Problems in the management of epilepsy
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The document discusses various topics related to the medical and surgical management of epilepsy including: 1. Classification of epilepsy, diagnostic testing such as EEG and neuroimaging, medication options and monitoring, management during pregnancy, and surgical treatment options. 2. Key factors in determining treatment include the epilepsy type, underlying causes, age of onset, control of seizures, and location of the epileptic focus. 3. Surgical options like temporal lobectomy can provide seizure freedom for 50% of patients after 2 years when the epileptic focus is in the temporal lobe.
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Hip dislocation
Definition:-
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Recurrent convulsions in pregnancy 2
This document discusses the management of recurrent seizures in pregnancy. It can be caused by eclampsia, epilepsy, neurological pathology, or complications of critical illness. For pregnant women presenting with seizures, the first step is stabilization of vital signs and determining if the cause is eclampsia by checking for hypertension and proteinuria. If it is eclampsia, magnesium sulfate is given for seizures along with controlling blood pressure. Investigations are done to identify other potential causes while treating seizures. Both maternal and fetal complications are discussed. Special considerations for managing epilepsy in pregnancy include monitoring anticonvulsant drug levels and making appropriate adjustments.
The seizing patient
This document discusses the classification, causes, management, and case scenarios of seizures and status epilepticus. It begins by defining seizures and differentiating between primary and secondary types. Various causes of reactive seizures in adults are outlined. Status epilepticus is defined as prolonged or serial seizure activity without recovery. Common causes and management strategies are discussed. Four case scenarios of patients presenting with seizures are then presented and managed. The document concludes by emphasizing the importance of aggressive therapy for status epilepticus and discussing newer anti-seizure medications.
PREGNANCY WITH CONVULSIONS
This document provides information on convulsions during pregnancy. It discusses the different causes of convulsions including eclampsia, epilepsy, infections, tumors, and electrolyte imbalances. Eclampsia is defined as new-onset seizures in a woman with preeclampsia after 20 weeks of gestation. The incidence of eclampsia is higher in developing countries. Magnesium sulfate is the primary treatment for preventing seizures in eclampsia. Management of eclampsia involves controlling blood pressure, delivering the fetus, and preventing further seizures and complications. Epilepsy during pregnancy can increase risks for the fetus but does not necessarily contraindicate breastfeeding with proper monitoring and treatment.
Epilepsy Management: Key issues and challenges
This brief presentation summarises the key issues and challenges in Epilepsy management, including diagnosis, treatment, compliance, special populations, adverse effects, psychiatric comorbidities and ASM withdrawal.
Epilepsy - pharmacology
Epilepsy is caused by excessive neuronal discharge in the brain and can cause seizures and abnormal neurological symptoms depending on the site of origin. Seizures are generally classified as partial or generalized based on whether neuronal activity is localized or spreads widely. Anti-seizure medications work by various mechanisms like enhancing GABA inhibition, blocking sodium or calcium channels, and interfering with glutamate transmission to suppress seizure activity. Treatment choice depends on seizure type, patient factors, and drug characteristics and side effects.
8 epilpsy
This document discusses epilepsy and its treatment. It begins by discussing guidelines for treating a first seizure, including that 16-62% of patients will have another seizure within 5 years. It then discusses guidelines for antiepileptic drug therapy, including starting with monotherapy using a first-line drug and optimizing compliance. If the first drug fails, a second first-line drug is tried before moving to second-line drugs or alternative treatments if needed. Common antiepileptic drugs from both old and new classes are listed along with their mechanisms of action and side effect profiles. Factors like epilepsy type, drug interactions, contraception, and pregnancy are addressed. Status epilepticus is defined as a medical emergency.
Pancreatitis.2012
George, a 40-year-old male with a history of chronic alcoholism and gallstones, presented with severe abdominal pain after starting sulfasalazine for ulcerative colitis. Lab results showed elevated amylase, lipase, and white blood cell count. The physician's diagnosis was acute pancreatitis, likely caused by sulfasalazine triggering the condition. Due to the severity of symptoms and lab abnormalities, the patient should be admitted to the ICU and given IV fluids, analgesics, and monitored closely for complications of acute pancreatitis.
Drug induced hyperprolactinaemia, do we have to treat
During antipsychotic treatment, prolactin concentrations can rise to ten times normal levels or above.
Existing data indicate that 17-78% of female patients have amenorrhoea with or without galactorrhoea.
Survey data, however, suggest that clinicians underestimate the prevalence of these conditions.
Long-term consequences of antipsychotic-related hypo-oestrogenism require further research but are likely to include premature bone loss.
Antipsychotic-induced hyperprolactinaemia should become a focus of interest in the drug treatment of psychiatric patients.
Seizures epileptics in children
This document discusses status epilepticus (SE), which refers to prolonged or repeated seizures without recovery between seizures. It defines SE as a single seizure lasting over 30 minutes or multiple seizures without recovery over 30 minutes. The longer SE persists, the harder it is to control and the higher the risk of complications. SE can be life-threatening and cause hypoxia, respiratory issues, hemodynamic changes, acidosis, and other systemic alterations. The document outlines treatment for SE, including securing airways, intravenous access, treating underlying causes, giving anticonvulsants like benzodiazepines and phenytoin rapidly followed by longer-acting drugs, and managing complications. It also discusses non-convulsive SE which can be
Antiepileptics I & Ii
The document defines epilepsy as a group of disorders characterized by chronic recurrent seizures caused by abnormalities in brain electrical activity. It provides definitions for several epilepsy-related terms and seizure types. It also summarizes epidemiological data on incidence and prevalence of epilepsy worldwide. Classification systems for seizures, antiepileptic drugs, and treatment principles and approaches for status epilepticus are outlined.
Seizure disorders
This document provides an overview of seizure disorders including basics, epidemiology, risk factors, pathophysiology, diagnosis, treatment, and prognosis. Some key points:
- Seizures are caused by excessive firing of neurons resulting in impaired brain function. Common causes include brain tumors, head injuries, infections, genetic factors.
- Around 200,000 new cases of epilepsy are diagnosed in the US each year, most commonly in children under 15 and older adults over 65.
- Diagnosis involves differentiating epileptic from non-epileptic seizures based on eyewitness accounts and EEG/MRI testing. Initial lab work checks for metabolic causes.
- Treatment primarily involves anti-epileptic medications chosen based
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Drug induced hyperprolactinaemia, do we have to treat
Drug induced hyperprolactinaemia, do we have to treat
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Lead poisoning in neurology
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Spinal cord disorders Anatomical Approach
This document provides an overview of spinal cord anatomy and disorders. It describes the spinal cord's location and functions, including conduction of information between the brain and body, control of locomotion, and reflexes. Anatomically, it details the spinal cord's segments, gray and white matter structures, vascular supply, and coverings. Regarding disorders, it notes that compressive myelopathies can be extradural or intradural, and intrinsic lesions can be intramedullary. Clinical features of spinal cord disorders include patterns of motor, sensory and autonomic dysfunction depending on the level and nature of the lesion.
Should we allow natural death?
Acceptance for death has become extremely rare among patients and caregivers. Situation is grave in Indian hospitals.
Chronic progressive external ophthalmoplegia
Chronic progressive external ophthalmoplegia (CPEO) is a descriptive term for a heterogeneous group of disorders characterized by chronic, progressive, bilateral, and usually symmetric ocular motility deficit and ptosis, without pain, proptosis and pupil involvement. Commonly a syndrome of Mitochondrial Cytopathy.
Motivating hospital workers
This document discusses different theories of motivation in the workplace. It covers intrinsic and extrinsic motivators, Maslow's hierarchy of needs, Herzberg's two-factor theory, and equity theory. The document also examines what motivates people in different countries, what employees value in their jobs, and how the 40-hour work week emerged. A key point is that while pleasure, leisure, and happiness are often seen as motivators, a truly happy and motivated person would feel compelled to act due to their nature but remain detached from outcomes and desires.
Brain stem 2014
This document discusses the anatomy and development of the brain stem. It begins with an overview of the three main regions of the brain stem - the medulla, pons, and midbrain. It then examines the development of the brain stem and cranial nerves in the early stages of gestation. The majority of the document focuses on detailed images and descriptions of the gross and microscopic anatomy of structures within the brain stem, including nuclei, tracts, and cranial nerve pathways.
Muscle tone
1) Muscle tone is a state of partial contraction of resting muscle that maintains body posture through continuous motor impulses from reflexes.
2) Muscle spindles are stretch receptors that provide sensory feedback on muscle length and rate of stretch. Their afferents signal to the CNS and regulate motor neuron activity.
3) Spasticity results from loss of supraspinal control over reflexes after upper motor neuron injury, causing velocity-dependent increases in tonic stretch reflexes and impaired voluntary movement.
Cerebellum Anatomy and Physiology
The document provides information about the cerebellum including its anatomical subdivisions, development, functional organization, and connections. It discusses the phylogenetic organization of the spinocerebellum, pontocerebellum, and vestibulocerebellum. It also summarizes the functions of the archicerebellum, paleocerebellum, and neocerebellum as well as cerebellar abnormalities caused by lesions in different areas.
Corticospinal system
The document summarizes research on the organization and function of the motor nervous system and motor cortex. It describes that the primary motor cortex directly controls spinal motor neurons to enable fine movement control. The dorsal premotor cortex contains movement-related neurons that encode sensorimotor transformations for visually and sensory-cued movements. The ventral premotor cortex encodes learned motor acts and fires before movement execution. Long-term practice leads to more extensive representation of movements in the primary motor cortex, demonstrating the adaptability and plasticity of cortical motor areas.
Motor paralysis clinical
This document discusses the motor nervous system and motor paralysis from multiple levels including:
- The motor cortex and its connections to other brain areas
- The extrapyramidal and pyramidal systems
- Different types of apraxia and their lesion locations
- Lesions of the brainstem, spinal cord, nerves and muscles that can cause hemiplegia, monoplegia, or paraplegia
- The clinical features and localization of upper and lower motor neuron lesions
- Specific motor syndromes and their etiologies
It provides an overview of the organization of the motor system and localization of lesions throughout the nervous system that can result in different clinical motor deficits.
Basal Ganglia Clinical Anatomy Physiology
The document discusses the basal ganglia, including its subdivisions and connections. It describes the basal ganglia's role in voluntary movement, including initiation and control of movement. Disorders of the basal ganglia like Parkinson's disease can cause issues with movement including bradykinesia, rigidity, and tremors. Lesion and stimulation studies in animals help explain how abnormalities in basal ganglia circuits lead to motor symptoms.
Myoclonus
This document provides information about myoclonus, which are sudden, shock-like contractions of muscles. It describes different types of myoclonus including focal, cortical, brainstem, spinal, peripheral, multifocal, generalized, essential, and childhood myoclonic epilepsies. Diagnostic tests like EMG and EEG are discussed. Various causes and treatment options are also mentioned.
Athetosis and dystonia
This document discusses athetosis and dystonia. It defines athetosis as irregular, slow writhing movements, often of the extremities and fingers. Dystonia is defined as an abnormal sustained muscle contraction causing twisting movements and abnormal postures. The document describes the clinical presentations and patterns of movement seen in athetosis. It discusses the potential pathophysiology of athetosis involving lesions in the frontal lobes, parietal lobes, and putamen. Causes of athetosis in children and adults are provided. Dystonia is similarly defined and classified. Potential pathology, types, hereditary forms, and secondary causes of dystonia are outlined in detail.
Tic disorder
This document discusses tic disorders, including Tourette Syndrome. It describes the characteristics and symptoms of simple and complex motor and vocal tics. Tourette Syndrome is defined by the presence of multiple motor and vocal tics with onset before age 18 that have been present for over a year. The document discusses the pathophysiology involving dopamine dysfunction and potential genetic and environmental factors. Diagnostic criteria from the Tourette Syndrome Study Group and DSM-IV are provided. Prognosis is noted to be generally good, with marked improvement in tics occurring in late teens to early twenties for most patients.
Chorea and ballismus
1. Chorea is a state of excessive, spontaneous, irregular movements that are randomly distributed and abnormal in character. It can range from mild restlessness to violent disabling movements.
2. Ballismus involves proximal, flinging, violent involuntary movements. Both chorea and ballismus are associated with basal ganglia dysfunction and abnormal neurotransmitter levels like decreased GABA and increased dopamine.
3. Causes of chorea and ballismus include infections, metabolic and endocrine disorders, drugs, trauma, vascular events, tumors, and hereditary conditions like Huntington's disease. Treatment involves reducing dopamine levels with antipsychotics or GABA agonists, as well as surgical procedures like pallidotomy or thalamotomy
Management of Tremor
This document provides information on different types of tremors, including their causes, characteristics, and pathophysiology. It discusses rest tremor seen in Parkinson's disease and other conditions. It also covers postural tremor, physiological tremor, essential tremor, kinetic tremor, and cerebellar intention tremor. For each type of tremor, the summary highlights key details like involved areas of the brain, typical frequencies, symptoms, and potential treatments.
Hypertension and stroke
This was lecture given at College of General Practitioner Hyderabad on 16th June 2013 as refresher course on Hypertension
Rapidly Progressive Fatal Neuromyositis
A 42/f presented with rapidly progressive Neruo-myositis with quadriplegia unresponsive to Immunosuppression.
Stroke management
This is a short presentation at Down Town Hospital clinical meeting for DNB Medicine students. It dose not cover the all aspects of stroke care especially Thrombolysis, since it is difficult to practice for Medical specialist, and ischemic stroke is not common in North East India
Neurologic manifestation of HIV/AIDS
This document discusses the neurologic manifestations of HIV/AIDS in India. Some key points include:
- Opportunistic infections like cryptococcal meningitis and tuberculosis account for the majority (around 70%) of neurologic events seen in HIV patients in India.
- Conditions like progressive multifocal leukoencephalopathy and myelopathy are relatively rare compared to Western countries.
- Common neurologic manifestations include meningitis, mass lesions in the brain, and various neuropathies.
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