Joseph J. Quinlan, MD
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Because of the ancillary information, the seizure type would be considered to be focal epileptic spasms (the term "motor" can be assumed). The previous classification would have called them infantile spasms, with information on focality not included. There is an approximately 7% incidence of de novo psychosis following temporal lobectomy for epilepsy that tends to occur within the first year following surgery [60]. Post-surgical psychosis may be more likely to occur in those with early onset epilepsy and abnormal pre-morbid personality traits [61]. Some studies have suggested a preponderance of right-sided temporal lobe surgeries among patients with post-surgical psychosis, but this has not been supported by later studies [60]. This study examined reasons for drug discontinuation and may not reflect psychotic episodes that did not precipitate discontinuation of the drug (for example if the episodes were not attributed to levetiracetam). Drug-induced psychosis should be considered whenever psychosis emerges immediately after the addition of a drug to which the patient is naive. Ultimately, though, many of these episodic psychoses may be multifactorial and difficult to place in a particular category. Similarly, patients with a past history of psychosis are more likely to develop psychosis with new drugs [59]. Thus, specific situational factors such as a limbic seizures or specific drugs may contribute to the development of a psychotic state, either in isolation or in combination, in certain patients who are susceptible because of pre-existing structural or genetic factors. When psychosis and epilepsy occur together in the same patient, a neurologic cause common to both must be sought, particularly when the psychosis precedes the onset of epilepsy. Pathology of the temporal lobes has a tendency to cause both epilepsy and psychosis [63]. Traumatic brain injury may significantly increase the risk for both psychosis and epilepsy, particularly when the temporal lobes are affected. Similarly, tumors involving the temporal lobes may cause both seizures and psychosis. Stimulant drugs such as cocaine or amphetamines may trigger both psychosis and seizures, particularly in susceptible individuals [64-67]. Withdrawal from benzodiazepines and alcohol can also trigger seizures as well as psychosis.
Fourth-level centers also offer a complete evaluation for epilepsy surgery, including intracranial electrodes, and provide a broad range of surgical procedures for epilepsy. Many level 4 centers are actively involved in clinical trials and are well aware of trials conducted in other level 4 centers to make patient referrals. Flow chart indicates points at which referral to a specialized epilepsy center should be considered. Table 3 lists some of the additional capabilities that a level 4 center must have to distinguish itself from the level 3 centers. Epilepsy surgery at level 4 centers Sectioning of the corpus callosum is being performed less frequently. Hemispherectomy is indicated infrequently in adults but still has a role in pediatric epilepsy surgery for specific clinical situations. Consequently, we do not recommend that fourth-level centers must be able to perform corpus callosum section or hemispherectomy. However, physicians making health care decisions at these centers should be aware of the indications for these procedures. They should establish referral arrangements with other fourth-level centers that perform these procedures and refer patients requiring these procedures when necessary. Emergency or elective neurosurgery, including biopsy and removal of incidental lesions and treatment of cerebral complications of epileptic seizures. Surgical resection of epileptogenic structural lesions with the goal of treating seizures (``straightforward lesionectomy'). Standard anterior temporal lobectomy in the presence of mesial temporal sclerosis. Implantation and management of vagus nerve stimulators or other neuromodulatory devices.
Estradiol patches, 50-100 mcg, are applied 48 hours prior to expected onset of migraine and used for one week. The 50 mcg estradiol patch, applied 48 hours before anticipated onset of menses and continuing for seven days, was effective in relieving headaches in a subgroup of women with menstrual migraines confirmed by neurophysiological testing. Others have shown a better clinical outcome with 100 mcg estradiol patches than with lower dose patches. Oral estrogen has been less effective than transdermal estrogen in prophylaxis of menstrual migraine. In one study, migraines worsened in 39% of patients, improved in 3%, and remained unchanged in 39%. Another author reported improvement in migraines in 35% of patients when estrogen-containing contraceptives were started. In 2011, the Food and Drug Administration concluded that drospirenone may be associated with a higher risk for blood clots than other progestin-containing pills. Suppression of ovarian steroid production followed by a constant estrogen-progestin milieu was studied in five women with severe menstrual migraine. All patients reported dramatic improvement in Return to Algorithm Return to Table of Contents This therapy should probably be managed by a gynecologist or endocrinologist in concert with a headache specialist. Tamoxifen, danazol and bromocriptine have shown limited efficacy in treatment of menstrual migraine. Whether oophorectomy is an effective treatment for refractory migraines is not settled at this time. Perimenopause is the span of time from the reproductive to the post-reproductive interval. In a study of 112 women taking hormone therapy, 52 reported worsening of migraines, 50 reported improvement, and 10 reported no change in migraine headaches. More women improved with transdermal than oral estrogen (Wang, 2003 [Low Quality Evidence]; Nappi, 2001 [High Quality Evidence]; MacGregor, 1997 [Low Quality Evidence]).
Antihistamine effects on actual driving performance in a standard test: a summary of Dutch experience, 1989-94. Acrivastine, terfenadine and diphenhydramine effects on several aspects of actual driving performance as a function of dose and time after dosing. The effects of benadryl and hismanal on psychomotor performance and perceived performance. Effects of semprex-D and diphenhydramine on learning in young adults with seasonal allergic rhinitis. Characterization of daytime sleepiness and psychomotor performance following H1 receptor antagonists. They are also sold as "natural supplements" over the internet, and in some health food stores and gymnasiums, and are marketed as natural, non-toxic dietary supplements. They are marketed as anti-aging drugs, for weight loss, to treat insomnia, anxiety and depression, and as mood enhancers and energizers. Potency, Purity and Dose: Clinical doses for alcohol withdrawal syndrome are 25-50 mg/kg every 12 hours (1. Illicit manufacture often introduces impurities and wide - 39 - variations in potency. Chronic use can consist of dosing every few hours, around the clock, for months to years. Pharmacokinetics: Oral doses are rapidly absorbed from the gastrointestinal tract and exhibit first pass metabolism. Absorption is capacity limited (an increase in dose results in increased time to peak concentration). The dose-response curve is steep, and a large between and within subject variability is noted.
Recurrent convulsive seizures in animals produced by immunologic and chemical means. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. Hidden synaptic differences in a neural circuit underlie differential behavioral susceptibility to a neural injury. Evidence of functional mossy fiber sprouting in hippocampal formation of kainic acid-treated rats. The Journal of neuroscience: the official journal of the Society for Neuroscience 5, 1016-1022 (1985). An experimental model with spontaneous interictal-like spikes for the study of epilepsy. Painted turtle cortex is resistant to an in vitro mimic of the ischemic mammalian penumbra. Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 32, 2033-2043 (2012). Hippocampal neuropathology of domoic acid-induced epilepsy in California sea lions (Zalophus californianus). On the emerging role of rabbit as human disease model and the instrumental role of novel transgenic tools. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. Use with caution: developmental systems divergence and potential pitfalls of animal models. The relevance of individual genetic background and its role in animal models of epilepsy. Mouse strain differences in kainic acid sensitivity, seizure behavior, mortality, and hippocampal pathology. Adult-born hippocampal neurons are more numerous, faster maturing, and more involved in behavior in rats than in mice. The Journal of neuroscience: the official journal of the Society for Neuroscience 29, 14484-14495 (2009). Dentate granule cell neurogenesis is increased by seizures and contributes to aberrant network reorganization in the adult rat hippocampus.
Illicit fentanyl-related overdoses are now a leading cause of deaths from overdose in the United States, often because of its use in combination with alcohol or illicitly obtained heroin, cocaine, diverted prescription opioids, and other drugs such as benzodiazepines. Common prescription opioid medications that can be considered for management of acute and chronic pain include hydromorphone, hydrocodone, codeine, oxycodone, methadone, and morphine. In some states, there is a significant challenge, however, for prescribing clinicians to get authorization for using buprenorphine for chronic pain management (see Section 2. Opioid treatment should be maintained for a period no longer than necessary for adequate pain control. Much of the risk at higher doses appears to be associated with co-prescribed benzodiazepines. They just look at us as another number or as those patients coming in seeking drugs. But I also do other things- vitamins, try to eat healthy, try not to be stressed out- just all sorts of things to help myself. But the main thing is, we need opioid medications to be an option in the tool box. Medicines play an important role in treating certain conditions and diseases, but they must be taken with care and stored securely where they cannot be misused by a third party or accidentally ingested by children or pets. Patients and caregivers can remove expired, unwanted, or unused medicine from their home as soon as they are no longer needed to help reduce the chance that others accidentally or intentionally misuse the unneeded medicine and to help reduce drugs from entering the environment. The illicit fentanyl analogues used are not necessarily the same product that is legally prescribed and used during surgeries or in the transdermal and mucosal fentanyl preparations provided for moderate to severe pain. One illicit analogue that has been seen is called carfentanil, which is 100 times more potent than fentanyl. The availability of naloxone as well as patient and family education about naloxone can mitigate the risks of fentanyl-related overdose. In many states, people may obtain naloxone without seeing their provider by obtaining a prescription through standing-order programs with pharmacies.
Diseases
Furthermore, only two seizure types had some limited degree of localizing value within the frontal lobes, with significant numbers of exceptions, limiting their utiltiy in clinical practice. In addition, few individual symptoms showed a marked statistical association with frontal or temporal lobe lesions and criteria of seizure timing or duration did not reliably distinguish different seizure types. Since imaging has increased our ability to identify these lesions, and with the weight of evidence suggesting that the site of the lesion is the best guide to localization (Engel et al. Commission on Classification and Terminology of the International League Against Epilepsy. Hippocampal volumetric and morphometric studies in frontal and temporal lobe epilepsy. Cordes M, Christe W, Henkes H, Delavier U, Eichstadt H, Schorner Association of seizure types: pseudo-generalized epilepsy the association of different seizure types is not a subject generally considered in the investigation of localizationrelated epilepsy. In this study, the only statistically significant association of seizure types was between absences and generalized motor seizures-pseudo-generalized epilepsy. Type 1 complex partial seizures of hippocampal origin: excellent results of anterior temporal lobectomy. Correlation of criteria used for localizing epileptic foci in patients considered for surgical therapy of epilepsy. Identification of subtypes of learning-disabled children at three age levels: a psychological multivariate approach. Clinical responses to electrical brain stimulation of the temporal and frontal lobes in patients with epilepsy. Late-onset drop attacks in temporal lobe epilepsy: a re-evaluation of the concept of temporal lobe syncope. Geier S, Bancaud J, Talairach J, Bonis A, Szikla G, Enjelvin M, the seizures of frontal lobe epilepsy. The role of the limbic system in experiential phenomena of temporal lobe epilepsy. The role of premotor cortex and the supplementary motor area in the temporal control of movement in man. Rearrangement of motor and sensory cortical areas following early cortical lesions [abstract]. Seizures with onset in the sensorimotor face area: clinical patterns and results of surgical treatment in 20 patients.
The intracarotid sodium amytal test was not routinely performed due to pediatric age considerations and poor baseline language function in some patients. It may be of use in the older patient where language transfer might not occur following dominant hemispherectomy. Finally, neuropsychological evaluation should be attempted to help gauge developmental delay and establish the preoperative baseline. In the preoperative period, a team of specialists, including adult and/or pediatric epileptologists, neurosurgeons, neuroradiologists, and neuropsychologists, evaluates these patients and the routine preoperative evaluation includes the following. Despite this, there is little evidence supporting early surgery and the risks related to the surgical procedure, especially in infants, need to be considered. In general, for noncatastrophic epilepsy, we consider a body weight of 10 kg or above acceptable. All patients and/or families are asked to donate blood prior to the operative procedure. For catastrophic hemispheric epilepsy, surgery is performed earlier with appropriate informed consent on the risks of excessive blood loss and mortality (14). History and Physical Examination A detailed history including prenatal events, birth and developmental history, and possible epilepsy risk factors are obtained. The neurological examination focuses on sensorimotor, language, visual, and cognitive functions. The ideal hemispherectomy candidate has a contralateral hemiparesis and hemianopsia with the absence of fine finger movements. The degree of motor impairment needs to be accurately documented to help counsel the parents on what to expect postoperatively. Similarly, the presence or absence of a hemianopsia should be assessed and parents need to be counseled about the presence of a contralateral hemianopsia postoperatively.
Users may feel several emotions at once or swing rapidly from one emotion to another. Physiological: Tachycardia, hypertension, dilated pupils, sweating, loss of appetite, sleeplessness, dry mouth, tremors, speech difficulties, and piloerection. Side Effect Profile: Rhabdomyolysis, renal failure, prolonged mania, panic, impairment in color discrimination, and residual visual effects have been described. Duration of Effects: Onset of effects is rapid following intravenous administration (10 minutes). Following oral ingestion, onset of the first effects are experienced in 20-30 minutes, peaking at 2-4 hours and gradually diminishing over 6-8 hours. Flashbacks may occur suddenly, often without warning, and may occur within a few days or more than a year after use. Tolerance does develop to the behavioral effects after 3-4 daily doses, but no withdrawal syndrome has been described. Drug Interactions: Cross-tolerance with mescaline and psilocybin has been demonstrated in animal models. Other characteristic indicators may include extreme changes in behavior and mood, trance-like state, sweating, body tremors, piloerection, hallucinations, paranoia, and changes in sense of light, hearing, touch and smell. Urine toxicology screens in drivers suspected of driving while impaired from drugs. Evaluating hallucinogenic or psychedelic drug intoxication in an emergency setting. Methadone is available by prescription as oral solutions (1-2 mg/mL strength), tablets (5-10 mg), dispersible tablets (40 mg), or injectable solutions (10 mg/mL). Medical and Recreational Uses: Methadone is an analgesic prescribed for the relief of moderate to severe pain, and is used in detoxification treatment of opioid dependence and maintenance in narcotic addiction. Compared to morphine, methadone has a much longer duration of action, suppressing opiate withdrawal symptoms and remaining efficacious for an extended period of time with repeated administration. Potency, Purity and Dose: Available as the racemic mixture, (R)- or l-methadone is 8-50 times more potent than the (S)- or d-isomer. For methadone maintenance the daily dose is generally 60-80 mg, but can vary from 30-120 mg.
Department of Housing and Urban Development, testimony before the Senate Committee on Indian Affairs, Mar. Compounding the problems of insufficient federal funding and inflation is the fact that the Native American population is growing at twice the rate of the national average-resulting in a greater need for housing development in Indian Country. In 2009, the Recovery Act appropriated $510 million for the Native American Housing Block Grant Program. Department of Housing and Urban Development, "American Recovery and Reinvestment Act of 2009 (Recovery Act Programs),". Department of Housing and Urban Development, Acting Deputy Assistant Secretary Randall R. Akers, "Statement to the United States Commission on Civil Rights, Quiet Crisis Briefing," Feb. As will be discussed below, these funding levels have been insufficient to address the dire, documented needs of Native American communities. The Indian Housing Loan Guarantee program is authorized pursuant to Section 184 of the Housing and Community Development Act of 1992, Pub. Department of Housing and Urban Development, Acting Deputy Assistant Secretary Randall R. Akers, "Statement to the United States Commission on Civil Rights, Quiet Crisis Briefing," Feb. Tribal housing officials stated that "the current funding environment made it difficult to develop a housing project without going to several sources and. Department of the Treasury (for low-income housing tax credits[,]) had different environmental review requirements.
Flint, 55 years: There was a large variation between subjects, with some having a 50% increase in caffeine clearance, and some a 90% decrease. The risks of seizure disorders among relatives of patients with childhood onset epilepsy.
Kasim, 58 years: Role of Tumor Type High-grade tumors may lead to epilepsy by abruptly damaging local tissue, causing tissue necrosis and hemosiderin deposition, and increasing excitability of local and immediately surrounding cortex (4,18,25). In addition to the desired skeletal muscle relaxing effects, - 13 - carisoprodol and meprobamate produce weak anticholinergic, antipyretic and analgesic properties.
Bozep, 62 years: Feeling bad about themselves occurs more often in children and adolescents with epilepsy when compared to other children and adolescents with or without chronic illnesses. Chapter 59: Zonisamide 725 Pregnancy Case reports suggest that clearance of zonisamide may increase toward the end of the second trimester, requiring an increase in dose (43).
Kan, 56 years: A furanocoumarin-free grapefruit establishes furanocoumarins as the mediators of the grapefruit juice-felodipine interaction. Of 28 patients treated with phenytoin, 6 (21%) had a seizure recurrence, compared with 5 (19%) of 27 patients given placebo.
Jensgar, 30 years: Five sustained an injury as a result of the initial recurrence, including four with lacerations and one with a broken arm. A very large majority of patients with self-reported seizure rates of 1 per month will have a diagnostic event recorded within 6 days.
Snorre, 52 years: The effect of herbal medicines on platelet function: an in vivo experiment and review of the literature. In this study indinavir 800 mg was given every 8 hours for 4 doses; with water or bitter orange juice given with the last 2 doses.
Rufus, 49 years: The study included 48 patients in 4 groups, given placebo, or betacarotene in doses of 30 mg, 60 mg or 120 mg. Juvenile myoclonic epilepsy, while having a favorable prognosis for remission on medications, usually requires prolonged treatment and has a high relapse rate when medications are withdrawn (25,90).
Jaroll, 36 years: Resection of cavernous angiomas should include the hemosiderin-stained rim (107) as the vascular malformation itself is not epileptogenic. However, carbamazepine is ineffective in neonatal or febrile seizures and is contraindicated and ineffective in idiopathic generalized epilepsies and epileptic encephalopathies.
References
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