Hello readers.................!!!!!!!!!!!!!!
This is my 32nd powerpoint.....its regarding a form of childhood epilepsy, known as "LENNOX-GASTAUT SYNDROME".
It has been dealt with in the Therapeutics way, and in precise format.
Do look into it and give your reviews!!!!
Thank you!!!!
@rxvichu-alwz4uh!!!!
:) :)
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.
Lennox-Gastaut Syndrome- A Case Study: By RxVichuZ!! :)RxVichuZ
This is my 53rd powerpoint....this is also my first CASE PRESENTATION ....deals with a rare disease....LENNOX-GASTAUT SYNDROME!!!
One of the most disastrous pediatric epilepsies of all time.....!!!
Do go through this....
Vishnu.R.Nair :) :)
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.
Lennox-Gastaut Syndrome- A Case Study: By RxVichuZ!! :)RxVichuZ
This is my 53rd powerpoint....this is also my first CASE PRESENTATION ....deals with a rare disease....LENNOX-GASTAUT SYNDROME!!!
One of the most disastrous pediatric epilepsies of all time.....!!!
Do go through this....
Vishnu.R.Nair :) :)
"Navigating Anti-Epileptic Drug Choices with Dr. Ganesh"
🌟 Greetings, friends! Welcome back to the channel. I'm Dr. Ganesh, and today we're delving into a crucial topic: the selection of Anti-Epileptic Drugs (AEDs). If you or someone you know is dealing with epilepsy, understanding the choices and considerations involved in AEDs is vital for effective management.
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptxkrishna keerthi
Explore this informative Slide share presentation to delve into the intricacies of Hepatomegaly, a condition characterized by an enlarged liver. This comprehensive slide deck covers the causes, symptoms, diagnostic approaches, and management strategies related to Hepatomegaly. Gain valuable insights into liver health, medical imaging, and associated pathologies. Whether you're a healthcare professional or some one curious about liver conditions, this presentation provides a detailed overview to enhance your understanding. Navigate through a visual journey that outlines the diverse symptoms associated with hepatomegaly, enabling a nuanced understanding of clinical presentations. The presentation extends beyond diagnosis to encompass management strategies, emphasizing the importance of a multidisciplinary approach in treating Hepatomegaly.
This presentation deals with pathophysiology of Parkinson's Disease.
Important headings, including normal physiology, etiological factors and clinical manifestations have been elucidated.
This powerpoint, deals with HIV pathophysiology, signs and symptoms, mode of transmission and diagnostic parameters.
Purely based on clinical pharmacist perspective.
This presentation deals with buprenorphine drug profile, from a clinical pharmacist perspective.
Summarized version of drug, including chief ADRs, interactions, and patient and health-care professional counselling tips have been mentioned.
This PDF deals with important catchpoints regarding the use of 5-alpha reductase inhibitors, their safety and efficacy stats, and important counselling tips.
This PDF deals with important guidelines, with respect to usage of antibiotics. This PDF outlines the important strategies involved while using antibiotics, and important factors involving antibiotic selection.
This word document deals with summarized drug profile of cotrimoxazole. Important pharmacological headings, along with important counselling tips and drug catchpoints have also been elucidated.
This is my first word document, converted into pdf format!
This document deals with AMOXICILLIN drug profile in brief.
It includes significant pharmacological headings, including an additional heading, stating important catchpoints with respect to amoxicillin!
Food drug interactions with penicillins: by RxVichuZ!RxVichuZ
This is my 107th powerpoint...it deals with significant drug-food interactions when taking specific penicillins.
This is my first powerpoint that deals with drug interactions.
Do support!
Snake bite poisoning and its treatment by RxVichuZ!RxVichuZ
My 106th powerpoint...that deals with snake bite poisoning.
Different types of venomous snakes, their characteristics, envenomation features and treatment strategies have been explained in a summary.
Hope it is effective for the readers involved.
This powerpoint is a case presentation, that explains the case of ADCHF, with comorbidities, comprising HTN, CAD and DLP.
A summary on the recent advancements in HF management, along with justification of therapy provided, has been elucidated.
A note on home remedies and counselling tips has also been provided.
Directly acting antivirals and Visceral Leishmaniasis: A case reportRxVichuZ
This presentation deals with visceral leishmaniasis induced by directly acting antivirals in a patient with Hepatitis C infection.
Case details in summary, along with case report publication details have been summarized.
References have been provided below each slide.
...and this is my 100th powerpoint.....!!
Sincerely thanking everyone who have supported me in my journey till now :) :)
This powerpoint deals with drug mnemonics, easy to remember mnemonics, that can be helpful for easy memory of some aspects of Pharmacology!!
Happy reading!!
Acute coronary syndrome management by RxVichuZ! ;)RxVichuZ
This is my 99th powerpoint...
Deals with ACS(Acute coronary syndrome), its clinical features, and management strategies, based on standard guidelines and literatures.
RNTCP guidelines for tuberculosis management: Extended versionRxVichuZ
This presentation is an extension of the already made presentation before, that deals with RNTCP guidelines for some special aspects encountered during tuberculosis management, other than management of individual diagnoses alone.
Have a look!
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
PPI-INDUCED BICYTOPENIA: MATTER OF CONCERN by RxVichuZ! ;)RxVichuZ
This presentation deals with bicytopenia induced by proton pump inhibitors, that were reported and published as a Case Report by researchers from China.
References have been provided as a separate textbox under each slide, for extensive referencing into the same.
Dipeptidyl peptidase inhibitors(DPP-IV): A deep insightRxVichuZ
This presentation deals with DPP-IV inhibitors, that are implicated for use in diabetes mellitus. Generalized pharmacology, including a precise insight into individual drugs have been elucidated.
Principles of cancer chemotherapy: a deep insight by RxVichuZ!RxVichuZ
This powerpoint deals with principles of cancer chemotherapy, that includes headings regarding cancer definition, its etiology, diagnostic measures and general considerations to be observed while initiating anti-cancer regimens in patients.
Sulfonylureas for Diabetes: A deep insightRxVichuZ
This powerpoint presentation solely deals with Sulfonylureas, that come under Insulin secretagogues. Their complete pharmacological profile, with pharmacovigilance parameters, important catchpoints and mnemonics have been explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
4. EPIDEMIOLOGICAL STATISTICS:
• Occurs in 1-4% of patients, with childhood epilepsy
• More common in boys than in girls
• Prevalence in boys: 0.1 per 1,000 population
• Prevalence in girls: 0.02 per 1,000 population
• Age onset: 26-28 months.
5. ETIOLOGY:
• Mainly occurs due to the following causes:
1. IDIOPATHIC CAUSES
2. CRYPTOGENIC CAUSES
3. SYMPTOMATIC CAUSES:
- Encephalitis
- Meningitis
- Tuberous sclerosis
- Cortical dysplasia
- Hypoxia-ischemia injury
7. PATHOPHYSIOLOGY:
• The exact mechanism behind this disease occurrence is not clearly defined,
though some theories exist
• According to one hypothesis maturation of anterior parts of brain increases
permeability of excitatory inter-hemisphere pathways in frontal areas
• Involvement of immunogenetic mechanisms in triggering LGS is also
reported(via an association between LGS & HLA-Class I Ag B7).
8. CLINICAL MANIFESTATIONS:
A. TONIC SEIZURES:
- Frequency: 17-95%
- More common during NON-REM SLEEP
B. ATYPICAL ABSENCE SEIZURES:
- Frequency: 17-100%
- Associated with incomplete loss of consciousness
- Eye myoclonias may occur
9. C. ATONIC/ MASSIVE MYOCLONIC/ MYOCLONIC+ ATONIC SEIZURES:
- Frequency: 10-50%
- May lead to a sudden fall, causing injuries
D. OTHER TYPES :
Include:
1. GTCS(15%)
2. Complex partial seizures(5%)
3. Absence Status Epilepticus(SE)
4. Tonic SE
5. Non-convulsive SE
10. E. GENERAL SYMPTOMS:
Include:
1. Abnormalities in mental status functions
2. Abnormalities in levels of consciousness
3. Mood instability
4. Personality disturbances
5. Acute psychotic episodes(in older children)
6. Social isolation(in older children)
7. Memory impairment.
11. DIAGNOSIS:
A. ELECTROENCEPHALOGRAPHY:
- Here both waking & sleeping EEG is recorded
- Helps to capture & classify different seizure types in the patient
- Video/EEG Telemetry is also helpful
B. INTERICTAL EEG:
- Helps to detect prognosis of the disease
- Used to check spikes pattern observed in an EEG
12. C. NEUROIMAGING STUDIES:
- MRI is preferred over CT-Scan
- Used to detect:
a. Brain malformations
b. Tuberous sclerosis
c. Hypoxia-ischemia injury
- PET/SPECT scan is not commonly used.
13. MANAGEMENT STRATEGIES FOR
LGS:
• Includes:
a. Goals of therapy
b. Treatment guidelines
c. Pharmacotherapy
d. Non-pharmacotherapy.
14. A. GOALS OF THERAPY:
• To avoid complications
• To focus on reducing/eliminating seizure frequency
• To focus on minimum ADRs, with maximal drug effectiveness
• To focus on using minimum number of drugs
• To focus on ameliorating symptoms
• To improve HRQoL.
15. B. TREATMENT GUIDELINES:
• Usually, 3 categories of drugs can be used:
1. FIRST-LINE AGENTS
2. SECOND-LINE AGENTS
3. THIRD-LINE AGENTS.
16. 1. FIRST-LINE AGENTS:
- Based on clinical experience
- Drugs include:
a. Valproic acid
b. Benzodiazepines(Clonazepam, clobazam, nitrazepam)
- NOTE: NITRAZEPAM is not FDA-APPROVED for treatment of LGS, yet, it is
used in some Western Countries
2. SECOND-LINE AGENTS:
- These are treatments, that are believed to be effective, based on OPEN-LABEL
CONTROLLED STUDIES
- Drugs include:
a. Vigabatrin
b. Lacosamide.
17. 3. THIRD-LINE AGENTS:
- They are treatments, that are believed to be effective, based on DOUBLE-
BLIND PLACEBO-CONTROLLED STUDIES
- Include:
a. Lamotrigine
b. Topiramate
c. Felbamate
d. Rufinamide.
19. 1. VALPROIC ACID:
- Considered as 1st line choice for treating LGS(for the past 2 decades)
- More effective in CRYPTOGENIC LGS
- Used mainly as DIVALPROEX
- Use in children, greater than 10 years of age
- ADRs:
a. Hepatotoxicity(if used in children < 3 years of age)
b. Weight gain
c. Alopecia
d. Tremors.
- DOSE: 60 mg/kg/day(Max. dose).
20. 2. LAMOTRIGINE:
- Useful for LGS patients, in spite of high risk of IDIOSYNCRATIC
DERMATOLOGICAL REACTIONS
- Use other anticonvulsant medications along with it, cautiously
- Start with a low dose, and then titre slowly
- ADRs:
a. life-threatening hypersensitivity(skin rashes)
b. SJS
c. TEN.
21. - DOSAGE REGIMEN:
a. With Valproate: 0.5-5 mg/kg/day; PO
b. Without Valproate: 5-10 mg/kg/day; PO
c. With enzyme-inducing AEDs: 5-15 mg/kg/day; PO
d. Maximum dose: 400 mg/day; PO.
22. 3. TOPIRAMATE:
- Safe & effective as adjunctive therapy for LGS
- ADRs:
a. Nephrolithiasis
b. Weight loss
- DOSE : 6 mg/kg/day; PO.
23. 4. FELBAMATE:
- Effective in LGS patients
- High risk of APLASTIC ANEMIA Mandates this drug to be used as 3rd/4th line
choice for LGS
- ADRs:
a. URTI
b. Aplastic anemia
c. Purpura
- DOSE:
a. Use in patients> 2 years of age
b. Max. dose: 45 mg/kg/day
c. Reduce concomitant dose of CBZ, phenytoin, valproate by 20%.
24. 5. ZONISAMIDE:
- Effective as long-term adjuvant therapy in LGS patients
- ADRs:
a. Somnolence
b. Dizziness
c. Nephrolithiasis
- Avoid usage in children < 16 years
- DOSE: 600 mg PO daily(Max. dose).
25. 6. VIGABATRIN:
- Approved by US-FDA in 2009, as:
a. Monotherapy for WEST SYNDROME(in patients, aged 1month-2 years)
b. Adjuvant treatment for adults with refractory complex partial seizures.
- ADRs:
a. Somnolence
b. Weight gain
c. Irreversible visual field defects, due to retinal atrophy.
- Avoid usage in patients, below 1 month of age
- DOSE : For patients, aged 1 month-2 years: 150 mg/kg/day(Max. dose).
26. 7. LEVETIRACETAM:
- Mainly FDA-approved for partial seizures
- May be used for a number of seizure types in LGS
- ADRs:
a. Sedation
b. Increased B.P(in children <4 years)
c. Dizziness.
- DOSE:
a. For patients, aged 4-12 years: 30 mg/kg/day(Max.dose)
b. For patients, aged >12 years: 1.5 g, BD(Max.dose).
27. 8. RUFINAMIDE:
- Drug modulates sodium channel activity prolongs its inactivated state
- Used as adjunct therapy in adults & children aged 1 year or older with LGS
- ADRs:
a. Dizziness
b. SJS
- DOSE : 3,200 mg/day(Max.dose).
28. 9. CLONAZEPAM:
- Effective 1st line AED for LGS
- DEMERITS :
a. ADRs, with long-term usage
b. Development of tolerance
- Since there is risk of development of tolerance it is advised to:
a. Use on alternative days, OR
b. Use alternate 2 BZDs daily.
29. 10. CLOBAZAM:
- Drug binds to GABA-A receptor potentiates GABA-ergic neurotransmission
- Drug has an active metabolite(N-DESMETHYL CLOBAZAM) shows long
duration of action
- Used for LGS in patients, older than 2 years
- ADRs:
a. Sedation
b. Weight gain
c. URTI
- DOSE: 40 mg/day(Max.dose).
31. A. CORPUS CALLOSTOMY:
- Only effective to reduce DROP ATTACKS
- Considered PALLIATIVE than CURATIVE
B. VAGAL NERVE STIMULATION:
- Done by means of a surgically-implanted programmable device
- Approved by FDA, as adjunct treatment for reducing seizure frequency in LGS
- Requires follow-up period within 5 years
C. FOCAL CORTICAL RESECTION:
- Used in rare cases
- Resection of localized lesion(vascular lesion, tumor) improves seizure control
in LGS
32. D. KETOGENIC DIET:
- Consists of high ratio of FATS to PROTEINS and CARBOHYDRATES
- Ratio is usually in between 2:1 to 4:1
- Benefits include:
a. Fewer seizures
b. Reduced drowsiness
c. Better behavior
d. Requires fewer number of concomitant AEDs.
33. - Diet includes:
a. HIGH FAT(Nuts, cream, butter)
b. LOW CARBOHYDRATES (Starchy fruits, bread, pasta, grains, sugar)
c. ADEQUATE PROTEINS(Pulses, soyabeans)
E. PATIENT COUNSELLING TIPS:
1. Avoid consuming artificial sweeteners/additives
2. Avoid skipping meals, especially breakfast
3. Avoid all “white products”, like:
a. White flour
b. White sugar
c. Table salt
d. White rice.
34. 4. Do not skip taking medicines, without doctor’s approval
5. Get enough sleep(since sleep deprivation can trigger seizures)
6. Manage stress, and avoid stressful situations.
35. BIBLIOGRAPHY/ REFERENCE:
1. Trevathan E, Murphy CC, Yeargin-Allsopp M. Prevalence and descriptive
epidemiology of Lennox-Gastaut Syndrome among Atlanta children. Epilepsia.
1997 Dec.38(12):1283-8.
2. Arzimanoglou A, et al. Lennox-Gastaut Syndrome: a consensus approach on
diagnosis, assessment, management and trial methodology. Lancet Neurol.
2009 Jan.8(1): 92-93.
3. Engel J Jr; International League Against Epilepsy(ILAE). A proposed
diagnostic scheme for people with epileptic seizures and with epilepsy: report
of the ILAE Task Force on Classification and Terminology. Epilepsia. 2001
Jun.42(6): 796-803.
4. Heiskala H. Community-based study of Lennox-Gastaut Syndrome.
Epilepsia.1997 May. 38(5):526-31.
5. Bare MA, Glauser TA, Strawsburg RH. Need for electroencephalogram video
confirmation of atypical absence seizures in children with Lennox-Gastaut
Syndrome. J Child Neurol. 1998 Oct. 13(10):498-500.