Abstract: Epilepsy is a serious and common chronic neurological disorder characterized by recurrent seizures, which are caused by abnormal synchronized neuronal disorders. It is a relatively common condition (up to 2% of the population) which can affect anyone at any age. Epilepsy can be controlled in a number of ways. The most common way to treat epilepsy is with anti-epileptic drugs. These AEDs can control but not cure epilepsy. Surgery can also be a possible treatment. Curative epilepsy surgery can only be performed in patients in whom the epileptogenic focus can be localized and does not overlap with eloquent brain areas. In the other patients with bilateral or multiple epileptogenic foci, with epilepsy onset in eloquent areas, or with no identifiable epileptogenic focus, treatments such as ketogenic diet, vagus nerve stimulation can be offered. VNS is an available procedure of which the mechanism of action is not understood, but with established efficacy for refractory epilepsy and low incidence of side-effects. The ketogenic diet is a high-fat, moderate protein, low carbohydrate diet used to treat intractable epilepsy, primary in the pediatric population. Hippocampal Deep Brain Stimulation has been used to treat patients with refractory epilepsy. Complementary and Alternative Medicine for epilepsy such as apuncture, aromatherapy, yoga etc may be used for lessening seizures, for alleviating related symptoms and for reducing side effects. Gene therapy aims to utilize viral and non-viral vectors in the delivery of DNA to target areas for the treatment of patients before their disease progresses. Gene therapy has delivered promising results in animal trials and pre-clinical settings and can be used for neurological disorders such as epilepsy.
Treatment Options for Drug-Resistant Epilepsy
In some people with drug resistant epilepsy, there are effective treatment options, with a high chance of seizure freedom. These include:
Resective Epilepsy Surgery
Resective epilepsy surgery consists of removing the area of the brain that is causing the seizures. However, for a patient to be a good candidate for surgery, the following conditions have to be met:
The area of the brain where seizures originate is clearly identified.
That area of the brain can be safely removed with surgery. In other words if the risk is greater than “minimal risk,” the patient is not a candidate.
The probability to achieve seizure freedom with epilepsy surgery varies depending on the structures of the brain involved. For example, patients whose seizures originate in the temporal lobe have a 50% to 70% chance of achieving seizure-freedom.
Today, newer, less-invasive techniques are being used in the place of resective surgery in appropriate cases. These include the use of laser, in which a laser probe burns the area of the brain causing the seizures. However, these new techniques may not work for all candidates for resective surgery.
Specific Metabolic Treatment
While metabolic causes of epilepsy are uncommon, identifying some of these conditions can lead to specific treatments to allow the body to compensate for the metabolic change.
Examples are treatment with a ketogenic diet for GLUT1 deficiency, treatment with pyridoxine or pyridoxal-5-phosphate for vitamin dependent epilepsies, and creatine supplementation for creatine deficiency syndromes.
Specific Genetic Causes
Identifying a specific genetic cause can help your doctor choose the best treatment for seizures.
For example, with SCN1A pathogenic variants, medications such as Oxcarbazepine (Trileptal), Carbamazepine (Tegretol) or Phenytoin (Dilantin) should be avoided. Whereas with other types of pathogenic variants, such as SCN2A and SCN8A variants, these medications can be very helpful.
Some specific treatments which target the underlying problem caused by the genetic variant are in clinical trials, and may improve learning and development as well as help with seizures.
Immunotherapy
In the last decade, the role of inflammatory processes in certain types of epilepsy has been recognized. In these cases, medications that counteract these processes have been used with success. However, they have to be used with caution as they are associated with a variety of adverse events.
Epilepsy is the disease which has prevalence in India more than 1 %
Of population. This is topic of research for young medicine practioner and pharmacist.
Epilepsy is a common condition, encountered by neurologists, pediatricians, physicians and other doctors. It can be easily treated with anti-epileptic drugs. The current presentation discusses the approach to management of epilepsy, focussing on diagnosis and treatment.
Recent advances in the management of Parkinson's Disease (PD)Sudhir Kumar
Parkinson's disease is a neurodegenerative disease causing severe disability. In the past 10-15 years, a lot of new medicines and treatments have become successful in helping patients with PD. The current review focuses in all approved treatments for PD
Wild Vegetable Used By the Tribal and Rural People of Area Kolwan, Arni Tahsi...paperpublications3
Abstract: Different wild vegetable used by Tribal and Rural people at Kolwan area of Arni Tahasil Dist. Yavatmal, (M.S.) India. Present survey studied during March, 2nd 2014 to January, 2nd 2015. A total 18 wild vegetable species were found used by these Tribal people. The study was done to observe the different species varieties used for the food purpose, on the condition of Biodiversity and also to conserve them.
Diversity of monogenean (Platyhelminthes) parasites in freshwater fishes of K...paperpublications3
Abstract: Monogeneans are ectoparasites of fishes that can cause serious damage in the aquaculture industry. Twenty five species of freshwater fishes collected from different freshwater habitats of the Kannur district of Kerala were analysed for monogenean infection. A total of seven species of monogeneans were recovered from six species of fishes and overall prevalence was 7.81%.The parasites recovered include Gyrodactylus recurvensis, Dactylogyrus daniconi, Bifurcohaptor indicus, Dactylogyroides tripathii, Scleirocleidoides etropli, Diplozoon indicum and Neodiplozoon barbi. Among the fish hosts, Cyprinidae was found to be most suitable host for monogeneans. Dactylogyridae was the most diverse family. Four new host records were reported and all the seven species are new to the locality.
Treatment Options for Drug-Resistant Epilepsy
In some people with drug resistant epilepsy, there are effective treatment options, with a high chance of seizure freedom. These include:
Resective Epilepsy Surgery
Resective epilepsy surgery consists of removing the area of the brain that is causing the seizures. However, for a patient to be a good candidate for surgery, the following conditions have to be met:
The area of the brain where seizures originate is clearly identified.
That area of the brain can be safely removed with surgery. In other words if the risk is greater than “minimal risk,” the patient is not a candidate.
The probability to achieve seizure freedom with epilepsy surgery varies depending on the structures of the brain involved. For example, patients whose seizures originate in the temporal lobe have a 50% to 70% chance of achieving seizure-freedom.
Today, newer, less-invasive techniques are being used in the place of resective surgery in appropriate cases. These include the use of laser, in which a laser probe burns the area of the brain causing the seizures. However, these new techniques may not work for all candidates for resective surgery.
Specific Metabolic Treatment
While metabolic causes of epilepsy are uncommon, identifying some of these conditions can lead to specific treatments to allow the body to compensate for the metabolic change.
Examples are treatment with a ketogenic diet for GLUT1 deficiency, treatment with pyridoxine or pyridoxal-5-phosphate for vitamin dependent epilepsies, and creatine supplementation for creatine deficiency syndromes.
Specific Genetic Causes
Identifying a specific genetic cause can help your doctor choose the best treatment for seizures.
For example, with SCN1A pathogenic variants, medications such as Oxcarbazepine (Trileptal), Carbamazepine (Tegretol) or Phenytoin (Dilantin) should be avoided. Whereas with other types of pathogenic variants, such as SCN2A and SCN8A variants, these medications can be very helpful.
Some specific treatments which target the underlying problem caused by the genetic variant are in clinical trials, and may improve learning and development as well as help with seizures.
Immunotherapy
In the last decade, the role of inflammatory processes in certain types of epilepsy has been recognized. In these cases, medications that counteract these processes have been used with success. However, they have to be used with caution as they are associated with a variety of adverse events.
Epilepsy is the disease which has prevalence in India more than 1 %
Of population. This is topic of research for young medicine practioner and pharmacist.
Epilepsy is a common condition, encountered by neurologists, pediatricians, physicians and other doctors. It can be easily treated with anti-epileptic drugs. The current presentation discusses the approach to management of epilepsy, focussing on diagnosis and treatment.
Recent advances in the management of Parkinson's Disease (PD)Sudhir Kumar
Parkinson's disease is a neurodegenerative disease causing severe disability. In the past 10-15 years, a lot of new medicines and treatments have become successful in helping patients with PD. The current review focuses in all approved treatments for PD
Wild Vegetable Used By the Tribal and Rural People of Area Kolwan, Arni Tahsi...paperpublications3
Abstract: Different wild vegetable used by Tribal and Rural people at Kolwan area of Arni Tahasil Dist. Yavatmal, (M.S.) India. Present survey studied during March, 2nd 2014 to January, 2nd 2015. A total 18 wild vegetable species were found used by these Tribal people. The study was done to observe the different species varieties used for the food purpose, on the condition of Biodiversity and also to conserve them.
Diversity of monogenean (Platyhelminthes) parasites in freshwater fishes of K...paperpublications3
Abstract: Monogeneans are ectoparasites of fishes that can cause serious damage in the aquaculture industry. Twenty five species of freshwater fishes collected from different freshwater habitats of the Kannur district of Kerala were analysed for monogenean infection. A total of seven species of monogeneans were recovered from six species of fishes and overall prevalence was 7.81%.The parasites recovered include Gyrodactylus recurvensis, Dactylogyrus daniconi, Bifurcohaptor indicus, Dactylogyroides tripathii, Scleirocleidoides etropli, Diplozoon indicum and Neodiplozoon barbi. Among the fish hosts, Cyprinidae was found to be most suitable host for monogeneans. Dactylogyridae was the most diverse family. Four new host records were reported and all the seven species are new to the locality.
Ecological Diversity of Flora and Fauna at Curzon Hall, University Of Dhaka, ...paperpublications3
Abstract:The diversity of local flora and fauna at the Curzon Hall premises, University of Dhaka, Bangladesh was studied from April 2nd, 2014 to January 10th, 2015. A total of 98 species of flora and fauna were found during the study. The study was done to observe the condition of the biodiversity and also to conserve them.
Abstract: Good nutrition is important for all New Zealanders, but it assumes an even greater Importance for women when they are pregnant or breastfeeding their infant. Pregnancy is a time when nutritional needs are higher, and meeting those needs has a positive effect on the health of both the mother and her unborn baby. The effects of nutrition while the foetus is developing during pregnancy last for a lifetime, and we want to see children inherit a legacy of good health for the future. We also want to see women enjoying a healthy pregnancy without the negative effects of poor nutrition on their health, and in the best possible nutritional state to support breastfeeding. Breastfeeding is the best and safest way to feed infants, and women and families need to be given all the advice and support possible to assist them in establishing and continuing breastfeeding for at least the first six months of the infant’s life.
This paper brings together all the key areas of food and nutrition affecting the health of pregnant and breastfeeding women. It is intended that health practitioners ,educators and caregivers will use this paper and the accompanying health education booklets, Eating for Healthy Pregnant Women and Eating for Healthy Breastfeeding Women, to provide sound advice and support to pregnant and breastfeeding women and their families to achieve a healthy lifestyle.
Study and compare Medical problems of ‘on the street’ and ‘of the street’ chi...paperpublications3
Abstract: Introduction; A more serious and vulnerable group of the urban poor that is growing rapidly in big cities is that of street children and working children, with a home or without a home. In comparison to the urban poor, the phenomenon of street children is a recent one. The present study is an attempt to determine the physical health problem of street children registered at “Apanga Va Niradhar Bahuddeshiya Kalyankari Sanstha”, Nagpur, Maharashtra, India. Methods: 461 children were included in the study of which 343 were ‘on the street’ and 118 were ‘of the street’ children. Detailed clinical examination was carried out at centres of NGO including general and systemic examinations. Height and weight were recorded as per standard procedure and compared with NCHS standard 17. The haemoglobin estimation was performed on 442 street children. Stool samples of 298 street children were send for microscopic examination. Treatment and referral – Treatment was given whenever required and necessary referrals to Government Hospital, Nagpur were made for further expert opinion and management. Results: The percentage change of median height and weight of boys as well as girls in ‘of the street’ category, from NCHS standard median height and weight was found to be more in all the ages than ‘on the street’ category. Major morbidities found to be in street children were anaemia. 192 (43.4%), wax in ear 175 (38%), dental carries 156 (33.8%), fungal infection 55 (11.9%), URI 49 (10.6%), worm infestation 28 (9.4%) and injury 36 (7.8%). The mean morbidity was found to be 1.7 per street children. Conclusions: The proportion of adoption of hygienic practices among ‘on the street’ children were significantly higher than ‘of the street’ children. Majority of street children 210 (45.6%) went to government hospital when become ill while 108 (23.4%) took treatment from medical store.
Dry Matter Yield and Agronomic Performance of Herbaceous Legumes Intercropped...paperpublications3
Abstract: The study was conducted at the two trial sites (Cheffa and Sirinka) of Sirinka Agricultural Research Center which represents the low and mid altitude agro ecologies of the eastern Amhara region to identify legume species that would have best compatibility with Napier grass and to examine the DM herbage yield of mixed cultures of legumes and Napier grass. Seven adaptable and recommended perennial herbaceous legume species (Desmodium unicinatum, Macrotyloma axillare, Clitoria ternatea, Macroptilium atropurpreum, Stylosanthes guianensis, Stylosanthes hamata and Medicago sativa) were intercropped with recommended Napier grass (Pennisetum purpureum) Acc. No. 14984 for the areas were included in the study. With in the three years experimental periods a total of six and four harvests, with an average harvesting interval of 135 and 206.75 days were obtained at Cheffa and Sirinka trial site, respectively. The agronomic performances of legumes among intercropped treatments and during each harvesting stages, respectively were significantly (P<0.001)><0.01)><0.05)><0.001) in advancement of harvesting stages. As the study result indicates, intercropping Napier grass with herbaceous legumes has significant advantage than growing Napier grass solely in increasing the DM yield harvested. Therefore, among the tested legumes and Napier grass combinations, intercropping Stylosanthes guianensis with Napier grass was found to be the best for its compatibility and higher Napier total (leaf + stem), legume and both (Legume + Napier) DM yields at each (Cheffa and Sirinka) trial site. Therefore, we recommend this combination for future use. However, further studies are needed to evaluate the effect of legume intercropping on herbage quality and soil fertility improvement, and the economic advantage of legumes and Napier intercropping.
Health Issue Related to Excess Consumption of Soft Drink: Obesitypaperpublications3
Abstract: Soft drink consumption has expanded rapidly in our daily life so that soft drinks are currently become choice for millions of people and the largest single contributors to energy intake. Indian beverage market is 21% and Indian ranked 3rd largest beverage consumption after the USA and China. In India every year beverage consumption is nearly 120 billion litters. Consumption of sugar-sweetened drinks increase the risk of overweight, diabetes and cardiometabolic disease. Soft drinks have consequently been targeted as a means to help curtail the rising prevalence of obesity, particularly among children. Several factors might account for this increased risk, including increased carbohydrate load and increased amounts of dietary fructose. Fructose acutely increases thermogenesis, triglycerides and lipogenesis as well as blood pressure.
Pharmacological and Biochemical Action of Angelica Sinensis (Dong Quai): Natu...paperpublications3
Abstract: The medicinal plants as well as the herbs are an important aspect of traditional Chinese medicine and even an enriched source of various chemicals. Among the medicinal herbs, Angelica sinensis, also known as Dong Quai is the most popular used as Chinese medicine. The main compounds found in the acetone extract of Angelica sinensis(AS-AC) are ferulic acid, butylidenephthalide, ligustilide, brefeldin A, angelicide , B-sitosterol, butyl phthalide, calcium channel-blocking compounds (which relax visceral organ muscle) ,carvacrol, coumarins (at least six coumarin derivatives(coumarin content in Dong Quai does not promote phototoxic, carcinogenic or mutagenic effects, but exerts antispasmodic and vasodilatory effects)) including: angelol, angelicone ; essential oils, consisting mainly of Ligustilide , N-butylidenphthalide; ferulic acid, flavonoids, fixed oil ,furanocoumarins ,nicotinic acid ,phytosterols ,polysaccharides ,stigmasterol ,vitamins E, A and B12. This traditional Chinese herbal medicine has various pharmacological and toxicological effects i.e. Cardiovascular effects, Neurological effects, Musculoskeletal effects, Immunological effects/Amineoplastic activity/Antimicrobial activity, Anti-Inflammatory activity, Darmatological effects, Carcinogenicity, Estrogenic effects, Gastrointestinal effects. The aims of this review are to summarize the history and an account of the adverse effects and potential interactions of Dong Quai, and a discussion about therapeutic effects of this herb.
Abstract:To fulfill our interest, we tried our best to observe the current status of squirrels in Bangladesh. In Bangladesh there are generally 8 species of squirrels which are different in size, color but same in food habit are found. From them, we observed that Pallas’s Squirrel (Callosciurus erythraeus), Irrawady Squirrel (Callosciurus pygerythrus), Three Stripped Palm Squirrel (Funambulus palmarum) and Five stripped Palm Squirrel (Funambulus pennantii) are widely distributed. A large number of variations were observed during winter and summer as we preferred these 2 seasons for our field study. All of them are frugivorous and sometimes feed on grass flowers too. Sometimes taking Insects as food fulfill the necessity of protein.
Assessment of Renal Function and Serum Levels of Alpha Tocopherol in HIV Sero...paperpublications3
Abstract: Increased Oxidative Stress markers in HIV/AIDS Patients may be as a result of free radicals generation and evidence is accumulating that Highly Active Antiretroviral Therapy (HAART) mimics AIDS progression but may be costly due to its Nephrotoxicity. In this research serum levels of Alpha tocopherol ( α- tocopherol), Urea, Creatinine as well as CD4 Counts were measured in 70 HIV Seropositive Patients (40 on HAART and 30 HAART-Naïve) and Thirty (30) apparently healthy individuals as controls in Federal Medical Centre Katsina, Nigeria.CD4 Counts, Serum Levels of Alpha tocopherol, Urea and Creatinine of HIV-HAART and HAART Naïve were 0.72±0.27mg/dl, 16.8±5.6 mmol/l, 237±123 µmol/l and 646±254cell/µl and 0.3±0.1mg/dl, 10.4±2.9 mmol/l, 91±26 µmol/l and 364±17 cell/ µl respectively. There were significantly (p<0.05) increased CD4 counts, serum levels of Alpha tocopherol, Urea and Creatinine in HIV/AIDS Patients on HAART compared to HAART- Naive. This is an indication that HIV/AIDS are predisposed to oxidative stress and that also HAART has debilitating effects on kidneys.
Community Resilience Mechanisms in Prevention, Control and Management of HIV/...paperpublications3
Resilience as a common goal has the potential to bring together those working on HIV/AIDs, social development and human rights. Resilience building facilitates an opportunity for different practitioners and policy makers to work in a way that responds to needs and empowers individual men and women, and their communities. Resilience makes us strong and community makes us thrive. This was a descriptive cross-sectional study, with one of the objective of finding out the community resilience mechanisms in prevention, control and management of HIV/AID’s in Nyamira district. A Sample size of 384 people were selected for participation in the study. The enumerators were trained on the tools and a dry run was done during the training so the interviewers can comprehend the flow of questions. This helped in restructuring and rearranging of questions so that there was ease of data collection when in the community. Before dissemination of the study finding the data analyzed and presented in text, graphs, figures and tables for ease of understanding. Most of the HIV/AIDS organizations (70%) showed that they had half-way (75%) fulfilled their objectives although they had not realized their potential due to inadequate funds. most of the organizations (65%) compared with (18%) householders advocated for care and support to PLWHA/orphans at the family unit for easy access to food and support. Most of the HIV/AIDS organizations (84%) reported that they got funding from NACC, churches (37%), Government (12%), and individuals (25%). Most of the HIV/AIDS organizations (84%) reported that they got funding from NACC, churches (37%), Government (12%), and individuals (25%). Most of the development partners working in field of HIV/AID’s should strengthen networks of local NGOs, FBOs, international humanitarian organisations, and government ministries both at local and national levels for effective knowledge management and information dissemination on HIV/AID’s resilience.
Studies on Integrated Nutrient Management on Seed Yield and Quality of Green ...paperpublications3
Abstract: A field experiment will be conducted to “studies on integrated nutrient management on seed yield and quality of greengram (Vigna radiate (L.)” The experiment was carried out during Kharif season 2014-15, Department of Biological Sciences, SHIATS, Allahabad (U.P.) which is located at 25o 24' 42" N latitude, 81o 50' 56" E longitude and 98 m altitude above the mean sea level. This area is situated on the right side of the river Yamuna by the side of Allahabad Rewa Road about 5 km away from Allahabad city. The pot experiment consisted of nine treatments with different organic and inorganic manures and laid out in randomized block design with three replications. results indicated that the application of 100% RDF + vermicompost @ 1.25 t/ha + Azatobactor @ 375 g/ha recorded significantly plant height (cm) 25 days (28.62) and 50 days (44.17),number of leaves 25 days (13.37) and 50 days (22.10),number of branches 25 days (3.34) and50 days (5.44),days of 50% flowering (41.24), number of pods per plant (24.77), number of seeds per pod (14.77),number of seeds per plant (342.74), seed yield per plant (14.80 g), seed yield per ha (1139.46 kg), thousand seed weight (42.52 g), Number of pods/plant (24.77) germination (99.90%), to others treatments.
The Effect of Fura De Nunu on Selected Clinical Isolates of Bacteriapaperpublications3
Abstract: Three clinical Isolates comprises of Gram-negative and Gram positive bacteria were invitrobially impregnated in agar-cup diffusion sensitivity of fura de nunu, a non-alcoholic fermented cow milk product. The undiluted samples of the locally fermented milk appreciably inhibited the growth of all the bacteria tested including, remarkably, Salmonella, Staphylococcus aureus and Pseudomonas aeruginosa,The bacteria however varied in their sensitivities to the fractional dilutions of the samples. This antimicrobial effect represents another property for fura de nunu and obviates the possibility of public health risk in its consumption.
Evaluations of community policing project for peace and security in West Poko...paperpublications3
Abstract: This research sought to examine the evaluation of Community Policing project “Nyumba Kumi Initiative” for peace and security in West Pokot County. The objectives of the study were to establish the extent of community partnership in community policing in West Pokot, assess the nature of personal relationship (citizen involvement) in the improvement of security situation in West Pokot County and suggested effective strategies for peace and security in West Pokot. The study targeted both the security officers and public members who are involved directly or indirectly with security members. Data for this study was obtained from both primary and secondary sources. The study adopted a constructivist (qualitative) and quantitative analysis based in West Pokot with data primarily collected through interviews.. The research was guided by a liberal peace theory which entailed mutual combination of factors used by community policing actors, and other actors on the relevance of peace and security by dealing with the conflict cycle from the structural causes of the struggle to its resolution and the assurance of a peaceful co-existence. The study established that insecurity in West Pokot reoccurs because of the adoption of ineffective methods of peace building, reconciliation and lack of community involvement. The study also found that complementary approach to peace building and policing efforts for long lasting peace is imperative. Today, a policing strategy which incorporates the communities as co-producers of their own security and safety has taken priority as a conflict management tool thus the birth of Community Policing or community oriented- policing. Community policing is one of the more significant recent developments in policing and the notion has been widely discussed and applied around the world. The recommendation established that the variety of conceptions about community policing highlight the complex nature of the notion and the many factors shaping its varied practices; police assumptions as to what constitutes good practice in community policing and what success might look like, deserve to be re-examined. The social constructions that police and citizens hold about community policing provide valuable sources of insight which challenge some of the conventional understandings regarding policing priorities.
Socio-Economic Effect of HIV/AIDS on Orphans and Vulnerable Children in Nyami...paperpublications3
Since the first case of HIV/AIDS was reported in Kenya in 1984 the numbers of those infected have risen and many people have since died or are living with the HIV/AIDS since the epidemic started in 1980s in the drug injecting people and the homosexuals. These deaths have resulted in Orphans and Vulnerable Children (OVC). This was a descriptive cross-sectional study, with one of the objective of finding out the socio-economic effect of HIV/AIDS on Orphans and Vulnerable Children in Nyamira district. A sample of 384 people participated in the study. The people were through simple random selected from Bonyegwe sublocation of Nyamusi division. Semi-structured interview schedules were used in data collection from the households. To remove ambiguity, the research tools were pre-tested to both HIV/AIDS organizations and householders not in the sample population but with similar characteristics. The research tools were refined and used on the actual sample population. Text, graphs, figures and tables were used in data presentation. The study indicates that those people who had not attained any level of formal education were (17%). The study revealed that householders (40%) had higher proportion of secondary education as compared with members of HIV/AIDS organizations (37%). Most of the members of HIV/AIDS organizations (89%) indicated that farming is their main source of income and a cushion for food security as compared with householders (63%). The ministry of health should strengthen provision of PMTCT services at the ANC clinic so that we prevent more cases of orphans and vulnerable children. The study suggests that in future all mothers who test positive for HIV virus should be put on treatment in order to reduce defaulters at the same time reach sustainable coverage in the provision of HIV/AIDS services to the orphans and vulnerable children in the society.
Abstract: Ethnoentomology is the study of the relationship between insects and people. “Ethno”-study of people and “entomology” –is the study of insects, so the focus of Ethnoentomology is on how insects have been or are being used in human societies around the world, which includes insects used for food rituals and medicine. While insects are commonly considered pests and a large part of man efforts are extended towards eradicating them, some insects have been counted as mankind s friend. Apitherapy is the one part of this field, is the medical use of honey bee products that includes the use of honey, pollen, bee bread, propolis, royal jelly, bee venom etc. The first use of apitherapy, the exact location is not traced but in general sense to ancient Egypt, Greece and China. Honey and other bee products have healing properties are included in many religious texts including the VEDA, BIBLE, and QURAN. The term apitherapy is use of bee venom not consumption of honey or other bee products. Whereas bee venom therapy is the use of live bee stings (or injectable venom) to treat various diseases such as arthritis, rheumatoid arthritis, multiple sclerosis (MS), lupus, sciatica, low back pain, and tennis elbow to name a few. It refers to any use of venom to assist the body in healing itself. Bee venom is a complex mixture of a variety of peptides and enzymes and amines some of which have strong neurotoxic and immunogenic effects. Such as melittin, has powerful anti inflammatory, anti bacterial, anti viral action. Sulfur is believed to be one of the main elements in inducing the release of cortisol from the adrenal glands and in protecting the body from infections. As because the therapeutic index of bee venom is median lethal dose i.e. adult person having weight 60 kg has a 50% chance of surviving injections totalling 168mg of bee venom. 560 stings could be lethal for such a person assuming 0.3mg venom per stings. Most human deaths result from bee stings due to allergic reactions, heart failure or suffocation from swelling around the neck or the mouth. So, apitherapy is very safe for human treatment.
Effects of Diabetes Mellitus in Prediction of Its Management in Kakamega Countypaperpublications3
Abstract: This descriptive study aimed at studying whether the effects of diabetes mellitus can predict its management in Kakamega County and Kenya. 327 respondents took part in the survey, with 135 (41.3%) being females and 192 (58.7%) being males. Most of the respondents, 190 (62.5%) had acquired primary education, 23 (7.6%) of the respondents had attained post-secondary education. 91(29.9%) of the respondents had attained secondary education. Most of the respondents did know the side effects of diabetes mellitus 204 (67.1%). Those who said loose of body weight 91 (29.9%) as side effects of diabetes were many as compared to those who identified non-healing wounds 9 (3%). Most of the respondents indicated that they did exercise as part of utilization of glucose in the blood stream. Although bicycling was done as an exercise but those who did were 13 (4.3%) as those who did not were 291 (95.7%). A balanced diet results in control of blood pressure and dyslipidemia which was a good riddance in the study area. Both the national government and the county government of Kenya and Kakamega respectively should strengthen health systems through innovative health care and promotion on effects of diabetes mellitus so that the burden of diabetes mellitus is reduced on both the health care services and the community in Kakamega and Kenya.
Prevalence of Low Birth Weight in Maternal Pregnancy Induced Hypertension in ...paperpublications3
Abstract: Pregnancy induced hypertension is one of the common conditions of unknown aetiology which increases the risk of maternal and perinatal morbidity and mortality. The aim of the study was to determine the prevalence of low birth weight in maternal pregnancy induced hypertension in patients of kashmiri origin. An observational study was carried out in the Postgraduate Department of Gynaecology and Obstetrics, Lalla Ded Hospital, Government Medical College Srinagar w.e.f September 2014 to February 2015. Methods: The study included all patients of PIH BP≥140/90 mm Hg after 20 weeks of gestation. Necessary information was collected such has detailed history, clinical examination, investigation performed, mode of delivery and neonatal birth weight Results: 37.5% had systolic blood pressure > 160 mmHg and 42.10% had a DBP > 110 mmHg. The frequency of caesarean section was 53% and 42% for normal birth. Low birth weight (<2.5 kg) was seen in (42.10%) when associated with severe diastolic hypertension and (37.5%) when severe systolic hypertension was taken into account Conclusion: DBP i.e. 110 mmHg or more was associated with low birth weight.
Comparison of Intubating Conditions of Succinylcholine and Rocuroniumpaperpublications3
Abstract: The aim of study on neuromuscular drugs was to have nondepolarising muscle relaxant, which is like succinylcholine without its side effects.
The new NDMR drug rocuronium became the first competitor for succinylcholine. Rocuronium introduced in 1994 is said to produce excellent to good intubating conditions in 60 seconds. Further rocuronium is said to be devoid of the adverse effects that are seen with succinylcholine
Hence, the present study was undertaken to evaluate the intubating conditions with rocuronium 0.6 mg kg-1 and 0.9 mg kg-1 body weight and to compare the intubating conditions with that of succinylcholine 1 mg kg-1 body weight, for use during rapid sequence intubation of anaesthesia in emergency cases.
The study population consisted of 90 adult patients of ASA grade I and II
Group I consisting of 30 patients were to receive ROCURONIUM 0.6 mg kg-1 body weight and intubation attempted at 60 seconds.
Group II consisting of 30 patients were to receive ROCURONIUM 0.9 mg kg-1 body weight and intubation attempted at 60 seconds.
Group III consisting of 30 patients were to receive SUCCINYLCHOLINE 1 mg kg-1 body weight and intubation attempted at 60 seconds.
group I patients who received rocuronium 0.6 mg kg-1 body weight, 10 patient had excellent intubating conditions with jaw relaxed, vocal cords apart and immobile and no diaphragmatic movements.
In group II, 24 patients (80%) out of 30 had excellent intubating conditions, 6 (20%) patients had satisfactory intubating conditions.
In group III patients, 23 (77%) patients out of 30 had excellent intubating conditions, 7 (23%) Patients had satisfactory intubation condition. There was no case of failed intubation at 60 seconds in any of the three groups.Heart rate ,systolic ,diastolic and mean arterial pressure changes were comparable in all three groups.
Rocuronium is a safe alternative to Succinycholine for rapid sequence induction in adult patients in situations where Succinycholine is contraindicated and in whom there is no anticipated difficult way.
ANTI-INFLAMMATORY AND ANALGESIC EFFECTS OF METHANOLIC EXTRACT OF Afrofritomia...paperpublications3
Abstract: Methanolic extract of the leaf of Afrofritomia sylvestris was investigated for its anti-inflammatory and analgesic effects. The extract was evaluated using carragenaan-induced paw oedema in rats (anti-inflammatory effect) as well as acetic acid-induced writhing (analgesic effect) in mice, after intra-peritoneal injection of the extract (250mg/kg, 500mg/kg and 1000mg/kg). The negative control animals were given normal saline (10ml/kg) and the effects were compared with that of Acetylsalicylic acid (100mg/kg), as a positive control drug. Each experiment consisted of twenty five animals divided into 5 groups of 5 animals each. Tail immersion reaction time and Naloxone antagonism of the extracts and morphine were further used to investigate the mode of action of the analgesic activity of the leaf. The extract significantly inhibited carageenan-induced hind paw inflammation in rats (P<0.05-0.01)><0.01). The methanolic extract failed to raise the pain threshold of mice towards heat stimulus and Naloxone did not show any significant antagonism (blocking effect) against the extract in the tail immersion experiment, thus ruling out the involvement of opioid receptors in the mechanism of analgesic action of the extract. Phytochemical analyses of the plant show the presence of flavonoids, alkaloids, saponins, tannins, steroids, triterpenes and cyanogenic glycosides. The LD50 of the extract was determined to be 3050+223.65mg/kg using the method of Tainter and Miller.In this study, methanolic extract of Afrofritomia sylvestris leaf was found to possess significant anti-inflammatory and analgesic effects in the tested models.
Epilepsy is a brain condition that causes repeated, sudden, brief changes in the brain's electrical activity. These changes cause various types of symptoms.
Dr Nivedita Bajaj - Basic Facts About Childhood EpilepsyNiveditabajaj
The basics Epilepsy by Dr Nivedita Bajaj , She is a Consultant Paediatrician working within NHS, currently employed by East and North Herts NHS Trust. Dr Bajaj has extensive experience in assessment and management of a wide range of neurodevelopmental conditions and neurodiabilities. She leads clinical autism service in her trust.
Visit - https://drniveditabajaj.blogspot.co.uk/
For more - https://www.nhs.uk/profiles/consultant/6068845
Read More - https://about.me/drniveditabajaj
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
This presentation explores a brief idea about the structural and functional attributes of nucleotides, the structure and function of genetic materials along with the impact of UV rays and pH upon them.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Comparing Evolved Extractive Text Summary Scores of Bidirectional Encoder Rep...University of Maribor
Slides from:
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Track: Artificial Intelligence
https://www.etran.rs/2024/en/home-english/
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
1. ISSN 2349-7823
International Journal of Recent Research in Life Sciences (IJRRLS)
Vol. 2, Issue 3, pp: (32-44), Month: July 2015 - September 2015, Available at: www.paperpublications.org
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Paper Publications
A Review on the Treatments of Epilepsy
1
Ishani Mazumder, 2
Krishnendu Giri
1, 2
Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
Abstract: Epilepsy is a serious and common chronic neurological disorder characterized by recurrent seizures,
which are caused by abnormal synchronized neuronal disorders. It is a relatively common condition (up to 2% of
the population) which can affect anyone at any age. Epilepsy can be controlled in a number of ways. The most
common way to treat epilepsy is with anti-epileptic drugs. These AEDs can control but not cure epilepsy. Surgery
can also be a possible treatment. Curative epilepsy surgery can only be performed in patients in whom the
epileptogenic focus can be localized and does not overlap with eloquent brain areas. In the other patients with
bilateral or multiple epileptogenic foci, with epilepsy onset in eloquent areas, or with no identifiable epileptogenic
focus, treatments such as ketogenic diet, vagus nerve stimulation can be offered. VNS is an available procedure of
which the mechanism of action is not understood, but with established efficacy for refractory epilepsy and low
incidence of side-effects. The ketogenic diet is a high-fat, moderate protein, low carbohydrate diet used to treat
intractable epilepsy, primary in the pediatric population. Hippocampal Deep Brain Stimulation has been used to
treat patients with refractory epilepsy. Complementary and Alternative Medicine for epilepsy such as apuncture,
aromatherapy, yoga etc may be used for lessening seizures, for alleviating related symptoms and for reducing side
effects. Gene therapy aims to utilize viral and non-viral vectors in the delivery of DNA to target areas for the
treatment of patients before their disease progresses. Gene therapy has delivered promising results in animal trials
and pre-clinical settings and can be used for neurological disorders such as epilepsy.
Keywords: Anti-epileptic drugs, Apuncture, Aromatherapy, Epilepsy, Gene therapy, Hippocampal deepbrain
stimulation, Ketogenic diet, Vagus nerve stimulation, Yoga.
I. INTRODUCTION
Seizures may be partial when the abnormal electrical activity occurs in one specific area of the brain, or generalized,
where the whole brain becomes involved. Partial seizures may be simple or complex. Some seizures may start as partial
then become generalized. There are several types of generalized seizures- absence, atonic, tonic, myoclonic, tonic-clonic.
Accurate diagnosis of the type of seizure is important in determining which medication is most likely to be effective, and
for prognosis and lifestyle advice. The purpose of this article is to provide a review of the therapies that can be used to
treat epilepsy. Many drugs are available to treat epilepsy, several of which have been recently released. Although generic
drugs are safely used for most medications, anticonvulsants are one category which should be recommended with caution.
Some older drugs which have been used to treat epilepsy for years are sodium valproate, phenytoin, clonazepum etc. and
some newer drugs used to treat epilepsy include lamotrigine, topiramate and others. The ketogenic diet was first
introduced into epilepsy therapy in the 1930s, but still rather surprisingly remains the subject of active research. The
medical use of the ketogenic diet emerged as a strategy to mimic the biochemical effects of fasting or starvation. This diet
can induce ketosis in a much more acceptable form and without restrictions on calories, fluids, proteins or need for a fast.
The patients need to follow the diet strictly for it to be successful. It is a high fat and low carbohydrate diet, which is
sometimes difficult for children to stick to. Some people‟s epilepsy is caused by a specific structural problem in part or
parts of the brain. This may have resulted from some form of head injury, occurring either at birth or in later life or from
celebral infection. It is also possible that the brain did not develop properly or there is some form of scarring, lesion or a
birth mark on the brain which the person was born with. Epilepsy surgery which means removing the abnormal or
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damaged part of the brain may help some of these. This is major brain surgery and is not undertaken lightly. Over 70% of
people who have epilepsy surgery become completely seizure free. Despite the advent of new pharmacological treatments
and high success rates of many surgical treatments for epilepsy, a substantial number of patients either do not become
seizure-free or they experience major adverse effects or both. Neurostimulation-based treatments have gained
considerable interest in the last decade. VNS is an alternative treatment for patients with medically refractory epilepsy,
who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optical outcome.
Hippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term
follow-up. Alternative or complementary medical therapies have always been popular in epilepsy. These include mind-
body medicines such as yoga; biomedical medicines such as herbal remedies, dietary supplements, homeopathy and
others.
II. VARIOUS FORMS OF TREATMENTS
2.1. Antiepileptic Medication:
The overall goal of antiepileptic medication is to prevent seizures and avoid untoward side effects with a regimen that is
convenient and easy to follow. People with epilepsy usually initiate treatment with one epileptic drug at the time of
diagnosis, but 30% of patients will be refractory to this medication.
TABLE 1: Important characteristics of antiepileptic medications
Drug Name
Mechanis
m of
Action
Seizure Types
Treated Adverse Effects Drug Interactions
Generic
Available
Carbamazepine
Na+
channel
inhibition
Partial
Tonic-Clonic
Neurological: dizziness, diplopia,
ataxia, vertigo
Non-Neurological: aplastic
anaemia, leucopenia,
gastrointestinal irritation,
hepatotoxicity, hyponatremia,
skin rash*
Enzyme Substrate:
CYP 3A4, 2C8
Enzyme Inducer:
CYP 1A2, 2B6, 2C8,
2C9, 2C19, 3A4
Enzyme Inhibitor:
None Yes
Clonazepam
Potentiate
GABA
receptor
function
Absence
Atypical
Absence
Myoclonic
Neurological: ataxia, sedation,
lethargy
Non-Neurological: anorexia
Enzyme Substrate:
CYP 3A4
Enzyme inducer:
None
Enzyme Inhibitor:
None No
Ethosuximide
T-type
Ca2+
channel
inhibition
in thalamus Absence
Neurological: ataxia, lethargy,
headache
Non-Neurological:
gastrointestinal irritation, skin
rash, bone marrow suppression
Enzyme Substrate:
CYP 3A4
Enzyme inducer:
None
Enzyme Inhibitor:
None
Yes, Only
Available
in Generic
Felbamate
NMDA
receptor
antagonist
and
increase
GABA
availability
Partial
Lennox-Gastaut
Neurological: insomnia,
dizziness, sedation, headache
Non-Neurological: aplastic
anaemia, hepatic failure, weight
loss, gastrointestinal irritation
Enzyme Substrate:
CYP 2E1, 3A4
Enzyme inducer:
CYP 3A4
Enzyme Inhibitor:
CYP 2C19
No, but
Patent
Expired
9/26/09
Gabapentin
GABA
analogue
for alpha-2
delta
subunit Partial
Neurological: sedation, dizziness,
ataxia, fatigue
Non-Neurological:
gastrointestinal irritation, weight
gain, oedema
Enzyme Substrate:
None
Enzyme Inducer:
None
Enzyme Inhibitor:
None Yes
Lacosamide
Na+
channel
inhibition Partial
Neurological: headache,
dizziness, diplopia, ataxia,
fatigue, tremor, somnolence,
Enzyme Substrate:
CYP 2C19
Enzyme inducer: No
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Drug Name
Mechanis
m of
Action
Seizure Types
Treated Adverse Effects Drug Interactions
Generic
Available
vomiting, nasopharyngitis,
blurred vision
None
Tiagabine
Increase
GABA
availability
Partial
Tonic-Clonic
Neurological: confusion,
sedation, depression, speech
problems, paresthesias, psychosis
Non-Neurological:
gastrointestinal irritation
Enzyme Substrate:
CYP 3A4
Enzyme inducer:
None
Enzyme Inhibitor:
None No
Topiramate
Na+
channel
inhibition
Partial
Tonic-Clonic
Lennox-Gastaut
Neurological: psychomotor
slowing, sedation, speech
problems, fatigue, paresthesias
Non-Neurological: kidney stones,
glaucoma, weight loss,
hypohydrosis
Enzyme Substrate:
None
Enzyme inducer:
CYP 3A4
Enzyme Inhibitor:
CYP 2C19 Yes
Valproic Acid
T-type
Ca++
channel
inhibition
in thalamus
increase
GABA
availability
Partial
Tonic-Clonic
Absence
Atypical
Absence
Myoclonic
Neurological: ataxia, sedation,
tremor
Non-Neurological:
Hepatotoxicity,
thrombocytopenia,
gastrointestinal irritation, weight
gain, hyperammonemia
Enzyme Substrate:
UGT 1A6, 1A9,
2B7, beta-oxidation
Enzyme Inducer:
CYP 2A6
Enzyme Inhibitor:
CYP 2C9, 2C19,
2D6, 3A4 Yes
Vigabatrin
Analogue
of GABA,
inhibits
GABA
catabolism
Complex
Partial
Neurological: headache, fatigue,
drowsiness, dizziness, tremor,
agitation, visual field defects,
abnormal vision, diplopia
Non-Neurological: nausea,
vomiting, diarrhoea, weight gain,
skin rash
Enzyme Substrate:
None
Enzyme inducer:
None
Enzyme Inhibitor:
None No
Zonisamide
Na+
channel
inhibition Partial
Neurological: sedation, dizziness,
confusion, headache, psychosis
Non-Neurological: Anorexia,
renal stones, hypohydrosis
Enzyme Substrate:
CYP 2C19, 3A4
Enzyme Inducer:
None
Enzyme Inhibitor:
None Yes
2.2. Surgery:
Evaluation of persons for surgery is generally recommended only after focal seizures persist despite the person having
tried at least two appropriately chosen and well-tolerated medications, or if there is an identifiable brain lesion (a
dysfunctional part of the brain) believed to cause the seizures. When someone is considered to be a good candidate for
surgery experts generally agree that it should be performed as early as possible.
Surgical evaluation takes into account the seizure type, the brain region involved, and the importance of the area of the
brain where seizures originate (called the focus) for everyday behaviour. Prior to surgery, individuals with epilepsy are
monitored intensively in order to pinpoint the exact location in the brain where seizures begin. Implanted electrodes may
be used to record activity from the surface of the brain, which yields more detailed information than an external scalp
EEG. Surgeons usually avoid operating in areas of the brain that are necessary for speech, movement, sensation, memory
and thinking, or other important abilities. fMRI can be used to locate such “eloquent” brain areas involved in an
individual.
While surgery can significantly reduce or even halt seizures for many people, any kind of surgery involves some level of
risk. Surgery for epilepsy does not always successfully reduce seizures and it can result in cognitive or personality
changes as well as physical disability, even in people who are excellent candidates for it. Nonetheless, when medications
fail, several studies have shown that surgery is much more likely to make someone seizure-free compared to attempts to
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use other medications. Anyone thinking about surgery for epilepsy should be assessed at an epilepsy centre experienced in
surgical techniques and should discuss with the epilepsy specialists the balance between the risks of surgery and desire to
become seizure-free.
Even when surgery completely ends a person's seizures, it is important to continue taking antiseizure medication for some
time. Doctors generally recommend continuing medication for at least two years after a successful operation to avoid
recurrence of seizures.
Surgical procedures for treating epilepsy disorders include:
Surgery to remove a seizure focus involves removing the defined area of the brain where seizures originate. It is the
most common type of surgery for epilepsy, which doctors may refer to as a lobectomy or lesionectomy, and is
appropriate only for focal seizures that originate in just one area of the brain. In general, people have a better chance
of becoming seizure-free after surgery if they have a small, well-defined seizure focus. The most common type of
lobectomy is a temporal lobe resection, which is performed for people with medial temporal lobe epilepsy. In such
individuals one hippocampus (there are two, one on each side of the brain) is seen to be shrunken and scarred on an
MRI scan.
Multiple subpial transection may be performed when seizures originate in part of the brain that cannot be removed. It
involves making a series of cuts that are designed to prevent seizures from spreading into other parts of the brain
while leaving the person's normal abilities intact.
Corpus callosotomy, or severing the network of neural connections between the right and left halves (hemispheres) of
the brain, is done primarily in children with severe seizures that start in one half of the brain and spread to the other
side. Corpus callosotomy can end drop attacks and other generalized seizures. However, the procedure does not stop
seizures in the side of the brain where they originate, and these focal seizures may even worsen after surgery.
Hemispherectomy and hemispherotomy involve removing half of the brain's cortex, or outer layer. These procedures
are used predominantly in children who have seizures that do not respond to medication because of damage that
involves only half the brain, as occurs with conditions such as Rasmussen's encephalitis. While this type of surgery is
very excessive and is performed only when other therapies have failed, with intense rehabilitation, children can
recover many abilities.
2.3. Vagus Nerve Stimulation:
The vagus nerve is the largest cranial nerve and comprises large myelinated A fibers and unmyelinated B fifers and
unmyelinated C fibers. About (80-90) % of its fibers are afferent, encoding predominantly visceral sensory non-pain
information, and emerge from or converge to four nuclei: the dorsal nucleus of the vagus nerve, the nucleus ambiguous,
the solitary tract nucleus and the spinal trigeminal nucleus. Asymmetric heart interventions play an important role: the
right vagus nerve is intimately associated with atriums and left nerve with ventricles, and owing to the fact of the atriums,
left VNS is associated with arrhythmias.
a) Mechanism of action: Despite many studies, the exact mechanism by which VNS reduces seizure frequency is
unknown, and many theories have been proposed. It is believed that VNS may modulate electrical stimuli to the nucleus
tractus solitarius and the brainstem reticular formation. In this way, VNS may interrupt the synchronous electrical activity
characteristic of seizures. Earlier research has attempted to characterize the mechanism of action of VNS by using EEGs,
evoked potentials, cerebrospinal fluid (CSF) neurochemistry and functional imaging. CSF studies have shown in gamma-
amino butyric acid (GABA) after 3-4 months of VNS treatment, but no significant decrease in glutamate, aspartate or 5-
hydroxyindoleacetic acid (5-HIAA) levels after 3 to 9 months of VNS treatment. Non-responders had the greatest effect
on neurotransmitter levels. Long-term VNS had no effect on interictal EEG background or epileptoform activity, and an
effect on visual or auditory evoked potentials. Although the VNS mechanism of action is essentially unknown, a number
of studies using functional imaging techniques, such as single-photon emission computed tomography (SPECT) and
positron emission tomography (PET), have demonstrated widespread changes in blood flow and metabolism in several
cortical and subcortical regions during short term VNS use. These widespread changes in blood flow and metabolism in
various celebral structures have formed the foundation of hypotheses that attempt to explain the VNS effect.
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b) VNS should be considered for patients with refractory epilepsy at any age in the following cases:
1. Patients who have failed to become seizure free following adequate trials whether as monotherapies or in combination
of two tolerated and appropriately chosen and used first-generation AEDs (Phenobarbital, phenytoin, carbamezapine,
valproic acid) plus another trial with second or third generation AED (oxcarbazepine, lamotrigine, topiramate, vigabatrin,
clobazam);
2. Patients who have been previously evaluated at specialized secondary or tertiary-level epilepsy centres with the aim of
diagnosis confirmation and exclusion of epilepsy surgery as a treatment option (owing to unacceptable neurologic
deficits, high surgery risk or refusal of the patient to undergo epilepsy surgery);
3. Patients with ultra-refractory status epilepticus;
c) VNS therapy: VNS therapy is a type of treatment for epilepsy that involves a stimulator for pulse generation which is
connected inside the body to the left vagus nerve in the neck. The stimulator sends regular, mild electrical stimulations to
this nerve. The vagus nerve sends these regular stimulations into the brain. The aim is to help calm down the irregular
electrical brain activity that leads to seizures.
d) The Stimulator: The stimulator is a bit like a heart pacemaker, it is implanted under the skin in the upper chest (under
the left collar bone) during a small operation under general anaesthetic. Because of the size of the stimulator there will be
a small lump where it lies and a small scar where it was put in. A lead connects the stimulator or in the chest to the left
side of the neck. Because the electrodes are coiled around the nerve in the neck, there will be a small scar where they are
inserted, usually in the fold of the neck. The stimulator is switched on within four weeks of it being implanted.
Fig.1: Vagus Nerve Stimulation
Fig.2: Ketogenic diet
7. ISSN 2349-7823
International Journal of Recent Research in Life Sciences (IJRRLS)
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2.4. Ketogenic diet:
The ketogenic diet includes about 75% fat, 20% protein, and 5% carbohydrate; the ratio of fat to carbohydrate plus protein
ranges from 2:1 to 4:1, with higher ratios seen as more restrictive but more effective. Initiation of the ketogenic diet is
preceded by a 24- to 48-hour fast, with the patient being hospitalized. During the fast, the patient can drink water or
sugar-free beverages and can eat unsweetened gelatin. Alternatively, Bergqvist et al have shown that a gradual initiation
results in fewer adverse events and is overall better tolerated yet maintains the efficacy of the diet. Contraindications such
as β-oxidation defects, liver disease, or metabolic disease interfering with glucose or ketone homeostasis must be
excluded before initiation of the diet. Laboratory parameters of blood and urine glucose and ketones need to be monitored
during fasting. The diet is introduced by starting with one-third of calories per meal, increasing to two-thirds of calories
per meal and to the total amount of calories per meal every 24 hours. Patients are discharged when the total amount of
calories per meal is reached and well tolerated, typically 2 to 3 days after initiation of the diet. Parents, patients, and
caretakers are educated during admission about suitable food items, calculation, and preparation of ketogenic meals. If the
diet is initiated without hospitalization, adequate facilities must be available to instruct families on meal preparation and
monitoring techniques.
Meal plans are patient-tailored and can include heavy cream, bacon, eggs, tuna, shrimp, vegetables, mayonnaise,
sausages, and other high-fat and low-carbohydrate products. Patients are not allowed starchy fruits or vegetables; breads,
pasta, or grains; or sources of simple sugars.
Benefits and side effects: Patients on the diet become more alert and exhibit considerable improvements in attention,
comprehension, activity levels, and endurance. Most of the side effects from the ketogenic diet are related to energy and
nutrient deficiencies. Lack of protein, carbohydrates, and other nutrients can result in lack of weight gain and growth
inhibition, especially at a young age. Inadequate calcium intake can further impair bone mineralization in children already
at risk of osteopenia due to antiseizure therapy. Lack of fibre in the diet causes constipation. Acidosis is also commonly
observed. Less common are kidney stones and hyperlipidemia. Adjustments to the diet (e.g. increased protein and
polyunsaturated fat) can be made in children with high lipid concentrations. Serious adverse events include coma and
obtundation. Rare side effects include cardiomyopathy, prolonged QT syndrome, vitamin and mineral deficiencies,
pancreatitis, basal ganglia injury, and bruising. The long-term results of these side effects have not been adequately
studied.
This review highlights the main neurobiochemical mechanisms:
a) Modulation of neurotransmitters: The major mechanisms proposed to explain the increased inhibition and/or
decreased excitation that are induced by the KD involve the neurotransmitters GABA and glutamate. KBs act not only as
energy sources but also contribute to reducing glucose consumption in the brain by modulating the activities of
neurotransmitters .Changes in the levels of glutamate and GABA, which are the major excitatory and inhibitory
neurotransmitters, respectively and their receptors have been proposed as the possible mechanisms of action of the KD .
GABA is an intermediate of α-ketoglutarate, which is synthesized in the Krebs cycle (via glutamate) and converted into
GABA by glutamate decarboxylase. Moreover, KBs inhibit glutamate decarboxylase and decreased levels stimulate the
synthesis of GABA, thus contributing to seizure control.
b) Biogenic monoamines: The modulation of biogenic monoamine levels was proposed as a plausible mechanism for
explaining the anticonvulsant effects of the KD. However, the specific mechanisms underlying such activities remain
unclear.
c) Neuroprotective mechanisms: Many studies have shown that the epileptogenic state involves complex molecular
pathways in which oxidative stress and mitochondrial dysfunction may exert important roles in neuronal
programmed/controlled (apoptosis) or uncontrolled/passive (necrosis) cell death. Thus, investigators have given particular
emphasis to the modulation of the mitochondrial biogenesis of neurons by the KD and caloric restriction, highlighting the
neuroprotective role of the mitochondria as the primary key to the control of apoptosis and cell death .Mitochondria are
intracellular organelles that primarily function in the production of cellular energy in the form of adenosine triphosphate
(ATP). This nucleotide is produced by the mitochondrial respiratory chain through oxidative phosphorylation, which is
performed by five multienzyme complexes (complexes I-V). The dysfunction of complex I may lead to decreased ATP
production, which is commonly observed in neuronal diseases. In prolonged seizures, a temporary reduction in ATP
levels can contribute to cell death.
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d) Anticonvulsant mechanisms and ketone bodies: There are many hypotheses regarding the antiepileptic mechanisms
of the KD. The early hypotheses regarding its activities were focused on the concepts of acidosis, dehydration and
increased ketone concentrations. Other factors, such as γ-amino butyric acid (GABA) and glutamate, membrane
potentials, ion channels, biogenic monoamines and neuroprotective activities (Figure 1), have been studied in
experimental models (in vivo or in vitro).Energy metabolism in the brain involves distinct and complex pathways. Under
physiological conditions, most precursors of KBs are long-chain fatty acids. They are released from adipose tissue in
response to a decrease in blood glucose, such as that which occurs during fasting .Similar mechanisms are involved in the
KD, during which long-chain fatty acids are metabolized in the liver and converted into KBs. These fatty acids are
oxidized in the mitochondria, producing high levels of acetyl-CoA, which cannot be oxidized in the Krebs cycle. The
excess acetyl-CoA is converted to acetoacetate and subsequently to acetone and β-hydroxybutyrate . The KBs cross the
blood-brain barrier and are transported by monocarboxylic acid transporters to the brain interstitial space, the glia and the
neurons. In these tissues, the KBs act as substrates in and respiratory chain, contributing to brain energy metabolism.
Fig.3: Production of ketone bodies and potential primary anticonvulsant mechanisms: (1) GABA neurotransmitter (neuronal
hyperpolarisation and membrane channels; (2) inactivation of VGLUT and inhibition of glutamate neurotransmitter; (3)
modified concentrations of biogenic monoamines; and (4) antioxidant mechanism of diminishing reactive oxygen species.
2.5. Complementary and Alternative Medicine:
The term "conventional medicine" refers to the methods and treatments most widely practised by Western health
professionals today to diagnose and treat health conditions. These methods and treatments are based on scientific
research. Their effectiveness is proven and their side effects are well known.
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The term "complementary and alternative medicine" (CAM) refers to the use of treatment methods that are not yet
approved by conventional Western medicine or proven by scientific research techniques. These may include physical
treatments or procedures; herbal therapies, vitamins, and other substances; and even complete systems of medical theory
and practice, such as traditional Chinese medicine and Ayurveda.
Strictly speaking, "alternative medicine" refers to using only the non-conventional treatment, whereas "complementary
medicine" means using the non-conventional treatment in conjunction with conventional ones. However, the terms
"complementary medicine" and "alternative medicine" are often used interchangeably. The terms "holistic" and
"integrative" medicine can also be used to refer to patient-centred care that combines mainstream and complementary
therapies.
CAM for epilepsy may be used for lessening seizures, for alleviating related symptoms, and for reducing side effects.
Some complementary and alternative therapies for epilepsy are based on the principle that relaxation may reduce seizures.
Others are based on the idea that the person with epilepsy has less of some vitamin or mineral in his body than is normal.
Still others focus on avoiding certain types of food.
In cases of epilepsy, people may investigate CAM for various reasons:
Conventional drugs, such as anti-epileptic drugs, may not be effective in controlling their child's seizures or if they are
effective, the side effects may be intolerable.
Parents may want to supplement the conventional treatment and improve the overall well-being of their child.
Surgery may be too risky, not an option, or tried and failed.
Their cultural beliefs may make the CAM a viable option.
Parents may have heard of the CAM helping another child with a similar condition.
2.6. Deep Brain Stimulation of the Anterior Nucleus of the Thalamus:
Rationale: In 1937, James W. Papez described a circuit linking hippocampal output via the fornix and mammillary nuclei
to ANT. Projections from ANT travel to the cingulum bundle and then around the wall of the lateral ventricle to the
parahippocampal cortex, completing the circuit by returning to the hippocampus. Radiologic alterations have been noted
in structures within the classic circuit of Papez in mesial temporal sclerosis, as well as other forms of epilepsy. Thus, it is
conceivable that DBS of structures within this circuit may result in direct anterograde cortical stimulation. ANT is an
appealing target because of its relatively small size and projections to limbic structures, ultimately affecting wide regions
of neocortex. Further, it is not as deep or close to basal vascular structures as the mammillary nuclei. These anatomic
connections and precursor ablative techniques have motivated investigation of ANT DBS for epilepsy.
Surgical procedure: The patient is placed in a supine or semi-sitting position. After Mayfield fixation, sterile preparation
of the unshaven head, and local infiltration with 1% Xylocaine 1:100,000 epinephrine, an incision is made overlying the
coronal suture. A burr hole is placed, and the dura and pia are sharply incised and cauterized. A guide cannula is inserted
and advanced deep into the brain to a point 10-mm from the desired target under direct fluoroscopic and Leksell frame
guidance. Under local anaesthesia, monopolar single-unit recording electrode (Advanced Research Systems, Atlanta, GA,
or FHC, Bowdoinham, ME) can be introduced to confirm anatomic depth for entry into thalamic tissue after traversing the
lateral ventricle. No units are recorded while traversing the lateral ventricle. The electrode tip is advanced until recordings
are first heard (ANT superficial surface), then until units cease (intralaminar region) and then recommence (dorsomedian
nucleus of the thalamus). Extracellular action potentials are amplified with a GS3000 (Axon Instruments, Sunnyvale, CA)
or Lead point (Medtronic, Minneapolis, MN) amplifier and simultaneously recorded using standard recording techniques
(300–10,000 Hz), together with a descriptive voice channel. ANT neurons are identified based on (1) regional
characteristics, (2) a firing rate previously described for human recordings, (3) and a characteristic burst firing pattern.
After removing the single-unit recording electrode, a stimulation lead (Radionics Stimulation/ Lesioning Probe,
Burlington, MA) is introduced to elicit the driving response suggestive of ANT placement with a stimulation frequency of
5 to 10 cycles/s, pulse width at 90-330 μs, pulse amplitude at 4-5 V, and total pulse durations between 3 and 10 s. ANT
DBS has been associated with recruiting rhythms on cortical EEG in patients with the most pronounced seizure frequency
reduction. These changes in EEG signal morphology, however, can be elicited from several other thalamic nuclei. Further,
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a recent report demonstrated that these recruiting rhythms induced by low frequency ANT DBS may reflect mixed
activation of both specific and nonspecific thalamocortical pathways, and thus may not serve as a physiologic verification
of optimal localization. Once this lead is removed, the DBS lead is advanced to ANT, ensuring that all contacts of the lead
are within thalamic parenchyma, and the cannula and lead stylet are withdrawn under fluoroscopy. The stimulation leads
we use are Medtronic 3387 DBS Medtronic (Minneapolis, MN) depth electrodes with 4 platinum-iridium stimulation
contacts 1.5 mm wide with 1.5 mm edge-to-edge separation, since ANT is relatively larger than other DBS targets.
Another fluoroscopic image is performed to show that the electrode is secure. The lead is secured to a burr hole cap, and
the skin incision is closed. The same sequence of steps is performed to place the contra lateral electrode. The stereotactic
frame is removed.
Scalp EEG driving response to stimulation of the left-sided anterior nucleus of the thalamus at a frequency of 5 to 10
cycles/s, pulse width at 90-330 μs, pulse amplitude at 4-5 V, and total pulse durations between 3 and 10 s. We elect to
place the internal pulse generator (IPG) at the same setting, but it can be placed at a later date. The head, neck, and
infraclavicular regions are sterilized in preparation for placement of the IPG (model Itrel II, Soletra, or Kinetra;
Medtronic) in a subclavicular pocket bilaterally. The scalp incision is reopened for connection of the lead to an extension
wire (Medtronic 7495 Lead Extension, Medtronic, Minneapolis, MN), which is tunnelled subcutaneously to the IPG (s).
Postoperative management: The site of placement of the DBS leads is confirmed postoperatively by MRI or CT after
reversal and recovery from anaesthesia. Patients are discharged to home two days postoperatively, but multiple outpatient
visits are usually necessary for optimization of stimulation parameters. Stimulators are turned on approximately 10 days
postoperatively, and initial stimulation parameters are set at a frequency of 90-130 Hz, pulse width at 60-90 μs, and pulse
amplitude at 4-5V, and adjusted over subsequent follow-up to maximize clinical benefit based on each individual
response and minimize side effects, such as nystagmus, lethargy and anorexia.
Fig.4: Deep Brain Stimulation
2.7. Gene Therapy For Epilepsy: Promising Results From An Epilepsy Research UK-Funded Study:
Neurons communicate with each other via chemical messengers known as neurotransmitters (NTs), and these can either
be excitatory or inhibitory. An excitatory NT causes the communicating neuron to „fire‟, whilst an inhibitory NT causes it
to be inactive. The most common excitatory and inhibitory neurotransmitters in the brain are glutamate and GABA
respectively, and a very fine balance between the two must be maintained for normal brain function to occur. Too much
excitation (either because of an increase in glutamate or a decrease in GABA) can cause neurons to become hyperactive
and seizures can result.
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Electrical current in neurons is generated by the flow of ions, including potassium and chloride, through structures known
as ion channels. Potassium ion channels include many subtypes and together they are one of the main regulators of
neuronal excitability. A potassium channel known as Kv1.1 also controls the release of glutamate from neurons, and
its malfunction has been linked to over-release of glutamate, an increase in brain excitability and epilepsy development.
Chloride channels are usually inhibitory, and they act by allowing chloride ions to enter a neuron, making it more difficult
for the neuron to fire. Loss of these channels has also been associated with certain types of epilepsy If a loss of/defect in
chloride or potassium ion channel function is associated with epilepsy susceptibility, can an increase in their activity treat
or even prevent epilepsy? In a recent study that was part-funded by Epilepsy Research UK, scientists at University
College London (UCL) explored this question, using advanced genetic techniques involving viruses.
Viruses have special mechanisms by which they can incorporate their DNA into the cells they infect, and scientists can
use them as vehicles (known as vectors) to transfer genes, e.g. ion channel genes, to cells. Provided that a gene is
incorporated successfully into the host cell DNA, it can encode a protein (e.g. an ion channel) that functions normally.
This technique can only be performed using certain types of virus that have been genetically modified to make them less
harmful; however it is a very useful tool in examining gene and protein function.
The researchers at UCL wanted to find out if it was possible to stop seizures in rodent epilepsy models, very soon after
they had begun, by increasing the number of chloride channels in their epileptic neurons. They chose to use a special type
of chloride channel known as halorhodopsin, which is found in certain bacteria and is activated by a specific frequency of
light. Halorhodopsin is encoded by a gene called NpHR.
After having induced epilepsy in the animals with a special toxin, and identified the seizure focus (the region in which
seizures originate) in each using wireless EEG; the scientists injected the seizure focus of each animal with viral vectors
containing NpHR. Seven to ten days later, they used optic fibres to deliver light of the appropriate frequency to the
NpHR-treated neurons, in order to activate the halorhodposin channels that had formed. They found that seizure activity
in all animals decreased dramatically upon channel activation.
The team then wanted to find out if seizures could be prevented from occurring in animals treated with toxin, by
increasing the number of Kv1.1 channels in their neurons. In order to do this, they used a vector to deliver the human gene
KCNA1, which encodes Kv1.1, to the animals‟ brains, and administered the epilepsy-inducing toxin at the same site, at
the same time. They then monitored the animals both visually and via wireless EEG for seizure activity, and found that it
was completed prevented in these animals.
Finally, the scientists explored whether or not an increase in Kv1.1 activity during well-established epilepsy could reverse
(cure) it. Again, they induced epilepsy in a group of animals, and after a week they delivered KCNA1 to the neurons in
their seizure foci. The team noticed that both the frequency of seizures experienced by the animals and the seizure activity
in their brains gradually decreased, and stopped completely after four weeks.
These results (although early) are extremely promising, because they show that it is possible to prevent and even cure
epilepsy in living mammals using KCNA1 and NpHR gene therapy. If this approach is validated in human trials, it could
revolutionise the treatment of epilepsy. In the future, it might even be possible to incorporate NpHR therapy into a device
that detects early seizure activity in neurons and inhibits it with light, before a clinical seizure develops. If combined with
longer-term seizure suppression via KCNA1, a very effective treatment could result. It is still the case that a third of
people with epilepsy do not respond to anti-epileptic drugs, and as epilepsy surgery is only feasible for a small proportion,
these findings are very welcome.
III. CONCLUSION
In this review paper we get a brief idea of some of the types of epilepsy. The first type of treatment is the use of anti-epileptic drugs.
Though this is the main type of treatment, these drugs can cause side effects for some people. With improved awareness of the
benefits of surgery, improvements in neuroimaging to identify abnormal brain areas, and improved technologies for
intervention, it is likely that surgery will be the option of choice for those patients who suffer the most from this disease.
On the horizon, and presently an intense area of research, is the use of deep brain stimulation (DBS) to control seizures in
patients who are not candidates for resective surgery. DBS, including responsive neurostimulation, is not yet FDA
approved. With improved awareness and ongoing technological advances, surgery for epilepsy is now well established
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and readily identified as the optimal therapy for many forms of intractable seizures. The ketogenic diet, being high in fat
and low in carbohydrates, has been suggested to reduce seizure frequency. It is currently used mainly for children who
continue to have seizures despite treatment with antiepileptic drugs. Recently there has been interest in less restrictive
ketogenic diets including the Atkins diet and the use of these diets has extended into adult practice. There are few
complications associated with vagus nerve stimulation. The implantation of the pulse generator is a surgical procedure
and therefore involves many of the related risks. The most common complication during surgery is nausea and vomiting,
which could result in stomach contents being inhaled into the lungs. Other less common complications include changes in
heart rate, blood pressure, allergic reactions, and lack of oxygen. CAM is used when other treatments do not work straight
away. There is no anxiety, depression, fatigue or side effects. Neuroactive peptides, adenosine, and γ-amino butyric acid,
are agents that can be delivered by gene and cell therapy with potential utility in epilepsy therapy.
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