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"text": "Costello was appointed Officer of the Order of the British Empire (OBE) in the 2019 Birthday Honours for services to music."
}
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"text": "2020s \nIn 2021, Costello released Spanish Model, a remix of 1978's This Year's Model with Spanish lyrics. Singers from Spanish-speaking parts of the world, with help from Spanish-speaking songwriters, translated all 16 songs of the album into Spanish, with the new vocals set to the original recording and instrumentation by the Attractions. The singers included Juanes, Jorge Drexler, Luis Fonsi, Francisca Valenzuela, Fuego, Draco Rosa, and Fito Páez."
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"text": "In 2021 Costello appeared at the Royal Variety Performance playing two songs with the Imposters. He was introduced by the MC Alan Carr as a man who has achieved everything except appearing at the Royal Variety Performance. Between songs Costello informed the audience that he was the second McManus to appear. His father Ross appeared in the 1960's with \"If I Had a Hammer\"."
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"text": "In January 2022 he performed on The Graham Norton Show."
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"text": "Costello has been married three times, the first time in 1974 to Mary Burgoyne, with whom he had a son, Matthew. Toward the end of his first marriage, Costello became embroiled in an on-again/off-again romance with Bebe Buell, then-girlfriend of Todd Rundgren. Buell has said she was the inspiration behind some of Costello's most bitter love songs from the Armed Forces era, though Costello countered by claiming most of those songs had been written before he met Buell."
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"text": "In 1985, Costello became involved with Cait O'Riordan, then the bassist of London Irish group the Pogues, while he was producing the Pogues' album Rum Sodomy and the Lash. They married in 1986 and split up by the end of 2002."
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"text": "Costello became engaged to pianist-vocalist Diana Krall in May 2003, and married her at the home of Elton John on 6 December that year. Krall gave birth to twin sons on 6 December 2006 in New York City."
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"text": "Vegetarianism\nA pescatarian since the early 1980s, Costello says he was moved to reject meat after seeing the documentary The Animals Film (1982), which also helped inspire his song \"Pills and Soap\" from 1983's Punch the Clock. In January 2013, Costello teamed up with Paul McCartney to create an ad campaign backing vegetarian foods produced by the Linda McCartney Foods brand."
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"text": "Football\nCostello is a keen football fan, supporting Premier League football club Liverpool F.C. since childhood, and appeared on Channel 4's Football Italia as a pundit. On 25 May 2005, Costello was due to take the stage with his band at a gig in Norwich, which clashed with Liverpool appearing in the 2005 UEFA Champions League Final against AC Milan. With Liverpool losing 3–0 at half time, Costello was due on stage and began warming up his voice in preparation for the gig, before deciding: \"I might as well see the first few minutes of the second half.\" With Liverpool staging a remarkable comeback (since dubbed the Miracle of Istanbul) by scoring three goals in six minutes and making it 3–3, Costello delayed his appearance on stage for over an hour. With the game going to penalties, after much delay he had no choice but to take the stage, with Costello recalling: \"I tried my best to keep my eyes from the TV screen over the bar at the back of the room but the words 'Oh shit, he's missed' might have accidentally crept into the lyrics of 'Good Year for the Roses'\". With Liverpool prevailing while he was on stage, an ecstatic Costello broke out into a performance of the club's anthem \"You'll Never Walk Alone\"."
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"text": "Health \nIn July 2018, Costello cancelled the remaining six dates of his European tour on doctor's orders, while recovering from surgery to treat cancer. Costello apologised to his fans and said he initially thought he had recovered enough from the surgery to complete the tour."
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"text": "Humanitarian causes \nCostello sits on the Advisory Board of the board of directors of the Jazz Foundation of America. Costello began working with the Jazz Foundation in 2001, and has been a featured performer in their annual benefit A Great Night in Harlem since 2006. Costello has donated his time working with the Jazz Foundation of America to save the homes and the lives of America's elderly jazz and blues musicians, including musicians who survived Hurricane Katrina. He has also performed at a benefit concert for the Seva Foundation."
}
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"text": "Collaborations\nIn addition to his major recorded collaborations with Burt Bacharach, the Brodsky Quartet, and Anne Sofie von Otter, Costello has frequently been involved in other collaborations."
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"text": "In 1981, Glenn Tilbrook from Squeeze and Martin Belmont from the Rumour guested on the song \"From a Whisper to a Scream\" from the album Trust. Around this time he also collaborated with Chris Difford, also of Squeeze, to write additional lyrics for the song \"Boy With A Problem\", which appeared on Costello's 1982 album Imperial Bedroom. In 1984, Daryl Hall provided backing vocals on the song \"The Only Flame In Town\" from the album Goodbye Cruel World. The following year he sang with Annie Lennox on the song \"Adrian\" from the Eurythmics record Be Yourself Tonight."
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"text": "In 1987, Costello began a songwriting collaboration with Paul McCartney. They wrote a number of songs together in a short period of time, that were released over a period of years. These songs included:\n \"Back On My Feet\", the B-side of McCartney's 1987 single \"Once Upon a Long Ago\", later added as a bonus track on the 1993 re-issue of McCartney's Flowers in the Dirt\n Costello's \"Veronica\" and \"Pads, Paws and Claws\" from his album Spike (1989)\n McCartney's \"My Brave Face\", \"Don't Be Careless Love\", \"That Day Is Done\" and the McCartney/Costello duet \"You Want Her Too\", all from McCartney's Flowers in the Dirt (1989)\n \"So Like Candy\" and \"Playboy to a Man\" from Costello's Mighty Like a Rose (1991)\n \"The Lovers That Never Were\" and \"Mistress and Maid\" from McCartney's Off the Ground (1993).\n \"Shallow Grave\" from Costello's All This Useless Beauty (1996).\n Costello has also issued solo demo recordings of \"Veronica\", \"Pads, Paws and Claws\" and \"Mistress and Maid\" (a song he did not otherwise record). Two other officially unissued McCartney/Costello compositions also exist as demos (\"Tommy's Coming Home\" and \"Twenty Fine FIngers\"). These two tracks, along with other McCartney/Costello demos of tunes they did release, have been widely bootlegged and have been released on the Paul McCartney Archive edition of Flowers in the Dirt."
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"text": "In 1987, he appeared on the HBO special Roy Orbison and Friends, A Black and White Night, which featured his long-time idol Roy Orbison. In 1988, Costello co-wrote \"The Other End (Of the Telescope)\" with Aimee Mann; this song appears on the Til Tuesday album Everything's Different Now."
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"text": "In 1994, he sang \"They Can't Take That Away from Me\" with Tony Bennett for MTV Unplugged, appearing on the album released from the broadcast. In 2000, Costello wrote lyrics to \"Green Song\", a solo cello piece by Svante Henryson; this song appears on the Anne Sofie von Otter album For the Stars."
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"text": "In 2005, Costello performed with Green Day frontman Billie Joe Armstrong. They played both Costello and Green Day songs together, including \"Alison\", \"No Action\", \"Basket Case\" and \"Good Riddance (Time of Your Life)\". In late 2005 Costello performed with Allen Toussaint in New York City at some Hurricane Katrina Relief Concerts and produced the studio album The River in Reverse. Also, Costello had a collaborative history with Toussaint, beginning with a couple of scattered album tracks in the 1980s, and skipping ahead to the aftermath of Hurricane Katrina with the production of The River in Reverse."
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"text": "In 2006, Costello performed with Fiona Apple in the Decades Rock TV special. Apple performed two Costello songs and Costello performed two Apple songs."
}
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"text": "In 2007, Costello collaborated with the Argentinean/Uruguayan electro-tango band Bajofondo on the song \"Fairly Right\" from the album Mar Dulce. In 2008, Costello collaborated with Fall Out Boy on the track \"What a Catch, Donnie\" from their album Folie a Deux. In Jenny Lewis' 2008 release, Acid Tongue, Costello provided vocals for the song \"Carpetbaggers\". In November 2009, Costello appeared live with Bruce Springsteen and the E Street Band at Madison Square Garden and performed the Jackie Wilson song \"(Your Love Keeps Lifting Me) Higher and Higher\"."
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"text": "In December 2009, Costello portrayed The Shape on the album Ghost Brothers of Darkland County, a collaboration between rock singer John Mellencamp and novelist Stephen King. In February 2010, Costello appeared in the live cinecast of Garrison Keillor's Prairie Home Companion, singing some of his own songs, and participating in many of the show's other musical and acting performances. On 30 April 2011, he played the song \"Pump it Up\" with the Odds before the start of a Vancouver Canucks playoff game at Rogers Arena in Vancouver, British Columbia."
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"text": "In 2012, he played ukulele, mandolin, guitar and added backing vocals on Diana Krall's 11th studio album, Glad Rag Doll (as \"Howard Coward\"). On 10 September 2013, he played during the Apple September 2013 Event after the introduction of iTunes Radio, iPhone 5C and 5S at Town Hall, at the Apple campus."
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"text": "On Gov't Mule's album Shout!, released in September 2013, he sang on the track \"Funny Little Tragedy\". In March 2014, Costello recorded Lost on the River: The New Basement Tapes with Rhiannon Giddens, Taylor Goldsmith, Jim James and Marcus Mumford. During the 2016 Detour, he performs with Larkin Poe."
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"text": "Legacy\nCostello has worked with Paul McCartney, Madness, Tony Bennett, Burt Bacharach, Allen Toussaint, T Bone Burnett, Lucinda Williams, Johnny Cash, Kid Rock, Lee Konitz, Brian Eno, and Rubén Blades."
}
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"text": "Costello, in print, often champions the works of others. He has written several pieces for the magazine Vanity Fair, including a summary of what a perfect weekend of music would be. He has contributed to two Grateful Dead tribute albums and covered Jerry Garcia/Robert Hunter tunes \"Ship of Fools\", \"Friend of the Devil\", \"It Must Have Been the Roses\", \"Ripple\" and \"Tennessee Jed\" in concert. His collaboration with Bacharach honoured Bacharach's place in pop music history. Costello appeared in documentaries about singers Dusty Springfield, Brian Wilson, Wanda Jackson, Ron Sexsmith and Memphis, Tennessee-based Stax Records. He has interviewed one of his own influences, Joni Mitchell, and appeared on the release A Tribute to Joni Mitchell performing \"Edith and the Kingpin\". He performed the title track of the Charles Mingus tribute collection, Weird Nightmare. He appeared on the Nick Lowe tribute album Labour of Love, performing the Lowe song \"Egypt\" and the Gram Parsons tribute album The Return of the Grievous Angel, performing the Parsons song \"Sleepless Nights\". He was instrumental in bringing Sexsmith to a wider audience in 1995 by championing his debut album in Mojo magazine, even appearing on the cover with Sexsmith's debut album."
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"text": "In 2004, Rolling Stone ranked him No. 80 on their list of the 100 Greatest Artists of All Time. In 2012, Costello was among the British cultural icons selected by artist Sir Peter Blake to appear in a new version of his most famous artwork – the Beatles' Sgt. Pepper's Lonely Hearts Club Band album cover – to celebrate the British cultural figures of his life that he most admires, to mark his 80th birthday. On being chosen, Costello remarked, \"I always dreamed that I might one day stand in the boots of Albert Stubbins [the Liverpool footballer who appeared in the original artwork].\""
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"text": "1998: Bespoke Songs, Lost Dogs, Detours & Rendezvous – (various artists)\n 2002: Almost You: The Songs of Elvis Costello – (various artists)\n 2003: The Elvis Costello Songbook – Bonnie Brett\n 2004: A Tribute to Elvis Costello – Patrik Tanner\n 2004: Davis Does Elvis – Stuart Davis\n 2008: Every Elvis Has His Impersonators: 7 Homemade Remade Elvis Costello Songs – Elastic No–No Band"
}
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"text": "Studio albums\n(including those with the Attractions, The Costello Show, and the Imposters)\nMy Aim Is True (1977)\nThis Year's Model (1978)\nArmed Forces (1979)\nGet Happy!! (1980)\nTrust (1981)\nAlmost Blue (1981)\nImperial Bedroom (1982)\nPunch the Clock (1983)\nGoodbye Cruel World (1984)\nKing of America (1986)\nBlood & Chocolate (1986)\nSpike (1989)\nMighty Like a Rose (1991)\nBrutal Youth (1994)\nKojak Variety (1995)\nAll This Useless Beauty (1996)\nWhen I Was Cruel (2002)\nNorth (2003)\nIl Sogno (2004)\nThe Delivery Man (2004)\nMomofuku (2008)\nSecret, Profane & Sugarcane (2009)\nNational Ransom (2010)\nLook Now (2018)\nHey Clockface (2020)\nThe Boy Named If (2022)"
}
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"text": "Collaborative albums\n The Courier (1988, soundtrack for the film, orchestral music by Declan MacManus, 8 songs by other artists including U2 and Hothouse Flowers)\nG.B.H. (1991, with Richard Harvey)\nThe Juliet Letters (1993, with the Brodsky Quartet)\nJake's Progress (1995, with Richard Harvey)\nDeep Dead Blue (1995, with Bill Frisell)\nPainted from Memory (1998, with Burt Bacharach)\nFor the Stars (2001, with Anne Sofie von Otter)\nPiano Jazz (2005, with Marian McPartland)\nMy Flame Burns Blue (2006, with Metropol Orkest)\nThe River in Reverse (2006, with Allen Toussaint)\nWise Up Ghost (2013, with the Roots)\nLost on the River (2014, as a member of The New Basement Tapes)"
}
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"text": "As actor\n 1979 film debut as \"The Earl of Manchester\" in Americathon. Costello and the Attractions mime the song \"Crawling to the U.S.A.\" in the film, which also appears on its soundtrack album.\n 1984 as \"Henry Scully\" in the UK TV series, Scully\n 1984 as \"Stone Deaf A&R Man\" in The Bullshitters, a movie made by members of the comedy troupe The Comic Strip, first aired on Channel 4\n 1985 as inept magician \"Rosco de Ville\" in the Alan Bleasdale film, No Surrender\n 1987 as \"Hives the Butler\" in the Alex Cox film, Straight to Hell, starring Joe Strummer and Courtney Love. Costello's \"Big Nothing\" (AKA \"Town Called Big Nothing\") appears in the film and on its soundtrack album.\n 1994 as himself on The Larry Sanders Show in the episode \"People's Choice\"\n 1996 as himself on The Larry Sanders Show in the episode \"Everybody Loves Larry\"\n 1997 as a barman in Spice World\n 1999 as himself in Austin Powers: The Spy Who Shagged Me, performing Burt Bacharach's \"I'll Never Fall In Love Again\" (with Bacharach), which also appears on its soundtrack album.\n 1999 as a younger version of himself in 200 Cigarettes\n 2001 as himself performing \"Fly Me to the Moon\" on the series finale of 3rd Rock from the Sun\n 2002 as himself on the episode \"How I Spent My Strummer Vacation\" of The Simpsons\n 2003 as Ben on Frasier, in the season 10 episode \"Farewell Nervosa\"\n 2003 as himself in I Love Your Work \n 2004 as himself in the UK TV Dead Ringers New Year Special, apparently and reportedly having serendipitously entered a filming venue.\n 2004 as himself in Two and a Half Men – Season 2, Episode 1\n 2004 as himself in De-Lovely\n 2006 as himself in Delirious\n 2006 as himself in Before the Music Dies\n 2006 as himself in Putting the River in Reverse\n 2006 as himself in Talladega Nights: The Ballad of Ricky Bobby\n 2008 as himself in A Colbert Christmas: The Greatest Gift of All!\n 2009 as himself on the 30 Rock episode \"Kidney Now!\"\n 2010 as himself on Treme\n 2017 as himself in Ex Libris – The New York Public Library\n 2017–2019 as Pete's Dad (voice) in Pete the Cat (Season 1)"
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"text": "As part of soundtracks\n 1983, \"Party Party\" appears in the film of the same name and on its soundtrack album.\n 1991, \"Days\" (a cover of the Kinks song) appears in the film Until the end of the World and on its soundtrack album.\n 1995, \"My Dark Life,\" a collaboration with Brian Eno, appears on the album Songs in the Key of X. \n 1996, \"God Give Me Strength,\" a collaboration with Burt Bacharach, appears in the film Grace of My Heart and on its soundtrack album. Nominated for Satellite Award for Best Original Song. \n 1998, \"My Mood Swings\" appears in the film The Big Lebowski and on its soundtrack album.\n 1998, \"I Throw My Toys Around,\" a collaboration with No Doubt, appears in the film The Rugrats Movie and on its soundtrack album.\n 1999, \"She\" (a cover of the Charles Aznavour song) appears in the film Notting Hill and on its soundtrack album. The song peaked at No. 19 on the UK Singles Chart.\n 2003, \"The Scarlet Tide,\" written by Costello and T-Bone Burnett and performed by Alison Krauss, appears in the film Cold Mountain and on its soundtrack album. Nominated for Academy Award for Best Original Song and Grammy Award for Best Song Written for Visual Media.\n 2019, \"I Want You\" appears twice in the critically acclaimed British film Only You."
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"text": "Bibliography\n1980: A Singing Dictionary sheet music \n1983: sheet music \n2016: memoir"
}
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"text": "Further reading\n Paumgarten, Nick. \"Profiles: Brilliant Mistakes,\" The New Yorker, vol. 86, no. 35 (8 November 2010), pp. 48–59.\n Perone, James E. Elvis Costello: A Bio-Bibliography. Westport, CT: Greenwood Press, 1998."
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"text": "1954 births\nLiving people\nColumbia Records artists\nDeutsche Grammophon artists\nDiana Krall\nElvis Costello & the Attractions members\nEnglish buskers\nEnglish expatriates in the United States\nEnglish male singer-songwriters\nEnglish new wave musicians\nEnglish people of Irish descent\nEnglish punk rock guitarists\nEnglish punk rock singers\nEnglish rock guitarists\nEnglish male guitarists\nEnglish rock singers\nGrammy Award winners\nIsland Records artists\nLost Highway Records artists\nMale new wave singers\nMercury Records artists\nPeople from Paddington\nRadar Records artists\nRykodisc artists\nSingers from London\nStiff Records artists\n2 Tone Records artists\nWarner Records artists\nOfficers of the Order of the British Empire\nThe New Basement Tapes members\nConcord Records artists\nEnglish autobiographers"
}
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"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 their condition."
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"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 electroencephalogram (EEG), but a normal test does not rule out the condition."
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"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."
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"text": ", about 50 million people suffer from 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\"."
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"text": "Signs and symptoms"
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"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."
}
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"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."
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"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."
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"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."
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"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."
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"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."
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"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."
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"text": "Post-ictal\nAfter 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."
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"text": "Psychosocial\nEpilepsy 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."
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"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."
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"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."
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"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."
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"text": "Genetics\nGenetics 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."
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"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."
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"text": "Acquired\nEpilepsy 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, 2–4% develop epilepsy. In the United Kingdom, strokes account for 15% of cases and they are believed to be the cause in 30% of the elderly. 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%."
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"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."
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"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."
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"text": "Mechanism \nNormally 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."
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"text": "Epilepsy\nThe 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"
}
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"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."
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"text": "Seizures\nThere 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 seizure threshold is lowered in epilepsy."
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"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."
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"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."
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"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."
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"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."
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"text": "Definition\nEpilepsy is a disorder of the brain defined by any of the following conditions:\n{| cellpadding=5 style=\"border:1px solid #ccc\"\n|- bgcolor=\"#fafafa\"\n|\nAt least two unprovoked (or reflex) seizures occurring more than 24 hours apart\nOne unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years\nDiagnosis of an epilepsy syndrome\n|}"
}
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"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."
}
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"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.\""
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"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."
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"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."
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"text": "Classification"
}
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"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."
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"text": "The International League Against Epilepsy (ILAE) provided a classification of the epilepsies and epileptic syndromes in 1989 as follows:"
}
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"text": "{| cellpadding=5 style=\"border:1px solid #ccc\"\n|- bgcolor=\"#fafafa\"\n|\nLocalization-related epilepsies and syndromes\nUnknown cause (e.g. benign childhood epilepsy with centrotemporal spikes)\nSymptomatic/cryptogenic (e.g. temporal lobe epilepsy)\nGeneralized\nUnknown cause (e.g. childhood absence epilepsy)\nCryptogenic or symptomatic (e.g. Lennox-Gastaut syndrome)\nSymptomatic (e.g. early infantile epileptic encephalopathy with burst suppression)\nEpilepsies and syndromes undetermined whether focal or generalized\nWith both generalized and focal seizures (e.g. epilepsy with continuous spike-waves during slow wave sleep)\nSpecial syndromes (with situation-related seizures)\n|}"
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"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."
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"text": "{| cellpadding=5 style=\"border:1px solid #ccc\"\n|- bgcolor=\"#fafafa\"\n|\nUnknown cause (mostly genetic or presumed genetic origin)\nPure epilepsies due to single gene disorders\nPure epilepsies with complex inheritance\nSymptomatic (associated with gross anatomic or pathologic abnormalities)\nMostly genetic or developmental causation\nChildhood epilepsy syndromes\nProgressive myoclonic epilepsies\nNeurocutaneous syndromes\nOther neurologic single gene disorders\nDisorders of chromosome function\nDevelopmental anomalies of cerebral structure\nMostly acquired causes\nHippocampal sclerosis\nPerinatal and infantile causes\nCerebral trauma, tumor or infection\nCerebrovascular disorders\nCerebral immunologic disorders\nDegenerative and other neurologic conditions\nProvoked (a specific systemic or environmental factor is the predominant cause of the seizures)\nProvoking factors\nReflex epilepsies\nCryptogenic (presumed symptomatic nature in which the cause has not been identified)\n|} A revised, operational classification of seizure types has been introduced by the ILAE. It allows more clearly understood terms and clearly defines focal and generalized onset dichotomy, when possible, even without observing the seizures based on description by patient or observers. The essential changes in terminology are that \"partial\" is called \"focal\" with awareness used as a classifier for focal seizures -based on description focal seizures are now defined as behavioral arrest, automatisms, cognitive , autonomic, emotional or hyperkinetic variants while atonic, myoclonic, clonic, infantile spasms, and tonic seizures may be either focal or generalized based on their onset. Several terms that were not clear or consistent in description were removed such as dyscognitive, psychic, simple and complex partial, while \"secondarily generalized\" is replaced by a clearer term \"focal to bilateral tonic clonic seizure\". New seizure types now believed to be generalized are eyelid myoclonia, myoclonic atonic, myoclonic absence, and myoclonic tonic clonic. Sometimes it is possible to classify seizures as focal or generalized based on presenting features even though onset in not known. This system is based on the 1981 seizure classification modified in 2010 and principally is the same with an effort to improve the flexibility and clarity of use to understand seizures types better in keeping with current knowledge."
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"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."
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"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."
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"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."
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"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."
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"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."
}
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"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."
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"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."
}
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"text": "Differential diagnosis\nDiagnosis 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."
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"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."
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"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."
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"text": "Prevention\nWhile 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."
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"text": "Management"
}
} |