Prognosis of epilepsy disease definition, mortality, relapse risks explainedsahil136
pilepsy is a neurological disorder marked by recurrent sudden episodes of convulsions, sensory disturbances, loss of consciousness correlated with abnormal electrical activity in the brain.
Prognosis of epilepsy disease definition, mortality, relapse risks explainedsahil136
pilepsy is a neurological disorder marked by recurrent sudden episodes of convulsions, sensory disturbances, loss of consciousness correlated with abnormal electrical activity in the brain.
A review of epilepsy in the elderly, the etiopathogenesis, clinical challenges, diagnosis, use of antiseizure drugs and outcomes. Also the various special considerations in managing elderly patients with epilepsy.
A review of epilepsy in the elderly, the etiopathogenesis, clinical challenges, diagnosis, use of antiseizure drugs and outcomes. Also the various special considerations in managing elderly patients with epilepsy.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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!
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
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. The Definition of Epilepsy
Robert S. Fisher, MD, PhD
Maslah Saul MD Professor of Neurology
Director, Stanford Epilepsy Center
In 2005, the ILAE released a conceptual definition of seizures and epilepsy, followed
by an operational (practical) definition in 2014. The key changes were: epilepsy can
exist after two unprovoked seizures more than 24 hours apart (the old definition) or
one unprovoked seizure when the risk for another is known to be high (>60%); reflex
seizures and seizures that are part of an epilepsy syndrome constitute epilepsy;
epilepsy may be considered resolved when an age-dependent syndrome is
outgrown or when a person is seizure-free for at least 10 years, the last 5 off anti-
seizure medicines.
The attached PowerPoint slide set may be used without need to request permission
for any non-commercial educational purpose meeting the usual "fair use"
requirements. Permission from robert.fisher@stanford.edu is however required to
use any of the slides in a publication or for commercial use. When using the slides,
please attribute them to Fisher et al. ILAE official report: a practical clinical definition
of epilepsy. Epilepsia, 2014; 55:475-82.
2. Epilepsy is a disease of the brain defined by any of the following conditions
1. A least two unprovoked (or reflex) seizures occurring >24 h apart
2. One unprovoked (or reflex) seizure and a probability of further seizures similar to
the general recurrence risk (at least 60%) after two unprovoked seizures, occurring
over the next 10 years
3. Diagnosis of an epilepsy syndrome
Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but
are now past the applicable age or those who have remained seizure-free for the last 10 years, with no
seizure medicines for the last 5 years.
ILAE OFFICIAL
REPORT
3. • A seizure is the event
• Epilepsy is the disease associated
with spontaneously recurring
seizures
Seizure versus Epilepsy
5. Epilepsy is a disorder characterized by two or more unprovoked seizures
occurring more than 24 hours apart.
Traditional Epilepsy Definition
Concise, easy to apply, known to many, but . . .
• Some people now are treated as if they have epilepsy after 1 seizure
• A person can never outgrow epilepsy
• Can have an epilepsy syndrome (e.g., BRE), but not epilepsy
• Those with photic or reflex seizures are not defined as having epilepsy
6. • Some people now are treated as if they have epilepsy after 1 seizure
7. • After two unprovoked seizures, the risk of
a 3rd by 60 months is 73% (59-87%, 95%
confidence intervals.
• So adopt 59 (~ 60%) as the lower end of
the confidence interval for the recurrence
risk we all agree is epilepsy.
Hauser et al. Risk of recurrent seizures after two
unprovoked seizures. NEJM 1998;338:429.
• Risk of epilepsy after 2 seizures
8. • Can a person outgrow epilepsy ?
Chadwick D, Taylor J, Johnson T. Outcomes after seizure recurrence in people
with well-controlled epilepsy and the factors that influence it. The MRC
Antiepileptic Drug Withdrawal Group. Epilepsia. 1996;37:1043-50.
If seizure-free for a few years,
Then relapse risk is relatively low.
9. Epilepsy Resolved
• Epilepsy is now considered to be resolved* for individuals who had
an age-dependent epilepsy syndrome but are now past the applicable
age or those who have remained seizure-free for the last 10 years,
with no seizure medicines for the last 5 years.
Fisher et al, Epilepsia 55 (4): 475-482, 2014
*Avoiding preconceptions associated with the words “cure” and “remission.”
“Resolved” has the connotation of “no longer present,” but it does not
guarantee that epilepsy will never come back
10. Reflex Epilepsies
• Despite the fact that seizures are “provoked” in reflex epilepsies, these are
considered epilepsy, because…
• If the seizure threshold were not altered, these precipitants would typically
not cause seizures
– e.g., photosensitive epilepsy, eating epilepsy
11. • “The revised definition places no burden on the treating
physician to specify recurrence risk in a particular
circumstance.
• In the absence of clear information about recurrence risk, or
even knowledge of such information, the default definition of
epilepsy originates at the second unprovoked seizure.
• On the other hand, if information is available to indicate that
risk for a second seizure exceeds that which is usually
considered to be epilepsy (about 60%), then epilepsy can be
considered to be present”
Fisher et al, Epilepsia 55 (4): 475-482, 2014
13. AAN Guideline
Conclusion:
• Adults with an unprovoked first seizure should be informed
that sz recurrence risk is greatest early within the first 2 years
(21%–45%) (Level A), and clinical variables associated with
increased risk may include:
– a prior brain insult (Level A),
– an epileptiform EEG (Level A),
– an abnormal CT/MRI(Level B)
– a nocturnal seizure (Level B).
Courtesy of Jacqueline French
14. AAN Guideline
• Immediate antiepileptic drug (AED) therapy, as compared
with delay of treatment pending a second seizure, is likely to
reduce recurrence risk within the first 2 years (Level B)
• Clinicians’ recommendations whether to initiate immediate
AED treatment after a first seizure should be based on
individualized assessments that weigh the risk of
recurrence against the adverse events of AED therapy.
Courtesy of Jacqueline French
15. These are not Epilepsy because there is small risk of a
seizure in the absence of a precipitating factor
• Febrile seizures in children age 0.5 – 6 years old
• Alcohol-withdrawal seizures
• Metabolic seizures (sodium, calcium, magnesium, glucose, oxygen)
• Toxic seizures (drug reactions or withdrawal, renal failure)
• Convulsive syncope
• Acute concussive convulsion
• Seizures within first week after brain trauma, infection or stroke
16. ILAE Definition of Acute Symptomatic Epilepsy
Acute symptomatic seizures are events, occurring in close temporal
relationship with an acute CNS insult, which may be metabolic, toxic,
structural, infectious, or due to inflammation. The interval between
the insult and seizure may vary due to the underlying clinical
condition.
• Acute symptomatic seizures have also been called:
• Reactive seizures
• Provoked seizures
• Situation-related seizures
Beghi et al. Epilepsia 2010;51:671-675 Courtesy of Dale Hesdorffer
17. Defining time in acute symptomatic seizures
Events within 1 week of:
• Stroke
• TBI
• Anoxic encephalopathy
• Intracranial surgery
• First identification of subdural hematoma
• Presence of an active CNS infection
• During an active phase of multiple sclerosis or other
autoimmune disease
Beghi et al. Epilepsia 2010;51:671-675 Courtesy of Dale Hesdorffer
18. Acute symptomatic afebrile seizures: Incidence,
proportion and recurrence
• Age-adjusted incidence of acute symptomatic seizures was
39/100,000 in Rochester, MN
• The acute symptomatic seizure incidence was 29/100,000 in
Gironde France
• These both represented 40% of all afebrile seizures in the
community
Recurrent seizures
• Acute symptomatic seizures are unlikely to be recurrent
• Unprovoked seizures are often recurrent
Annegers et al. Epilepsia 1995;36:327-333; Loiseau et al. These, 1987.
Courtesy of Dale Hesdorffer
19. Cumulative risk for recurrent unprovoked seizure, Rochester 1955-
84: Structural Etiologies: CNS infection, stroke, TBI
First Unprovoked
Acute Symptomatic
Log Rank p<0.001
0.00
0.25
0.50
0.75
1.00
0 2 4 6 8 10
Time (Years)
Univariate RR=0.2, 95% CI=0.1-0.3
Adjusted RR=0.02 (95% CI=0.2-0.4), adjusting for age gender and SE
Hesdorffer et al. Epilepsia 2009
More than 1 week after injury
Courtesy of Dale Hesdorffer
20. A 25 year-old woman has two unprovoked seizures one year
apart.
HYPOTHETICAL CASE: Two seizures
21. A 25 year-old woman has two unprovoked seizures one year
apart.
HYPOTHETICAL CASE: Two seizures
Comment: This person has epilepsy, according
to both the old and new definitions.
22. A 65 year-old man had a left middle cerebral artery stroke 6
weeks ago and now presented with an unprovoked seizure.
HYPOTHETICAL CASE: Stroke & Seizure
23. A 65 year-old man had a left middle cerebral artery stroke 6
weeks ago and now presented with an unprovoked seizure.
HYPOTHETICAL CASE: Stroke & Seizure
Comment: With a seizure in this time relation to a stroke (or brain infection or
brain trauma) the literature (Hesdorffer et al., 2009) suggests a high (> 70%)
risk of another unprovoked seizure. Therefore, in the new (but not the old)
definition, this man would have epilepsy.
24. A 6 year-old boy has had 2 seizures 3 days apart while
playing a videogame involving flashing lights. There have
been no other seizures. EEG shows an abnormal
photoparoxysmal response.
HYPOTHETICAL CASE: Photic Seizure
25. A 6 year-old boy has had 2 seizures 3 days apart while
playing a videogame involving flashing lights. There have
been no other seizures. EEG shows an abnormal
photoparoxysmal response.
HYPOTHETICAL CASE: Photic Seizure
Comment: This boy has epilepsy according to the new definition (but not the
old), even though the seizures are provoked by lights, since there is an
abnormal enduring predisposition to have seizures with light flashes.
26. A 25 year-old man had seizures with face twitching when
falling asleep at ages 9, 10 and 11 years; none since. EEG at
age 9 years demonstrated centro-temporal spikes.
Benign Epilepsy with Centro-Temporal Spikes (BECTS)
27. A 25 year-old man had seizures with face twitching when
falling asleep at ages 9, 10 and 11 years; none since. EEG at
age 9 years demonstrated centro-temporal spikes.
Benign Epilepsy with Centro-Temporal Spikes (BECTS)
Comment: For this young man, epilepsy is no
longer present, because of passing the relevant
age range of an age-dependent syndrome. The
old definition has no provision for considering
epilepsy to be no longer present.
28. A 40 year-old man had a focal seizure characterized by left hand
twitching that progressed to a tonic-clonic seizure. This was his
only seizure. MRI shows a probable periventricular dysplasia in
the right frontal lobe and EEG shows right fronto-temporal
interictal spikes.
HYPOTHETICAL CASE: Single Seizure & Dysplasia
dysplasia
29. Comment: Although many clinicians would reasonably treat this man with
anti-seizure medications, the recurrence risk for seizures is not precisely
known, and therefore epilepsy cannot yet be said to be present according to
either definition. Should evidence later indicate at least a 60% risk for another
seizure, then a diagnosis of epilepsy would be justified by the new definition.
A 40 year-old man had a focal seizure characterized by left hand
twitching that progressed to a tonic-clonic seizure. This was his
only seizure. MRI shows a probable periventricular dysplasia in
the right frontal lobe and EEG shows right fronto-temporal
interictal spikes.
HYPOTHETICAL CASE: Single Seizure & Dysplasia
30. An 85 year-old man had a focal seizure at age 6 and another at
age 8 years. EEG, MRI, blood tests and family history were all
unrevealing. He received anti-seizure drugs from age 8 to age 10
years, when they were discontinued. There have been no further
seizures.
HYPOTHETICAL CASE: Two Seizures Long Ago
31. An 85 year-old man had a focal seizure at age 6 and another at
age 8 years. EEG, MRI, blood tests and family history were all
unrevealing. He received anti-seizure drugs from age 8 to age 10
years, when they were discontinued. There have been no further
seizures.
HYPOTHETICAL CASE: Two Seizures Long Ago
Comment: According to the new definition, epilepsy is no longer present,
since he has been more than 10 years seizure-free and off seizure medication.
This is not a guarantee against future seizures, but he has a right to be viewed
as someone who does not currently have epilepsy.
33. A 70 year-old woman had unprovoked seizures at ages 15 and 70.
EEG, MRI and family history are unremarkable.
HYPOTHETICAL CASE: Long-Interval Seizures
Age 15 70
34. A 70 year-old woman had unprovoked seizures at ages 15 and 70.
EEG, MRI and family history are unremarkable.
HYPOTHETICAL CASE: Long-Interval Seizures
Comment: Both old and new definitions consider this woman to have epilepsy.
Despite the diagnosis, many clinicians would not treat because of the
infrequency of seizures. Should investigations somehow show that the causes
of the two seizures were different, then epilepsy would not be considered to be
present.
35. A 20 year-old man has had 3 unobserved episodes over 6 months
consisting of sudden fear, difficulty talking and a need to walk
around. He is not aware of any memory loss during the episodes.
There are no other symptoms. He has no risk factors for epilepsy
and no prior known seizures.
HYPOTHETICAL CASE: Questionable Information
36. A 20 year-old man has had 3 unobserved episodes over 6 months
consisting of sudden fear, difficulty talking and a need to walk
around. He is not aware of any memory loss during the episodes.
There are no other symptoms. He has no risk factors for epilepsy
and no prior known seizures.
HYPOTHETICAL CASE: Questionable Information
Comment: Declaring this man to have epilepsy is impossible by either the old
or new definition. Focal seizures are on the differential diagnosis of his
episodes, but both definitions of epilepsy require confidence that the person
has had at least one seizure, rather than one of the imitators of seizures. Future
discussions may define the boundaries of “possible and probable epilepsy.”
38. Possible Consequences
Good
Closer to clinician view
Helps reimbursement
Support for earlier diagnosis
Encourages disease-modifying therapy
Allows for epilepsy no longer present
Not so Good
May upset those diagnosed sooner
May increase stigma for some
Label of epilepsy may restrict some activities
Data on seizure recurrence is limited
Makes diagnosis more complex