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"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."
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"text": "First aid\nRolling 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."
}
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"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."
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"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."
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"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. 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."
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"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."
}
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"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."
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"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."
}
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"text": "Surgery\nEpilepsy 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."
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"text": "Neurostimulation may be another option in those who are not candidates for surgery. Three types have been used in those who do not respond to medications: vagus nerve stimulation, anterior thalamic stimulation, and closed-loop responsive stimulation."
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"text": "Diet\nThere 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."
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"text": "Other\nAvoidance 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."
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"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."
}
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"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."
}
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"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."
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"text": "In pregnancy \nIn 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 till more definitive evidence is available in the future."
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"text": "Alternative medicine\nAlternative 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."
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"text": "Prognosis"
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"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."
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"text": "Mortality\nPeople 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."
}
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"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."
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"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."
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"text": "Epidemiology\nEpilepsy 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."
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"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."
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"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 (c. 1790 BC) as reason for which a purchased slave may be returned for a refund, and the Edwin Smith Papyrus (c. 1700 BC) describes cases of individuals with epileptic convulsions."
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"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)."
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"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."
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"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."
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"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."
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"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."
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"text": "Stigma\nStigma 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."
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"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."
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"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."
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"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."
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"text": "Support organizations\nThere 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."
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"text": "International Epilepsy Day (World Epilepsy Day) began in 2015 and occurs on the second Monday in February."
}
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"text": "Seizure prediction and modeling\nSeizure 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."
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"text": "Potential future therapies\nGene 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."
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"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."
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}
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"text": "Further reading"
}
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"text": "World Health Organization fact sheet"
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"text": "Articles containing video clips\nDisorders causing seizures\nNeurological disorders in children\nWikipedia medicine articles ready to translate (full)\nWikipedia neurology articles ready to translate"
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"text": "Extrasensory perception or ESP, also called sixth sense, includes claimed reception of information not gained through the recognized physical senses, but sensed with the mind. The term was adopted by Duke University psychologist J. B. Rhine to denote psychic abilities such as intuition, telepathy, psychometry, clairvoyance, and their trans-temporal operation as precognition or retrocognition."
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"text": "Second sight is a form of extrasensory perception, whereby a person perceives information, in the form of a vision, about future events before they happen (precognition), or about things or events at remote locations (remote viewing). There is no scientific evidence that second sight exists. Reports of second sight are known only from anecdotal evidence. Second sight and ESP are classified as pseudosciences."
}
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"text": "In the 1930s, at Duke University in North Carolina, J. B. Rhine and his wife Louisa E. Rhine conducted investigation into extrasensory perception. While Louisa Rhine concentrated on collecting accounts of spontaneous cases, J. B. Rhine worked largely in the laboratory, carefully defining terms such as ESP and psi and designing experiments to test them. A simple set of cards was developed, originally called Zener cards – now called ESP cards. They bear the symbols circle, square, wavy lines, cross, and star. There are five of each type of card in a pack of 25."
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"text": "In a telepathy experiment, the \"sender\" looks at a series of cards while the \"receiver\" guesses the symbols. To try to observe clairvoyance, the pack of cards is hidden from everyone while the receiver guesses. To try to observe precognition, the order of the cards is determined after the guesses are made. Later he used dice to test for psychokinesis."
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"text": "The parapsychology experiments at Duke evoked criticism from academics and others who challenged the concepts and evidence of ESP. A number of psychological departments attempted, unsuccessfully, to repeat Rhine's experiments. W. S. Cox (1936) from Princeton University with 132 subjects produced 25,064 trials in a playing card ESP experiment. Cox concluded \"There is no evidence of extrasensory perception either in the 'average man' or of the group investigated or in any particular individual of that group. The discrepancy between these results and those obtained by Rhine is due either to uncontrollable factors in experimental procedure or to the difference in the subjects.\" Four other psychological departments failed to replicate Rhine's results."
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"text": "In 1938, the psychologist Joseph Jastrow wrote that much of the evidence for extrasensory perception collected by Rhine and other parapsychologists was anecdotal, biased, dubious and the result of \"faulty observation and familiar human frailties\". Rhine's experiments were discredited due to the discovery that sensory leakage or cheating could account for all his results such as the subject being able to read the symbols from the back of the cards and being able to see and hear the experimenter to note subtle clues."
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"text": "In the 1960s parapsychologists became increasingly interested in the cognitive components of ESP, the subjective experience involved in making ESP responses, and the role of ESP in psychological life. This called for experimental procedures that were not limited to Rhine's favored forced-choice methodology. Such procedures have included dream telepathy experiments, and the ganzfeld experiments (a mild sensory deprivation procedure)."
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"text": "Second sight may have originally been so called because normal vision was regarded as coming first, while supernormal vision is a secondary thing, confined to certain individuals. An dà shealladh or \"the two sights\", meaning \"the sight of the seer\", is the way Gaels refer to \"second sight\", the involuntary ability of seeing the future or distant events. There are many Gaelic words for the various aspects of second sight, but an dà shealladh is the one mostly recognized by non-Gaelic speakers, even though, strictly speaking, it does not really mean second sight, but rather \"two sights\"."
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"text": "Skepticism"
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"text": "Parapsychology is the study of paranormal psychic phenomena, including ESP. Parapsychology has been criticized for continuing investigation despite being unable to provide convincing evidence for the existence of any psychic phenomena after more than a century of research. The scientific community rejects ESP due to the absence of an evidence base, the lack of a theory which would explain ESP and the lack of positive experimental results; it considers ESP to be pseudoscience."
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"text": "The scientific consensus does not view extrasensory perception as a scientific phenomenon. Skeptics have pointed out that there is no viable theory to explain the mechanism behind ESP, and that there are historical cases in which flaws have been discovered in the experimental design of parapsychological studies."
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"text": "There are many criticisms pertaining to experiments involving extrasensory perception, particularly surrounding methodological flaws. These flaws are not unique to a single experimental design, and are effective in discrediting much of the positive research surrounding ESP. Many of the flaws seen in the Zener cards experiment are present in the Ganzfeld experiment as well. First is the stacking effect, an error that occurs in ESP research. Trial-by-trial feedback given in studies using a “closed” ESP target sequence (e.g., a deck of cards) violates the condition of independence used for most standard statistical tests. Multiple responses for a single target cannot be evaluated using statistical tests that assume independence of responses. This increases likelihood of card counting and in turn, increases the chances for the subject to guess correctly without using ESP. Another methodological flaw involves cues through sensory leakage. For example, when the subject receives a visual cue. This could be the reflection of a Zener card in the holder's glasses. In this case, the subject is able to guess the card correctly because they can see it in the reflection, not because of ESP. Finally, poor randomization of target stimuli could be happening. Poor shuffling methods can make the orders of the cards easier to predict, or the cards could’ve been marked and manipulated, again, making it easier to predict which cards come next.\nThe results of a meta-analysis found that when these errors were corrected and accounted for, there was still no significant effect of ESP. Many of the studies only appeared to have significant occurrence of ESP, when in fact, this result was due to the many methodological errors in the research."
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"text": "Dermo-optical perception"
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"text": "In the early 20th century, Joaquin María Argamasilla, known as the \"Spaniard with X-ray Eyes\", claimed to be able to read handwriting or numbers on dice through closed metal boxes. Argamasilla managed to fool Gustav Geley and Charles Richet into believing he had genuine psychic powers. In 1924, he was exposed by Harry Houdini as a fraud. Argamasilla peeked through his simple blindfold and lifted up the edge of the box so he could look inside it without others noticing."
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"text": "Science writer Martin Gardner has written that the ignorance of blindfold deception methods has been widespread in investigations into objects at remote locations from persons who claim to possess second sight. Gardner documented various conjuring techniques psychics such as Rosa Kuleshova, Lina Anderson and Nina Kulagina have used to peek from their blindfolds to deceive investigators into believing they used second sight."
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],
"text": "See also"
}
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"text": "Extrasensory Perception (book)\n Inner eye\n List of psychic abilities\n List of topics characterized as pseudoscience\n Magic\n Outline of parapsychology"
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"text": "Notes"
}
} |
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}
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"text": "Further reading\n Georges Charpak, Henri Broch, and Bart K. Holland (2004). Debunked! ESP, Telekinesis, and Other Pseudoscience. Johns Hopkins University. .\n Milbourne Christopher (1970). ESP, Seers & Psychics: What the Occult Really Is. Thomas Y. Crowell Co. \n Henry Gordon (1988). Extrasensory Deception: ESP, Psychics, Shirley MacLaine, Ghosts, UFOs. Macmillan of Canada. . \n Donald Hebb (1980). \"Extrasensory Perception: A Problem\". In Essays on Mind. Lawrence Erlbaum Associates. .\n Paul Kurtz (1985). A Skeptic's Handbook of Parapsychology. Prometheus Books. .\nTarg, Russell (2012). The Reality of ESP: a physicist's proof of psychic abilities. Quest Books. .\n Richard Wiseman. (1997). Deception and Self-Deception: Investigating Psychics. Prometheus Press. ."
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"text": "External links\n \n FBI file on Extrasensory perception"
}
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"text": "Parapsychology\nPsychic powers\nParanormal terminology\nPseudoscience"
}
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"text": "In microeconomics, economies of scale are the cost advantages that enterprises obtain due to their scale of operation, and are typically measured by the amount of output produced. A decrease in cost per unit of output enables an increase in scale. At the basis of economies of scale there may be technical, statistical, organizational or related factors to the degree of market control."
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"text": "Economies of scale apply to a variety of the organizational and business situations and at various levels, such as a production, plant or an entire enterprise. When average costs start falling as output increases, then economies of scale occur.\nSome economies of scale, such as capital cost of manufacturing facilities and friction loss of transportation and industrial equipment, have a physical or engineering basis."
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"text": "The economic concept dates back to Adam Smith and the idea of obtaining larger production returns through the use of division of labor. Diseconomies of scale are the opposite."
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"text": "Economies of scale often have limits, such as passing the optimum design point where costs per additional unit begin to increase. Common limits include exceeding the nearby raw material supply, such as wood in the lumber, pulp and paper industry. A common limit for a low cost per unit weight commodities is saturating the regional market, thus having to ship product uneconomic distances. Other limits include using energy less efficiently or having a higher defect rate."
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"text": "Large producers are usually efficient at long runs of a product grade (a commodity) and find it costly to switch grades frequently. They will, therefore, avoid specialty grades even though they have higher margins. Often smaller (usually older) manufacturing facilities remain viable by changing from commodity-grade production to specialty products."
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"text": "Economies of scale must be distinguished from economies stemming from an increase in the production of a given plant. When a plant is used below its optimal production capacity, increases in its degree of utilization bring about decreases in the total average cost of production. As noticed, among the others, by Nicholas Georgescu-Roegen (1966) and Nicholas Kaldor (1972) these economies are not economies of scale."
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"text": "Overview\nThe simple meaning of economies of scale is doing things more efficiently with increasing size. Common sources of economies of scale are purchasing (bulk buying of materials through long-term contracts), managerial (increasing the specialization of managers), financial (obtaining lower-interest charges when borrowing from banks and having access to a greater range of financial instruments), marketing (spreading the cost of advertising over a greater range of output in media markets), and technological (taking advantage of returns to scale in the production function). Each of these factors reduces the long run average costs (LRAC) of production by shifting the short-run average total cost (SRATC) curve down and to the right."
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"text": "Economies of scale is a concept that may explain patterns in international trade or in the number of firms in a given market. The exploitation of economies of scale helps explain why companies grow large in some industries. It is also a justification for free trade policies, since some economies of scale may require a larger market than is possible within a particular country—for example, it would not be efficient for Liechtenstein to have its own carmaker if they only sold to their local market. A lone carmaker may be profitable, but even more so if they exported cars to global markets in addition to selling to the local market. Economies of scale also play a role in a \"natural monopoly\". There is a distinction between two types of economies of scale: internal and external. An industry that exhibits an internal economy of scale is one where the costs of production fall when the number of firms in the industry drops, but the remaining firms increase their production to match previous levels. Conversely, an industry exhibits an external economy of scale when costs drop due to the introduction of more firms, thus allowing for more efficient use of specialized services and machinery."
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"text": "Determinants of economies of scale"
}
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"text": "Physical and engineering basis: economies of increased dimension\nSome of the economies of scale recognized in engineering have a physical basis, such as the square–cube law, by which the surface of a vessel increases by the square of the dimensions while the volume increases by the cube. This law has a direct effect on the capital cost of such things as buildings, factories, pipelines, ships and airplanes."
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"text": "In structural engineering, the strength of beams increases with the cube of the thickness."
}
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"text": "Drag loss of vehicles like aircraft or ships generally increases less than proportional with increasing cargo volume, although the physical details can be quite complicated. Therefore, making them larger usually results in less fuel consumption per ton of cargo at a given speed."
}
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"text": "Heat loss from industrial processes vary per unit of volume for pipes, tanks and other vessels in a relationship somewhat similar to the square–cube law. In some productions, an increase in the size of the plant reduces the average variable cost, thanks to the energy savings resulting from the lower dispersion of heat."
}
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"text": "Economies of increased dimension are often misinterpreted because of the confusion between indivisibility and three-dimensionality of space. This confusion arises from the fact that three-dimensional production elements, such as pipes and ovens, once installed and operating, are always technically indivisible. However, the economies of scale due to the increase in size do not depend on indivisibility but exclusively on the three-dimensionality of space. Indeed, indivisibility only entails the existence of economies of scale produced by the balancing of productive capacities, considered above; or of increasing returns in the utilisation of a single plant, due to its more efficient use as the quantity produced increases. However, this latter phenomenon has nothing to do with the economies of scale which, by definition, are linked to the use of a larger plant."
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"text": "Economies in holding stocks and reserves\nAt the base of economies of scale there are also returns to scale linked to statistical factors. In fact, the greater of the number of resources involved, the smaller, in proportion, is the quantity of reserves necessary to cope with unforeseen contingencies (for instance, machine spare parts, inventories, circulating capital, etc.)."
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"text": "Transaction economies\nA larger scale generally determines greater bargaining power over input prices and therefore benefits from pecuniary economies in terms of purchasing raw materials and intermediate goods compared to companies that make orders for smaller amounts. In this case, we speak of pecuniary economies, to highlight the fact that nothing changes from the \"physical\" point of view of the returns to scale. Furthermore, supply contracts entail fixed costs which lead to decreasing average costs if the scale of production increases."
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"text": "Economies deriving from the balancing of production capacity\nEconomies of productive capacity balancing derives from the possibility that a larger scale of production involves a more efficient use of the production capacities of the individual phases of the production process. If the inputs are indivisible and complementary, a small scale may be subject to idle times or to the underutilzation of the productive capacity of some sub-processes. A higher production scale can make the different production capacities compatible. The reduction in machinery idle times is crucial in the case of a high cost of machinery."
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"text": "Economies resulting from the division of labour and the use of superior techniques\nA larger scale allows for a more efficient division of labour. The economies of division of labour derive from the increase in production speed, from the possibility of using specialized personnel and adopting more efficient techniques. An increase in the division of labour inevitably leads to changes in the quality of inputs and outputs."
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"text": "Managerial economics\nMany administrative and organizational activities are mostly cognitive and, therefore, largely independent of the scale of production. When the size of the company and the division of labour increase, there are a number of advantages due to the possibility of making organizational management more effective and perfecting accounting and control techniques. Furthermore, the procedures and routines that turned out to be the best can be reproduced by managers at different times and places."
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"text": "Learning and growth economies\nLearning and growth economies are at the base of dynamic economies of scale, associated with the process of growth of the scale dimension and not to the dimension of scale per se. Learning by doing implies improvements in the ability to perform and promotes the introduction of incremental innovations with a progressive lowering of average costs. Learning economies are directly proportional to the cumulative production (experience curve).\nGrowth economies occur when a company acquires an advantage by increasing its size. These economies are due to the presence of some resource or competence that is not fully utilized, or to the existence of specific market positions that create a differential advantage in expanding the size of the firms. That growth economies disappear once the scale size expansion process is completed. For example, a company that owns a supermarket chain benefits from an economy of growth if, opening a new supermarket, it gets an increase in the price of the land it owns around the new supermarket. The sale of these lands to economic operators, who wish to open shops near the supermarket, allows the company in question to make a profit, making a profit on the revaluation of the value of building land."
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"text": "Capital and operating cost"
}
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"text": "Overall costs of capital projects are known to be subject to economies of scale. A crude estimate is that if the capital cost for a given sized piece of equipment is known, changing the size will change the capital cost by the 0.6 power of the capacity ratio (the point six to the power rule)."
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"text": "In estimating capital cost, it typically requires an insignificant amount of labor, and possibly not much more in materials, to install a larger capacity electrical wire or pipe having significantly greater capacity."
}
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"text": "The cost of a unit of capacity of many types of equipment, such as electric motors, centrifugal pumps, diesel and gasoline engines, decreases as size increases. Also, the efficiency increases with size."
}
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"text": "Crew size and other operating costs for ships, trains and airplanes"
}
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"text": "Operating crew size for ships, airplanes, trains, etc., does not increase in direct proportion to capacity. (Operating crew consists of pilots, co-pilots, navigators, etc. and does not include passenger service personnel.) Many aircraft models were significantly lengthened or \"stretched\" to increase payload."
}
} |