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A
Absence
(Previously termed 'Petit Mal') A generalised seizure predominantly seen in children - commonly mistaken for daydreaming and inattentiveness. Characterised by staring, loss of facial expression, unresponsiveness, cessation of activity and sometimes eye blinking or upward eye movements - they start and end abruptly, and can last from 2-20 seconds. There is usually an immediate recovery of mental function and resumption of previous activity with no memory of the event. Intelligence is normal, but if the seizures are not treated, gaps in learning can occur due to seizures occurring numerous times a day.
Acupuncture
Ancient Chinese medical therapy that involves inserting fine needles and stimulating specific regions of the body for therapeutic purposes.
Acute
Having a short and relatively severe course of symptoms with a sudden onset.
Adversive Seizures
Rotation of the eyes, head or body during a seizure.
Aetiology
The cause of the disease or disorder. Also spelt etiology (US).
Afebrile
The absence of fever, normal body temperature.
Agenesis
The absence or failure of formation of an organ or body part.
Aicardi syndrome
Is a rare genetic disorder characterised by partial or complete absence of the connection betweent the two hemispheres of the brain, the corpus callosum. This only affects femalse and the onset is generally between ages 3-5 months with seizures called infantile spasms. Symptoms include seizures, profound learning disabilities and brain abnormalities such as smaller than average brain and cavities or gaps in the brain.
Amnesia
Loss of memory. Total or partial inability to recall past experiences.
Anticonvulsants
See antiepileptic drugs (AED's)
Antiepileptic drugs (AED's)
Also called anticonvulsants. These medications are used to prevent the recurrence of seizures.
Aphasia
A total or partial loss of communication skills to express oneself or understand others. This can occur during or after seizures of dominant hemisphere (usually the left side of the brain).
Apnoea
Interruption or absence of spontaneous breathing.
Aromatherapy
Is the use of pure aromatic oils in the management of disease or maintenance of a health lifestyle. It can be either diluted and massaged into the skin or heated in an oil burner. These oils are a mixture of plant chemicals, many which do have pharmacological effects.
Ataxia
Poor coordination - an inability to coordinate muscle activity during voluntary movement. This can occur when some medication levels are too high.
Atonic seizure
Also known as drop attacks. An atonic seizure is a generalised seizure where body tone is suddenly lost and the person slumps to the floor or if sitting, it may result in a sudden head nod. They are difficult to control with medication, often occur in intellectually disabled people, and often result in head and facial injuries.
Atypical Absence
Similar to an absence seizure but it may last longer or have additional features such as repetitive movements, jerking or falling. The EEG changes are slightly different to absence seizures and a typical absences are often more difficult to control with medications.
Aura
This the start of a seizure and is actually a simple partial seizure which involves no loss of awareness. They can occur in isolation and include feelings such as: strange smells, visual disturbances, numbness, tingling, blushing, nausea, different emotions or feelings of déjà vu.
Automatism
Purposeless, often repetitive movements that accompany a complex partial seizure. These include lip smacking, chewing, picking at clothes, pill rolling, mumbling or wandering in a confused state.
Axon
Is a part of the neuron (nerve cell) that resembles a cable. Nerve impulses travel along the axon and its main function is part of the process of communication between neurons.
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B
Barbiturate
Family of medications with a sedative effect, used in epilepsy to prevent seizures. The most common is Phenobarbital. Related drugs include Prominal and Mysoline. They are effective in management of partial and generalised tonic –clonic seizures but ineffective for absence seizures. Adverse side effects and reactions make this a less preferable choice for epilepsy.
Benign
A word frequently used to indicate that a disease process is mild or non-malignant. It usually indicates a favourable outcome.
Benign Rolandic Epilepsy
An epilepsy syndrome seen in children. It is characterised by partial seizures during sleep involving sensation changes around the face and tongue, gurgling noises may be heard by the parents and focal jerking of facial muscles is often seen. These sometimes progress into a tonic-clonic seizure. There is a typical EEG, seizures are usually infrequent, often not requiring medication. The condition is usually outgrown during puberty.
Benzodiazepine
Family of medications including Diazepam (Valium), Clonazepam (Rivotril), Clobazam (Frisium), Midazolam (Hypnovel) and Lorazepam (Ativan) which can be used as anticonvulsants. Some are used often in acute situations such as prolonged seizures or clusters of seizures (status epilepticus). The sedative effect and increased brain tolerance levels limit their usefulness in long term therapy. There can be respiratory problems if the dose is too high or given too quickly and other behavioural problems.
Brainstem
Is situated at the base of the brain and connects the brain with the spinal cord. It controls many functions including breathing and heart-rate, reflexes and level of alertness.
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C
Carbamazepine
Commonly known as Tegretol or Teril. It is an antiepileptic medication used in the treatment of partial and generalised epilepsies, and can also be used for nerve pain.
Catamenial epilepsy
Used to describe seizures in women that are exacerbated or occur exclusively in association with menstruation.
Cataplexy
A brief attack of sudden weakness which can cause falling or head nodding. It is often triggered by an emotional response and is associated with a sleep disorder called narcolepsy.
Cerebrum
Refers to the largest part of the brain – it is divided into two hemispheres (divided by a deep groove) and four main lobes. The right side controls what happens on the left side of the body and vice versa.
Chromosome
One of 46 bodies in the nucleus of all body cells that is the bearer of genes.
Chronic epilepsy
When seizures are resistant to medical management and seizure control is not obtained. Further investigations may need to be performed to rule out other pathology in some cases.
Clonic seizure
The rhythmic jerking of an extremity or of the whole body.
Clobazam
Also known as Frisium, is sometimes used in the treatment of epilepsy. It is also used as an anti-anxiety medication.
Clonazepam
Also known as Rivotril or Paxam. It can be used in the management of epilepsy, but has a sedative effect and people develop a tolerance, needing higher doses. It is frequently used in the management of acute prolonged or clusters of seizures (status epilepticus)
Cognition
Mental activities associated with thinking, learning and memory.
Comorbidity
Having two or more unrelated diseases.
Complex partial
Also termed 'focal seizures' meaning they involve only one region of the brain. There is an impairment of consciouseness and awareness, usually producing a confused, vague or dreamlike appearance. Behaviour may be inappropriate, random, repetitive and purposeless. Common behaviours (automatisms) include chewing, fidgeting, wandering, and vocalising. There is a period of confusion after the seizure and little, if any, memory for the event. They can last from approximately 30 seconds to 3 minutes.
Convulsion
Is an older term used for a tonic-clonic seizure ('grand mal', fit and turn are also terms).
Corpus Callosum
The major structure of nerve fibres connecting the two hemispheres of the brain.
Cortex
The outer surface of the brain - the grey matter.
CT or CAT Scan
Computerised Axial Tomography. Uses x-rays and computer analysis to produce images of the brain for diagnostic uses.
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D
De'ja' vu
A feeling that you have been somewhere or seen something before, whether you have or not.
Diazepam
Also known as Valium. This medication used as an anti-epileptic moreso in acute situations such as status epilepticus, prolonged seizures or febrile convulsions. In these situations it is given intravenously or rectally. It is also used as a sedative, muscle relaxant and anti-anxiety agent. It is not considered for long term management because of its sedative and tolerance effects.
Dilantin
See Phenytoin.
DNA
Deoxyribonucleic acid. The molecule that encodes genetic information in the nucleus of cells. It determines the structure, function and behaviour of the cell.
Drop Attacks
Episodes where a person suddenly falls to the ground without warning, often causing injury, particularly to the head and face. When these drop attacks are epilepsy, they are tonic or atonic seizures.
Dysphasia
Difficulty with speech and language function. Inability to speak words which one has in mind or to think of correct words, or inability to understand spoken or written words. Associated with dysfunction of the dominant hemisphere particularly the frontal, temporal or parietal lobes.
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E
ECG
Electrocardiogram. A record of the electrical activity (function) of the heart. Often done in conjunction with an EEG.
EEG
Electroencephalogram. A diagnostic test that records the electrical activity (function) of the brain.
Encephalitis
Inflammation of the brain, usually caused by a virus or bacteria.
Epidemiology
The study of the distribution and determinants of health-related states or events in particular populations - and the application of this study to the control of health problems, the study of epidemic disease.
EPC
Epilepsia Partialis Continua. A form of epilepsy in which there is repetitive motor seizures (jerking, twitching) involving one small area or all of one side of the body. Consciousness is preserved. Treatment with anti-epileptic drugs is often not very effective; surgical treatment should be considered. These seizures can also be associated with Rasmussen's Encephalitis.
Epilepsy
A condition that is characterised by recurrent, usually unprovoked seizures. The seizures are a result of sudden abnormal electical activity in the brain. The type of seizure will depend on where it starts and spreads within the brain.
Epilepsy Syndrome
Is characterised by a cluster of signs and symptoms customarily occurring together often with an known prognosis. One syndrome can evolve into another.
Epilim
Epilim is the trade name for the drug Sodium Valproate. See Sodium Valproate.
Ethosuximide
Also known as Zarontin. This antiepileptic drug is used effectively to treat absence seizures.
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F
Febrile Seizures
Also known as Febrile Convulsions. These are tonic-clonic seizures (convulsions) that occur in children only during a fever. Most febrile seizures occur between the ages of 6 months and 4 years, but are occasionally seen in children as old as 6 or 7 years. They may recur if the child has a fever at other times, but do not warrant a diagnosis of epilepsy.
Felbamate
Felbamate is a very effective anti-convulsant in many instances of relatively difficult partial seizures; unfortunately, this drug is associated with a prohibitively high rate of serious side effects (aplastic anemia and hepatopathy)and should be used only as a last resort in these seizure types. It has also been useful in the management of Lennox-Gastaut, but is once again a last choice.
Fits
See Seizures.
Focal
Pertaining to one region or area (of the brain).
Focus
A local area of abnormality (in the brain), usually where seizures begin (seizure focus).
Folic Acid
Pteridine derivative that is abundant in liver and green plants and is a growth factor for some bacteria. It is recommended to be taken prior to and during early stages of pregnancy to help prevent birth defects.
Frontal Lobe Epilepsy
An epileptic condition where seizures originate from one of the frontal lobes. Seizures are characterised often start and end abruptly, with little, if any confusion afterwards. They are likely to occur in clusters and often are quite bizarre seizures, resulting in difficulty obtaining a diagnosis..
G
GABA
Gaba aminobutyric acid, an important amino acid, functions as the principle inhibitory neurotransmitter in the central nervous system. This helps control the nerve cells from firing too fast, which can cause seizures. The action of GABA decreases epileptic seizures and muscle spasms.
Gabapentin
Also known as Neurontin, Pendine and Gantin. It is used for partial seizures and also for nerve pain.
Genetic
A genetic disorder is an inherited disorder - transmitted by family.
Generalised
Meaning the entire brain. A primary generalised seizure starts simultaneously in all regions of the brain while a secondarily generalised seizure begins in one part of the brain before spreading to the rest of the brain.
Genes
Contains information that codes individuals genetic makeup and is passed on from generation to generation.
Glioma
A type of tumour found in the central nervous system (brain or spinal cord).
Glutamate
Major fast excitatory neurotransmitter in the central nervous system (brain and spinal cord).
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H
Hippocampal Sclerosis
Scarring which has developed in the temporal lobe as a result of things such as; lack of oxygen to the brain, trauma, prolonged seizures. It is the most common cause of partial seizures (temporal lobe epilepsy) in adults.
Hippocampus
Situated on the inner aspect of the temporal lobe. The hippocampus is important for long term memory storage and is often the focus of many seizures.
Hypoxia
Lack of oxygen (below normal levels) to the tissues and organs, including the brain.
I
Ictal (Ictus)
A seizure or during a seizure.
Idiopathic
Disease of unknown cause.
Infantile Spasms (West Syndrome)
Brief muscle spasms seen in infants characterised by head nodding or sudden bending forward. The seizures are brief and may be missed by casual observers. They typically begin during the first 2 years of life, with a peak onset between 4 and 6 months of age. They are associated with a chaotic EEG and developmental delay.
Intellectual disability
Refers to limitations in intellectual functioning such as difficulties in learning and performing daily life skills. It is evident before the age of 18 years and IQ is below 70.
Interaction
In pharmacology - The effect of two or more drugs acting on each other.
Interictal
The periods between seizures.
Intractable Seizures
Epilepsy not controlled despite adequate medication.
Isolated Seizures
A single seizure, nearly always a tonic-clonic seizure, with no risk factors for epilepsy and a normal neurological examination. Does no warrant long term treatment.
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J
Jacksonian March
A motor seizure (involving muscles) starting in one part of the body then progressing to other parts of the body on the same side. They can spread and become generalised. Seizures of this type typically cause no change in awareness or alertness. They are temporary, and short-lived.
JAE Juvenile Absence Epilepsy
A form of absence seizure with onset around puberty. Characterised by absence seizures, generalised tonic-clonic seizures and sometimes myoclonic jerks.
JME Juvenile Myoclonic Epilepsy
This is a common form of epilepsy typically beginning in early adolescence. It is characterised by myoclonic jerks on awakening, and sometimes can progress into generalised tonic-clonic seizures. Other features include clumsiness or clouding in the morning, and normal intelligence. EEG is usually normal apart from the period after awakening. It is managed easily with low doses of anti-epileptic medication.
K
Ketogenic Diet
This is a high fat, normal protein, and low carbohydrate diet used to treat seizures. It is mostly used with children. The diet is based on ketosis, a change in the body's metabolic state in which the body burns primarily fat, not sugar, for energy. Calories and liquid intake are strictly limited and, to work, the diet must be carefully and individually calculated and rigidly controlled.
L
Lamotrigine (Lamictal)
Also known as Lamictal. Is an antiepileptic medication used for the treatment of partial and generalised seizures.
Landau- Kleffener Syndrome
Also called Acquired Epileptic Aphasia is a rare childhood disorder in which there is speech problems associated with seizures and severe EEG abnormalities. It occurs more commonly in boys than girls, usually between the ages of 4 and 7 years.
Lennox-Gastaut Syndrome
Usually begins in preschool aged children. Secondary generalised seizures associated with severe brain damage which may also cause intellectual handicap. The seizures are often difficult to control and the child may experience a variety of seizure types like tonic clonic, tonic, myoclonic, atypical absences, atonic and absences.
M
MEG
Magnetic encephalograph is a research tool which measures magnetic fields in the brain.
Midazolam
Also known as Hypnovel. It is a short acting medication used in the management of acute or prolonged seizures - liquid is dripped into the nose or mouth. It is sometimes given by injection prior to minor diagnostic and surgical procedures.
Monotherapy
Taking only one medication.
MRI
Magnetic Resonance Imaging. This imaging technique creates detailed pictures of the inside of the body and the brain without the use of xrays. It is used for diagnosis and can help to identify particular structures of the brain and detect abnormalities.
Myoclonic seizures
These are generalised seizures characterised by sudden, brief, muscle contractions. Often involving the muscles of the upper body, but can involve lower body or all groups of muscles.
Meningitis
Inflammation of the membranes of the brain and spinal cord caused by a bacteria or virus.
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N
Narcolepsy
A sleep disorder characterised by sudden and uncontrollable attacks of sleep, cataplexy, sleep paralysis and hallucinations when going off or waking up from sleep.
Neonatal seizures
Seizures occurring in the first month of life.
Neural migration defects
Epilepsy is often associated with defects that occur during brain development when the cells are migrating out to the cerebral cortex.
Neural tube defects
The neural tube is the tube that forms from fusion of the neural folds from which the brain and spinal cord arise. Defects can occur during development of the brain and spinal cord eg. spina bifida.
Neuroimaging
Production of images of the brain and/or spinal cord. It can nclude computerised tomography ( CT) scanning, Magnetic Resonance Imaging (MRI), Photon Emission Computerised Tomography (SPECT) and Positron Emission Tomography ( PET).
Neuron(e)
The nerve cells of the brain and nervous system.
Neurologist
A specialist in the diagnosis and treatment of neurological disorders, including epilepsy. Paediatric Neurologists see children.
Neurontin
See Gabapentin.
Neuropsychologist
A psychologist who specialises in the study of the relationship between the brain and behaviour. Test and assessment techniques are used to diagnose specific cognitive and behavioural deficits. This is important in determining a seizure focus.
Neurosurgeon
A surgeon who operates on the brain, spinal cord, spinal column and nerves.
Neurotransmitter
Chemicals produced by nerve cells, necessary for the transportation of electrical signals in the nervous system.
Night terrors
A sleep disorder occurring mainly in young children. During sleep the child suddenly sits up, screams and appears terrified, but is not actually awake. They are usually inconsolable and will resume sleep after a 10-20 minutes with no memory of the event in the morning.
Nocturnal Seizures
Seizures that occur during sleep.
Non-epileptic seizures
Also called pseudo-seizures or psychogenic seizures. An event mimicking a seizure that arises from an emotional or psychological cause, rather than a physiological or electrical changes in the brain. Can also occur in people with epilepsy.
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O
Occipital
Pertains to the back of the head where the occipital lobe of the brain is located. The main function of the occipital lobe is vision.
Oxcarbazepine
Also known as Trileptal. It is an antiepileptic drug used in the management of partial and generalised seizures.
P
Partial Seizures
Also known as focal, psychomotor or 'petit mal seizures. These seizures arise from one small region of the brain. They can often be very subtle or bizarre, and may go unnoticed or be confused with other events. They start in one area of the brain and may spread to other regions of the brain. They sometimes spread to become a generalised seizure, termed a secondarily generalised seizure. Two types of partial seizure are simple (consciousness retained) and complex (consciousness impaired).
Parietal lobe
Pertains to the part of the brain located behind the frontal lobes, above the temporal lobes and in front of the occipital lobes. The main function is sensation, perception of where the body is.
Paroxysm
Pertaining to a sudden outburst, such as the sudden recurrence of symptoms or burst of epileptiform activity on the EEG.
Pathophysiology
The study of how normal physiological processes are affected by disease.
PET
Positron emission tomography. A diagnostic test that uses a dose of radioactive glucose to measure metabolic activity in the body and brain.
Petit Mal
An older term for absence seizures. It is sometimes used incorrectly to refer to any seizure that is not convulsive, eg partial seizures.
Pharmacokinetics
The study of the metabolism and action of drugs in the body. It involves absorption, duration of action, distribution in the body, and method of elimination.
Phenobarbitone
A barbiturate drug sometimes used to treat seizures, particularly in the short-term or acute situations. It is also used for sedation.
Phenytoin
Also known as Dilantin. It is used in the treatment of partial and generalised seizures.
Photosensitive epilepsy
A form of epilepsy in which seizures can be triggered by flashing or flickering lights, television, and geometric shapes or patterns. This type of epilepsy is uncommon and there is evidence that it is inherited.
Photic stimulation
Using strobe or flashing lights at different frequencies during an EEG to detect photosensitive epilepsy.
Polytherapy
Taking more than one medication.
Post-ictal
The period following a seizure. During this time a person may be confused and drowsy.
Predisposition
To be more susceptible to a disease or condition.
Prognosis
The outcome of a medical condition such as, the chances the condition will improve, remain unchanged or worsen.
Pseudoseizure
A term referring to non-epileptic seizures, no longer used. See non-epileptic seizures.
Psychomotor Seizures
An older term for complex partial seizures.
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R
Reading epilepsy
A reflex epilepsy where seizures are triggered by reading. There is jerking of the jaw, which can evolve to a generalised seizure, especially if the person keeps reading. There is a genetic basis and a positive family history in about 25% of cases.
Reflex epilepsy
Seizures that are triggered by a specific form of stimulus such as photosensitive epilepsy, reading epilepsy, and hot water epilepsy. The stimuli reported to trigger seizures include flashing lights (photosensitivity) and other visual stimuli, startle, bathing in hot water, music reading and movement.
Rolandic epilepsy
Also known as benign focal epilepsy of childhood or Sylvian fissure epilepsy. Age of onset between 4 – 10 yrs. Seizures are simple partial (usually involving the face and mouth), are seen during sleep and they sometimes secondarily generalise. Most people have infrequent seizures which do not need medication. This condition is usually outgrown around puberty.
S
Secondarily generalised seizure
A seizure with a focal onset (partial seizure) which spreads to involve the whole brain and become a generalised seizure - almost always a tonic-clonic seizure.
Seizure
A seizure is a disruption in the normal pattern of electrical impulses in the brain. This can cause changes in sensation, awareness, and behaviour, or sometimes convulsions, muscle spasms or loss of consciousness, depending on where the seizure starts and spreads in the brain.
Simple partial seizure
These seizures involve no loss of consciousness. Many people term them an 'aura' or warning. The symptoms can include; numbness, tingling, blushing, pallor, nausea, dejavu, strange tastes or smells, different emotions, twitching or jerking of a limb. They start in one area of the brain and may spread to other regions of the brain.
Sodium Valproate
Also known as Epilim or Valpro. Used in the management of generalised seizures and in partial seizures. Can also be used to treat mood disorders, particularly mania.
SPECT
Single Photon Emission Computerised Tomography. A diagnostic scan where a radioactive isotope is injected to determine blood flow. During a seizure there is increased blood flow in the region of the brain where a seizure begins. Inbetween seizures, the bloodflow is reduced in this area. The SPECT is performed on people with epilepsy who are working up for possible surgery for epilepsy. Scanning can help determine the origin of the seizure.
Spike and wave complex
An EEG pattern which is characteristic in some forms of epilepsy and may be seen in some people with epilepsy.
Status epilepticus
Is a condition where there is a prolonged seizure or repeated seizures without regaining consciousness for 30 mins or more. They can be convulsive or non-convulsive and can be life-threatening.
Sturge-Weber Syndrome
Sturge Weber Syndrome is a congenital abnormality typically involving a facial birthmark (called a port wine stain or angioma) and a leptomeningeal angioma (or birthmark on the brain). Glaucoma can also be present. Neurological symptoms can include seizures, developmental delay or intellectual disability, hemiparesis (weakening of one side of the body) and hemianopia (deficit in vision). The facial port wine stain is typically on the forehead and upper eyelid however variations of this can occur. The brain involvement is mostly on one side but can also be on both sides of the brain. Bilateral brain involvement can increase the risk of greater neurological impairment. Seizures can be severe and difficult to control. Age of onset, type of seizures and response to treatment can all play a role in the potential outcome. Each case of SWS is individual and displays the possible symptoms in varying fashion. It is difficult to predict potential outcomes from the diagnosing features. Further information can be found at http://www.austsws.com
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T
Tegretol
Also known as Teril or Carbamazepine. See Carbamazepine.
Telemetry - video EEG
A technique for recording seizures on video with simultaneous EEG; changes in behavior can be correlated with changes in the EEG; useful in making the diagnosis of epilepsy and localising the seizure focus. Useful in diagnosis and assessment for surgery for epilepsy.
Temporal lobe
The lobes in the brain situated beneath the temples. Seizures commonly originate in this region in the partial epilepsies. The temporal lobe is associated with memory, speech, language, learning and behaviour.
Tiagabine
Also known as Gabitril. Used in partial and secondarily generalised seizures.
Tic
Repeated involuntary contractions of muscles, such as sniffing, clearing the throat, rapid head jerks or eye blinks; may be under partial voluntary control (ie can be temporarily supressed). Not epilepsy.
Todd's paralysis
Weakness or paralysis occurring in one limb or one side of the body after a seizure. Todd's paralysis after a seizure is usually resolved in one or two hours but may, on occasion, continue for several days. It always disappears completely.
Topirimate
Also known as Topamax. Used in partial and secondarily generalised seizures, and tonic-clonic seizures. Also used in Lennox-Gastaut syndrome.
Tonic-clonic seizure
Previously called "Grand Mal" and also termed convulsion or fit. These are the most universally recognised seizures. They often begin with a sudden cry and loss of consciousness. The body becomes quite stiff (tonic) shortly followed by jerking of the muscles (clonic). The seizure usually lasts no more than 2 minutes and is followed by a period of confusion, agitation or sleep. Headaches and soreness are common afterwards.
Tonic seizure
Also termed 'drop attack'. Muscles of the body briefly stiffen simultaneously, and if standing, the person will crash to the ground. These often happen in sleep. More likely to be seen in people with severe epilepsy.
Tuberous sclerosis (Bourneville's syndrome)
Is an inherited condition which benign tumors affect the brain, eyes, skin and internal organs. Epilepsy occurs in 80% of cases, and the type of seizures are strongly age related.
Tumour
A growth of abnormal tissue characterised by progressive, uncontrolled proliferation of cells.
V
Vagal Nerve Stimulation
VNS uses intermittent stimulation of the left vagus nerve in the neck to reduce the frequency and intensity of seizures. A programmable generator (like a pacemaker) is surgically placed under the skin in the chest with a stimulating lead attached to the vagus nerve. The stimulator frequency is tailored on an individual basis.
Video EEG telemetry
See Telemetry - video EEG
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W
Wada test
An test used occasionally prior to surgery for epilepsy. It is used to determine the area of speech, memory and language in the brain.
West syndrome
See Infantile spasms
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