into use in 1938.


title: Epilepsy

text: Stigma is commonly experienced, around the world, by those with epilepsy. It can affect people economically, socially and culturally. In India and China, epilepsy may be used as justification to deny marriage. People in some areas still believe those with epilepsy to be cursed. In parts of Africa, such as Tanzania and Uganda, epilepsy is claimed to be associated with possession by evil spirits, witchcraft, or poisoning and is incorrectly believed by many to be contagious. Before 1971 in the United Kingdom, epilepsy was considered grounds for the annulment of marriage. The stigma may result in some people with epilepsy denying that they have ever had seizures.


title: Epilepsy

text: Seizures result in direct economic costs of about one billion dollars in the United States. Epilepsy resulted in economic costs in Europe of around 15.5 billion euros in 2004. In India epilepsy is estimated to result in costs of US$1.7 billion or 0.5% of the GDP. It is the cause of about 1% of emergency department visits (2% for emergency departments for children) in the United States.


title: Epilepsy

text: Those with epilepsy are at about twice the risk of being involved in a motor vehicular collision and thus in many areas of the world are not allowed to drive or only able to drive if certain conditions are met. Diagnostic delay has been suggested to be a cause of some potentially avoidable motor vehicle collisions since at least one study showed that most motor vehicle accidents occurred in those with undiagnosed nonmotor seizures as opposed to those with motor seizures at epilepsy onset. In some places physicians are required by law to report if a person has had a seizure to the licensing body while in others the requirement is only that they encourage the person in question to report it himself. Countries that require physician reporting include Sweden, Austria, Denmark and Spain. Countries that require the individual to report include the UK and New Zealand, and physicians may report if they believe the individual has not already. In Canada, the United States and Australia the requirements around reporting vary by province or state. If seizures are well controlled most feel allowing driving is reasonable. The amount of time a person must be free from seizures before he can drive varies by country. Many countries require one to three years without seizures. In the United States the time needed without a seizure is determined by each state and is between three months and one year.


title: Epilepsy

text: Those with epilepsy or seizures are typically denied a pilot license. In Canada if an individual has had no more than one seizure, they may be considered after five years for a limited license if all other testing is normal. Those with febrile seizures and drug related seizures may also be considered. In the United States, the Federal Aviation Administration does not allow those with epilepsy to get a commercial pilot license. Rarely, exceptions can be made for persons who have had an isolated seizure or febrile seizures and have remained free of seizures into adulthood without medication. In the United Kingdom, a full national private pilot license requires the same standards as a professional driver's license. This requires a period of ten years without seizures while off medications. Those who do not meet this requirement may acquire a restricted license if free from seizures for five years.


title: Epilepsy

text: There are organizations that provide support for people and families affected by epilepsy. The "Out of the Shadows" campaign, a joint effort by the World Health Organization, the International League Against Epilepsy and the International Bureau for Epilepsy, provides help internationally. In the United States, the Epilepsy Foundation is a national organization that works to increase the acceptance of those with the disorder, their ability to function in society and to promote research for a cure. The Epilepsy Foundation, some hospitals, and some individuals also run support groups in the United States. In Australia, the Epilepsy Foundation provides support, delivers education and training and funds research for people living with epilepsy.


title: Epilepsy

text: International Epilepsy Day (World Epilepsy Day) began in 2015 and occurs on the second Monday in February.


title: Epilepsy

text: Purple Day, a different world-wide epilepsy awareness day for epilepsy, was initiated by a nine-year-old Canadian named Cassidy Megan in 2008, and is every year on March 26.


title: Epilepsy

text: Seizure prediction refers to attempts to forecast epileptic seizures based on the EEG before they occur. , no effective mechanism to predict seizures has been developed. Kindling, where repeated exposures to events that could cause seizures eventually causes seizures more easily, has been used to create animal models of epilepsy. One of the hypotheses present in the literature is based on inflammatory pathways. Studies supporting this mechanism revealed that inflammatory, glycolipid, and oxidative factors are higher in epilepsy patients, especially those with generalized epilepsy.


title: Epilepsy

text: Gene therapy is being studied in some types of epilepsy. Medications that alter immune function, such as intravenous immunoglobulins, are poorly supported by evidence. Noninvasive stereotactic radiosurgery is, , being compared to standard surgery for certain types of epilepsy.


title: Epilepsy

text: Epilepsy occurs in a number of other animals including dogs and cats; it is in fact the most common brain disorder in dogs. It is typically treated with anticonvulsants such as phenobarbital or bromide in dogs and phenobarbital in cats. Imepitoin is also used in dogs. While generalized seizures in horses are fairly easy to diagnose, it may be more difficult in non-generalized seizures and EEGs may be useful.


title: Finn Cole

text: Finlay Lewis J. Cole is an English actor from Kingston, London. He is known for his role in the BBC series "Peaky Blinders" as Michael Gray. He is currently starring as Joshua "J" Cody in TNT's "Animal Kingdom", and played young Jakob Toretto in the film "F9".


title: Finn Cole

text: As a child, Cole wanted to work on boats like his father. His older brother Joe is also an actor and helped Finn get the audition for his first acting job. In 2015, Finn appeared as Eric Birling in Helen Edmundson's BBC One adaptation of "An Inspector Calls".


title: Finn Cole

text: Cole was born in London, the second-youngest of five brothers. One of his elder brothers is Joe Cole, whom he starred alongside in "Peaky Blinders".


title: Huey Long

text: Huey Pierce Long Jr. (August 30, 1893September 10, 1935), nicknamed "the Kingfish", was an American politician who served as the 40th governor of Louisiana from 1928 to 1932 and as a United States senator from 1932 until his assassination in 1935. He was a left-wing populist member of the Democratic Party and rose to national prominence during the Great Depression for his vocal criticism of President Franklin D. Roosevelt and his New Deal, which Long deemed insufficiently radical. As the political leader of Louisiana, he commanded wide networks of supporters and often took forceful action. A controversial figure, Long is celebrated as a populist champion of the poor or, conversely, denounced as a fascistic demagogue.


title: Huey Long

text: Long was born in the impoverished north of Louisiana in 1893. After working as a traveling salesman and briefly attending three colleges, he was admitted to the bar in Louisiana. Following a short career as an attorney, in which he frequently represented poor plaintiffs, Long was elected to the Louisiana Public Service Commission. As Commissioner, he prosecuted large corporations such as Standard Oil, a lifelong target of his rhetorical attacks. After Long successfully argued before the U.S. Supreme Court, Chief Justice and former president William Howard Taft praised him as "the most brilliant lawyer who ever practiced before the United States Supreme Court".


title: Huey Long

text: After a failed 1924 campaign, Long used the sharp economic and class divisions in Louisiana to win the 1928 gubernatorial election. Once in office, he expanded social programs, organized massive public works projects, such as a modern highway system and the tallest capitol building in the nation, and proposed a cotton holiday. Through political maneuvering, Long became the political boss of Louisiana. He was impeached in 1929 for abuses of power, but the proceedings collapsed in the State Senate. His opponents argued his policies and methods were unconstitutional and dictatorial. At its climax, political opposition organized a minor insurrection.


title: Huey Long

text: Long was elected to the U.S. Senate in 1930 but did not assume his seat until 1932. He established himself as an isolationist, arguing that Standard Oil and Wall Street orchestrated American foreign policy. He was instrumental in securing Roosevelt's 1932 nomination but split with him in 1933, becoming a prominent critic of his New Deal. As an alternative, he proposed the Share Our Wealth program in 1934. To stimulate the economy, he advocated massive federal spending, a wealth tax, and wealth redistribution. These proposals drew wide support with millions joining local Share Our Wealth clubs. Poised for a 1936 presidential bid, Long was mortally wounded by a lone assassin in 1935. Although Long's movement faded, Roosevelt adopted many of his proposals in the Second New Deal, and Louisiana elections would be organized along anti- or pro-Long factions until the 1960s. He left behind a political dynasty that included his wife, Senator Rose McConnell Long; his son Senator Russell B. Long; and his brother, Governor Earl Long, among others.


title: Huey Long

text: Long was born on August 30, 1893, near Winnfield, a small town in north-central Louisiana, the seat of Winn Parish. Although Long often told followers he was born in a log cabin to an impoverished family, they lived in a "comfortable" farmhouse and were well-off compared to others in Winnfield. Winn Parish was impoverished, and its residents, mostly Southern Baptists, were often outsiders in Louisiana's political system. During the Civil War, Winn Parish had been a stronghold of Unionism in an otherwise Confederate state. At Louisiana's 1861 convention on secession, the delegate from Winn voted to remain in the Union saying: "Who wants to fight to keep the Negroes for the wealthy planters?" In the 1890s, the parish was a bastion of the Populist Party, and in the 1912 election, a plurality (35%) voted for the Socialist presidential candidate, Eugene V. Debs. Long embraced these populist sentiments.


title: Huey Long

text: One of nine children, Long was home schooled until age eleven. In the public system, he earned a reputation as an excellent student with a remarkable memory and convinced his teachers to let him skip seventh grade. At Winnfield High School, he and his friends formed a secret society, advertising their exclusivity by wearing a red ribbon. According to Long, his club's mission was "to run things, laying down certain rules the students would have to follow". The faculty learned of Long's antics and warned him to obey the school's rules. Long continued to rebel, writing and distributing a flyer that criticized his teachers and the necessity of a recently state-mandated fourth year of secondary education, for which he was expelled in 1910. Although Long successfully petitioned to fire the principal, he never returned to high school. As a student, Long proved a capable debater. At a state debate competition in Baton Rouge, he won a full-tuition scholarship to Louisiana State University (LSU). Because the scholarship did not cover textbooks or living expenses, his family could not afford for him to attend. Long was also unable to attend because he did not graduate from high school. Instead, he entered the workforce as a traveling salesman in the rural South.


title: Huey Long

text: In September 1911, Long started attending seminary classes at Oklahoma Baptist University at the urging of his mother, a devout Baptist. Living with his brother George, Long attended for only one semester, rarely appearing at lectures. After deciding he was unsuited to preaching, Long focused on law. Borrowing one hundred dollars from his brother (which he later lost playing roulette in Oklahoma City), he attended the University of Oklahoma College of Law for a semester in 1912. To earn money while studying law part-time, he continued to work as a salesman. Of the four classes Long took, he received one incomplete and three C's. He later confessed he learned little because there was "too much excitement, all those gambling houses and everything".


title: Huey Long

text: Long met Rose McConnell at a baking contest he had promoted to sell Cottolene shortening. The two began a two-and-a-half-year courtship and married in April 1913 at the Gayoso Hotel in Memphis, Tennessee. On their wedding day, Long had no cash with him and had to borrow $10 from his fiancée to pay the officiant. Shortly after their marriage, Long revealed to his wife his aspirations to run for a statewide office, the governorship, the Senate, and ultimately the presidency. The Longs had a daughter named Rose (1917–2006) and two sons: Russell B. Long (1918–2003), who became a U.S. senator, and Palmer Reid Long (1921–2010), who became an oilman in Shreveport, Louisiana.


title: Huey Long

text: Long enrolled at Tulane University Law School in New Orleans in the fall of 1914. After a year of study that concentrated on the courses necessary for the bar exam, he successfully petitioned the Louisiana Supreme Court for permission to take the test before its scheduled June 1915 date. He was examined in May, passed, and received his license to practice. According to Long: "I came out of that courtroom running for office."


title: Huey Long

text: In 1915, Long established a private practice in Winnfield. He represented poor plaintiffs, usually in workers' compensation cases. Long avoided fighting in World War I by obtaining a draft deferment on the grounds that he was married and had a dependent child. He successfully defended from prosecution under the Espionage Act of 1917 the state senator who had loaned him the money to complete his legal studies, and later claimed he did not serve because, "I was not mad at anybody over there." In 1918, Long invested $1,050 () in a well that struck oil. The Standard Oil Company refused to accept any of the oil in its pipelines, costing Long his investment. This episode served as the catalyst for Long's lifelong hatred of Standard Oil.


title: Huey Long

text: That same year, Long entered the race to serve on the three-seat Louisiana Railroad Commission. According to historian William Ivy Hair, Long's political message:


title: Huey Long

text: ... would be repeated until the end of his days: he was a young warrior of and for the plain people, battling the evil giants of Wall Street and their corporations; too much of America's wealth was concentrated in too few hands, and this unfairness was perpetuated by an educational system so stacked against the poor that (according to his statistics) only fourteen out of every thousand children obtained a college education. The way to begin rectifying these wrongs was to turn out of office the corrupt local flunkies of big business ... and elect instead true men of the people, such as [himself].


title: Huey Long

text: In the Democratic primary, Long polled second behind incumbent Burk Bridges. Since no candidate garnered a majority of the votes, a run-off election was held, for which Long campaigned tirelessly across northern Louisiana. The race was close: Long defeated Burk by just 636 votes. Although the returns revealed wide support for Long in rural areas, he performed poorly in urban areas. On the Commission, Long forced utilities to lower rates, ordered railroads to extend service to small towns, and demanded that Standard Oil cease the importation of Mexican crude oil and use more oil from Louisiana wells.


title: Huey Long

text: In the gubernatorial election of 1920, Long campaigned heavily for John M. Parker; today, he is often credited with helping Parker win northern parishes. After Parker was elected, the two became bitter rivals. Their break was largely caused by Long's demand and Parker's refusal to declare the state's oil pipelines public utilities. Long was infuriated when Parker allowed oil companies, led by Standard Oil's legal team, to assist in writing severance tax laws. Long denounced Parker as corporate "chattel". The feud climaxed in 1921, when Parker tried unsuccessfully to have Long ousted from the commission.


title: Huey Long

text: By 1922, Long had become chairman of the commission, now called the "Public Service Commission". That year, Long prosecuted the Cumberland Telephone & Telegraph Company for unfair rate increases; he successfully argued the case on appeal before the United States Supreme Court, which resulted in cash refunds to thousands of overcharged customers. After the decision, Chief Justice and former President William Howard Taft praised Long as "the most brilliant lawyer who ever practiced" before the court.


title: Huey Long

text: On August 30, 1923, Long announced his candidacy for the governorship of Louisiana. Long stumped throughout the state, personally distributing circulars and posters. He denounced Governor Parker as a corporate stooge, vilified Standard Oil, and assailed local political bosses.


title: Huey Long

text: He campaigned in rural areas disenfranchised by the state's political establishment, the "Old Regulars". Since the 1877 end of Republican-controlled Reconstruction government, they had controlled most of the state through alliances with local officials. With negligible support for Republicans, Louisiana was essentially a one party state under the Democratic Old Regulars. Holding mock elections in which they invoked the Lost Cause of the Confederacy, the Old Regulars presided over a corrupt government that largely benefited the planter class. Consequently, Louisiana was one of the least developed states: It had just 300 miles of paved roads and the lowest literacy rate.


title: Huey Long

text: Despite an enthusiastic campaign, Long came third in the primary and was eliminated. Although polls projected only a few thousand votes, he attracted almost 72,000, around 31% of the electorate, and carried 28 parishes—more than either opponent. Limited to sectional appeal, he performed best in the poor rural north.


title: Huey Long

text: The Ku Klux Klan's prominence in Louisiana was the campaign's primary issue. While the two other candidates either strongly opposed or supported the Klan, Long remained neutral, alienating both sides. He also failed to attract Catholic voters, which limited his chances in the south of the state. In majority Catholic New Orleans, he polled just 12,000 votes (17%). Long blamed heavy rain on election day for suppressing voter turnout among his base in the north, where voters could not reach the polls over dirt roads that had turned to mud. It was the only election Long ever lost.


title: Huey Long

text: Long spent the intervening four years building his reputation and political organization, particularly in the heavily Catholic urban south. Despite disagreeing with their politics, Long campaigned for Catholic U.S. Senators in 1924 and 1926. Government mismanagement during the Great Mississippi Flood of 1927 gained Long the support of Cajuns, whose land had been affected. He formally launched his second campaign for governor in 1927, using the slogan, "Every man a king, but no one wears a crown", a phrase adopted from Democratic presidential candidate William Jennings Bryan.


title: Huey Long

text: Long developed novel campaign techniques, including the use of sound trucks and radio commercials. His stance on race was unorthodox. According to T. Harry Williams, Long was "the first Southern mass leader to leave aside race baiting and appeals to the Southern tradition and the Southern past and address himself to the social and economic problems of the present". The campaign sometimes descended into brutality. When the 60-year-old incumbent governor called Long a liar during a chance encounter in the lobby of the Roosevelt Hotel, Long punched him in the face.


title: Huey Long

text: In the Democratic primary election, Long polled 126,842 votes: a plurality of 43.9 percent. His margin was the largest in state history, and no opponent chose to face him in a runoff. After earning the Democratic nomination, he easily defeated the Republican nominee in the general election with 96.1 percent of the vote. At age 35, Long was the youngest person ever elected governor of Louisiana.


title: Huey Long

text: Some fifteen thousand Louisianians traveled to Baton Rouge for Long's inauguration. He set up large tents, free drinks, and jazz bands on the capitol grounds, evoking Andrew Jackson's 1829 inaugural festivities. His victory was seen as a public backlash against the urban establishment; journalist Hodding Carter described it as a "fantastic vengeance upon the Sodom and Gomorrah that was called New Orleans". While previous elections were normally divided culturally and religiously, Long highlighted the sharp economic divide in the state and built a new coalition based on class. Long's strength, said the contemporary novelist Sherwood Anderson, relied on "the terrible South ... the beaten, ignorant, Bible-ridden, white South. Faulkner occasionally really touches it. It has yet to be paid for."


title: Huey Long

text: Once in office on May 21, 1928, Long moved quickly to consolidate power, firing hundreds of opponents in the state bureaucracy at all ranks from cabinet-level heads of departments to state road workers. Like previous governors, he filled the vacancies with patronage appointments from his network of political supporters. Every state employee who depended on Long for a job was expected to pay a portion of their salary at election time directly into his campaign fund.


title: Huey Long

text: Once his control over the state's political apparatus was strengthened, Long pushed several bills through the 1929 session of the Louisiana State Legislature to fulfill campaign promises. His bills met opposition from legislators, wealthy citizens, and the media, but Long used aggressive tactics to ensure passage. He would appear unannounced on the floor of both the House and Senate or in House committees, corralling reluctant representatives and state senators and bullying opponents. When an opposing legislator once suggested Long was unfamiliar with the Louisiana Constitution, he declared, "I'm the Constitution around here now."


title: Huey Long

text: One program Long approved was a free textbook program for schoolchildren. Long's free school books angered Catholics, who usually sent their children to private schools. Long assured them that the books would be granted directly to all children, regardless of whether they attended public school. Yet this assurance was criticized by conservative constitutionalists, who claimed it violated the separation of church and state and sued Long. The case went to the U.S. Supreme Court, which ruled in Long's favor.


title: Huey Long

text: Irritated by "immoral" gambling dens and brothels in New Orleans, Long sent the National Guard to raid these establishments with orders to "shoot without hesitation". Gambling equipment was burned, prostitutes were arrested, and over $25,000 () was confiscated for government funds. Local newspapers ran photos of National Guardsmen forcibly searching nude women. City authorities had not requested military force, and martial law had not been declared. The Louisiana attorney general denounced Long's actions as illegal but Long rebuked him saying: "Nobody asked him for his opinion."


title: Huey Long

text: Despite wide disapproval, Long had the Governor's Mansion, built in 1887, razed by convicts from the State Penitentiary under his personal supervision. In its place, Long had a much larger Georgian mansion built. It bore a strong resemblance to the White House; he reportedly wanted to be familiar with the residence when he became president.


title: Huey Long

text: In 1929, Long called a special legislative session to enact a five-cent per barrel tax on refined oil production to fund his social programs. The state's oil interests opposed the bill. Long declared in a radio address that any legislator who refused to support the tax had been "bought" by oil companies. Instead of persuading the legislature, the accusation infuriated many of its members. The "dynamite squad", a caucus of opponents led by freshman lawmakers Cecil Morgan and Ralph Norman Bauer, introduced an impeachment resolution against Long. Nineteen charges were listed, ranging from blasphemy to subornation of murder. Even Long's lieutenant governor, Paul Cyr, supported impeachment; he accused Long of nepotism and alleged he had made corrupt deals with a Texan oil company.


title: Huey Long

text: Concerned, Long tried to close the session. Pro-Long Speaker John B. Fournet called for a vote to adjourn. Despite most representatives opposing adjournment, the electronic voting board tallied 68 ayes and 13 nays. This sparked confusion; anti-Long representatives began chanting that the voting machine had been rigged. Some ran for the speaker's chair to call for a new vote but met resistance from their pro-Long colleagues, sparking a brawl later known as "Bloody Monday". In the scuffle, legislators threw inkwells, allegedly attacked others with brass knuckles, and Long's brother Earl bit a legislator's neck. Following the fight, the legislature voted to remain in session and proceed with impeachment. A trial in the house took place with dozens of witnesses, including a hula dancer who claimed that Long had been "frisky" with her. Impeached on eight of the 19 charges, Long was the first Louisiana governor charged in the state's history.


title: Huey Long

text: Long was frightened by the prospect of conviction, for it would force him from the governorship and permanently disqualify him from holding public office in Louisiana. He took his case to the people with a mass meeting in Baton Rouge, where he alleged that impeachment was a ploy by Standard Oil to thwart his programs. The House referred the charges to the Louisiana Senate, in which conviction required a two-thirds majority. Long produced a round robin statement signed by fifteen senators pledging to vote "not guilty" regardless of the evidence. The impeachment process, now futile, was suspended. It has been alleged that both sides used bribes to buy votes and that Long later rewarded the round robin signers with positions or other favors.


title: Huey Long

text: Following the failed trial, Long treated his opponents ruthlessly. He fired their relatives from state jobs and supported their challengers in elections. Long concluded that extra-legal means would be needed to accomplish his goals: "I used to try to get things done by saying 'please.' Now... I dynamite 'em out of my path." Receiving death threats, he surrounded himself with bodyguards. Now a resolute critic of the "lying" press, Long established his own newspaper in March 1930: the "Louisiana Progress". The paper was extremely popular, widely distributed by policemen, highway workers, and government truckers.


title: Huey Long

text: Shortly after the impeachment, Long—now nicknamed "The Kingfish" after an "Amos 'n' Andy" character—announced his candidacy for the U.S. Senate in the 1930 Democratic primary. He framed his campaign as a referendum. If he won, he presumed the public supported his programs over the opposition of the legislature. If he lost, he promised to resign.


title: Huey Long

text: His opponent was incumbent Joseph E. Ransdell, the Catholic senator whom Long endorsed in 1924. At 72 years old, Ransdell had served in the U.S. Congress since Long was aged six. Aligned with the establishment, Ransdell had the support of all 18 of the state's daily newspapers. To combat this, Long purchased two new $30,000 sound trucks and distributed over two million circulars. Although promising not to make personal attacks, Long seized on Ransdell's age, calling him "Old Feather Duster". The campaign became increasingly vicious, "The New York Times" calling it "as amusing as it was depressing". Long critic Sam Irby, set to testify on Long's corruption to state authorities, was abducted by Long's bodyguards shortly before the election. Irby emerged after the election; he had been missing for four days. Surrounded by Long's guards, he gave a radio address in which he "confessed" that he had actually asked Long for protection. The New Orleans mayor labelled it "the most heinous public crime in Louisiana history".


title: Huey Long

text: Ultimately, on September 9, 1930, Long defeated Ransdell by 149,640 (57.3 percent) to 111,451 (42.7 percent). There were accusations of voter fraud against Long; voting records showed people voting in alphabetical order, among them celebrities like Charlie Chaplin, Jack Dempsey and Babe Ruth.


title: Huey Long

text: Although his Senate term began on March 4, 1931, Long completed most of his four-year term as governor, which did not end until May 1932. He declared that leaving the seat vacant would not hurt Louisiana: "[W]ith Ransdell as Senator, the seat was vacant anyway." By occupying the governorship until January 25, 1932, Long prevented Lieutenant Governor Cyr, who threatened to undo Long's reforms, from succeeding to the office. In October 1931, Cyr learned Long was in Mississippi and declared himself the state's legitimate governor. In response, Long ordered National Guard troops to surround the Capitol to block Cyr's "coup d'état" and petitioned the Louisiana Supreme Court. Long successfully argued that Cyr had vacated the office of lieutenant-governor when trying to assume the governorship and had the court eject Cyr.


title: Huey Long

text: Now governor and senator-elect, Long returned to completing his legislative agenda with renewed strength. He continued his intimidating practice of presiding over the legislature, shouting "Shut up!" or "Sit down!" when legislators voiced their concerns. In a single night, Long passed 44 bills in just two hours: one every three minutes. He later explained his tactics: "The end justifies the means." Long endorsed pro-Long candidates and wooed others with favors; he often joked his legislature was the "finest collection of lawmakers money can buy". He organized and concentrated his power into a political machine: "a one-man" operation, according to Williams. He placed his brother Earl in charge of allotting patronage appointments to local politicians and signing state contracts with businessmen in exchange for loyalty. Long appointed allies to key government positions, such as giving Robert Maestri the office of Conservation Commissioner and making Oscar K. Allen head of the Louisiana Highway Commission. Maestri would deliberately neglect the regulation of energy companies in exchange for industry donations to Long's campaign fund, while Allen took direction from Earl on which construction and supply companies to contract for road work. Concerned by these tactics, Long's opponents charged he had become the virtual dictator of the state.


title: Huey Long

text: To address record low cotton prices amid a Great Depression surplus, Long proposed the major cotton-producing states mandate a 1932 "cotton holiday", which would ban cotton production for the entire year. He further proposed that the holiday be imposed internationally, which some nations, such as Egypt, supported. In 1931, Long convened the New Orleans Cotton Conference, attended by delegates from every major cotton-producing state. The delegates agreed to codify Long's proposal into law on the caveat that it would not come into effect until states producing three-quarters of U.S. cotton passed such laws. As the proposer, Louisiana unanimously passed the legislation. When conservative politicians in Texas—the largest cotton producer in the U.S.—rejected the measure, the holiday movement collapsed. Although traditional politicians would have been ruined by such a defeat, Long became a national figure and cemented his image as a champion of the poor. Senator Carter Glass, although a fervid critic of Long, credited him with first suggesting artificial scarcity as a solution to the depression.


title: Huey Long

text: Long was unusual among southern populists in that he achieved tangible progress. Williams concluded "the secret of Long's power, in the final analysis, was not in his machine or his political dealings but in his record—he delivered something". Referencing Long's contributions to Louisiana, Robert Penn Warren, a professor at LSU during Long's term as governor, stated: "Dictators, always give something for what they get."


title: Huey Long

text: Long created a public works program that was unprecedented in the South, constructing roads, bridges, hospitals, schools, and state buildings. During his four years as governor, Long increased paved highways in Louisiana from and constructed of gravel roads. By 1936, the infrastructure program begun by Long had completed some of new roads, doubling Louisiana's road system. He built 111 bridges and started construction on the first bridge over the Mississippi entirely in Louisiana, the Huey P. Long Bridge. These projects provided thousands of jobs during the depression: Louisiana employed more highway workers than any other state. Long built a State Capitol, which at tall remains the tallest capitol, state or federal, in the United States. Long's infrastructure spending increased the state government's debt from $11 million in 1928 to $150 million in 1935.


title: Huey Long

text: Long was an ardent supporter of the state's flagship public university, Louisiana State University (LSU). Having been unable to attend, Long now regarded it as "his" university. He increased LSU's funding and intervened in the university's affairs, expelling seven students who criticized him in the school newspaper. He constructed new buildings, including a fieldhouse that reportedly contained the longest pool in the United States. Long founded an LSU Medical School in New Orleans. To raise the stature of the football program, he converted the school's military marching band into the flashy "Show Band of the South" and hired Costa Rican composer Castro Carazo as the band director. As well as nearly doubling the size of the stadium, he arranged for lowered train fares, so students could travel to away games. Long's contributions resulted in LSU gaining a class A accreditation from the Association of American Universities.


title: Huey Long

text: Long's night schools taught 100,000 adults to read. His provision of free textbooks contributed to a 20 percent increase in school enrollment. He modernized public health facilities and ensured adequate conditions for the mentally ill. He established Louisiana's first rehabilitation program for penitentiary inmates. Through tax reform, Long made the first $2,000 in property assessment free, waiving property taxes for half the state's homeowners. Historians have criticized other policies, like high consumer taxes on gasoline and cigarettes, a reduced mother's pension, and low teacher salaries.