This document defines epilepsy as a chronic neurological disorder characterized by recurrent seizures resulting from abnormal neuronal activity in the brain. Seizures can vary in severity from brief periods of lack of awareness to major motor convulsions. Epilepsy is classified based on whether seizures originate in one area of the brain (focal) or engage both hemispheres (generalized). Common causes include trauma, tumors, infections, genetic factors, and metabolic imbalances. Diagnostic workup may include EEG, CT/MRI, and genetic testing. Treatment primarily involves anti-seizure medications, while refractory cases may be treated with surgery to remove the seizure focus.
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
Epilepsy is a brain condition that causes repeated, sudden, brief changes in the brain's electrical activity. These changes cause various types of symptoms.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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.
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.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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
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!
2. Definition
A chronic neurologic disorder manifesting by
repeated epileptic seizures (attacks or fits) which
result from paroxysmal uncontrolled discharges
of neurons within the central nervous system (grey
matter disease).
The clinical manifestations range from a major
motor convulsion to a brief period of lack of
awareness.
stereotyped and uncontrollable nature of the attacks
is characteristic of epilepsy.
3. A seizure (from the Latin sacire , “to take
possession of ”) is a paroxysmal event due to
abnormal excessive or synchronous neuronal
activity in the brain.
The meaning of the term seizure needs to be
carefully distinguished from that of epilepsy.
Epilepsy describes a condition in which a
person has recurrent seizures due to a
chronic, underlying process.
4. Classification of Seizures:
ILAE-2010
1. Focal seizures
(Can be further described as having motor, sensory, autonomic,
cognitive, or other features)
2. Generalized seizures
a. Absence: Typical, Atypical
b. Tonic clonic
c. Clonic
d. Tonic
e. Atonic
f. Myoclonic
3. May be focal, generalized, or unclear
Epileptic spasms
5. Pathogenesis
The 19th century neurologist Hughlings Jackson
suggested “a sudden excessive disorderly
discharge of cerebral neurons“ as the causation
of epileptic seizures.
Recent studies in animal models of focal epilepsy
suggest a central role for the excitatory
neurotransmiter glutamate (increased in epi) and
inhibitory gamma amino butyric acid (GABA)
(decreased)
6. Epidemiology and course
Epilepsy usually presents in childhood or
adolescence but may occur for the first time at any
age.
Newborns
Early school age
Adolescents
Seniors
7. Epidemiology and course
5% of the population suffer a single sz at some
time
0.5-1% of the population have recurrent sz =
EPILEPSY
70% = well controlled with drugs (prolonged
remissions)
30% epilepsy at least partially resistant to drug
treatments = INTRACTABLE
(PHARMACORESISTANT) EPILEPSY.
8. Epilepsy versus epileptic
syndromes
Epilepsy is not a nosological entity – not one
disease! Not unique aetiology...
Might be a symptom of numerous disorders –
symptomatic epilepsy (TBI, tumours,
inflammation, stroke, neurodegeneration, ...)
Sometimes the cause remains unclear despite
careful history taking,examination and
investigation!
9. Focal seizures
arise from a neuronal network either discretely
localized within one cerebral hemisphere or
more broadly distributed but still within the
hemisphere.
Typically consciousness is preserved
10. Three additional features of focal motor
seizures are worth noting
1. Jacksonian march
2. Todd’s paralysis
3. Epilepsia partialis continua
11. Focal seizures
EEG: epileptiform spikes or sharp waves, Since focal
seizures can arise from the medial temporal lobe or
inferior frontal lobe (i.e., regions distant from the
scalp), the EEG recorded during the seizure may be
nonlocalizing.
Can be detected?
12. Focal seizures with
dyscognitive features
accompanied by automatisms , which are
involuntary, automaticbehaviors that have a
wide range of manifestations.
consist of very basic behaviors such as
chewing, lip smacking,swallowing, or
“picking” movements of the hands, or display
of emotion or running.
may show an anterograde amnesia or, in
cases involving the dominant hemisphere, a
postictal aphasia.
13. Focal seizures without
dyscognitive features
motor, sensory, autonomic, or psychic
symptoms without impairment of cognition.
For example, a patient movements are
typically clonic (i.e., repetitive,
flexion/extension movements) at a frequency
of 2–3 Hz; pure tonic posturing may be seen∼
14. Focal seizures
Also psychomotor seizures
Initial subjective feeling (aura), loss of
consciousness, abnormal behavior (perioral and
hand automatisms)
Usually originates in TL
16. Generalized seizures
are thought to arise at some point in the brain
but immediately and rapidly engage neuronal
networks in both cerebral hemispheres.
19. Epilepsy
Differential Diagnosis
The following should be considered in the diff. dg. of epilepsy:
Syncope attacks (when pt. is standing; results from global
reduction of cerebral blood flow; prodromal pallor, nausea,
sweating; jerks!)
Cardiac arrythmias (e.g. Adams-Stokes attacks). Prolonged arrest
of cardiac rate will progressively lead to loss of consciousness –
jerks!
Migraine (the slow evolution of focal hemisensory or hemimotor
symptomas in complicated migraine contrasts with more rapid
“spread“ of such manifestation in SPS. Basilar migraine may lead to
loss of consciousness!
Hypoglycemia – seizures or intermittent behavioral disturbances
may occur.
Narcolepsy – inappropriate sudden sleep episodes
Panic attacks
PSEUDOSEIZURES – psychosomatic and personality disorders
20. Epilepsy – Investigation
The concern of the clinician is that epilepsy may
be symptomatic of a treatable cerebral lesion.
Routine investigation:
Haematology,
biochemistry (electrolytes, urea and calcium),
chest X-ray,
electroencephalogram (EEG)
Neuroimaging (CT/MRI) should be performed in
all persons aged 25 or more presenting with first
seizure and in those pts. with focal epilepsy
irrespective of age.
21. Specialised neurophysiological
investigations: Sleep deprived EEG, video-
EEG monitoring.
Advanced investigations
(in pts. with intractable focal epilepsy where surgery is considered):
Neuropsychology,
Semiinvasive or invasive EEG recordings,
MR Spectroscopy,
Positron emission tomography (PET) and
ictal Single photon emission computed
tomography (SPECT)
22. Epilepsy - Treatment
drug therapy (anticonvulsants).
In intractable cases surgery may be necessary
treatment target is seizure-freedom and improvement in
quality of life!
The commonest drugs used in clinical practice are:
Carbamazepine, Sodium valproate, Lamotrigine (first line drugs)
Levetiracetam, Topiramate, Pregabaline (second line drugs)
Zonisamide, Eslicarbazepine, Retigabine (new AEDs)
Basic rules for drug treatment: Drug treatment should be
simple, preferably using one anticonvulsant
(monotherapy). “Start low, increase slow“.
Add-on therapy is necessary in some patients…
23. Epilepsy – Treatment (cont.)
If pt is seizure-free for three years, withdrawal of
pharmacotherapy should be considered.
It should be performed very carefully and slowly! 20%
of pts will suffer a further sz within 2 yrs.
The risk of teratogenicity is well known (~5%),
especially with valproates, but withdrawing drug
therapy in pregnancy is more risky than continuation.
Epileptic females must be aware of this problem and
thorough family planning should be recommended.
Over 90% of pregnant women with epilepsy will deliver
a normal child.
24. Epilepsy – Surgical Treatment
intractable epilepsy will benefit from surgery.
Epilepsy surgery procedures:
Curative (removal of epileptic focus) and palliative
(seizure-related risk decrease and improvement of
the QOL)
Curative (resective) procedures:
Anteromesial temporal resection,
selective amygdalohippocampectomy,
extensive lesionectomy,
cortical resection,
hemispherectomy.
Palliative procedures: Corpus callosotomy and
25. Status Epilepticus
A condition when consciousness does not return
between seizures for more than 30 min
(practically 5min)
state may be life-threatening with the development
of pyrexia, deepening coma and circullatory
collapse.
Death occurs in 5-10%.
26. causes
frontal lobe lesions (incl. strokes)
following head injury,
on reducing drug therapy,
with alcohol withdrawal,
drug intoxication,
metabolic disturbances or
pregnancy.