Ebook ABC of one to seven (5/E): Part 2
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Ebook ABC of one to seven (5/E): Part 2
CHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2e the most important guide to the diagnosis of a fit•Recurrent attacks with simdar features are essential for the diagnosis of epilepsy.•The attacks may cause changes of consciousness or mood or produce abnormal sensory, motor, or visceral symptoms or signs. These changes are caused by recurring exc Ebook ABC of one to seven (5/E): Part 2essive neuronal discharges in the brain, although the electroencephalogram (EEG) may be normal•Investigations are no substitute for a history taken caEbook ABC of one to seven (5/E): Part 2
refully from a witness and the EEG should not be used to determine whether an episode IS caused by a fit•Documented absence of ỈÉ-rer IS essential to CHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2about 6 in 1000 .schoolchildren whereas the incidence of children with febrile convulsions is about 30 in 1000 preschool children. A single seizure may need investigation but should not be called epilepsy and specific treatment is usually not indicated. When a second attack occurs within 1 month of Ebook ABC of one to seven (5/E): Part 2the first, early treatment is mandatory and may influence long-term outcome.Disability depends partly on the frequency and severity of the fits but alEbook ABC of one to seven (5/E): Part 2
so on the presence or absence of developmental delay, cerebral palsy, or defects in the special senses that would suggest a structural brain abnormaliCHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2cdivided into those with no established aetiology but where there is a probability of genetic origin (idiopathic or primary) and those with a known aetiology (symptomatic or secondary) in which a structural brain lesion is suspected or can be shown. Epileptic fits can be divided into generalized or Ebook ABC of one to seven (5/E): Part 2partial seizures. Generalized seizures include tonic-clonic, absence, and myoclonic fits. Partial seizures include focal and temporal lobe fits.ARC ofEbook ABC of one to seven (5/E): Part 2
One to Seven, 5th edition. Edited by II Valman. © 2010 Bhckwdl Publishing. ISBN: 974-1-4051-8105-1.Box 211 Assessment of epilepsy•Developmental levelCHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2seizures. The child may appear irritable or show other unusual behaviour for a few minutes or even for hours before an attack. Sudden loss of consciousness occurs during the tonic phase, which lasts 20-30 seconds and is accompanied by temporary cessation of respiratory movements and central cyanosis Ebook ABC of one to seven (5/E): Part 2. The clonic phase follows with jerking movement of limbs and face. The movements gradually stop and the child may sleep for a few minutes before wakiEbook ABC of one to seven (5/E): Part 2
ng, confused and irritable. The best prognosis occurs in older children and those who respond promptly to anticonvulsants. When epilepsy is secondary CHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2cial value in children with a structural brain abnormality. Sodium valproate should not be used in polytherapy in infants under the age of 3 years, or in liver disease as fatal hepatotoxicity may occur. The drug should also be stopped if there are prodromal signs of nausea, vomiting, anorexia, or le Ebook ABC of one to seven (5/E): Part 2thargy. Anticonvulsants are given until 2-4 years have passed with no symptoms and then discontinued gradually over several months.Over half of patienEbook ABC of one to seven (5/E): Part 2
ts with idiopathic tonic-clonic epilepsy and normal EEG have no recurrence, and a similar good prognosis is found in over 75% of patients who have beeCHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2 and can be precipitated by hyperventilation. Typical absence attacks are rarely associated with developmental delay or a structural brain abnormality. There80Figure 21.1 Fk-I lnxsiieiri.iltxit.iin |FFG) in.ilyz'iKf I^tikiz.yis a typical EEG appearance (Figure 21.1) and the frequent attacks respond Ebook ABC of one to seven (5/E): Part 2promptly to ethosuximide, sodium valproate, or lamotrigine inưoduccd slowly. Treatment is continued for 2 years after the fils have been controlled.CaEbook ABC of one to seven (5/E): Part 2
rliarnazepine may exacerbate absence seizures, especially if the blcxxl concentration is high.Figure 21.2 I’artal seizures begn in a soecrfie part of CHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness are Ebook ABC of one to seven (5/E): Part 2tal delay and some evidence of brain abnormality before the fits begin. The child may have a variety of seizures including:1Symmetrical synchronous flexion movements (myoclonic);2Brief loss of consciousness; or3Sudden head-dropping attacks (atonic-akinetic). Ebook ABC of one to seven (5/E): Part 2CHAPTER 21EpilepsyBernard VaỉtnanNorthwick Park Hospital and Imperial College London, UKOVERVIEW•Detailed observations of the episode by a witness areGọi ngay
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