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10510_20 | 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.
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.
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.
In 2006, Costello performed with Fiona Apple in the Decades Rock TV special. Apple performed two Costello songs and Costello performed two Apple songs.
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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10510_21 | 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.
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.
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.
Legacy
Costello 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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10510_22 | 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.
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]."
Tribute albums
1998: Bespoke Songs, Lost Dogs, Detours & Rendezvous – (various artists)
2002: Almost You: The Songs of Elvis Costello – (various artists)
2003: The Elvis Costello Songbook – Bonnie Brett
2004: A Tribute to Elvis Costello – Patrik Tanner
2004: Davis Does Elvis – Stuart Davis
2008: Every Elvis Has His Impersonators: 7 Homemade Remade Elvis Costello Songs – Elastic No–No Band
Discography | [
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10510_23 | Discography
Studio albums
(including those with the Attractions, The Costello Show, and the Imposters)
My Aim Is True (1977)
This Year's Model (1978)
Armed Forces (1979)
Get Happy!! (1980)
Trust (1981)
Almost Blue (1981)
Imperial Bedroom (1982)
Punch the Clock (1983)
Goodbye Cruel World (1984)
King of America (1986)
Blood & Chocolate (1986)
Spike (1989)
Mighty Like a Rose (1991)
Brutal Youth (1994)
Kojak Variety (1995)
All This Useless Beauty (1996)
When I Was Cruel (2002)
North (2003)
Il Sogno (2004)
The Delivery Man (2004)
Momofuku (2008)
Secret, Profane & Sugarcane (2009)
National Ransom (2010)
Look Now (2018)
Hey Clockface (2020)
The Boy Named If (2022)
Collaborative albums
The Courier (1988, soundtrack for the film, orchestral music by Declan MacManus, 8 songs by other artists including U2 and Hothouse Flowers)
G.B.H. (1991, with Richard Harvey)
The Juliet Letters (1993, with the Brodsky Quartet)
Jake's Progress (1995, with Richard Harvey)
Deep Dead Blue (1995, with Bill Frisell)
Painted from Memory (1998, with Burt Bacharach)
For the Stars (2001, with Anne Sofie von Otter)
Piano Jazz (2005, with Marian McPartland)
My Flame Burns Blue (2006, with Metropol Orkest)
The River in Reverse (2006, with Allen Toussaint)
Wise Up Ghost (2013, with the Roots)
Lost on the River (2014, as a member of The New Basement Tapes)
Filmography | [
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10510_24 | Filmography
As actor
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.
1984 as "Henry Scully" in the UK TV series, Scully
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
1985 as inept magician "Rosco de Ville" in the Alan Bleasdale film, No Surrender
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.
1994 as himself on The Larry Sanders Show in the episode "People's Choice"
1996 as himself on The Larry Sanders Show in the episode "Everybody Loves Larry"
1997 as a barman in Spice World
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.
1999 as a younger version of himself in 200 Cigarettes
2001 as himself performing "Fly Me to the Moon" on the series finale of 3rd Rock from the Sun
2002 as himself on the episode "How I Spent My Strummer Vacation" of The Simpsons
2003 as Ben on Frasier, in the season 10 episode "Farewell Nervosa"
2003 as himself in I Love Your Work
2004 as himself in the UK TV Dead Ringers New Year Special, apparently and reportedly having serendipitously entered a filming venue.
2004 as himself in Two and a Half Men – Season 2, Episode 1
2004 as himself in De-Lovely
2006 as himself in Delirious
2006 as himself in Before the Music Dies
2006 as himself in Putting the River in Reverse
2006 as himself in Talladega Nights: The Ballad of Ricky Bobby
2008 as himself in A Colbert Christmas: The Greatest Gift of All!
2009 as himself on the 30 Rock episode "Kidney Now!"
2010 as himself on Treme
2017 as himself in Ex Libris – The New York Public Library
2017–2019 as Pete's Dad (voice) in Pete the Cat (Season 1) | [
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10510_25 | As part of soundtracks
1983, "Party Party" appears in the film of the same name and on its soundtrack album.
1991, "Days" (a cover of the Kinks song) appears in the film Until the end of the World and on its soundtrack album.
1995, "My Dark Life," a collaboration with Brian Eno, appears on the album Songs in the Key of X.
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.
1998, "My Mood Swings" appears in the film The Big Lebowski and on its soundtrack album.
1998, "I Throw My Toys Around," a collaboration with No Doubt, appears in the film The Rugrats Movie and on its soundtrack album.
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.
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.
2019, "I Want You" appears twice in the critically acclaimed British film Only You.
Bibliography
1980: A Singing Dictionary sheet music
1983: sheet music
2016: memoir
References
Further reading
Paumgarten, Nick. "Profiles: Brilliant Mistakes," The New Yorker, vol. 86, no. 35 (8 November 2010), pp. 48–59.
Perone, James E. Elvis Costello: A Bio-Bibliography. Westport, CT: Greenwood Press, 1998.
External links
Official Elvis Costello Lost Highway Records Artist Page
The Elvis Costello Wiki (moved 2007 from original The Elvis Costello Home Page) | [
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10510_26 | 1954 births
Living people
Columbia Records artists
Deutsche Grammophon artists
Diana Krall
Elvis Costello & the Attractions members
English buskers
English expatriates in the United States
English male singer-songwriters
English new wave musicians
English people of Irish descent
English punk rock guitarists
English punk rock singers
English rock guitarists
English male guitarists
English rock singers
Grammy Award winners
Island Records artists
Lost Highway Records artists
Male new wave singers
Mercury Records artists
People from Paddington
Radar Records artists
Rykodisc artists
Singers from London
Stiff Records artists
2 Tone Records artists
Warner Records artists
Officers of the Order of the British Empire
The New Basement Tapes members
Concord Records artists
English autobiographers | [
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10511_0 | 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.
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.
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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10511_1 | , 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".
Signs and symptoms
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.
Seizures
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.
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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10511_2 | 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.
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.
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.
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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10511_3 | Post-ictal
After the active portion of a seizure (the ictal state) there is typically a period of recovery during which there is confusion, referred to as the postictal period, before a normal level of consciousness returns. It usually lasts 3 to 15 minutes but may last for hours. Other common symptoms include feeling tired, headache, difficulty speaking, and abnormal behavior. Psychosis after a seizure is relatively common, occurring in 6–10% of people. Often people do not remember what happened during this time. Localized weakness, known as Todd's paralysis, may also occur after a focal seizure. It would typically last for seconds to minutes but may rarely last for a day or two.
Psychosocial
Epilepsy can have adverse effects on social and psychological well-being. These effects may include social isolation, stigmatization, or disability. They may result in lower educational achievement and worse employment outcomes. Learning disabilities are common in those with the condition, and especially among children with epilepsy. The stigma of epilepsy can also affect the families of those with the disorder.
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.
Causes
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.
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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10511_4 | Genetics
Genetics is believed to be involved in the majority of cases, either directly or indirectly. Some epilepsies are due to a single gene defect (1–2%); most are due to the interaction of multiple genes and environmental factors. Each of the single gene defects is rare, with more than 200 in all described. Most genes involved affect ion channels, either directly or indirectly. These include genes for ion channels themselves, enzymes, GABA, and G protein-coupled receptors.
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.
Acquired
Epilepsy may occur as a result of several other conditions, including tumors, strokes, head trauma, previous infections of the central nervous system, genetic abnormalities, and as a result of brain damage around the time of birth. Of those with brain tumors, almost 30% have epilepsy, making them the cause of about 4% of cases. The risk is greatest for tumors in the temporal lobe and those that grow slowly. Other mass lesions such as cerebral cavernous malformations and arteriovenous malformations have risks as high as 4060%. Of those who have had a stroke, 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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10511_5 | 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.
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.
Mechanism
Normally brain electrical activity is non-synchronous, as large numbers of neurons do not normally fire at the same time, but rather fire in order as signals travel throughout the brain. Neuron activity is regulated by various factors both within the cell and the cellular environment. Factors within the neuron include the type, number and distribution of ion channels, changes to receptors and changes of gene expression. Factors around the neuron include ion concentrations, synaptic plasticity and regulation of transmitter breakdown by glial cells. | [
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10511_6 | Epilepsy
The exact mechanism for epilepsy is unknown, but a little is known about its cellular and network mechanisms. However, it is unknown under which circumstances the brain shifts into the activity of a seizure with its excessive synchronization. Changes in MicroRNAs (miRNAs) levels seems to play a leading role. MicroRNAs (miRNAs) are a family of small non-coding RNAs that control the expression levels of multiple proteins by decreasing mRNA stability and translation, and could therefore be key regulatory mechanisms and therapeutic targets in epilepsy
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.
Seizures
There is evidence that epileptic seizures are usually not a random event. Seizures are often brought on by factors (also known as triggers) such as stress, excessive alcohol use, flickering light, or a lack of sleep, among others. The term seizure threshold is used to indicate the amount of stimulus necessary to bring about a seizure, this seizure threshold is lowered in epilepsy.
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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10511_7 | 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.
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.
Diagnosis
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.
Definition
Epilepsy is a disorder of the brain defined by any of the following conditions:
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At least two unprovoked (or reflex) seizures occurring more than 24 hours apart
One 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
Diagnosis of an epilepsy syndrome
|}
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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10511_8 | 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."
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.
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.
Classification
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.
The International League Against Epilepsy (ILAE) provided a classification of the epilepsies and epileptic syndromes in 1989 as follows: | [
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10511_9 | {| cellpadding=5 style="border:1px solid #ccc"
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Localization-related epilepsies and syndromes
Unknown cause (e.g. benign childhood epilepsy with centrotemporal spikes)
Symptomatic/cryptogenic (e.g. temporal lobe epilepsy)
Generalized
Unknown cause (e.g. childhood absence epilepsy)
Cryptogenic or symptomatic (e.g. Lennox-Gastaut syndrome)
Symptomatic (e.g. early infantile epileptic encephalopathy with burst suppression)
Epilepsies and syndromes undetermined whether focal or generalized
With both generalized and focal seizures (e.g. epilepsy with continuous spike-waves during slow wave sleep)
Special syndromes (with situation-related seizures)
|}
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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10511_10 | {| cellpadding=5 style="border:1px solid #ccc"
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Unknown cause (mostly genetic or presumed genetic origin)
Pure epilepsies due to single gene disorders
Pure epilepsies with complex inheritance
Symptomatic (associated with gross anatomic or pathologic abnormalities)
Mostly genetic or developmental causation
Childhood epilepsy syndromes
Progressive myoclonic epilepsies
Neurocutaneous syndromes
Other neurologic single gene disorders
Disorders of chromosome function
Developmental anomalies of cerebral structure
Mostly acquired causes
Hippocampal sclerosis
Perinatal and infantile causes
Cerebral trauma, tumor or infection
Cerebrovascular disorders
Cerebral immunologic disorders
Degenerative and other neurologic conditions
Provoked (a specific systemic or environmental factor is the predominant cause of the seizures)
Provoking factors
Reflex epilepsies
Cryptogenic (presumed symptomatic nature in which the cause has not been identified)
|} 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.
Syndromes | [
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10511_11 | Syndromes
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.
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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10511_12 | 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.
Tests
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.
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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10511_13 | 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.
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.
Differential diagnosis
Diagnosis of epilepsy can be difficult. A number of other conditions may present very similar signs and symptoms to seizures, including syncope, hyperventilation, migraines, narcolepsy, panic attacks and psychogenic non-epileptic seizures (PNES). In particular a syncope can be accompanied by a short episode of convulsions. Nocturnal frontal lobe epilepsy, often misdiagnosed as nightmares, was considered to be a parasomnia but later identified to be an epilepsy syndrome. Attacks of the movement disorder paroxysmal dyskinesia may be taken for epileptic seizures. The cause of a drop attack can be, among many others, an atonic seizure.
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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10511_14 | 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.
Prevention
While many cases are not preventable, efforts to reduce head injuries, provide good care around the time of birth, and reduce environmental parasites such as the pork tapeworm may be effective. Efforts in one part of Central America to decrease rates of pork tapeworm resulted in a 50% decrease in new cases of epilepsy.
Management
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.
First aid
Rolling people with an active tonic-clonic seizure onto their side and into the recovery position helps prevent fluids from getting into the lungs. Putting fingers, a bite block or tongue depressor in the mouth is not recommended as it might make the person vomit or result in the rescuer being bitten. Efforts should be taken to prevent further self-injury. Spinal precautions are generally not needed. | [
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10511_15 | 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.
Medications
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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10511_16 | 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.
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.
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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10511_17 | 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.
Surgery
Epilepsy surgery may be an option for people with focal seizures that remain a problem despite other treatments. These other treatments include at least a trial of two or three medications. The goal of surgery is total control of seizures and this may be achieved in 60–70% of cases. Common procedures include cutting out the hippocampus via an anterior temporal lobe resection, removal of tumors, and removing parts of the neocortex. Some procedures such as a corpus callosotomy are attempted in an effort to decrease the number of seizures rather than cure the condition. Following surgery, medications may be slowly withdrawn in many cases.
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.
Diet
There is promising evidence that a ketogenic diet (high-fat, low-carbohydrate, adequate-protein) decreases the number of seizures and eliminates seizures in some; however, further research is necessary. It is a reasonable option in those who have epilepsy that is not improved with medications and for whom surgery is not an option. About 10% stay on the diet for a few years due to issues of effectiveness and tolerability. Side effects include stomach and intestinal problems in 30%, and there are long-term concerns about heart disease. Less radical diets are easier to tolerate and may be effective. It is unclear why this diet works. In people with coeliac disease or non-celiac gluten sensitivity and occipital calcifications, a gluten-free diet may decrease the frequency of seizures. | [
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10511_18 | Other
Avoidance therapy consists of minimizing or eliminating triggers. For example, those who are sensitive to light may have success with using a small television, avoiding video games, or wearing dark glasses. Operant-based biofeedback based on the EEG waves has some support in those who do not respond to medications. Psychological methods should not, however, be used to replace medications.
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.
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.
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.
In pregnancy
In women of childbearing age, use of antiepileptic drugs is a major concern balancing possible side effects on the fetus against risk from uncontrolled seizures. Use of AEDs entail teratogenic effects including intrauterine growth retardation, major congenital malformations and developmental (neurocognitive) and behavioral issues, that need to be discussed with the patient at the time of starting the AEDs and before they plan pregnancy. Most women with epilepsy receive safe and effective treatment and have normal children, however risks exist. The International League Against Epilepsy created a task force on women and epilepsy which published consensus recommendations to guide therapy decisions till more definitive evidence is available in the future.
Alternative medicine
Alternative medicine, including acupuncture, routine vitamins, and yoga, have no reliable evidence to support their use in epilepsy. Melatonin, , is insufficiently supported by evidence. The trials were of poor methodological quality and it was not possible to draw any definitive conclusions.
Prognosis | [
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10511_19 | Prognosis
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.
Mortality
People with epilepsy are at an increased risk of death. This increase is between 1.6 and 4.1 fold greater than that of the general population. The greatest increase in mortality from epilepsy is among the elderly. Those with epilepsy due to an unknown cause have little increased risk.
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.
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.
Epidemiology
Epilepsy is one of the most common serious neurological disorders affecting about 39 million people . It affects 1% of the population by age 20 and 3% of the population by age 75. It is more common in males than females with the overall difference being small. Most of those with the disorder (80%) are in low income populations or the developing world. | [
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10511_20 | 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.
History
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.
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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10511_21 | 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.
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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10511_22 | In most cultures, persons with epilepsy have been stigmatized, shunned, or even imprisoned. As late as in the second half of the 20th century, in Tanzania and other parts of Africa epilepsy was associated with possession by evil spirits, witchcraft, or poisoning and was believed by many to be contagious. In the Salpêtrière, the birthplace of modern neurology, Jean-Martin Charcot found people with epilepsy side by side with the mentally ill, those with chronic syphilis, and the criminally insane. In ancient Rome, epilepsy was known as the morbus comitialis ('disease of the assembly hall') and was seen as a curse from the gods. In northern Italy, epilepsy was once traditionally known as Saint Valentine's malady.
In 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.
Society and culture
Stigma
Stigma is commonly experienced, around the world, by those with epilepsy. It can affect people economically, socially and culturally. In India and China, epilepsy may be used as justification to deny marriage. People in some areas still believe those with epilepsy to be cursed. In parts of Africa, such as Tanzania and Uganda, epilepsy is claimed to be associated with possession by evil spirits, witchcraft, or poisoning and is incorrectly believed by many to be contagious. Before 1971 in the United Kingdom, epilepsy was considered grounds for the annulment of marriage. The stigma may result in some people with epilepsy denying that they have ever had seizures.
Economics
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.
Vehicles | [
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10511_23 | Vehicles
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.
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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10511_24 | Support organizations
There are organizations that provide support for people and families affected by epilepsy. The Out of the Shadows campaign, a joint effort by the World Health Organization, the International League Against Epilepsy and the International Bureau for Epilepsy, provides help internationally. In the United States, the Epilepsy Foundation is a national organization that works to increase the acceptance of those with the disorder, their ability to function in society and to promote research for a cure. The Epilepsy Foundation, some hospitals, and some individuals also run support groups in the United States. In Australia, the Epilepsy Foundation provides support, delivers education and training and funds research for people living with epilepsy.
International Epilepsy Day (World Epilepsy Day) began in 2015 and occurs on the second Monday in February.
Research
Seizure prediction and modeling
Seizure prediction refers to attempts to forecast epileptic seizures based on the EEG before they occur. , no effective mechanism to predict seizures has been developed. Kindling, where repeated exposures to events that could cause seizures eventually causes seizures more easily, has been used to create animal models of epilepsy. One of the hypotheses present in the literature is based on inflammatory pathways. Studies supporting this mechanism revealed that inflammatory, glycolipid, and oxidative factors are higher in epilepsy patients, especially those with generalized epilepsy.
Potential future therapies
Gene therapy is being studied in some types of epilepsy. Medications that alter immune function, such as intravenous immunoglobulins, are poorly supported by evidence. Noninvasive stereotactic radiosurgery is, , being compared to standard surgery for certain types of epilepsy.
Other animals
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.
References
Further reading
External links
World Health Organization fact sheet | [
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10511_25 | External links
World Health Organization fact sheet
Articles containing video clips
Disorders causing seizures
Neurological disorders in children
Wikipedia medicine articles ready to translate (full)
Wikipedia neurology articles ready to translate | [
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10515_0 | 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.
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.
History
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.
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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10515_1 | 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.
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.
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).
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".
Skepticism | [
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10515_2 | Skepticism
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.
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.
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.
The 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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10515_3 | Dermo-optical perception
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.
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.
See also
Extrasensory Perception (book)
Inner eye
List of psychic abilities
List of topics characterized as pseudoscience
Magic
Outline of parapsychology
Notes
References
Further reading
Georges Charpak, Henri Broch, and Bart K. Holland (2004). Debunked! ESP, Telekinesis, and Other Pseudoscience. Johns Hopkins University. .
Milbourne Christopher (1970). ESP, Seers & Psychics: What the Occult Really Is. Thomas Y. Crowell Co.
Henry Gordon (1988). Extrasensory Deception: ESP, Psychics, Shirley MacLaine, Ghosts, UFOs. Macmillan of Canada. .
Donald Hebb (1980). "Extrasensory Perception: A Problem". In Essays on Mind. Lawrence Erlbaum Associates. .
Paul Kurtz (1985). A Skeptic's Handbook of Parapsychology. Prometheus Books. .
Targ, Russell (2012). The Reality of ESP: a physicist's proof of psychic abilities. Quest Books. .
Richard Wiseman. (1997). Deception and Self-Deception: Investigating Psychics. Prometheus Press. .
External links
FBI file on Extrasensory perception
Parapsychology
Psychic powers
Paranormal terminology
Pseudoscience | [
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10517_0 | 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.
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.
Some economies of scale, such as capital cost of manufacturing facilities and friction loss of transportation and industrial equipment, have a physical or engineering basis.
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.
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.
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.
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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10517_1 | Overview
The 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.
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.
Determinants of economies of scale
Physical and engineering basis: economies of increased dimension
Some 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.
In structural engineering, the strength of beams increases with the cube of the thickness. | [
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10517_2 | 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.
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.
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.
Economies in holding stocks and reserves
At 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.).
Transaction economies
A 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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10517_3 | Economies deriving from the balancing of production capacity
Economies 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.
Economies resulting from the division of labour and the use of superior techniques
A 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.
Managerial economics
Many 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.
Learning and growth economies
Learning 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).
Growth 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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10517_4 | Capital and operating cost
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).
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.
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.
Crew size and other operating costs for ships, trains and airplanes
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.
Many manufacturing facilities, especially those making bulk materials like chemicals, refined petroleum products, cement and paper, have labor requirements that are not greatly influenced by changes in plant capacity. This is because labor requirements of automated processes tend to be based on the complexity of the operation rather than production rate, and many manufacturing facilities have nearly the same basic number of processing steps and pieces of equipment, regardless of production capacity.
Economical use of byproducts
Karl Marx noted that large scale manufacturing allowed economical use of products that would otherwise be waste. Marx cited the chemical industry as an example, which today along with petrochemicals, remains highly dependent on turning various residual reactant streams into salable products. In the pulp and paper industry, it is economical to burn bark and fine wood particles to produce process steam and to recover the spent pulping chemicals for conversion back to a usable form.
Economies of scale and the size of exporter
Large and more productive firms typically generate enough net revenues abroad to cover the fixed costs associated with exporting. However, in the event of trade liberalization, resources will have to be reallocated toward the more productive firm, which raises the average productivity within the industry. | [
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10517_5 | Firms differ in their labor productivity and the quality of their goods produced. It is because of this that more efficient firms are more likely to generate more net income abroad and thus become exporters of their goods or services. There is a correlating relationship between a firms' total sales and underlying efficiency. Firms with higher productivity will always outperform a firm with lower productivity which will lead to lower sales. Through trade liberalization, organizations are able to drop their trade costs due to export growth. However, trade liberalization does not account for any tariff reduction or shipping logistics improvement. However, total economies of scale is based on the exporters individual frequency and size. So large-scale companies are more likely to have a lower cost per unit as opposed to small-scale companies. Likewise, high trade frequency companies are able to reduce their overall cost attributed per unit when compared to those of low-trade frequency companies.
Economies of scale and returns to scale
Economies of scale is related to and can easily be confused with the theoretical economic notion of returns to scale. Where economies of scale refer to a firm's costs, returns to scale describe the relationship between inputs and outputs in a long-run (all inputs variable) production function. A production function has constant returns to scale if increasing all inputs by some proportion results in output increasing by that same proportion. Returns are decreasing if, say, doubling inputs results in less than double the output, and increasing if more than double the output. If a mathematical function is used to represent the production function, and if that production function is homogeneous, returns to scale are represented by the degree of homogeneity of the function. Homogeneous production functions with constant returns to scale are first degree homogeneous, increasing returns to scale are represented by degrees of homogeneity greater than one, and decreasing returns to scale by degrees of homogeneity less than one. | [
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10517_6 | If the firm is a perfect competitor in all input markets, and thus the per-unit prices of all its inputs are unaffected by how much of the inputs the firm purchases, then it can be shown that at a particular level of output, the firm has economies of scale if and only if it has increasing returns to scale, has diseconomies of scale if and only if it has decreasing returns to scale, and has neither economies nor diseconomies of scale if it has constant returns to scale. In this case, with perfect competition in the output market the long-run equilibrium will involve all firms operating at the minimum point of their long-run average cost curves (i.e., at the borderline between economies and diseconomies of scale).
If, however, the firm is not a perfect competitor in the input markets, then the above conclusions are modified. For example, if there are increasing returns to scale in some range of output levels, but the firm is so big in one or more input markets that increasing its purchases of an input drives up the input's per-unit cost, then the firm could have diseconomies of scale in that range of output levels. Conversely, if the firm is able to get bulk discounts of an input, then it could have economies of scale in some range of output levels even if it has decreasing returns in production in that output range.
In essence, returns to scale refer to the variation in the relationship between inputs and output. This relationship is therefore expressed in "physical" terms. But when talking about economies of scale, the relation taken into consideration is that between the average production cost and the dimension of scale. Economies of scale therefore are affected by variations in input prices. If input prices remain the same as their quantities purchased by the firm increase, the notions of increasing returns to scale and economies of scale can be considered equivalent. However, if input prices vary in relation to their quantities purchased by the company, it is necessary to distinguish between returns to scale and economies of scale. The concept of economies of scale is more general than that of returns to scale since it includes the possibility of changes in the price of inputs when the quantity purchased of inputs varies with changes in the scale of production. | [
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10517_7 | The literature assumed that due to the competitive nature of reverse auctions, and in order to compensate for lower prices and lower margins, suppliers seek higher volumes to maintain or increase the total revenue. Buyers, in turn, benefit from the lower transaction costs and economies of scale that result from larger volumes. In part as a result, numerous studies have indicated that the procurement volume must be sufficiently high to provide sufficient profits to attract enough suppliers, and provide buyers with enough savings to cover their additional costs.
However, surprisingly enough, Shalev and Asbjornse found, in their research based on 139 reverse auctions conducted in the public sector by public sector buyers, that the higher auction volume, or economies of scale, did not lead to better success of the auction. They found that auction volume did not correlate with competition, nor with the number of bidders, suggesting that auction volume does not promote additional competition. They noted, however, that their data included a wide range of products, and the degree of competition in each market varied significantly, and offer that further research on this issue should be conducted to determine whether these findings remain the same when purchasing the same product for both small and high volumes. Keeping competitive factors constant, increasing auction volume may further increase competition.
Economies of scale in the history of economic analysis
Economies of scale in classical economists
The first systematic analysis of the advantages of the division of labour capable of generating economies of scale, both in a static and dynamic sense, was that contained in the famous First Book of Wealth of Nations (1776) by Adam Smith, generally considered the founder of political economy as an autonomous discipline.
John Stuart Mill, in Chapter IX of the First Book of his Principles, referring to the work of Charles Babbage (On the economics of machines and manufactories), widely analyses the relationships between increasing returns and scale of production all inside the production unit. | [
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10517_8 | Economies of scale in Marx and distributional consequences
In Das Kapital (1867), Karl Marx, referring to Charles Babbage, extensively analyzed economies of scale and concludes that they are one of the factors underlying the ever-increasing concentration of capital. Marx observes that in the capitalist system the technical conditions of the work process are continuously revolutionized in order to increase the surplus by improving the productive force of work. According to Marx, with the cooperation of many workers brings about an economy in the use of the means of production and an increase in productivity due to the increase in the division of labour. Furthermore, the increase in the size of the machinery allows significant savings in construction, installation and operation costs. The tendency to exploit economies of scale entails a continuous increase in the volume of production which, in turn, requires a constant expansion of the size of the market. However, if the market does not expand at the same rate as production increases, overproduction crises can occur. According to Marx the capitalist system is therefore characterized by two tendencies, connected to economies of scale: towards a growing concentration and towards economic crises due to overproduction.
In his 1844 Economic and Philosophic Manuscripts, Karl Marx observes that economies of scale have historically been associated with an increasing concentration of private wealth and have been used to justify such concentration. Marx points out that concentrated private ownership of large-scale economic enterprises is a historically contingent fact, and not essential to the nature of such enterprises. In the case of agriculture, for example, Marx calls attention to the sophistical nature of the arguments used to justify the system of concentrated ownership of land:
As for large landed property, its defenders have always sophistically identified the economic advantages offered by large-scale agriculture with large-scale landed property, as if it were not precisely as a result of the abolition of property that this advantage, for one thing, received its greatest possible extension, and, for another, only then would be of social benefit.
Instead of concentrated private ownership of land, Marx recommends that economies of scale should instead be realized by associations: | [
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10517_9 | Association, applied to land, shares the economic advantage of large-scale landed property, and first brings to realization the original tendency inherent in land-division, namely, equality. In the same way association re-establishes, now on a rational basis, no longer mediated by serfdom, overlordship and the silly mysticism of property, the intimate ties of man with the earth, for the earth ceases to be an object of huckstering, and through free labor and free enjoyment becomes once more a true personal property of man.
Economies of scale in Marshall
Alfred Marshall notes that "some, among whom Cournot himself," have considered "the internal economies [...] apparently without noticing that their premises lead inevitably to the conclusion that, whatever firm first gets a good start will obtain a monopoly of the whole business of its trade … ". Marshall believes that there are factors that limit this trend toward monopoly, and in particular:
the death of the founder of the firm and the difficulty that the successors may have inherited his/her entrepreneurial skills;
the difficulty of reaching new markets for one's goods;
the growing difficulty of being able to adapt to changes in demand and to new techniques of production;
The effects of external economies, that is the particular type of economies of scale connected not to the production scale of an individual production unit, but to that of an entire sector.
Sraffa's critique
Piero Sraffa observes that Marshall, in order to justify the operation of the law of increasing returns without it coming into conflict with the hypothesis of free competition, tended to highlight the advantages of external economies linked to an increase in the production of an entire sector of activity. However, "those economies which are external from the point of view of the individual firm, but internal as regards the industry in its aggregate, constitute precisely the class which is most seldom to be met with." "In any case - Sraffa notes – in so far as external economies of the kind in question exist, they are not linked to be called forth by small increases in production," as required by the marginalist theory of price. Sraffa points out that, in the equilibrium theory of the individual industries, the presence of external economies cannot play an important role because this theory is based on marginal changes in the quantities produced. | [
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10517_10 | Sraffa concludes that, if the hypothesis of perfect competition is maintained, economies of scale should be excluded. He then suggests the possibility of abandoning the assumption of free competition to address the study of firms that have their own particular market. This stimulated a whole series of studies on the cases of imperfect competition in Cambridge. However, in the succeeding years Sraffa followed a different path of research that brought him to write and publish his main work Production of commodities by means of commodities . In this book, Sraffa determines relative prices assuming no changes in output, so that no question arises as to the variation or constancy of returns. | [
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10517_11 | Economies of scale and the tendency towards monopoly: "Cournot's dilemma"
It has been noted that in many industrial sectors there are numerous companies with different sizes and organizational structures, despite the presence of significant economies of scale. This contradiction, between the empirical evidence and the logical incompatibility between economies of scale and competition, has been called the ‘Cournot dilemma’. As Mario Morroni observes, Cournot's dilemma appears to be unsolvable if we only consider the effects of economies of scale on the dimension of scale. If, on the other hand, the analysis is expanded, including the aspects concerning the development of knowledge and the organization of transactions, it is possible to conclude that economies of scale do not always lead to monopoly. In fact, the competitive advantages deriving from the development of the firm's capabilities and from the management of transactions with suppliers and customers can counterbalance those provided by the scale, thus counteracting the tendency towards a monopoly inherent in economies of scale. In other words, the heterogeneity of the organizational forms and of the size of the companies operating in a sector of activity can be determined by factors regarding the quality of the products, the production flexibility, the contractual methods, the learning opportunities, the heterogeneity of preferences of customers who express a differentiated demand with respect to the quality of the product, and assistance before and after the sale. Very different organizational forms can therefore co-exist in the same sector of activity, even in the presence of economies of scale, such as, for example, flexible production on a large scale, small-scale flexible production, mass production, industrial production based on rigid technologies associated with flexible organizational systems and traditional artisan production. The considerations regarding economies of scale are therefore important, but not sufficient to explain the size of the company and the market structure. It is also necessary to take into account the factors linked to the development of capabilities and the management of transaction costs.
External economies of scale
External economies of scale tend to be more prevalent than internal economies of scale. Through the external economies of scale, the entry of new firms benefits all existing competitors as it creates greater competition and also reduces the average cost for all firms as opposed to internal economies of scale which only allows benefits to the individual firm. Advantages that arise from external economies of scale include;
Expansion of the industry.
Benefits most or all of the firms within the industry.
Can lead to rapid growth of local governments.
Sources | [
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10517_12 | Sources
Purchasing
Firms are able to lower their average costs by buying their inputs required for the production process in bulk or from special wholesalers.
Managerial
Firms might be able to lower their average costs by improving their management structure within the firm. This can range from hiring better skilled or more experienced managers from the industry.
Technological
Technological advancements will change the production process which will subsequently reduce the overall cost per unit.
See also
Economies of scope
Ideal firm size
Long tail
Mass production
Network effect
Economies of density
Notes
References
Bibliography
New ed. with Appendices by Léon Walras, Joseph Bertrand and Vilfredo Pareto, Introduction and notes by Georges Lutfalla, Paris: Librairie des Sciences Politiques et Sociales Marcel Rivière, 1938. English translation: Repr. New York: A.M. Kelley, 1971.
Repr. 1997.
Repr. 1990.
Repr. 1990.
Repr. 2009.
Repr. (1997).
English translation: Repr. in
Repr. in
External links
Economies of Scale Definition by The Linux Information Project (LINFO)
Economies of Scale by Economics Online
Production economics
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