Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures. It can be classified as generalized seizures originating from both hemispheres of the brain or focal seizures arising from one hemisphere. The majority of childhood epilepsy cases are idiopathic, while secondary causes include brain malformations, infections, tumors or trauma. Diagnosis involves clinical history and examination along with an EEG. Treatment primarily consists of antiepileptic drug monotherapy tailored to the seizure type, with the goal of seizure control and prevention of recurrence. Status epilepticus is a medical emergency defined by prolonged or repeated seizures, and requires rapid treatment to prevent neurological injury.
Epilepsy: A Neurological Condition Affecting the Nervous System. Epilepsy is also known as a seizure disorder. Here is a quick who, what, where, when, why, and how about epilepsy.
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
Epilepsy: A Neurological Condition Affecting the Nervous System. Epilepsy is also known as a seizure disorder. Here is a quick who, what, where, when, why, and how about epilepsy.
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
It contains description and salient points to diagnose various epileptic encephalopathies seen during infancy such as early myoclonic encephalopathies, Otahara syndrome, Dravet syndrome, West syndrome.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. WHAT IS EPILEPSY?
Epilepsy is a chronic neurological condition
characterized by recurrent, unprovoked seizures,
occurrence of at least 2 unprovoked seizures 24
hours apart.
Epileptic seizure → clinical manifestation of
abnormal & excessive discharge of a set of neurons
in the brain
8. TONIC CLONIC SEIZURES
Tonic phase
The tonic phase begins with flexion of the trunk and
elevation and abduction of the elbows. Subsequent
extension of the back and neck is followed by extension
of arms and legs.
Piercing cry may be present due to passage of air
through closed vocal cords.
Autonomic signs are common during this phase and
include increase in pulse rate and blood pressure,
profuse sweating
This stage lasts for 10-20 seconds.
9. Clonic phase
tremor occurs at a rate of 8 tremors per second,
which may slow down to about 4 tremors per
second. This is because phases of atonia alternate
with repeated violent flexor spasms. Each spasm is
accompanied by pupillary contraction and dilation.
Some patients may have tongue or cheek bites.
The atonic period lasts about 30 sec.
The clonic phase lasts for 30 sec. to 1minute.
TONIC CLONIC SEIZURES
10. ABSENCE SEIZURES
Patient stares briefly and stop talking or ceases to
respond.
Most of the patient are completely motionless while
some feel some myoclonic movements in eye
lids,facial muscles,fingers at a rate of 3 per sec..and
this rate corresponds to the abnormality in EEG as
generalized 3 per sec.spike & wave pattern.
Occurs at the age of 4-12 years
Prognosis is good.95% remission in adolescense
11. MYOCLONIC SEIZURES
These are brisque,brief muscular contractions
some of them involve only single muscle or a part of the
muscle & some of them are so large that they include
whole body or both the limbs.
Myoclonic jerks are common in the morning involving entire
body both the limbs and sometimes absence seizures are
common.
This is the most common form of idiopathic gen.epilepsy in
childhood.it begins at adolescence (15 yr).
4 to 6 Hz irregular spikes have been noted in EEG.
14. PARTIAL SEIZURE - FOCAL SEIZURE
Begin in a relatively small group of dysfunctional
neurones in one of the cerebral hemispheres.
Mayb e heralded by an aura which reflects the site
of the origin
May or may not be associated with change in
consciousness or more generalised motor jerking.
15. Frontal seizures
• Involve the motor
cortex
• May lead to clonic
movements → travel
proximally→
(Jacksonian March)
• Asymmetrical tonic
seizures → bizarre
,hyperkinetic & easily
dismissed as non –
epileptic events
Temporal lobe seizure
• Most common
• Strange warning
feeling/ aura with
smell , taste
abnormalities &
distortion of sound &
shape
• Automatism → spread
to the premotor cortex
• Deja-vu & Jamais-vu
• Consiousness may be
impaired, length of
event is longer than a
typical absence
16. Occipital
• Distortion of vision
Parietal
• Causes contralateral
dysaesthesias (altered
sensation )
• Distorted body image
17. SPECIAL EPILEPSY SYNDROME
1.INFANTILE SPASM:-
-Most cases appears in 1st yr of life.
- Single brief recurrent gross flexion movements of
the limb …rarely extension movements
-EEG shows multifocal,multiple small spikes.
-On maturity it disappears(4 to 5yr)
-CT & MRI mostly normal.
-Later progress to LENOX GASTAUT SYND.
18. HISTORY TAKING
HOPI:-
Two unprovoked seizures >24 hr apart suggest the presence of an
epileptic disorder
Any aura?change in the behaviour?
Types of seizures
-tonic clonic(tensing,then shaking,LOC)
-atonic(drop attack)
-absence(jus staring,not responding,blinking)
-partial(maybe consciouss,only ½ limbs shaking/jerking
How long did it last?frequency?time of day?precipatating factor?
Any loss of consciousness?tongue bitting?
What did you do for the child?(appropriate first aid measures)
Post ictal:drowsy?sleeping?vomiting?
19. PERINATAL HISTORY
Infection during pregnancy?TORCH
Birth history - birth asphyxia , birth trauma
Neonatal jaundice
POST NATAL HISTORY
Central nervous system (CNS) infection e.g. meningitis,
encephalitis etc.
Head injury
Lead contact (lead fumes from burning batteries, pica)
20. PAST HISTORY
Age at 1st seizure?describe seizure?
h/o febrile seizures
When and how diagnosed?any event preceding seizure?
DRUG HISTORY
1. Anticonvulsant medications
2. How many?
3. Any increase in dosage?types?
4. Compliance,how often dose missed?what to do if missed?
5. Side effect?
6. Responding current medication or not
21. Outpatient review
1. Frequency
2. Test done
3. Other investigations(eg.EEG to date)
Hospitalization
1. How many?reasons?
Any identified medical problems associated with seizures?
1. Any history of trauma,meningitis?encephalitis?
2. How are this problem managed?
FAMILY HISTORY
1. Of convulsion?inborn error metabolism?
22. SOCIAL HISTORY:-
Impact on child:
1. Schooling
2. Athletic participation?
3. Self esteem
4. Does teacher know about the condition?
5. On family:financial burden
CONTINGENCY PLAN:
1. What to do in the event of a seizure?
26. DIAGNOSIS
The clinical diagnosis is more important then any
tool… (H/O, Eye witnesses, substantiated by video
if available)
# EEG:-
EEG is most sensitive tool for diagnosis which
shows electrical activity changes in the brain but it
also require clinical correlation
Many children with epilepsy may have normal EEG
and many children who will never have epilepsy
have EEG abnormalities
Done for dx, classification, selection of anti-epileptic
drugs and prognosis
29. MRI and CT
-not required routinely for childhood generalized epilepsy.
To identify a tumour,vascular lesion or area of sclerosis.
PET and SPECT.
To detect areas of hypometabolism in epileptogenic
lesions
OTHER INVESTIGATIONS
Blood test and metabolic investigations(seizures related to
feed and fasting).
Genetic studies
Lumbar puncture
30. PRINCIPLES OF ANTICONVULSANT THERAPY
Treatment recommended if ≥ 2 episodes→ recurrence risk
80%
Attempt to classify the seizure type & epileptic syndrome
Monotherapy as far as possible → most appropriate drug →
increase dose gradually till epilepsy controlled, maximum
dose reached / side effects occur
Alternative monotherapy (Add on the 2nd drug if 1st drug
failed. Optimise 2nd drug, then try to withdraw 1st drug.
Rational combination therapy (usually 2 or maximum 3 drugs
)
Combines drugs with different mechanism of action &
consider their spectrum of efficacy, drug interactions &
adverse affects.
31. Monitor drug levels (carbamazepine, phenytoin,
phenobarbitone) to check compliance → if seizures not
well controlled/in situations of polypharmacy where drug
interaction is suspected.
When withdrawal of medication is planned → seizure
free for 2 years, consideration should be given to
epilepsy syndrome, likely prognosis & individual
circumstances before attempting slow withdrawal of
medication over 3-6 months (longer if clonazepam/
phenobarbitone)
If seizures recur → last dose reduction is reversed &
medical advice sought
32. INTRACTABLE EPILEPSY?
Re- evaluate the following possibilities
Is it a seizure /non epileptic event
Anticonvulsant dose not optimized
Poor compliance to anticonvulsant
Wrong classification of epilepsy syndrome → wrong
anticonvulsant
Anticonvulsant aggravating seizures
Lesional epilepsy, hence a potential epilepsy
surgery candidate
Progressive epilepsy or neurodegenerative disorder
33. REFERRAL TO PAEDIATRIC NEUROLOGIST
Poor seizure control despite monotherapy with 2
different anticonvulsants
Difficult to control seizures beginning in the 1st year
of life
Seizures & developmental regression
Structural lesion on neuroimaging
34. ADVICE FOR PATIENTS
Educate and counsel on epilepsy.
Emphasize compliance if on anticonvulsant.
Don’t stop the medication by themselves.this may
precipitate breakthrough seizures.
In photosensitive seizures-watch tv in brightly lit
room.avoid sleep deprivation.
Use a shower with bathroom door unlocked
No cycling in traffic,climbing sports or swimming
alone.
Know emergency treatment for seizure
Inform teachers and school abt the condition.
36. SIDE EFFECTS AND SERIOUS TOXICITIES
OF ANTICONVULSANT
CARBAMAZEPINE—drowsiness,dizziness,ataxia,diplopia,rash
(serious toxicity—agranulocytosis
Steven Johnson syndrome)
CLONAZEPAM----
hypotonia,salivary and bronchiol hypersecretion,paradoxical
hyperactivity,aggresiveness
PHENYTOIN---
ataxia,diplopia,rash,gum hypertrophy,hirsutism
(serious toxicity—megaloblastic anemia)
38. STATUS EPILECTUS
Any seizures lasting > 30 minutes OR
Intermittent seizures longer than 30 minutes from which the
patient does not regain consciousness
39. CURRENT DEFINITION
IMPENDING STATUS EPILEPTICUS
0 to 5-10 mins
ESTABLISHED STATUS EPILEPTICUS
>30 mins
REFRACTORY STATUS EPILEPTICUS
>60 mins
40. •Highest incidence in very young children
• 70% of children with epilepsy experience
at least one episode of SE
Mortality rate 8 to 32%
41. CAUSES OF SE
1)Prolonged febrile seizures
Lasting for >30mins
Particularly in child younger than 3 years old
Associated with severe damage to the
hippocampus in children(Hippocampus sclerosis)
Most common cause of SE
May be the initial manifestation of encephalitis, and
epilepsy may be a long term complication of
meningitis
42. CAUSES OF SE
2)Idiopathic status epilepticus
Includes epilepticus patients in whom SE followed
sudden withdrawal of anticonvulsants(esp.
benzodiazepines and barbiturates)
Given anticonvulsants on an irregular basis or who
are noncompliant are more likely to develop SE
43. CAUSES OF SE(CONTINUED)
Acute head trauma
Brain tumor
Neurodegenerative disorders
Hepatic or renal encephalopathy
Storage diseases.
44. MECHANISM OF SE
Inreased cerebral metabolic rate
Increased in cerebral flow
(half an hour)
Inadequate oxygen tension and togetther with
other factors lead to
Neuronal injury
STATUS EPILEPTICUS
45. MANAGEMENT OF STATUS EPILEPTICUS
Securing airway ,breathing and circulation
(with continuous monitoring of vital signs ,ECG)
Determination and management of the underlying
etiology(eg.hypoglycemia)
Laboratory studies(glucose,sodium,Ca)
Blood and spinal culture,toxic screens
test for inborn error of metabolism
Antiepilectic drugs level
EEG(ruling out pseudostatus epilepticus)
46.
47. SUMMARY
affects 1 in 200 children
Is classified as generalised or focal(partial) or an
epilepsy syndrome of childhood
If suspected EEG is indicated
Most but not all requires antiepileptic drug
therapy,which should be appropriate for the
seizure,compromise as few drugs and with the least
potential for unwanted effects as possible
Requires liaison with the school about the
management of seizures and avoiding situations
ehich could lead to injury.
48. REFERENCES
PAEDIATRIC PROTOCOL
2ND EDITION
ILLUSTRATED TEXTBOOK OF PAEDIATRICS
3RD EDITION BY TOM LISSAUER,GRAHAM
CLAYDEN
NELSON TEXTBOOK OF PEADITRICS
19TH EDITION
Neurodegeneration is the umbrella term for the progressive loss of structure or function of neurons, including death of neurons. Many neurodegenerative diseases including Parkinson’s, Alzheimer’s, and Huntington’s occur as a result of neurodegenerative processes.
Neurocutaneous syndrome – NF,VonHippelLindau,Sturgeweber,tuberoussclerosis,ataxiatelengiectasia