Prophylactic antiepileptics are used after traumatic brain injury to prevent post-traumatic seizures. While prophylaxis with phenytoin decreases early seizures, it does not reduce the risk of late post-traumatic epilepsy. Levetiracetam may be superior to phenytoin as it has antiepileptogenic properties in animal models. However, evidence is still lacking and more research is needed to determine the ideal drug, duration of treatment, and whether prophylaxis reduces long-term disability from post-traumatic epilepsy. Genetic factors may also influence an individual's risk, and warrant further investigation.
Kapan aneurysma yang belum ruptur memerlukan intervensi?
"In the decision-making process, the PHASES score may be considered for predicting a patient’s risk of aneurysm rupture."
Kapan aneurysma yang belum ruptur memerlukan intervensi?
"In the decision-making process, the PHASES score may be considered for predicting a patient’s risk of aneurysm rupture."
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
This is a lecture by Dr. Mark Rosner from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Introduction of Autoimmune encephalitis for Non medical professionals and mental health professionals work in neurology. Reference provided in last slide and prepared of self learning purpose not for any commercial purpose.
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
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.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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!
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
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Introduction
• Seizures are a longterm complication of
trauma
• Early seizures- less likely to recur
• 4% of epilepsy –are traumatic
• Major disability in trauma survivors, 15-24
years
3. Classification of post traumatic
seizures
• Immediate /concussive seizures < 24 hours
• Early 24 hrs – 7 days
• Late >7 days
4.
5. Late post-traumatic epilepsy
• Pathogenesis of late PTE remains unknown
• Studies suggest that - Iron-induced lipid peroxidation of
neural membranes may accompany cerebral
haemorrhage
• prophylactic use of standard anticonvulsant drugs is
unsubstantiated
• K.A. Dakin, D.F. WeaverMechanisms of post-traumatic seizures: a quantum
pharmacological analysis of the molecular properties of an epileptogenic focus
following iron-induced membrane peroxidation. Seizure.Europian journal of
Epilepsy DOI: http://dx.doi.org/10.1016/S1059-1311(05)80098-6
6. Late PTE
• 86% of patients with one late posttraumatic
seizure had a second seizure within 2 years
• Haltiner AM, Temkin NR, Dikmen SS. Risk of seizure recurrence after the
first late posttraumatic seizure. Arch Phys Med Rehabil 1997;78:835–40.
7. Incidence of seizures following
trauma
Severe head injury -7.1% within 1 year and
11.5% in 5 years,
moderate injury -0.7 and 1.6%,
mild injury -0.1 and 0.6%.
Annegers JF, Grabow JD, Groover RV, Laws ER Jr, Elveback LR,
Kurland LT. Seizures after head trauma: a population study.
Neurology. 1980 Jul;30(7 Pt 1):683-9.
9. • Seizure activity in the early post-traumatic
period following head injury may cause
secondary brain damage as a result of
increased metabolic demands, raised
intracranial pressure and excess
neurotransmitter release.
10. NATURAL HISTORY OF
POSTTRAUMATIC EILEPSY
• The lifetime total number of seizures in patients
with PTE is not associated with any identifiable
variables such as age or severity of injury,
• 39% of patients in the Korean conflict veteran
series had a total of between one and three
seizures during a 10-year period of follow-up.
• Of the same group, however, 38% had >30
seizures
• Caveness WF, Meirowsky AM, Rish BL, et al. The nature of posttraumatic
epilepsy. J Neurosurg 1979;50:545–53.
11. • Remission rates among patients with PTE range from 25 to
40%, with higher overall remission rates reported in studies
done after the development of effective AEDs.
• One early study found that seizure remission was less likely
in patients whose seizures began later after injury,
especially if the latency to seizure onsetwas>4 years
• Jennett B. Epilepsy after non-missile head injuries. England:
William Heinemann Medical Books, 1975.
12. • However, no significant relation exists between
the latency to first seizure and seizure duration or
persistence , although patients with frequent
seizures in the first year will often continue to
have frequent seizures and have a smaller chance
of seizure remission .
• Salazar AM, Jabbari B, Vance SC, et al. Epilepsy after
penetrating head injury, I: clinical correlates: a report of
theVietnam Head Injury Study. Neurology 1985;35:1406–14.
13. • Most patients who will have a second unprovoked late
PTE do so during the first 2 years after their first late
PTE. Haltiner et al. reported that up to 86% of TBI
survivors with a first PTE will also have a second within
the following 2 years .
• A certain percentage of PTS patients remain refractory
to AED therapy. For example, in the treatment arms of
various anticonvulsant prophylactic trials, a pooled
estimate of 13.3% seized despite aggressive treatment
regimens .
• Schierhout G, Roberts I. Prophylactic antiepileptic agents after head
injury: a systematic review. JNNP 1998;64:108–12.
14. Risk factors
Chesnut RM: Secondary brain insults after head injury: clinical perspectives.
New Horiz 1995, 3:366-75.
Temkin NR: Risk factors for posttraumatic seizures in adults. Epilepsia 2003,
44(Suppl 10):18-20.
18. • The idea behind the use of AEDs in the
immediate post-injury period is based on the
desire to prevent the development of late PTE
as a long-term, and at times debilitating,
comorbidity, ie, finding a time window for an
intervention that will stop the process of
epileptogenesis.
19. • As per guidelines from multiple organizations,
including the Brain Trauma Foundation and the
American Academy of Neurology, the most
commonly used prophylactic agent is PHT, which
is typically administered for the first 7 days after
TBI.
• Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of
Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain
injury: report of the Quality Standards Subcommittee of the American Academy of
Neurology. Neurology. 2003;60(1):10–16.
• Rowe AS, Goodwin H, Brophy GM, et al; Neurocritical Care Society Pharmacy Section. Seizure
prophylaxis in neurocritical care: a review of evidence-based support. Pharmacotherapy.
2014;34(4):396–409.
20. • But, while prophylaxis with PHT decreases the
incidence of early posttraumatic seizures from
14.2% to 3.6% when compared with placebo,
this treatment has not been shown to
decrease the risk of late posttraumatic
seizures and epilepsy
• Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin
for the prevention of post-traumatic seizures. N Engl J Med. 1990;323(8):497–502.
23. Cochrane review...
• six randomised controlled trials, including 1405 participants
• the pooled relative risk (RR) for early seizure prevention was 0.34 (95%CI
0.21, 0.54); based on this estimate, for every 100 patients treated, 10 would
be kept seizure free in the first week.
• Seizure control in the acute phase was not accompanied by a reduction in
mortality (RR = 1.15; 95%CI 0.89, 1.51), a reduction in death and
neurological disability (RR = 1.49; 95%CI 1.06, 2.08 for carbamazepine
and RR = 0.96; 95%CI 0.72, 1.26 for phenytoin) or a reduction in late
seizures (pooled RR = 1.28; 95%CI 0.90, 1.81). The pooled relative risk for
skin rashes was 1.57 (95%CI 0.57, 39.88).
• Schierhout G1, Roberts I, Antiepileptic drugs for preventing seizures following
acute traumatic brain injury. Cochrane Database Syst Rev. 2012 Jun
13;6:CD000173. doi: 10.1002/14651858.CD000173.
24. author concluded
• that Prophylactic AED -reduces early seizures,
no evidences for late seizures.
• Pitfall - Insufficient evidence is available to
establish the net benefit of prophylactic
treatment at any time after injury.
25. Conclusions—Seizures occur in more than one in
five patients during the 1st week after moderate-to-
severe brain injury and may play a role in the
pathobiological conditions associated with brain
injury.
26. • Whether the usual 7- day course of antiepileptic
prophylaxis established by Temkins et al., and
now widely used within the neurosurgical
community for the TBI population, could be
applied to specific subset of patients????
• The role of antiseizure prophylaxis following
head injury. Brain Trauma Foundation:
Antiseizure prophylaxis. J Neurotrauma.
2007;24:S83–6.
27. • There are ample number of evidences
regarding prophylactic AED for early PTE but
evidences are lacking for late PTE
28. PTE in paediatric population
• Prophylactic AED is recommended in children
with diffuse cerebral edema, acute subdural
hematoma, open, depressed skull fracture with
parenchymal damage, or severe head injury
• 35% of severely head-injured children compared
to 5.1% with minor head injury .
• Hahn YS1, Fuchs S, Flannery AM, Barthel MJ, McLone DG. Factors
influencing posttraumatic seizures in children. Neurosurgery. 1988
May;22(5):864-7.
29. • BTF recommended prophylaxis therapy to
prevent early post-traumatic seizure in TBI
patients who are at high risk for seizures
• The risk factors include: GCS score < 10, cortical
contusion, depressed skull fracture, subdural
hematoma, epidural hematoma, intracerebral
hematoma, penetrating TBI, and seizures within
24 hours of injury
• Chesnut RM: Secondary brain insults after head injury:
clinical perspectives. New Horiz 1995, 3:366-75.
• Temkin NR: Risk factors for posttraumatic seizures in adults.
Epilepsia 2003, 44(Suppl 10):18-20.
30. • Vivek Ramakrishnan et al. Anti-epileptic prophylaxis in traumatic brain injury:
A retrospective analysis of patients undergoing craniotomy versus
decompressive craniectomy, Surg Neurol Int. 2015; 6: 8. Published online 2015
Jan 20. doi: 10.4103/2152-7806.149613 PMCID: PMC4310133
• Study shows a trend toward increased seizure incidence in
craniectomy group, which does not reach significance, but
suggests they are at higher risk. Whether this higher risk
translates into a benefit on being on AEDs for a longer
duration than the current standard of 7 days cannot be
concluded as there is no significant difference or trend on
the onset date for seizures in either group. Moreover, a
prospective study will be necessary to more profoundly
evaluate the duration of AED prophylaxis for each one of
the stated groups.
32. • None of the drugs studied (phenytoin,
phenobarbital, their combination,
carbamazepine, valproate, or magnesium)
have shown reliable evidence that they
prevent, or even suppress,
epileptic seizures after TBI
• Epilepsia. 2009 Feb;50 Suppl 2:10-3. doi: 10.1111/j.1528-1167.2008.02005.x.
• Preventing and treating posttraumatic seizures: the human experience.
• Temkin NR1.
33. Leviteracetam vs phenytoin
• Past attempts at preventing posttraumatic
epilepsy (PTE) using antiepileptic drugs (AEDs)
have been unsuccessful, probably because
those older AEDs either had no
antiepileptogenic effect in animal models
(phenytoin sodium and carbamazepine) or
had effects in doses too high and toxic for
human use (phenobarbital sodium, valproate
sodium, and clonazepam).
34. Incidence of PTE less with
levetiracetam- Pavel kleim et al 2012
35. • Löscher and Brandt review:
• Relevant levetiracetam levels in blood retards
kindling with a true antiepileptogenic (vs
anticonvulsant
• prevents epilepsy in a genetic model of epilepsy,
the “spontaneously epileptic rat.”
• levetiracetam attenuates the development of
spontaneous seizures after self-sustaining status
epilepticus .
36. • block increases in neuronal excitability and
synchronization, 2 key processes of
epileptogenesis. Other AEDs (such as
phenobarbital, valproate sodium, lamotrigine,
or clonazepam) lack these effects.
38. Conclusions
Levetiracetam treatment resulted in a similar incidenceof EEG-proven PTS when
compared to phenytoin with similar ICU, hospital, and study drug cost.
Phenytoin prophylaxis was associated with a higher total AED cost than
levetiracetam.
39. Other drugs
• Prophylactic efficacy of other drugs, like lipid
peroxidation inhibitors, neuroprotectors
(especially antioxidants), glutamic receptor
blockers, NMDA receptor blockers, and drugs
that modulate apoptosis via caspasas
inhibition--- to be well established
• Rev Neurol. 2002 Mar 1-15;34(5):448-59.
• [Preventive prophylactic treatment in posttraumatic epilepsy].
• Oliveros-Juste A1, Bertol V, Oliveros-Cid A
40. Genetic study
To date, genetic studies have primarily focused on the molecular
events that contribute to epileptogenesis after traumatic injury.
APOE 4 has been associated
aminobutyric acid receptor
haptoglobin HPh2–2 allele
hypothesized that longer-term events have specific molecular
triggers, which in turn could be linked to specific genotypes.
warrant further study for targetted medications.
Gurnett CA, Hedera P. New ideas in epilepsy genetics: novel epilepsy genes, copy number alterations, and gene regulation. Arch
Neurol 2007;64:324 –328.
Benarroch EE. GABAA receptor heterogeneity, function, and implications for epilepsy. Neurology 2007;68:612– 614.
Bazan NG, Serou MJ. Second messengers, long-term potentiation, gene expression and epileptogenesis. Adv Neurol 1999;79:659–
664.
Prince DA. Epileptogenic neurons and circuits. Adv Neurol 1999;79:665– 684