chapter 4. studies on seizures and epilepsy

Transcription

THE OFFICIAL
PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D.
AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications
ICON Group International, Inc.
4370 La Jolla Village Drive, 4th Floor
San Diego, CA 92122 USA
Copyright Ó2003 by ICON Group International, Inc.
Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it
may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without written permission from the publisher.
Printed in the United States of America.
Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle
Editor(s): James Parker, M.D., Philip Parker, Ph.D.
Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for
consultation with your physician. All matters regarding your health require medical supervision. As new medical or
scientific information becomes available from academic and clinical research, recommended treatments and drug therapies
may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date
and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not
responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or
implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in
accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation,
in close consultation with a qualified physician. The reader is advised to always check product information (package inserts)
for changes and new information regarding dose and contraindications before taking any drug or pharmacological product.
Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements,
alternative therapies, complementary therapies and medicines, and integrative medical treatments.
Cataloging-in-Publication Data
Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Seizures and Epilepsy: A Revised and Updated Directory for the Internet
Age/James N. Parker and Philip M. Parker, editors
p.
cm.
Includes bibliographical references, glossary and index.
ISBN: 0-597-83535-7
1. Seizures and Epilepsy-Popular works.
I. Title.
iii
Disclaimer
This publication is not intended to be used for the diagnosis or treatment of a health
problem or as a substitute for consultation with licensed medical professionals. It is sold
with the understanding that the publisher, editors, and authors are not engaging in the
rendering of medical, psychological, financial, legal, or other professional services.
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not responsible for the content of any Web pages nor publications referenced in this
publication.
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If a physician wishes to copy limited passages from this sourcebook for patient use, this
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iv
Dedication
To the healthcare professionals dedicating their time and efforts to the study of seizures and
epilepsy.
Acknowledgements
The collective knowledge generated from academic and applied research summarized in
various references has been critical in the creation of this sourcebook which is best viewed
as a comprehensive compilation and collection of information prepared by various official
agencies which directly or indirectly are dedicated to seizures and epilepsy. All of the
Official Patient’s Sourcebooks draw from various agencies and institutions associated with the
United States Department of Health and Human Services, and in particular, the Office of the
Secretary of Health and Human Services (OS), the Administration for Children and Families
(ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and
Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the
Centers for Disease Control and Prevention (CDC), the Food and Drug Administration
(FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services
Administration (HRSA), the Indian Health Service (IHS), the institutions of the National
Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and
Mental Health Services Administration (SAMHSA). In addition to these sources,
information gathered from the National Library of Medicine, the United States Patent Office,
the European Union, and their related organizations has been invaluable in the creation of
this sourcebook. Some of the work represented was financially supported by the Research
and Development Committee at INSEAD. This support is gratefully acknowledged. Finally,
special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
v
About the Editors
James N. Parker, M.D.
Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the
University of California, Riverside and his M.D. from the University of California, San
Diego. In addition to authoring numerous research publications, he has lectured at various
academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook
series published by ICON Health Publications.
Philip M. Parker, Ph.D.
Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at
INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the
University of California, San Diego and has taught courses at Harvard University, the Hong
Kong University of Science and Technology, the Massachusetts Institute of Technology,
Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s
Sourcebook series published by ICON Health Publications.
vi
About ICON Health Publications
In addition to seizures and epilepsy, Official Patient’s Sourcebooks are available for the
following related topics:
·
The Official Patient's Sourcebook on Acute Disseminated Encephalomyelitis
·
The Official Patient's Sourcebook on Agenesis of the Corpus Callosum
·
The Official Patient's Sourcebook on Agnosia
·
The Official Patient's Sourcebook on Arachnoid Cysts
·
The Official Patient's Sourcebook on Arachnoiditis
·
The Official Patient's Sourcebook on Binswanger's Disease
·
The Official Patient's Sourcebook on Brain and Spinal Cord Tumors
·
The Official Patient's Sourcebook on Central Pain Syndrome
·
The Official Patient's Sourcebook on Cerebral Atrophy
·
The Official Patient's Sourcebook on Coma
·
The Official Patient's Sourcebook on Corticobasal Degeneration
·
The Official Patient's Sourcebook on Empty Sella Syndrome
·
The Official Patient's Sourcebook on Headaches
·
The Official Patient's Sourcebook on Locked in Syndrome
·
The Official Patient's Sourcebook on Occipital Neuralgia
·
The Official Patient's Sourcebook on Olivopontocerebellar Atrophy
·
The Official Patient's Sourcebook on Progressive Multifocal Leukoencephalopathy
·
The Official Patient's Sourcebook on Pseudotumor Cerebri
·
The Official Patient's Sourcebook on Stroke
·
The Official Patient's Sourcebook on Syncope
·
The Official Patient's Sourcebook on Todd's Paralysis
·
The Official Patient's Sourcebook on Traumatic Brain Injury
·
The Official Patient's Sourcebook on Wallenberg's Syndrome
To discover more about ICON Health Publications, simply check with your preferred online
booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of
our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts:
ICON Group International, Inc.
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Fax: 858-546-4341
Web site: www.icongrouponline.com/health
Contents vii
Table of Contents
INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1
Organization......................................................................................................... 3
Scope ..................................................................................................................... 3
Moving Forward................................................................................................... 5
PART I: THE ESSENTIALS ................................................. 7
CHAPTER 1. THE ESSENTIALS ON SEIZURES AND EPILEPSY:
GUIDELINES ........................................................................................... 9
Overview............................................................................................................... 9
What Is Epilepsy?............................................................................................... 10
What Causes Epilepsy? ...................................................................................... 12
What Are the Different Kinds of Seizures? ........................................................ 15
What Are the Different Kinds of Epilepsy?........................................................ 17
When Are Seizures Not Epilepsy? ..................................................................... 20
How Is Epilepsy Diagnosed?.............................................................................. 22
Can Epilepsy Be Prevented?............................................................................... 24
How Can Epilepsy Be Treated? .......................................................................... 24
How Does Epilepsy Affect Daily Life? ............................................................... 32
Are There Special Risks Associated with Epilepsy? ........................................... 36
What Research Is Being Done on Epilepsy?....................................................... 38
How Can I Help Research on Epilepsy?............................................................. 39
What to Do If You See Someone Having a Seizure............................................ 41
Information Resources ........................................................................................ 43
More Guideline Sources ..................................................................................... 46
Vocabulary Builder............................................................................................. 58
CHAPTER 2. SEEKING GUIDANCE ....................................................... 67
Overview............................................................................................................. 67
Associations and Seizures and Epilepsy............................................................. 67
Finding More Associations................................................................................. 74
Finding Doctors.................................................................................................. 75
Finding a Neurologist......................................................................................... 76
Selecting Your Doctor ........................................................................................ 77
Working with Your Doctor ................................................................................ 77
Broader Health-Related Resources ..................................................................... 79
Vocabulary Builder............................................................................................. 79
CHAPTER 3. CLINICAL TRIALS AND SEIZURES AND EPILEPSY ........... 81
Overview............................................................................................................. 81
Recent Trials on Seizures and Epilepsy.............................................................. 84
Benefits and Risks............................................................................................. 105
Keeping Current on Clinical Trials.................................................................. 108
viii Contents
General References............................................................................................ 109
Vocabulary Builder........................................................................................... 110
PART II: ADDITIONAL RESOURCES AND
ADVANCED MATERIAL................................................ 113
CHAPTER 4. STUDIES ON SEIZURES AND EPILEPSY ........................... 115
Overview........................................................................................................... 115
The Combined Health Information Database ................................................... 115
Federally Funded Research on Seizures and Epilepsy...................................... 123
E-Journals: PubMed Central ............................................................................ 139
The National Library of Medicine: PubMed .................................................... 140
CHAPTER 5. PATENTS ON SEIZURES AND EPILEPSY.......................... 163
Overview........................................................................................................... 163
Patents on Seizures and Epilepsy..................................................................... 164
Patent Applications on Seizures and Epilepsy................................................. 166
Keeping Current ............................................................................................... 168
CHAPTER 6. BOOKS ON SEIZURES AND EPILEPSY ............................. 171
Overview........................................................................................................... 171
Book Summaries: Federal Agencies .................................................................. 171
Book Summaries: Online Booksellers ............................................................... 180
The National Library of Medicine Book Index ................................................. 181
Chapters on Seizures and Epilepsy................................................................... 185
General Home References ................................................................................. 194
CHAPTER 7. MULTIMEDIA ON SEIZURES AND EPILEPSY................... 197
Overview........................................................................................................... 197
Video Recordings .............................................................................................. 197
Bibliography: Multimedia on Seizures and Epilepsy ....................................... 209
CHAPTER 8. PERIODICALS AND NEWS ON SEIZURES AND EPILEPSY 213
Overview........................................................................................................... 213
News Services & Press Releases ....................................................................... 213
Newsletter Articles ........................................................................................... 218
Academic Periodicals covering Seizures and Epilepsy..................................... 219
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 223
Overview........................................................................................................... 223
NIH Guidelines................................................................................................. 223
NIH Databases.................................................................................................. 224
Other Commercial Databases ........................................................................... 231
The Genome Project and Seizures and Epilepsy............................................... 231
Specialized References....................................................................................... 236
Contents
ix
CHAPTER 10. DISSERTATIONS ON SEIZURES AND EPILEPSY ............. 239
Overview........................................................................................................... 239
Dissertations on Seizures and Epilepsy............................................................ 239
Keeping Current ............................................................................................... 240
PART III. APPENDICES .................................................. 241
APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 243
Overview........................................................................................................... 243
Your Medications: The Basics .......................................................................... 243
Learning More about Your Medications .......................................................... 245
Commercial Databases...................................................................................... 249
Contraindications and Interactions (Hidden Dangers) ................................... 250
A Final Warning .............................................................................................. 251
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 255
Overview........................................................................................................... 255
What Is CAM? ................................................................................................. 255
What Are the Domains of Alternative Medicine?............................................ 256
Can Alternatives Affect My Treatment? ......................................................... 259
Finding CAM References on Seizures and Epilepsy........................................ 260
Additional Web Resources................................................................................ 263
APPENDIX C. RESEARCHING NUTRITION ......................................... 293
Overview........................................................................................................... 293
Food and Nutrition: General Principles........................................................... 293
Finding Studies on Seizures and Epilepsy ....................................................... 298
Federal Resources on Nutrition........................................................................ 299
Additional Web Resources................................................................................ 300
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 307
Overview........................................................................................................... 307
Preparation ....................................................................................................... 307
Finding a Local Medical Library ...................................................................... 308
Medical Libraries Open to the Public............................................................... 308
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 315
Overview........................................................................................................... 315
Your Rights as a Patient................................................................................... 315
Patient Responsibilities .................................................................................... 319
Choosing an Insurance Plan............................................................................. 320
Medicare and Medicaid .................................................................................... 322
x
Contents
NORD’s Medication Assistance Programs ..................................................... 325
Additional Resources ........................................................................................ 326
APPENDIX F. NIH CONSENSUS STATEMENT ON SURGERY FOR
EPILEPSY ............................................................................................ 327
Overview........................................................................................................... 327
Abstract ............................................................................................................ 328
What Is Epilepsy?............................................................................................. 328
How Should Patients Be Selected? ................................................................... 330
What Evaluation Is Necessary to Localize Epileptic Foci? .............................. 332
What Procedures Are Appropriate for Specific Epilepsies? ............................. 334
How Should Outcome Be Assessed? ................................................................ 336
Directions for Future Research......................................................................... 337
Conclusions and Recommendations ................................................................. 338
ONLINE GLOSSARIES.................................................... 341
Online Dictionary Directories.......................................................................... 345
SEIZURES AND EPILEPSY GLOSSARY ..................... 347
General Dictionaries and Glossaries ................................................................ 369
INDEX................................................................................... 371
Introduction
1
INTRODUCTION
Overview
Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best
prescription is knowledge.”1 The Agency for Healthcare Research and
Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view
and recommends that every patient incorporate education into the treatment
process. According to the AHRQ:
Finding out more about your condition is a good place to start. By
contacting groups that support your condition, visiting your local
library, and searching on the Internet, you can find good information
to help guide your treatment decisions. Some information may be
hard to find—especially if you don’t know where to look.2
As the AHRQ mentions, finding the right information is not an obvious task.
Though many physicians and public officials had thought that the
emergence of the Internet would do much to assist patients in obtaining
reliable information, in March 2001 the National Institutes of Health issued
the following warning:
The number of Web sites offering health-related resources grows
every day. Many sites provide valuable information, while others may
have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com.
The Agency for Healthcare Research and Quality (AHRQ):
http://www.ahcpr.gov/consumer/diaginfo.htm.
3 From the NIH, National Cancer Institute (NCI):
http://cancertrials.nci.nih.gov/beyond/evaluating.html.
1
2
2
Seizures and Epilepsy
Since the late 1990s, physicians have seen a general increase in patient
Internet usage rates. Patients frequently enter their doctor’s offices with
printed Web pages of home remedies in the guise of latest medical research.
This scenario is so common that doctors often spend more time dispelling
misleading information than guiding patients through sound therapies. The
Official Patient’s Sourcebook on Seizures and Epilepsy has been created for
patients who have decided to make education and research an integral part
of the treatment process. The pages that follow will tell you where and how
to look for information covering virtually all topics related to seizures and
epilepsy, from the essentials to the most advanced areas of research.
The title of this book includes the word “official.” This reflects the fact that
the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced
to give you some of the latest official information available to date on
seizures and epilepsy.
Given patients’ increasing sophistication in using the Internet, abundant
references to reliable Internet-based resources are provided throughout this
sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the
Internet. E-book and electronic versions of this sourcebook are fully
interactive with each of the Internet sites mentioned (clicking on a hyperlink
automatically opens your browser to the site indicated). Hard copy users of
this sourcebook can type cited Web addresses directly into their browsers to
obtain access to the corresponding sites. Since we are working with ICON
Health Publications, hard copy Sourcebooks are frequently updated and
printed on demand to ensure that the information provided is current.
In addition to extensive references accessible via the Internet, every chapter
presents a “Vocabulary Builder.” Many health guides offer glossaries of
technical or uncommon terms in an appendix. In editing this sourcebook, we
have decided to place a smaller glossary within each chapter that covers
terms used in that chapter. Given the technical nature of some chapters, you
may need to revisit many sections. Building one’s vocabulary of medical
terms in such a gradual manner has been shown to improve the learning
process.
We must emphasize that no sourcebook on seizures and epilepsy should
affirm that a specific diagnostic procedure or treatment discussed in a
research study, patent, or doctoral dissertation is “correct” or your best
option. This sourcebook is no exception. Each patient is unique. Deciding on
Introduction
3
appropriate options is always up to the patient in consultation with their
physician and healthcare providers.
Organization
This sourcebook is organized into three parts. Part I explores basic
techniques to researching seizures and epilepsy (e.g. finding guidelines on
diagnosis, treatments, and prognosis), followed by a number of topics,
including information on how to get in touch with organizations,
associations, or other patient networks dedicated to seizures and epilepsy. It
also gives you sources of information that can help you find a doctor in your
local area specializing in treating seizures and epilepsy. Collectively, the
material presented in Part I is a complete primer on basic research topics for
patients with seizures and epilepsy.
Part II moves on to advanced research dedicated to seizures and epilepsy.
Part II is intended for those willing to invest many hours of hard work and
study. It is here that we direct you to the latest scientific and applied
research on seizures and epilepsy. When possible, contact names, links via
the Internet, and summaries are provided. It is in Part II where the
vocabulary process becomes important as authors publishing advanced
research frequently use highly specialized language. In general, every
attempt is made to recommend “free-to-use” options.
Part III provides appendices of useful background reading for all patients
with seizures and epilepsy or related disorders. The appendices are
dedicated to more pragmatic issues faced by many patients with seizures
and epilepsy. Accessing materials via medical libraries may be the only
option for some readers, so a guide is provided for finding local medical
libraries which are open to the public. Part III, therefore, focuses on advice
that goes beyond the biological and scientific issues facing patients with
Scope
While this sourcebook covers seizures and epilepsy, your doctor, research
publications, and specialists may refer to your condition using a variety of
terms. Therefore, you should understand that seizures and epilepsy is often
considered a synonym or a condition closely related to the following:
·
Convulsions
4
·
Jacksonian Seizure
·
Jacksonian Seizures
·
Minor Motor Seizures
·
Petit Mal Seizures
·
Psychomotor Seizures
·
Seizure Disorder
·
Seizures
·
Simple Seizure
In addition to synonyms and related conditions, physicians may refer to
seizures and epilepsy using certain coding systems. The International
Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is
the most commonly used system of classification for the world’s illnesses.
Your physician may use this coding system as an administrative or tracking
tool. The following classification is commonly used for seizures and
epilepsy:4
·
345 epilepsy
·
345.0 generalized nonconvulsive epilepsy
·
345.1 generalized convulsive epilepsy
·
345.2 petit mal status
·
345.3 grand mal status
·
345.4 partial epilepsy, with impairment of consciousness
·
345.5 partial epilepsy, without mention of impairment of consciousness
·
345.5 partial epilepsy, without mention of impairment of con-sciousness
·
345.6 infantile spasms
·
345.7 epilepsia partialis continua
·
345.8 other forms of epilepsy
·
345.9 epilepsy, unspecified
·
780.3 convulsions
·
780.31 febrile convulsions
4 This list is based on the official version of the World Health Organization’s 9th Revision,
International Classification of Diseases (ICD-9). According to the National Technical
Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or
errata other than those approved by the U.S. Public Health Service and the Health Care
Financing Administration are not to be considered official and should not be utilized.
Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
·
5
780.39 other convulsions
For the purposes of this sourcebook, we have attempted to be as inclusive as
possible, looking for official information for all of the synonyms relevant to
seizures and epilepsy. You may find it useful to refer to synonyms when
accessing databases or interacting with healthcare professionals and medical
librarians.
Moving Forward
Since the 1980s, the world has seen a proliferation of healthcare guides
covering most illnesses. Some are written by patients or their family
members. These generally take a layperson’s approach to understanding and
coping with an illness or disorder. They can be uplifting, encouraging, and
highly supportive. Other guides are authored by physicians or other
healthcare providers who have a more clinical outlook. Each of these two
styles of guide has its purpose and can be quite useful.
As editors, we have chosen a third route. We have chosen to expose you to
as many sources of official and peer-reviewed information as practical, for
the purpose of educating you about basic and advanced knowledge as
recognized by medical science today. You can think of this sourcebook as
your personal Internet age reference librarian.
Why “Internet age”? All too often, patients diagnosed with seizures and
epilepsy will log on to the Internet, type words into a search engine, and
receive several Web site listings which are mostly irrelevant or redundant.
These patients are left to wonder where the relevant information is, and how
to obtain it. Since only the smallest fraction of information dealing with
seizures and epilepsy is even indexed in search engines, a non-systematic
approach often leads to frustration and disappointment. With this
sourcebook, we hope to direct you to the information you need that you
would not likely find using popular Web directories. Beyond Web listings, in
many cases we will reproduce brief summaries or abstracts of available
reference materials. These abstracts often contain distilled information on
topics of discussion.
While we focus on the more scientific aspects of seizures and epilepsy, there
is, of course, the emotional side to consider. Later in the sourcebook, we
provide a chapter dedicated to helping you find peer groups and
associations that can provide additional support beyond research produced
by medical science. We hope that the choices we have made give you the
6
most options available in moving forward. In this way, we wish you the best
in your efforts to incorporate this educational approach into your treatment
plan.
The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I
Part I has been edited to give you access to what we feel are “the essentials”
on seizures and epilepsy. The essentials of a disease typically include the
definition or description of the disease, a discussion of who it affects, the
signs or symptoms associated with the disease, tests or diagnostic
procedures that might be specific to the disease, and treatments for the
disease. Your doctor or healthcare provider may have already explained the
essentials of seizures and epilepsy to you or even given you a pamphlet or
brochure describing seizures and epilepsy. Now you are searching for more
in-depth information. As editors, we have decided, nevertheless, to include a
discussion on where to find essential information that can complement what
your doctor has already told you. In this section we recommend a process,
not a particular Web site or reference book. The process ensures that, as you
search the Web, you gain background information in such a way as to
maximize your understanding.
Guidelines
9
CHAPTER 1. THE ESSENTIALS ON SEIZURES AND EPILEPSY:
GUIDELINES
Overview
Official agencies, as well as federally funded institutions supported by
national grants, frequently publish a variety of guidelines on seizures and
epilepsy. These are typically called “Fact Sheets” or “Guidelines.” They can
take the form of a brochure, information kit, pamphlet, or flyer. Often they
are only a few pages in length. The great advantage of guidelines over other
sources is that they are often written with the patient in mind. Since new
guidelines on seizures and epilepsy can appear at any moment and be
published by a number of sources, the best approach to finding guidelines is
to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5
The National Institutes of Health (NIH) is the first place to search for
relatively current patient guidelines and fact sheets on seizures and epilepsy.
Originally founded in 1887, the NIH is one of the world’s foremost medical
research centers and the federal focal point for medical research in the
United States. At any given time, the NIH supports some 35,000 research
grants at universities, medical schools, and other research and training
institutions, both nationally and internationally. The rosters of those who
have conducted research or who have received NIH support over the years
include the world’s most illustrious scientists and physicians. Among them
are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Seizures and Epilepsy
There is no guarantee that any one Institute will have a guideline on a
specific disease, though the National Institutes of Health collectively publish
over 600 guidelines for both common and rare diseases. The best way to
access NIH guidelines is via the Internet. Although the NIH is organized into
many different Institutes and Offices, the following is a list of key Web sites
where you are most likely to find NIH clinical guidelines and publications
dealing with seizures and epilepsy and associated conditions:
·
Office of the Director (OD); guidelines consolidated across agencies
available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M.,
Inc.) with guidelines available at
http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Neurological Disorders and Stroke (NINDS);
http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
Among the above, the National Institute of Neurological Disorders and
Stroke (NINDS) is particularly noteworthy. The mission of the NINDS is to
reduce the burden of neurological disease—a burden borne by every age
group, by every segment of society, by people all over the world.6 To support
this mission, the NINDS conducts, fosters, coordinates, and guides research
on the causes, prevention, diagnosis, and treatment of neurological disorders
and stroke, and supports basic research in related scientific areas. The
following patient guideline was recently published by the NINDS on
What Is Epilepsy?7
Few experiences match the drama of a convulsive seizure. A person having a
severe seizure may cry out, fall to the floor unconscious, twitch or move
uncontrollably, drool, or even lose bladder control. Within minutes, the
attack is over, and the person regains consciousness but is exhausted and
dazed. This is the image most people have when they hear the word
epilepsy. However, this type of seizure—a generalized tonic-clonic
seizure*—is only one kind of epilepsy. There are many other kinds, each
with a different set of symptoms.
6 This paragraph has been adapted from the NINDS:
http://www.ninds.nih.gov/about_ninds/mission.htm. “Adapted” signifies that a passage
has been reproduced exactly or slightly edited for this book.
7 Adapted from The National Institute of Neurological Disorders and Stroke (NINDS):
http://www.ninds.nih.gov/health_and_medical/pubs/seizures_and_epilepsy_htr.htm.
Guidelines 11
Epilepsy was one of the first brain disorders to be described. It was
mentioned in ancient Babylon more than 3,000 years ago. The strange
behavior caused by some seizures has contributed through the ages to many
superstitions and prejudices. The word epilepsy is derived from the Greek
word for “attack.” People once thought that those with epilepsy were being
visited by demons or gods. However, in 400 B.C., the early physician
Hippocrates suggested that epilepsy was a disorder of the brain—and we
now know that he was right.
Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in
the brain sometimes signal abnormally. Neurons normally generate
electrochemical impulses that act on other neurons, glands, and muscles to
produce human thoughts, feelings, and actions. In epilepsy, the normal
pattern of neuronal activity becomes disturbed, causing strange sensations,
emotions, and behavior, or sometimes convulsions, muscle spasms, and loss
of consciousness. During a seizure, neurons may fire as many as 500 times a
second, much faster than the normal rate of about 80 times a second. In some
people, this happens only occasionally; for others, it may happen up to
hundreds of times a day.
More than 2 million people in the United States—about 1 in 100—have
experienced an unprovoked seizure or been diagnosed with epilepsy. For
about 80 percent of those diagnosed with epilepsy, seizures can be controlled
with modern medicines and surgical techniques. However, about 20 percent
of people with epilepsy will continue to experience seizures even with the
best available treatment. Doctors call this situation intractable epilepsy.
Having a seizure does not necessarily mean that a person has epilepsy. Only
when a person has had two or more seizures is he or she considered to have
epilepsy.
Epilepsy is not contagious and is not caused by mental illness or mental
retardation. Some people with mental retardation may experience seizures,
but seizures do not necessarily mean the person has or will develop mental
impairment. Many people with epilepsy have normal or above-average
intelligence. Famous people who are known or rumored to have had
epilepsy include the Russian writer Dostoyevsky, the philosopher Socrates,
the military general Napoleon, and the inventor of dynamite, Alfred Nobel,
who established the Nobel prize. Several Olympic medalists and other
athletes also have had epilepsy. Seizures sometimes do cause brain damage,
particularly if they are severe. However, most seizures do not seem to have a
detrimental effect on the brain. Any changes that do occur are usually subtle,
and it is often unclear whether these changes are caused by the seizures
themselves or by the underlying problem that caused the seizures.
While epilepsy cannot currently be cured, for some people it does eventually
go away. One study found that children with idiopathic epilepsy, or epilepsy
with an unknown cause, had a 68 to 92 percent chance of becoming seizurefree by 20 years after their diagnosis. The odds of becoming seizure-free are
not as good for adults, or for children with severe epilepsy syndromes, but it
is nonetheless possible that seizures may decrease or even stop over time.
This is more likely if the epilepsy has been well-controlled by medication or
if the person has had epilepsy surgery.
What Causes Epilepsy?
Epilepsy is a disorder with many possible causes. Anything that disturbs the
normal pattern of neuron activity — from illness to brain damage to
abnormal brain development — can lead to seizures.
Epilepsy may develop because of an abnormality in brain wiring, an
imbalance of nerve signaling chemicals called neurotransmitters, or some
combination of these factors. Researchers believe that some people with
epilepsy have an abnormally high level of excitatory neurotransmitters that
increase neuronal activity, while others have an abnormally low level of
inhibitory neurotransmitters that decrease neuronal activity in the brain.
Either situation can result in too much neuronal activity and cause epilepsy.
One of the most-studied neurotransmitters that plays a role in epilepsy is
GABA, or gamma-aminobutyric acid, which is an inhibitory
neurotransmitter. Research on GABA has led to drugs that alter the amount
of this neurotransmitter in the brain or change how the brain responds to it.
Researchers also are studying excitatory neurotransmitters such as
glutamate.
In some cases, the brain’s attempts to repair itself after a head injury, stroke,
or other problem may inadvertently generate abnormal nerve connections
that lead to epilepsy. Abnormalities in brain wiring that occur during brain
development also may disturb neuronal activity and lead to epilepsy.
Research has shown that the cell membrane that surrounds each neuron
plays an important role in epilepsy. Cell membranes are crucial for neurons
to generate electrical impulses. For this reason, researchers are studying
details of the membrane structure, how molecules move in and out of
Guidelines 13
membranes, and how the cell nourishes and repairs the membrane. A
disruption in any of these processes may lead to epilepsy. Studies in animals
have shown that, because the brain continually adapts to changes in stimuli,
a small change in neuronal activity, if repeated, may eventually lead to fullblown epilepsy. Researchers are investigating whether this phenomenon,
called kindling, may also occur in humans.
In some cases, epilepsy may result from changes in non-neuronal brain cells
called glia. These cells regulate concentrations of chemicals in the brain that
can affect neuronal signaling.
About half of all seizures have no known cause. However, in other cases, the
seizures are clearly linked to infection, trauma, or other identifiable
problems.
Genetic Factors
Research suggests that genetic abnormalities may be some of the most
important factors contributing to epilepsy. Some types of epilepsy have been
traced to an abnormality in a specific gene. Many other types of epilepsy
tend to run in families, which suggests that genes influence epilepsy. Some
researchers estimate that more than 500 genes could play a role in this
disorder. However, it is increasingly clear that, for many forms of epilepsy,
genetic abnormalities play only a partial role, perhaps by increasing a
person’s susceptibility to seizures that are triggered by an environmental
factor.
Several types of epilepsy have now been linked to defective genes for ion
channels, the “gates” that control the flow of ions in and out of cells and
regulate neuron signaling. Another gene, which is missing in people with
progressive myoclonus epilepsy, codes for a protein called cystatin B. This
protein regulates enzymes that break down other proteins. Another gene,
which is altered in a severe form of epilepsy called LaFora disease, has been
linked to a gene that helps to break down carbohydrates.
While abnormal genes sometimes cause epilepsy, they also may influence
the disorder in subtler ways. For example, one study showed that many
people with epilepsy have an abnormally active version of a gene that
increases resistance to drugs. This may help explain why anticonvulsant
drugs do not work for some people. Genes also may control other aspects of
the body’s response to medications and each person’s susceptibility to
seizures, or seizure threshold. Abnormalities in the genes that control
neuronal migration—a critical step in brain development— can lead to areas
of misplaced or abnormally formed neurons, or dysplasia, in the brain that
can cause epilepsy. In some cases, genes may contribute to development of
epilepsy even in people with no family history of the disorder. These people
may have a newly developed abnormality, or mutation, in an epilepsyrelated gene.
Other Disorders
In many cases, epilepsy develops as a result of brain damage from other
disorders. For example, brain tumors, alcoholism, and Alzheimer’s disease
frequently lead to epilepsy because they alter the normal workings of the
brain. Strokes, heart attacks, and other conditions that deprive the brain of
oxygen also can cause epilepsy in some cases. About 32 percent of all newly
developed epilepsy in elderly people appears to be due to cerebrovascular
disease, which reduces the supply of oxygen to brain cells. Meningitis, AIDS,
viral encephalitis, and other infectious diseases can lead to epilepsy, as can
hydrocephalus—a condition in which excess fluid builds up in the brain.
Epilepsy also can result from intolerance to wheat gluten (known as celiac
disease), or from a parasitic infection of the brain called neurocysticercosis.
Seizures may stop once these disorders are treated successfully. However,
the odds of becoming seizure-free after the primary disorder is treated are
uncertain and vary depending on the type of disorder, the brain region that
is affected, and how much brain damage occurred prior to treatment.
Epilepsy is associated with a variety of developmental and metabolic
disorders, including cerebral palsy, neurofibromatosis, pyruvate deficiency,
tuberous sclerosis, Landau-Kleffner syndrome, and autism. Epilepsy is just
one of a set of symptoms commonly found in people with these disorders.
Head Injury
In some cases, head injury can lead to seizures or epilepsy. Safety measures
such as wearing seat belts in cars and using helmets when riding a
motorcycle or playing competitive sports can protect people from epilepsy
and other problems that result from head injury.
Prenatal Injury and Developmental Problems
The developing brain is susceptible to many kinds of injury. Maternal
infections, poor nutrition, and oxygen deficiencies are just some of the
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conditions that may take a toll on the brain of a developing baby. These
conditions may lead to cerebral palsy, which often is associated with
epilepsy, or they may cause epilepsy that is unrelated to any other disorders.
About 20 percent of seizures in children are due to cerebral palsy or other
neurological abnormalities. Abnormalities in genes that control development
also may contribute to epilepsy. Advanced brain imaging has revealed that
some cases of epilepsy that occur with no obvious cause may be associated
with areas of dysplasia in the brain that probably develop before birth.
Poisoning
Seizures can result from exposure to lead, carbon monoxide, and many other
poisons. They also can result from exposure to street drugs and from
overdoses of antidepressants and other medications.
Seizure Triggers
Seizures are often triggered by factors such as lack of sleep, alcohol
consumption, stress, or hormonal changes associated with the menstrual
cycle. These seizure triggers do not cause epilepsy but can provoke first
seizures or cause breakthrough seizures in people who otherwise experience
good seizure control with their medication. Sleep deprivation in particular is
a universal and powerful trigger of seizures. For this reason, people with
epilepsy should make sure to get enough sleep and should try to stay on a
regular sleep schedule as much as possible. For some people, light flashing at
a certain speed or the flicker of a computer monitor can trigger a seizure; this
problem is called photosensitive epilepsy. Smoking cigarettes also can
trigger seizures. The nicotine in cigarettes acts on receptors for the excitatory
neurotransmitter acetylcholine in the brain, which increases neuronal firing.
Seizures are not triggered by sexual activity except in very rare instances.
What Are the Different Kinds of Seizures?
Doctors have described more than 30 different types of seizures. Seizures are
divided into two major categories—partial seizures and generalized seizures.
However, there are many different types of seizures in each of these
categories.
Partial Seizures
Partial seizures occur in just one part of the brain. About 60 percent of
people with epilepsy have partial seizures. These seizures are frequently
described by the area of the brain in which they originate. For example,
someone might be diagnosed with partial frontal lobe seizures.
In a simple partial seizure, the person will remain conscious but may
experience unusual feelings or sensations that can take many forms. The
person may experience sudden and unexplainable feelings of joy, anger,
sadness, or nausea. He or she also may hear, smell, taste, see, or feel things
that are not real.
In a complex partial seizure, the person has a change in or loss of
consciousness. His or her consciousness may be altered, producing a
dreamlike experience. People having a complex partial seizure may display
strange, repetitious behaviors such as blinks, twitches, mouth movements, or
even walking in a circle. These repetitious movements are called
automatisms. They also may fling objects across the room or strike out at
walls or furniture as though they are angry or afraid. These seizures usually
last just a few seconds.
Some people with partial seizures, especially complex partial seizures, may
experience auras—unusual sensations that warn of an impending seizure.
These auras are actually simple partial seizures in which the person
maintains consciousness. The symptoms an individual person has, and the
progression of those symptoms, tends to be stereotyped, or similar every
time.
The symptoms of partial seizures can easily be confused with other
disorders. For instance, the dreamlike perceptions associated with a complex
partial seizure may be misdiagnosed as migraine headaches, which also can
cause a dreamlike state. The strange behavior and sensations caused by
partial seizures also can be mistaken for symptoms of narcolepsy, fainting, or
even mental illness. It may take many tests and careful monitoring by a
knowledgeable physician to tell the difference between epilepsy and other
disorders.
Guidelines 17
Generalized Seizures
Generalized seizures are a result of abnormal neuronal activity in many
parts of the brain. These seizures may cause loss of consciousness, falls, or
massive muscle spasms.
There are many kinds of generalized seizures. In absence seizures, the
person may appear to be staring into space and/or have jerking or twitching
muscles. These seizures are sometimes referred to as petit mal seizures,
which is an older term. Tonic seizures cause stiffening of muscles of the
body, generally those in the back, legs, and arms. Clonic seizures cause
repeated jerking movements of muscles on both sides of the body. Myoclonic
seizures cause jerks or twitches of the upper body, arms, or legs. Atonic
seizures cause a loss of normal muscle tone. The affected person will fall
down or may nod his or her head involuntarily. Tonic-clonic seizures cause a
mixture of symptoms, including stiffening of the body and repeated jerks of
the arms and/or legs as well as loss of consciousness. Tonic-clonic seizures
are sometimes referred to by an older term: grand mal seizures.
Not all seizures can be easily defined as either partial or generalized. Some
people have seizures that begin as partial seizures but then spread to the
entire brain. Other people may have both types of seizures but with no clear
pattern.
Society’s lack of understanding about the many different types of seizures is
one of the biggest problems for people with epilepsy. People who witness a
non-convulsive seizure often find it difficult to understand that behavior
which looks deliberate is not under the person’s control. In some cases, this
has led to the affected person being arrested, sued, or placed in a mental
institution. To combat these problems, people everywhere need to
understand the many different types of seizures and how they may appear.
What Are the Different Kinds of Epilepsy?
Just as there are many different kinds of seizures, there are many different
kinds of epilepsy. Doctors have identified hundreds of different epilepsy
syndromes—disorders characterized by a specific set of symptoms that
include epilepsy. Some of these syndromes appear to be hereditary. For
other syndromes, the cause is unknown. Epilepsy syndromes are frequently
described by their symptoms or by where in the brain they originate. People
should discuss the implications of their type of epilepsy with their doctors to
understand the full range of symptoms, the possible treatments, and the
prognosis.
People with absence epilepsy have repeated absence seizures that cause
momentary lapses of consciousness. These seizures almost always begin in
childhood or adolescence, and they tend to run in families, suggesting that
they may be at least partially due to a defective gene or genes. Some people
with absence seizures have purposeless movements during their seizures,
such as a jerking arm or rapidly blinking eyes. Others have no noticeable
symptoms except for brief times when they are “out of it.” Immediately after
a seizure, the person can resume whatever he or she was doing. However,
these seizures may occur so frequently that the person cannot concentrate in
school or other situations. Childhood absence epilepsy usually stops when
the child reaches puberty. Absence seizures usually have no lasting effect on
intelligence or other brain functions.
Psychomotor Epilepsy
Psychomotor epilepsy is another term for recurrent partial seizures,
especially seizures of the temporal lobe. The term psychomotor refers to the
strange sensations, emotions, and behavior seen with these seizures.
Temporal Lobe Epilepsy
Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome
with partial seizures. These seizures are often associated with auras. TLE
often begins in childhood. Research has shown that repeated temporal lobe
seizures can cause a brain structure called the hippocampus to shrink over
time. The hippocampus is important for memory and learning. While it may
take years of temporal lobe seizures for measurable hippocampal damage to
occur, this finding underlines the need to treat TLE early and as effectively
as possible.
Frontal Lobe Epilepsy
Frontal lobe epilepsy usually involves a cluster of short seizures with a
sudden onset and termination. There are many subtypes of frontal lobe
seizures. The symptoms depend on where in the frontal lobe the seizures
occur.
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Occipital Lobe Epilepsy
Occipital lobe epilepsy usually begins with visual hallucinations, rapid eye
blinking, or other eye-related symptoms. Otherwise, it resembles temporal or
frontal lobe epilepsy.
The symptoms of parietal lobe epilepsy closely resemble those of other types
of epilepsy. This may reflect the fact that parietal lobe seizures tend to
spread to other areas of the brain.
Other Types of Epilepsy
There are many other types of epilepsy, each with its own characteristic set
of symptoms. Many of these, including Lennox-Gastaut syndrome and
Rasmussen’s encephalitis, begin in childhood. Children with Lennox-Gastaut
syndrome have severe epilepsy with several different types of seizures,
including atonic seizures, which cause sudden falls and are also called drop
attacks. This severe form of epilepsy can be very difficult to treat effectively.
Rasmussen’s encephalitis is a progressive type of epilepsy in which half of
the brain shows continual inflammation. It sometimes is treated with a
radical surgical procedure called hemispherectomy (see the section on
Surgery). Some childhood epilepsy syndromes, such as childhood absence
epilepsy, tend to go into remission or stop entirely during adolescence,
whereas other syndromes such as juvenile myoclonic epilepsy are usually
present for life once they develop. Seizure syndromes do not always appear
in childhood. For example, Ramsay Hunt syndrome type II is a rare and
severe progressive type of epilepsy that generally begins in early adulthood
and leads to reduced muscle coordination and cognitive abilities in addition
to seizures.
Benign Epilepsy Syndromes
Epilepsy syndromes that do not seem to impair cognitive functions or
development are often described as benign. Benign epilepsy syndromes
include benign infantile encephalopathy and benign neonatal convulsions.
Other syndromes, such as early myoclonic encephalopathy, include
neurological and developmental problems. However, these problems may be
caused by underlying neurodegenerative processes rather than by the
seizures. Epilepsy syndromes in which the seizures and/or the person’s
cognitive or motor abilities get worse over time are called progressive
epilepsy.
Infantile Epilepsy
Several types of epilepsy begin in infancy. The most common type of
infantile epilepsy is infantile spasms, clusters of seizures that usually begin
before the age of 6 months. During these seizures the infant may bend and
cry out. Anticonvulsant drugs often do not work for infantile spasms, but the
seizures can be treated with ACTH (adrenocorticotropic hormone) or
prednisone.
When Are Seizures Not Epilepsy?
While any seizure is cause for concern, having a seizure does not by itself
mean a person has epilepsy. First seizures, febrile seizures, nonepileptic
events, and eclampsia are examples of seizures that may not be associated
with epilepsy.
First Seizures
Many people have a single seizure at some point in their lives. Often these
seizures occur in reaction to anesthesia or a strong drug, but they also may
be unprovoked, meaning that they occur without any obvious triggering
factor. Unless the person has suffered brain damage or there is a family
history of epilepsy or other neurological abnormalities, these single seizures
usually are not followed by additional seizures. One recent study that
followed patients for an average of 8 years found that only 33 percent of
people have a second seizure within 4 years after an initial seizure. People
who did not have a second seizure within that time remained seizure-free for
the rest of the study. For people who did have a second seizure, the risk of a
third seizure was about 73 percent on average by the end of 4 years.
When someone has experienced a first seizure, the doctor will usually order
an electroencephalogram, or EEG, to determine what type of seizure the
person may have had and if there are any detectable abnormalities in the
person’s brain waves. The doctor also may order brain scans to identify
abnormalities that may be visible in the brain. These tests may help the
doctor decide whether or not to treat the person with antiepileptic drugs. In
some cases, drug treatment after the first seizure may help prevent future
seizures and epilepsy. However, the drugs also can cause detrimental side
effects, so doctors prescribe them only when they feel the benefits outweigh
the risks. Evidence suggests that it may be beneficial to begin anticonvulsant
Guidelines 21
medication once a person has had a second seizure, as the chance of future
seizures increases significantly after this occurs.
Febrile Seizures
Sometimes a child will have a seizure during the course of an illness with a
high fever. These seizures are called febrile seizures (febrile is derived from
the Latin word for “fever”) and can be very alarming to the parents and
other caregivers. In the past, doctors usually prescribed a course of
anticonvulsant drugs following a febrile seizure in the hope of preventing
epilepsy. However, most children who have a febrile seizure do not develop
epilepsy, and long-term use of anticonvulsant drugs in children may damage
the developing brain or cause other detrimental side effects. Experts at a
1980 consensus conference coordinated by the National Institutes of Health
concluded that preventive treatment after a febrile seizure is generally not
warranted unless certain other conditions are present: a family history of
epilepsy, signs of nervous system impairment prior to the seizure, or a
relatively prolonged or complicated seizure. The risk of subsequent nonfebrile seizures is only 2 to 3 percent unless one of these factors is present.
Researchers have now identified several different genes that influence the
risk of febrile seizures in certain families. Studying these genes may lead to
new understanding of how febrile seizures occur and perhaps point to ways
of preventing them.
Nonepileptic Events
Sometimes people appear to have seizures, even though their brains show no
seizure activity. This type of phenomenon has various names, including
nonepileptic events and pseudoseizures. Both of these terms essentially
mean something that looks like a seizure but isn’t one. Nonepileptic events
that are psychological in origin may be referred to as psychogenic seizures.
Psychogenic seizures may indicate dependence, a need for attention,
avoidance of stressful situations, or specific psychiatric conditions. Some
people with epilepsy have psychogenic seizures in addition to their epileptic
seizures. Other people who have psychogenic seizures do not have epilepsy
at all. Psychogenic seizures cannot be treated in the same way as epileptic
seizures. Instead, they are often treated by mental health specialists.
Other nonepileptic events may be caused by narcolepsy, Tourette syndrome,
cardiac arrhythmia, and other medical conditions with symptoms that
resemble seizures. Because symptoms of these disorders can look very much
like epileptic seizures, they are often mistaken for epilepsy. Distinguishing
between true epileptic seizures and nonepileptic events can be very difficult
and requires a thorough medical assessment, careful monitoring, and
knowledgeable health professionals. Improvements in brain scanning and
monitoring technology may improve diagnosis of nonepileptic events in the
future.
Eclampsia
Eclampsia is a life-threatening condition that can develop in pregnant
women. Its symptoms include sudden elevations of blood pressure and
seizures. Pregnant women who develop unexpected seizures should be
rushed to a hospital immediately. Eclampsia can be treated in a hospital
setting and usually does not result in additional seizures or epilepsy once the
pregnancy is over.
How Is Epilepsy Diagnosed?
Doctors have developed a number of different tests to determine whether a
person has epilepsy and, if so, what kind of seizures the person has. In some
cases, people may have symptoms that look very much like a seizure but in
fact are nonepileptic events caused by other disorders. Even doctors may not
be able to tell the difference between these disorders and epilepsy without
close observation and intensive testing.
EEG Monitoring
An EEG records brain waves detected by electrodes placed on the scalp. This
is the most common diagnostic test for epilepsy and can detect abnormalities
in the brain’s electrical activity. People with epilepsy frequently have
changes in their normal pattern of brain waves, even when they are not
experiencing a seizure. While this type of test can be very useful in
diagnosing epilepsy, it is not foolproof. Some people continue to show
normal brain wave patterns even after they have experienced a seizure. In
other cases, the unusual brain waves are generated deep in the brain where
the EEG is unable to detect them. Many people who do not have epilepsy
also show some unusual brain activity on an EEG. Whenever possible, an
EEG should be performed within 24 hours of a patient’s first seizure. Ideally,
EEGs should be performed while the patient is sleeping as well as when he
Guidelines 23
or she is awake, because brain activity during sleep is often quite different
than at other times.
Video monitoring is often used in conjunction with EEG to determine the
nature of a person’s seizures. It also can be used in some cases to rule out
other disorders such as cardiac arrhythmia or narcolepsy that may look like
epilepsy.
In some cases, doctors may use an experimental diagnostic technique called
a magnetoencephalogram, or MEG. MEG detects the magnetic signals
generated by neurons to allow doctors to monitor brain activity at different
points in the brain over time, revealing different brain functions. While MEG
is similar in concept to EEG, it does not require electrodes and it can detect
signals from deeper in the brain than an EEG.
Brain Scans
One of the most important ways of diagnosing epilepsy is through the use of
brain scans. The most commonly used brain scans include CT (computed
tomography), PET (positron emission tomography) and MRI (magnetic
resonance imaging). CT and MRI scans reveal the structure of the brain,
which can be useful for identifying brain tumors, cysts, and other structural
abnormalities. PET and an adapted kind of MRI called functional MRI
(fMRI) can be used to monitor the brain’s activity and detect abnormalities in
how it works. SPECT (single photon emission computed tomography) is a
relatively new kind of brain scan that is sometimes used to locate seizure foci
in the brain. Doctors also are experimenting with brain scans called magnetic
resonance spectroscopy (MRS) that can detect abnormalities in the brain’s
biochemical processes, and with near-infrared spectroscopy, a technique that
can detect oxygen levels in brain tissue.
Medical History
Taking a detailed medical history, including symptoms and duration of the
seizures, is still one of the best methods available to determine if a person
has epilepsy and what kind of seizures they have. The doctor will ask
questions about the seizures and any past illnesses or other symptoms a
person may have had. Since people who have suffered a seizure often do not
remember what happened, caregivers’ accounts of the seizure are vital to
this evaluation.
Blood Tests
Doctors often take blood samples for testing, particularly when they are
examining a child. These blood samples are often screened for metabolic or
genetic disorders that may be associated with the seizures. They also may be
used to check for underlying problems such as infections, lead poisoning,
anemia, and diabetes that may be causing or triggering the seizures.
Developmental, Neurological, and Behavioral Tests
Doctors often use tests devised to measure motor abilities, behavior, and
intellectual capacity as a way to determine how the epilepsy is affecting that
person. These tests also can provide clues about what kind of epilepsy the
person has.
Can Epilepsy Be Prevented?
Many cases of epilepsy can be prevented by wearing seatbelts and bicycle
helmets, putting children in car seats, and other measures that prevent head
injury and other trauma. Prescribing medication after first or second seizures
or febrile seizures also may help prevent epilepsy in some cases. Good
prenatal care, including treatment of high blood pressure and infections
during pregnancy, can prevent brain damage in the developing baby that
may lead to epilepsy and other neurological problems later. Treating
cardiovascular disease, high blood pressure, infections, and other disorders
that can affect the brain during adulthood and aging also may prevent many
cases of epilepsy. Finally, identifying the genes for many neurological
disorders can provide opportunities for genetic screening and prenatal
diagnosis that may ultimately prevent many cases of epilepsy.
How Can Epilepsy Be Treated?
Accurate diagnosis of the type of epilepsy a person has is crucial for finding
an effective treatment. There are many different ways to treat epilepsy.
Currently available treatments can control seizures at least some of the time
in about 80 percent of people with epilepsy. However, another 20 percent —
about 600,000 people with epilepsy in the United States — have intractable
seizures, and another 400,000 feel they get inadequate relief from available
Guidelines 25
treatments. These statistics make it clear that improved treatments are
desperately needed.
Doctors who treat epilepsy come from many different fields of medicine.
They include neurologists, pediatricians, pediatric neurologists, internists,
and family physicians, as well as neurosurgeons and doctors called
epileptologists who specialize in treating epilepsy. People who need
specialized or intensive care for epilepsy may be treated at large medical
centers and neurology clinics at hospitals, or by neurologists in private
practice. Many epilepsy treatment centers are associated with university
hospitals that perform research in addition to providing medical care.
Once epilepsy is diagnosed, it is important to begin treatment as soon as
possible. Research suggests that medication and other treatments may be less
successful in treating epilepsy once seizures and their consequences become
established.
Medications
By far the most common approach to treating epilepsy is to prescribe
antiepileptic drugs. The first effective antiepileptic drugs were bromides,
introduced by an English physician named Sir Charles Locock in 1857. He
noticed that bromides had a sedative effect and seemed to reduce seizures in
some patients. More than 20 different antiepileptic drugs are now on the
market, all with different benefits and side effects. The choice of which drug
to prescribe, and at what dosage, depends on many different factors,
including the type of seizures a person has, the person’s lifestyle and age,
how frequently the seizures occur, and, for a woman, the likelihood that she
will become pregnant. People with epilepsy should follow their doctor’s
advice and share any concerns they may have regarding their medication.
Doctors seeing a patient with newly developed epilepsy often prescribe
carbamazapine, valproate, or phenytoin first, unless the epilepsy is a type
that is known to require a different kind of treatment. For absence seizures,
ethosuximide is often the primary treatment. Other commonly prescribed
drugs include clonazepam, phenobarbital, and primidone. In recent years, a
number of new drugs have become available. These include tiagabine,
lamotrigine, gabapentin, topiramate, levetiracetam, felbamate, and
zonisamide, as well as oxcarbazapine, a drug that is similar to
carbamazapine but has fewer side effects. These new drugs may have
advantages for many patients. Other drugs are used in combination with one
of the standard drugs or for intractable seizures that do not respond to other
medications. A few drugs, such as fosphenytoin, are approved for use only
in hospital settings to treat specific problems such as status epilepticus (see
section, “Are There Special Risks Associated With Epilepsy?”). For people
with stereotyped recurrent severe seizures that can be easily recognized by
the person’s family, the drug diazepam is now available as a gel that can be
administered rectally by a family member. This method of drug delivery
may be able to stop prolonged seizures before they develop into status
epilepticus.
For most people with epilepsy, seizures can be controlled with just one drug
at the optimal dosage. Combining medications usually amplifies side effects
such as fatigue and decreased appetite, so doctors usually prescribe
monotherapy, or the use of just one drug, whenever possible. Combinations
of drugs are sometimes prescribed if monotherapy fails to effectively control
a patient’s seizures.
The number of times a person needs to take medication each day is usually
determined by the drug’s half-life, or the time it takes for half the drug dose
to be metabolized or broken down into other substances in the body. Some
drugs, such as phenytoin and phenobarbital, only need to be taken once a
day, while others such as valproate must be taken more frequently.
Most side effects of antiepileptic drugs are relatively minor, such as fatigue,
dizziness, or weight gain. However, severe and life-threatening side effects
such as allergic reactions can occur. Epilepsy medication also may
predispose people to developing depression or psychoses. People with
epilepsy should consult a doctor immediately if they develop any kind of
rash while on medication, or if they find themselves depressed or otherwise
unable to think in a rational manner. Other danger signs that should be
discussed with a doctor immediately are extreme fatigue, staggering or other
movement problems, and slurring of words. People with epilepsy should be
aware that their epilepsy medication can interact with many other drugs in
potentially harmful ways. For this reason, people with epilepsy should
always tell doctors who treat them which medications they are taking.
Women also should know that some antiepileptic drugs can interfere with
the effectiveness of oral contraceptives, and they should discuss this
possibility with their doctors.
Since people can become more sensitive to medications as they age, they
should have their blood levels of medication checked occasionally to see if
the dose needs to be adjusted. The effects of a particular medication also
sometimes wear off over time, leading to an increase in seizures if the dose is
not adjusted. People should know that some citrus fruit, in particular
Guidelines 27
grapefruit juice, may interfere with breakdown of many drugs. This can
cause too much of the drug to build up in their bodies, often worsening the
side effects.
Tailoring the Dosage of Antiepileptic Drugs
When a person starts a new epilepsy drug, it is important to tailor the dosage
to achieve the best results. People’s bodies react to medications in very
different and sometimes unpredictable ways, so it may take some time to
find the right drug at the right dose to provide optimal control of seizures
while minimizing side effects. A drug that has no effect or very bad side
effects at one dose may work very well at another dose. Doctors will usually
prescribe a low dose of the new drug initially and monitor blood levels of the
drug to determine when the best possible dose has been reached.
Generic versions are available for many antiepileptic drugs. The chemicals in
generic drugs are exactly the same as in the brand-name drugs, but they may
be absorbed or processed differently in the body because of the way they are
prepared. Therefore, patients should always check with their doctors before
switching to a generic version of their medication.
Discontinuing Medication
Some doctors will advise people with epilepsy to discontinue their
antiepileptic drugs after two years have passed without a seizure. Others feel
it is better to wait for four to five years. Discontinuing medication should
only be done with a doctor’s advice and supervision. It is very important to
continue taking epilepsy medication for as long as the doctor prescribes it.
People also should ask the doctor or pharmacist ahead of time what they
should do if they miss a dose. Discontinuing medication without a doctor’s
advice is one of the major reasons people who have been seizure-free begin
having new seizures. Seizures that result from suddenly stopping
medication can be very serious and can lead to status epilepticus.
Furthermore, there is some evidence that uncontrolled seizures trigger
changes in neurons that can make it more difficult to treat the seizures in the
future.
The chance that a person will eventually be able to discontinue medication
varies depending on the person’s age and his or her type of epilepsy. More
than half of children who go into remission with medication can eventually
stop their medication without having new seizures. One study showed that
68 percent of adults who had been seizure-free for 2 years before stopping
medication were able to do so without having more seizures and 75 percent
could successfully discontinue medication if they had been seizure-free for 3
years. However, the odds of successfully stopping medication are not as
good for people with a family history of epilepsy, those who need multiple
medications, those with partial seizures, and those who continue to have
abnormal EEG results while on medication.
Surgery
When seizures cannot be adequately controlled by medications, doctors may
recommend that the person be evaluated for surgery. Most surgery for
epilepsy is performed by teams of doctors at medical centers. To decide if a
person may benefit from surgery, doctors consider the type or types of
seizures he or she has. They also take into account the brain region involved
and how important that region is for everyday behavior. Surgeons usually
avoid operating in areas of the brain that are necessary for speech, language,
hearing, or other important abilities. Doctors may perform tests such as a
Wada test (administration of the drug amobarbitol into the carotid artery) to
find areas of the brain that control speech and memory. They often monitor
the patient intensively prior to surgery in order to pinpoint the exact location
in the brain where seizures begin. They also may use implanted electrodes to
record brain activity from the surface of the brain. This yields better
information than an external EEG.
A 1990 National Institutes of Health consensus conference on surgery for
epilepsy concluded that there are three broad categories of epilepsy that can
be treated successfully with surgery. These include partial seizures, seizures
that begin as partial seizures before spreading to the rest of the brain, and
unilateral multifocal epilepsy with infantile hemiplegia (such as
Rasmussen’s encephalitis). Doctors generally recommend surgery only after
patients have tried two or three different medications without success, or if
there is an identifiable brain lesion — a damaged or abnormally functioning
area — believed to cause the seizures.
If a person is considered a good candidate for surgery and has seizures that
cannot be controlled with available medication, experts generally agree that
surgery should be performed as early as possible. It can be difficult for a
person who has had years of seizures to fully re-adapt to a seizure-free life if
the surgery is successful. The person may never have had an opportunity to
develop independence and he or she may have had difficulties with school
and work that could have been avoided with earlier treatment. Surgery
Guidelines 29
should always be performed with support from rehabilitation specialists and
counselors who can help the person deal with the many psychological,
social, and employment issues he or she may face.
While surgery can significantly reduce or even halt seizures for some people,
it is important to remember that any kind of surgery carries some amount of
risk (usually small). Surgery for epilepsy does not always successfully
reduce seizures and it can result in cognitive or personality changes, even in
people who are excellent candidates for surgery. Patients should ask their
surgeon about his or her experience, success rates, and complication rates
with the procedure they are considering.
Even when surgery completely ends a person’s seizures, it is important to
continue taking seizure medication for some time to give the brain time to
re-adapt. Doctors generally recommend medication for 2 years after a
successful operation to avoid new seizures.
Surgery to Treat Underlying Conditions
In cases where seizures are caused by a brain tumor, hydrocephalus, or other
conditions that can be treated with surgery, doctors may operate to treat
these underlying conditions. In many cases, once the underlying condition is
successfully treated, a person’s seizures will stop as well.
Surgery to Remove a Seizure Focus
The most common type of surgery for epilepsy is removal of a seizure focus,
or small area of the brain where seizures originate. This type of surgery,
which doctors may refer to as a lobectomy or lesionectomy, is appropriate
only for partial seizures that originate in just one area of the brain. In
general, people have a better chance of becoming seizure-free after surgery if
they have a small, well-defined seizure focus. Lobectomies have a 55-70
percent success rate when the type of epilepsy and the seizure focus is welldefined. The most common type of lobectomy is a temporal lobe resection,
which is performed for people with temporal lobe epilepsy. Temporal lobe
resection leads to a significant reduction or complete cessation of seizures
about 70 - 90 percent of the time.
Multiple Subpial Transection
When seizures originate in part of the brain that cannot be removed,
surgeons may perform a procedure called a multiple subpial transection. In
this type of operation, which was first described in 1989, surgeons make a
series of cuts that are designed to prevent seizures from spreading into other
parts of the brain while leaving the person’s normal abilities intact. About 70
percent of patients who undergo a multiple subpial transection have
satisfactory improvement in seizure control.
Corpus Callosotomy
Corpus callosotomy, Corpus callosotomy, or severing the network of neural
connections between the right and left halves, or hemispheres, of the brain, is
done primarily in children with severe seizures that start in one half of the
brain and spread to the other side. Corpus callosotomy can end drop attacks
and other generalized seizures. However, the procedure does not stop
seizures in the side of the brain where they originate, and these partial
seizures may even increase after surgery.
Hemispherectomy
This procedure, which removes half of the brain’s cortex, or outer layer, is
used only for children who have Rasmussen’s encephalitis or other severe
damage to one brain hemisphere and who also have seizures that do not
respond well to medication. While this type of surgery is very radical and is
performed only as a last resort, children often recover very well from the
procedure, and their seizures usually are greatly reduced or may cease
altogether. With intense rehabilitation, they often recover nearly normal
abilities. Since the chance of a full recovery is best in young children,
hemispherectomy should be performed as early in a child’s life as possible. It
is almost never performed in children older than 13.
Devices
The vagus nerve stimulator was approved by the U.S. Food and Drug
Administration (FDA) in 1997 for use in people with seizures that are not
well-controlled by medication. The vagus nerve stimulator is a batterypowered device that is surgically implanted under the skin of the chest,
much like a pacemaker, and is attached to the vagus nerve in the lower neck.
Guidelines 31
This device delivers short bursts of electrical energy to the brain via the
vagus nerve. On average, this stimulation reduces seizures by about 20-40
percent. Patients usually cannot stop taking epilepsy medication because of
the stimulator, but they often experience fewer seizures and they may be
able to reduce the dose of their medication. Side effects of the vagus nerve
stimulator are generally mild, but may include ear pain, a sore throat, or
nausea. Adjusting the amount of stimulation can usually eliminate these side
effects. The batteries in the vagus nerve stimulator need to be replaced about
once every 5 years; this requires a minor operation that can usually be
performed as an outpatient procedure.
Several new devices may become available for epilepsy in the future.
Researchers are studying whether transcranial magnetic stimulation, a
procedure which uses a strong magnet held outside the head to influence
brain activity, may reduce seizures. They also hope to develop implantable
devices that can deliver drugs to specific parts of the brain.
Diet
Studies have shown that, in some cases, children may experience fewer
seizures if they maintain a strict diet rich in fats and low in carbohydrates.
This unusual diet, called the ketogenic diet, causes the body to break down
fats instead of carbohydrates to survive. This condition is called ketosis. One
study of 150 children whose seizures were poorly controlled by medication
found that about one-fourth of the children had a 90 percent or better
decrease in seizures with the ketogenic diet, and another half of the group
had a 50 percent or better decrease in their seizures. Moreover, some
children can discontinue the ketogenic diet after several years and remain
seizure-free. The ketogenic diet is not easy to maintain, as it requires strict
adherence to an unusual and limited range of foods. Possible side effects
include retarded growth due to nutritional deficiency and a buildup of uric
acid in the blood, which can lead to kidney stones. People who try the
ketogenic diet should seek the guidance of a dietician to ensure that it does
not lead to serious nutritional deficiency.
Researchers are not sure how ketosis inhibits seizures. One study showed
that a byproduct of ketosis called beta-hydroxybutyrate (BHB) inhibits
seizures in animals. If BHB also works in humans, researchers may
eventually be able to develop drugs that mimic the seizure-inhibiting effects
of the ketogenic diet.
Other Treatment Strategies
Researchers are studying whether biofeedback—a strategy in which
individuals learn to control their own brain waves—may be useful in
controlling seizures. However, this type of therapy is controversial and most
studies have shown discouraging results. Taking large doses of vitamins
generally does not help a person’s seizures and may even be harmful in
some cases. However, a good diet and some vitamin supplements,
particularly folic acid, may help reduce some birth defects and medicationrelated nutritional deficiencies. Use of non-vitamin supplements such as
melatonin is controversial and can be risky. One study showed that
melatonin may reduce seizures in some children, while another found that
the risk of seizures increased measurably with melatonin. Most non-vitamin
supplements such as those found in health food stores are not regulated by
the FDA, so their true effects and their interactions with other drugs are
largely unknown.
How Does Epilepsy Affect Daily Life?
Most people with epilepsy lead outwardly normal lives. Approximately 80
percent can be significantly helped by modern therapies, and some may go
months or years between seizures. However, epilepsy can and does affect
daily life for people with epilepsy, their families, and their friends. People
with severe seizures that resist treatment have, on average, a shorter life
expectancy and an increased risk of cognitive impairment, particularly if the
seizures developed in early childhood. These impairments may be related to
the underlying conditions that cause epilepsy or to epilepsy treatment rather
than the epilepsy itself.
Behavior and Emotions
It is not uncommon for people with epilepsy, especially children, to develop
behavioral and emotional problems. Sometimes these problems are caused
by embarrassment or frustration associated with epilepsy. Other problems
may result from bullying, teasing, or avoidance in school and other social
settings. In children, these problems can be minimized if parents encourage a
positive outlook and independence, do not reward negative behavior with
unusual amounts of attention, and try to stay attuned to their child’s needs
and feelings. Families must learn to accept and live with the seizures without
blaming or resenting the affected person. Counseling services can help
families cope with epilepsy in a positive manner. Epilepsy support groups
Guidelines 33
also can help by providing a way for people with epilepsy and their family
members to share their experiences, frustrations, and tips for coping with the
disorder.
People with epilepsy have an increased risk of poor self-esteem, depression,
and suicide. These problems may be a reaction to a lack of understanding or
discomfort about epilepsy that may result in cruelty or avoidance by other
people. Many people with epilepsy also live with an ever-present fear that
they will have another seizure.
Driving and Recreation
For many people with epilepsy, the risk of seizures restricts their
independence, in particular the ability to drive. Most states and the District
of Columbia will not issue a driver’s license to someone with epilepsy unless
the person can document that they have gone a specific amount of time
without a seizure (the waiting period varies from a few months to several
years). Some states make exceptions for this policy when seizures don’t
impair consciousness, occur only during sleep, or have long auras or other
warning signs that allow the person to avoid driving when a seizure is likely
to occur. Studies show that the risk of having a seizure-related accident
decreases as the length of time since the last seizure increases. One study
found that the risk of having a seizure-related motor vehicle accident is 93
percent less in people who wait at least 1 year after their last seizure before
driving, compared to people who wait for shorter intervals.
The risk of seizures also restricts people’s recreational choices. For instance,
people with epilepsy should not participate in sports such as skydiving or
motor racing where a moment’s inattention could lead to injury. Other
activities, such as swimming and sailing, should be done only with
precautions and/or supervision. However, jogging, football, and many other
sports are reasonably safe for a person with epilepsy. Studies to date have
not shown any increase in seizures due to sports, although these studies
have not focused on any activity in particular. There is some evidence that
regular exercise may even improve seizure control in some people. Sports
are often such a positive factor in life that it is best for the person to
participate, although the person with epilepsy and the coach or other leader
should take appropriate safety precautions. It is important to take steps to
avoid potential sports-related problems such as dehydration, overexertion,
and hypoglycemia, as these problems can increase the risk of seizures.
Education and Employment
By law, people with epilepsy or other handicaps in the United States cannot
be denied employment or access to any educational, recreational, or other
activity because of their seizures. However, one survey showed that only
about 56 percent of people with epilepsy finish high school and about 15
percent finish college — rates much lower than those for the general
population. The same survey found that about 25 percent of working-age
people with epilepsy are unemployed. These numbers indicate that
significant barriers still exist for people with epilepsy in school and work.
Restrictions on driving limit the employment opportunities for many people
with epilepsy, and many find it difficult to face the misunderstandings and
social pressures they encounter in public situations. Antiepileptic drugs also
may cause side effects that interfere with concentration and memory.
Children with epilepsy may need extra time to complete schoolwork, and
they sometimes may need to have instructions or other information repeated
for them. Teachers should be told what to do if a child in their classroom has
a seizure, and parents should work with the school system to find reasonable
ways to accommodate any special needs their child may have.
Pregnancy and Motherhood
Women with epilepsy are often concerned about whether they can become
pregnant and have a healthy child. This is usually possible. While some
seizure medications and some types of epilepsy may reduce a person’s
interest in sexual activity, most people with epilepsy can become pregnant.
Moreover, women with epilepsy have a 90 percent or better chance of having
a normal, healthy baby, and the risk of birth defects is only about 4-6
percent. The risk that children of parents with epilepsy will develop epilepsy
themselves is only about 5 percent unless the parent has a clearly hereditary
form of the disorder. Parents who are worried that their epilepsy may be
hereditary may wish to consult a genetic counselor to determine what the
risk might be. Amniocentesis and high-level ultrasound can be performed
during pregnancy to ensure that the baby is developing normally, and a
procedure called a maternal serum alpha-fetoprotein test can be used for
prenatal diagnosis of many conditions if a problem is suspected.
There are several precautions women can take before and during pregnancy
to reduce the risks associated with pregnancy and delivery. Women who are
thinking about becoming pregnant should talk with their doctors to learn
any special risks associated with their epilepsy and the medications they
may be taking. Some seizure medications, particularly valproate,
Guidelines 35
trimethadione, and phenytoin, are known to increase the risk of having a
child with birth defects such as cleft palate, heart problems, or finger and toe
defects. For this reason, a woman’s doctor may advise switching to other
medications during pregnancy. Whenever possible, a woman should allow
her doctor enough time to properly change medications, including phasing
in the new medications and checking to determine when blood levels are
stabilized, before she tries to become pregnant. Women should also begin
prenatal vitamin supplements — especially with folic acid, which may
reduce the risk of some birth defects — well before pregnancy. Women who
discover that they are pregnant but have not already spoken with their
doctor about ways to reduce the risks should do so as soon as possible.
However, they should continue taking seizure medication as prescribed until
that time to avoid preventable seizures. Seizures during pregnancy can harm
the developing baby or lead to miscarriage, particularly if the seizures are
severe. Nevertheless, many women who have seizures during pregnancy
have normal, healthy babies.
Women with epilepsy sometimes experience a change in their seizure
frequency during pregnancy, even if they do not change medications. About
25 to 40 percent of women have an increase in their seizure frequency while
they are pregnant, while other women may have fewer seizures during
pregnancy. The frequency of seizures during pregnancy may be influenced
by a variety of factors, including the woman’s increased blood volume
during pregnancy, which can dilute the effect of medication. Women should
have their blood levels of seizure medications monitored closely during and
after pregnancy, and the medication dosage should be adjusted accordingly.
Pregnant women with epilepsy should take prenatal vitamins and get plenty
of sleep to avoid seizures caused by sleep deprivation. They also should take
vitamin K supplements after 34 weeks of pregnancy to reduce the risk of a
blood-clotting disorder in infants called neonatal coagulopathy that can
result from fetal exposure to epilepsy medications. Finally, they should get
good prenatal care, avoid tobacco, caffeine, alcohol, and illegal drugs, and
try to avoid stress.
Labor and delivery usually proceed normally for women with epilepsy,
although there is a slightly increased risk of hemorrhage, eclampsia,
premature labor, and cesarean section. Doctors can administer antiepileptic
drugs intravenously and monitor blood levels of anticonvulsant medication
during labor to reduce the risk that the labor will trigger a seizure. Babies
sometimes have symptoms of withdrawal from the mother’s seizure
medication after they are born, but these problems wear off in a few weeks
or months and usually do not cause serious or long-term effects. A mother’s
blood levels of anticonvulsant medication should be checked frequently after
delivery as medication often needs to be decreased.
Epilepsy medications need not influence a woman’s decision about breastfeeding her baby. Only minor amounts of epilepsy medications are secreted
in breast milk; usually not enough to harm the baby and much less than the
baby was exposed to in the womb. On rare occasions, the baby may become
excessively drowsy or feed poorly, and these problems should be closely
monitored. However, experts believe the benefits of breast-feeding outweigh
the risks except in rare circumstances.
To increase doctors’ understanding of how different epilepsy medications
affect pregnancy and the chances of having a healthy baby, Massachusetts
General Hospital has begun a nationwide registry for women who take
antiepileptic drugs while pregnant. Women who enroll in this program are
given educational materials on pre-conception planning and perinatal care
and are asked to provide information about the health of their children (this
information is kept confidential). Women and physicians can contact this
registry by calling 1-888-233-2334 or 617-726-7739 (fax: 617-724-8307).
Women with epilepsy should be aware that some epilepsy medications can
interfere with the effectiveness of oral contraceptives. Women who wish to
use oral contraceptives to prevent pregnancy should discuss this with their
doctors, who may be able to prescribe a different kind of antiepileptic
medication or suggest other ways of avoiding an unplanned pregnancy.
Are There Special Risks Associated with Epilepsy?
Although most people with epilepsy lead full, active lives, they are at special
risk for two life-threatening conditions: status epilepticus and sudden
unexplained death.
Status Epilepticus
Status epilepticus is a severe, life-threatening condition in which a person
either has prolonged seizures or does not fully regain consciousness between
seizures. The amount of time in a prolonged seizure that must pass before a
person should be diagnosed with status epilepticus is a subject of debate.
Many doctors now diagnose status epilepticus if a person has been in a
prolonged seizure for 5 minutes. However, other doctors use more
conservative definitions of this condition and may not diagnose status
Guidelines 37
epilepticus unless the person has had a prolonged seizure of 10 minutes or
even 30 minutes.
Status epilepticus affects about 195,000 people each year in the United States
and results in about 42,000 deaths. While people with epilepsy are at an
increased risk for status epilepticus, about 60 percent of people who develop
this condition have no previous seizure history. These cases often result from
tumors, trauma, or other problems that affect the brain and may themselves
be life-threatening.
While most seizures do not require emergency medical treatment, someone
with a prolonged seizure lasting more than 5 minutes may be in status
epilepticus and should be taken to an emergency room immediately. It is
important to treat a person with status epilepticus as soon as possible. One
study showed that 80 percent of people in status epilepticus who received
medication within 30 minutes of seizure onset eventually stopped having
seizures, whereas only 40 percent recovered if 2 hours had passed before
they received medication. Doctors in a hospital setting can treat status
epilepticus with several different drugs and can undertake emergency lifesaving measures, such as administering oxygen, if necessary.
People in status epilepticus do not always have severe convulsive seizures.
Instead, they may have repeated or prolonged nonconvulsive seizures. This
type of status epilepticus may appear as a sustained episode of confusion or
agitation in someone who does not ordinarily have that kind of mental
impairment. While this type of episode may not seem as severe as convulsive
status epilepticus, it should still be treated as an emergency.
Sudden Unexplained Death
For reasons that are poorly understood, people with epilepsy have an
increased risk of dying suddenly for no discernible reason. This condition,
called sudden unexplained death, can occur in people without epilepsy, but
epilepsy increases the risk about two-fold. Researchers are still unsure why
sudden unexplained death occurs. One study suggested that use of more
than two anticonvulsant drugs may be a risk factor. However, it is not clear
whether the use of multiple drugs causes the sudden death, or whether
people who use multiple anticonvulsants have a greater risk of death
because they have more severe types of epilepsy.
What Research Is Being Done on Epilepsy?
While research has led to many advances in understanding and treating
epilepsy, there are many unanswered questions about how and why seizures
develop, how they can best be treated or prevented, and how they influence
other brain activity and brain development. Researchers, many of whom are
supported by the National Institute of Neurological Disorders and Stroke
(NINDS), are studying all of these questions. They also are working to
identify and test new drugs and other treatments for epilepsy and to learn
how those treatments affect brain activity and development. NINDS’
Epilepsy Therapeutics Research Program studies potential antiepileptic
drugs with the goal of enhancing treatment for epilepsy. Since it began in
1975, this program has screened more than 22,000 compounds for their
potential as antiepileptic drugs and has contributed to the development of
five drugs that are now approved for use in the United States as well as
others that are still being developed or tested.
Scientists continue to study how excitatory and inhibitory neurotransmitters
interact with brain cells to control nerve firing. They can apply different
chemicals to cultures of neurons in laboratory dishes to study how those
chemicals influence neuronal activity. They also are studying how glia and
other non-neuronal cells in the brain contribute to seizures. This research
may lead to new drugs and other new ways of treating seizures.
Researchers also are working to identify genes that may influence epilepsy in
some way. Identifying these genes can reveal the underlying chemical
processes that influence epilepsy and point to new ways of preventing or
treating this disorder. Researchers also can study rats and mice that have
missing or abnormal copies of certain genes to determine how these genes
affect normal brain development and resistance to damage from disease and
other environmental factors. Researchers may soon be able to use devices
called gene chips to determine each person’s genetic makeup or to learn
which genes are active. This information may allow doctors to prevent
epilepsy or to predict which treatments will be most beneficial.
Doctors are now experimenting with several new types of therapies for
epilepsy. In one preliminary clinical trial, doctors have begun transplanting
fetal pig neurons that produce GABA into the brains of patients to learn
whether the cell transplants can help control seizures. Preliminary research
suggests that stem cell transplants also may prove beneficial for treating
epilepsy. Research showing that the brain undergoes subtle changes prior to
a seizure has led to a prototype device that may be able to predict seizures
up to 3 minutes before they begin. If this device works, it could greatly
Guidelines 39
reduce the risk of injury from seizures by allowing people to move to a safe
area before their seizures start. This type of device also may be hooked up to
a treatment pump or other device that will automatically deliver an
antiepileptic drug or an electric impulse to forestall the seizures.
Researchers are continually improving MRI and other brain scans. Presurgical brain imaging can guide doctors to abnormal brain tissue and away
from essential parts of the brain. Researchers also are using brain scans such
as magnetoencephalograms (MEG) and magnetic resonance spectroscopy
(MRS) to identify and study subtle problems in the brain that cannot
otherwise be detected. Their findings may lead to a better understanding of
epilepsy and how it can be treated.
How Can I Help Research on Epilepsy?
There are many ways that people with epilepsy and their families can help
with research on this disorder. Pregnant women with epilepsy who are
taking antiepileptic drugs can help researchers learn how these drugs affect
unborn children by participating in the Antiepileptic Drug Pregnancy
Registry, which is maintained by the Genetics and Teratology Unit of
Massachusetts General Hospital (see section on Pregnancy and
Motherhood). People with epilepsy that may be hereditary can aid research
by participating in the Epilepsy Gene Discovery Project, which is supported
by the Epilepsy Foundation. This project helps to educate people with
epilepsy about new genetic research on the disorder and enlists families with
hereditary epilepsy for participation in gene research. People who enroll in
this project are asked to create a family tree showing which people in their
family have or have had epilepsy. Researchers then examine this information
to determine if the epilepsy is in fact hereditary, and they may invite
participants to enroll in genetic research studies. In many cases, identifying
the gene defect responsible for epilepsy in an individual family leads
researchers to new clues about how epilepsy develops. It also can provide
opportunities for early diagnosis and genetic screening of individuals in the
family.
People with epilepsy can help researchers test new medications, surgical
techniques, and other treatments by enrolling in clinical trials. Information
on clinical trials can be obtained from the NINDS as well as many private
pharmaceutical and biotech companies, universities, and other
organizations. A person who wishes to participate in a clinical trial must ask
his or her regular physician to refer him or her to the doctor in charge of that
trial and to forward all necessary medical records. While experimental
therapies may benefit those who participate in clinical trials, patients and
their families should remember that all clinical trials also involve some risks.
Therapies being tested in clinical trials may not work, and in some cases
doctors may not yet be certain that the therapies are safe. Patients should be
certain they understand the risks before agreeing to participate in a clinical
trial.
NINDS supports a number of Epilepsy Research Centers that perform a
broad spectrum of clinical research on epilepsy. Some of the studies require
patient volunteers. A list of these centers is available from the NIH
Neurological Institute, which can be reached at the address and phone
number found on the Information Resources card in the back pocket of this
brochure.
Patients and their families also can help epilepsy research by donating their
brain to a brain bank after death. Brain banks supply researchers with tissue
they can use to study epilepsy and other disorders. Below are some brain
banks that accept tissue from patients with epilepsy:
Brain and Tissue Bank for Neurological Disorders
University of Maryland, Baltimore
Dr. Ron Zielke
Director
800-847-1539
www.som1.umaryland.edu/BTBank/
Brain and Tissue Bank for Developmental Disorders
University of Miami
Dr. Carol Petito
Director
800-59Brain (592-7246)
E-mail: btbcoord@med.Miami.edu
Fax: 305-243-6970
Tissue from children only.
Brain Endowment Bank
University of Miami
Dr. Deborah Mash
Director
800-UMBrain (862-7246)
FAX: 305-243-3649
Tissue from adults only.
Guidelines 41
National Disease Research Interchange
1880 JFK Boulevard, 6th Floor
Philadelphia, Pennsylvania 19103
215-557-7361
800-222-NDRI (6374)
National Neurological Research Specimen Bank
VAMC (W127A)-West Los Angeles
11301 Wilshire Boulevard
Los Angeles, California 90073
310-268-3536
24-hour pager: 310-636-5199
What to Do If You See Someone Having a Seizure
If you see someone having a seizure with convulsions and/or loss of
consciousness, here’s how you can help:
·
Roll the person on his or her side to prevent choking on any fluids or
vomit.
·
Cushion the person’s head.
·
Loosen any tight clothing around the neck.
·
Keep the person’s airway open. If necessary, grip the person’s jaw gently
and tilt his or her head back.
·
Do NOT restrict the person from moving unless he or she is in danger.
·
Do NOT put anything into the person’s mouth, not even medicine or
liquid. These can cause choking or damage to the person’s jaw, tongue, or
teeth. Contrary to widespread belief, people cannot swallow their
tongues during a seizure or any other time.
·
Remove any sharp or solid objects that the person might hit during the
seizure.
·
Note how long the seizure lasts and what symptoms occurred so you can
tell a doctor or emergency personnel if necessary.
·
Stay with the person until the seizure ends.
Call 911 if:
·
The person is pregnant or has diabetes.
·
The seizure happened in water.
·
The seizure lasts longer than 5 minutes.
·
The person does not begin breathing again and return to consciousness
after the seizure stops.
·
Another seizure starts before the person regains consciousness.
·
The person injures himself or herself during the seizure.
·
This is a first seizure or you think it might be. If in doubt, check to see if
the person has a medical identification card or jewelry stating that he or
she has epilepsy or a seizure disorder.
After the seizure ends, the person will probably be groggy and tired. He or
she also may have a headache and be confused or embarrassed. Be patient
with the person and try to help him or her find a place to rest if he or she is
tired or doesn’t feel well. If necessary, offer to call a taxi, a friend, or a
relative to help the person get home safely.
If you see someone having a non-convulsive seizure, remember that the
person’s behavior is not intentional. The person may wander aimlessly or
make alarming or unusual gestures. You can help by following these
guidelines:
·
Remove any dangerous objects from the area around the person or in his
or her path.
·
Don’t try to stop the person from wandering unless he or she is in
danger.
·
Don’t shake the person or shout.
·
Stay with the person until he or she is completely alert.
Many people with epilepsy lead productive and outwardly normal lives.
Many medical and research advances in the past two decades have led to a
better understanding of epilepsy and seizures than ever before. Advanced
brain scans and other techniques allow greater accuracy in diagnosing
epilepsy and determining when a patient may be helped by surgery. More
than 20 different medications and a variety of surgical techniques are now
available and provide good control of seizures for most people with
epilepsy. Other treatment options include the ketogenic diet and the first
implantable device, the vagus nerve stimulator. Research on the underlying
causes of epilepsy, including identification of genes for some forms of
epilepsy and febrile seizures, has led to a greatly improved understanding of
epilepsy that may lead to more effective treatments or even new ways of
preventing epilepsy in the future.
Guidelines 43
Information Resources
The National Institute of Neurological Disorders and Stroke, a component of
the National Institutes of Health, is the leading Federal supporter of research
on disorders of the brain and nervous system. The Institute also sponsors an
active public information program with staff who can answer questions
about diagnosis and research related to seizures and epilepsy. For
information on seizures or other neurological disorders, contact the
Institute’s Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, Maryland 20824
800-352-9424
www.ninds.nih.gov
Private voluntary organizations that provide information on treatment,
diagnosis, and services include the following:
American Epilepsy Society
342 North Main Street
West Hartford, Connecticut 06117
860-586-7505
www.aesnet.org
The American Epilepsy Society, one of the oldest neurological
professional organizations in the country, promotes research and
education for professionals interested in seizure disorders and epilepsy.
Membership consists of clinicians, scientists investigating basic and
clinical aspects of epilepsy, and other professionals interested in both
pediatric and adult seizure disorders. The Society develops resources and
collaborative relationships worldwide to advance patient care and to
support efforts leading to the prevention, treatment, and cure of epilepsy.
It also holds an annual scientific meeting that attracts more than 3,500
professionals.
Citizens United for Research in Epilepsy (CURE)
505 North Lake Shore Drive, #4605
Chicago, Illinois 60611
312-923-9117
312-923-9118 (fax)
CUReepi@aol.com
www.CUREepilepsy.org
CURE is a global grassroots organization dedicated to finding a cure for
pediatric intractable epilepsy. CURE works to stimulate innovative
epilepsy research through private funding sources and by publishing the
long overlooked need for a cure for this disease.
Epilepsy Foundation
4351 Garden City Drive
Suite 500
Landover, Maryland 20785
301-459-3700
800-332-1000
301-577-2684 (fax)
postmaster@efa.org
www.epilepsyfoundation.org
The Epilepsy Foundation is a national voluntary health agency that
works for people affected by seizures through research, education,
advocacy, and service. Its goals are the prevention and cure of seizure
disorders, the alleviation of their effects, and the promotion of
independence and optimal quality of life for people who have these
disorders. Epilepsy Foundation affiliates serve people with epilepsy and
their families in more than 100 communities throughout the United
States.
National Association of Epilepsy Centers
5775 Wayzata Boulevard
Suite 200
Minneapolis, Minnesota 55416
952-525-4526
The goals of this Association, which includes the majority of specialized
epilepsy centers in the U.S., are to provide information about the care of
patients with epilepsy to the appropriate government and industry
officials; to exchange information among its members; and to participate
in developing standards for programs providing services.
Epilepsy Institute
257 Park Avenue South
New York, NY 10010
212-677-8550
212-677-5825 (fax)
website@epilepsyinstitute.org
www.epilepsyinstitute.org
A non-profit organization that provides comprehensive social services
and resources for people with epilepsy and their families.
Guidelines 45
National Organization for Rare Disorders (NORD)
P.O. Box 8923
100 Route 37
New Fairfield, Connecticut 06812-8923
203-746-6518
800-999-NORD (6673)
203-746-6481 (fax)
orphan@rarediseases.org
www.rarediseases.org
The National Organization for Rare Disorders (NORD), a federation of
voluntary health organizations dedicated to helping people with rare
“orphan”diseases, is committed to the identification, treatment, and cure
of rare disorders through programs of education, advocacy, research, and
service.
For information on prescription medicines, contact:
National Council on Patient Information and Education
4915 St. Elmo Avenue
Suite 505
Bethesda, Maryland 20814
301-656-8565
301-656-4464 (fax)
ncpie@erols.com
www.talkaboutrx.org
The National Council on Patient Information and Education is a coalition
of organizations committed to providing patients, consumers, and
caregivers with useful and appropriate medicine information.
Pregnant women with epilepsy can help researchers learn how epilepsy
drugs affect unborn children by participating in the following program:
Antiepileptic Drug Pregnancy Registry
Massachusetts General Hospital
Genetics and Teratology Unit
55 Fruit Street
Boston, Massachusetts 02114
888-233-2334
http://www.aedpregnancyregistry.org/
Other support organizations include:
Family Caregiver Alliance
690 Market Street, Suite 600
San Francisco, California 94104
415-434-3388
800-445-8106
415-434-3508 (fax)
info@caregiver.org
www.caregiver.org
Services offered by the Family Caregiver Alliance include specialized
information and assistance, consultation on long-term care planning,
service linkage and arrangement, legal and financial consultation, respite
services, counseling, and education.
National Family Caregivers Association
10400 Connecticut Avenue
Suite 500
Kensington, Maryland 20895
301-942-6430
800-896-365
301-942-2302 (fax)
info@nfacares.org
www.nfcacares.org
Through its services in the areas of education and information, support
and validation, public awareness, and advocacy, the National Family
Caregivers Association strives to improve caregivers’ quality of life.
More Guideline Sources
The guideline above on seizures and epilepsy is only one example of the
kind of material that you can find online and free of charge. The remainder
of this chapter will direct you to other sources which either publish or can
help you find additional guidelines on topics related to seizures and
epilepsy. Many of the guidelines listed below address topics that may be of
particular relevance to your specific situation or of special interest to only
some patients with seizures and epilepsy. Due to space limitations these
sources are listed in a concise manner. Do not hesitate to consult the
following sources by either using the Internet hyperlink provided, or, in
cases where the contact information is provided, contacting the publisher or
author directly.
Topic Pages: MEDLINEplus
For patients wishing to go beyond guidelines published by specific Institutes
of the NIH, the National Library of Medicine has created a vast and patient-
Guidelines 47
oriented healthcare information portal called MEDLINEplus. Within this
Internet-based system are “health topic pages.” You can think of a health
topic page as a guide to patient guides. To access this system, log on to
http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you
can either search using the alphabetical index or browse by broad topic
areas. Recently, MEDLINEplus listed the following as being relevant to
seizures and epilepsy:
·
Guides on Seizures and Epilepsy
http://www.nlm.nih.gov/medlineplus/tutorials/seizuresandepileps
yloader.html
Epilepsy
http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm
Within the health topic page dedicated to seizures and epilepsy, the
following was recently recommended to patients:
·
General/Overviews
Source: Patient Education Institute
http://www.nlm.nih.gov/medlineplus/tutorials/seizuresandepileps
yloader.html
·
Diagnosis/Symptoms
Brain Imaging
Source: Epilepsy Foundation
http://www.epilepsyfoundation.org/answerplace/treatment/brain.
html
Computed Tomography (CT)-Head
Source: American College of Radiology, Radiological Society of North
America
http://www.radiologyinfo.org/content/ct_of_the_head.htm
Electroencephalogram (EEG)
Source: img src='/medlineplus/images/linkpdf.gif' width='100'
height='17' border=0 alt='Links to PDF File'> (National Institutes of
Health, Clinical Center
http://www.cc.nih.gov/ccc/patient_education/procdiag/eeg.pdf
Electrophysiology
Source: We Move
http://www.wemove.org/kidsmove/dia_exa_electro.html
Functional MR Imaging (fMRI) - Brain
Source: American College of Radiology, Radiological Society of North
America
http://www.radiologyinfo.org/content/functional_mr.htm
·
Treatment
Treatment Through Vagus Nerve Stimulation
http://www.epilepsyfoundation.org/answerplace/treatment/vns.ht
ml
·
Nutrition
Ketogenic Diet as Therapy: An Update
http://www.epilepsyfoundation.org/answerplace/epusa/ketogenic.
html
·
Specific Conditions/Aspects
All About Partial Seizures
http://www.epilepsyfoundation.org/answerplace/partialseizures/t
ypes.html
Petit Mal Seizure
Source: Mayo Foundation for Medical Education and Research
http://www.mayoclinic.com/invoke.cfm?id=DS00216
Seizure Recognition and First Aid
http://www.epilepsyfoundation.org/answerplace/recognition/chart
.html
Guidelines 49
Todd's Paralysis
Source: img src='/medlineplus/images/shortsummary.gif' width='90'
height='17' border=0 alt='Short Summary'> (National Institute of
Neurological Disorders and Stroke
http://www.ninds.nih.gov/health_and_medical/disorders/toddspar
alysis.htm
What is a Grand Mal Seizure?
What is a Temporal Lobe Seizure?
·
Children
Febrile Seizures
Source: National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/health_and_medical/pubs/febrile_seizur
es.htm
Infantile Spasms
Source: img src='/medlineplus/images/shortsummary.gif' width='90'
height='17' border=0 alt='Short Summary'> (National Institute of
Neurological Disorders and Stroke
http://www.ninds.nih.gov/health_and_medical/disorders/infantile
spasms.htm
Know the Signs of Childhood Seizures
http://www.epilepsyfoundation.org/answerplace/knowsigns/know
signs.html
Nonfebrile and Generalized Seizures
Source: American Academy of Pediatrics
http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZ
Z9I77NBAC&sub_cat=107
Seizures
Source: Nemours Foundation
http://kidshealth.org/parent/firstaid_safe/emergencies/seizure.htm
l
·
From the National Institutes of Health
Seizures and Epilepsy: Hope Through Research
http://www.ninds.nih.gov/health_and_medical/pubs/seizures_and
_epilepsy_htr.htm
·
Law and Policy
Arrest For Seizure-Related Behavior
http://www.epilepsyfoundation.org/answerplace/factsheets/arrest.
html
·
Organizations
Epilepsy Foundation
http://www.epilepsyfoundation.org/index.cfm
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/
Society for Neuroscience
http://web.sfn.org/
·
Research
Febrile Seizures After MMR And DTP Vaccinations
Source: National Immunization Program
http://www.cdc.gov/nip/issues/mmr-dtp/mmr-dtp-faqs.htm
Safe Effective Treatment to Stop Seizures Can Be Delivered Outside
of the Hospital
http://www.ninds.nih.gov/news_and_events/pressrelease_seizure_t
reatment_082901.htm
Guidelines 51
·
Teenagers
Seizure Smart Babysitters
http://www.epilepsyfoundation.org/answerplace/babysitters/intro.
html
·
Women
Seizure Disorders in Pregnancy
Source: American College of Obstetricians and Gynecologists
http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZ
ZG14EX77C&sub_cat=3
If you do not find topics of interest when browsing health topic pages, then
you can choose to use the advanced search utility of MEDLINEplus at
http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is
similar to the NIH Search Utility, with the exception that it only includes
material linked within the MEDLINEplus system (mostly patient-oriented
information). It also has the disadvantage of generating unstructured results.
We recommend, therefore, that you use this method only if you have a very
targeted search.
The Combined Health Information Database (CHID)
CHID Online is a reference tool that maintains a database directory of
thousands of journal articles and patient education guidelines on seizures
and epilepsy and related conditions. One of the advantages of CHID over
other sources is that it offers summaries that describe the guidelines
available, including contact information and pricing. CHID’s general Web
site is http://chid.nih.gov/. To search this database, go to
http://chid.nih.gov/detail/detail.html. In particular, you can use the
advanced search options to look up pamphlets, reports, brochures, and
information kits. The following was recently posted in this archive:
·
Safety and Seizures: Tips for Living with Seizure Disorders
Source: Landover, MD, Epilepsy Foundation of America, 29 p., 1996.
Contact: Epilepsy Foundation of America, 4351 Garden City Drive,
Landover, MD 20785. (800) EFA-1000; (301) 459-3700, ext. 641. TDD: (800)
332-2070. INTERNET/EMAIL: www.efa.org.
Summary: Safety and Seizures: Tips for Living with Seizure Disorders is
a booklet designed to help individuals with seizure disorders cope with
the condition by helping them think about any risks they may face and
offering suggestions on how to have a safe and active life. Section 1
discusses seizure first aid for convulsions and partial seizures, and when
to call an ambulance. Section 2 discusses how to take an inventory of
personal risk, including (1) seizure type, (2) seizure characteristics, (3)
seizure history, (4) seizure triggers, and (5) seizure frequency. Section 3
describes how to take an inventory of activity risk by thinking about
common activities and lifestyle. Section 4 presents a menu of safety tips
for daily living that may reduce the risk of injury during or following a
seizure. The menu focuses on (1) personal safety, (2) bathroom safety, (3)
kitchen safety, (4) household safety, (5) workplace safety, (6)
transportation safety, (7) recreation safety, (8) children's safety, and (9)
parenting safety. Each section offers a personal story from one individual
who creatively handled a safety situation. Section 5 presents information
on getting help from experts (rehabilitation technology specialists),
offering telephone numbers of organizations with rehabilitation
technology specialists. Section 5 describes how becoming a member of
the EFA can help the organization and individuals with epilepsy.
·
Seizures and Seniors
Source: Landover, MD, Epilepsy Foundation of America, 28 p., (n.d.).
Landover, MD 20785. (301) 459-3700. (800) EFA-1000.
Summary: Seizures and Seniors is a brochure that provides information
about seizures in older individuals. Topics include (1) about epilepsy; (2)
types of seizures; (3) things to remember about seizures; (4) how to
respond to seizures and handle convulsions; (5) how to respond to
confusion during a seizure or during the recovery period; (6) seizure
warning signals; (7) how to respond to seizures in an older person who
also has other medical problems; (8) causes of epilepsy; (9) antiepileptic
drugs; (10) mental alertness, mood, and memory related to epilepsy; (11)
the importance of remembering to take medication at the proper time;
(12) living with epilepsy, (13) driving by individuals with epilepsy; (14)
changes in attitudes toward and treatment for epilepsy over the years;
and (15) information on the Epilepsy Foundation of America.
·
Epilepsy: Questions and Answers about Seizure Disorders
Landover, MD 20785. (301) 577-0100. FAX: (301) 577-4951.
Guidelines 53
Summary: Epilepsy: Questions and Answers about Seizure Disorders is a
brochure that provides general information about epilepsy to the public.
Topics include (1) questions and answers about epilepsy; (2) questions
and answers about seizures; (3) seizures that look like sleepwalking; (4)
most seizures do not injure the brain; (5) seizures do not cause injuries to
other people; (6) questions and answers about first aid; (7) simple first aid
for epilepsy; (8) how doctors treat epilepsy with drugs; (9) surgery, the
ketogenic diet, vitamin and mineral treatment, and biofeedback; (10)
questions and answers about daily living for individuals with epilepsy,
including information on driving, employment, discrimination, drinking,
serving in the armed forces, sports, swimming, insurance, aging, and
mental illness; and (11) how the Epilepsy Foundation of America helps
people with epilepsy and the benefits of membership in the Foundation.
A final section offers an annotated list of selected videos, pamphlets, and
books available from the Epilepsy Foundation of America.
·
Americans with Disabilities Act: Questions and Answers About
Provisions Affecting Persons with Seizure Disorders
Landover, MD 20785. (301) 577-0100. (800) EFA-1000.
Summary: Americans with Disabilities Act: Questions and Answers
about Provisions Affecting Persons with Seizure Disorders is a brochure
that provides basic information about epilepsy and employment. Topics
include (1) the Americans with Disabilities Act (ADA); (2) how the ADA
works in connection with current state and local laws; (3) why people
with epilepsy are covered by the ADA; (4) basic employment provisions
of the ADA (Title I); (5) the provisions of the ADA concerning state and
local governments (Title II); (6) transportation standards under the ADA
(Title II, Part 1 and 2); (7) provisions for Public Accommodation under
the ADA (Title III); (8) what the ADA requires regarding
telecommunications (Title IV); (9) which employers are covered by the
ADA and when employment provisions take effect; (10) the employment
application process; (11) job interviews; (12) establishing that applicants
are qualified individuals with a disability; (13) essential job functions;
(14) reasonable accommodation; (15) medical examinations and drug
testing; (16) how the ADA affects the availability and administration of
employee benefits; (17) employment discrimination claims; and (18) what
defenses are available to employers who are charged with violating the
ADA.
·
Epilepsy: Part of Your Life: Living with Seizure Disorders
Source: Landover, MD, Epilepsy Foundation of America, 43 p., (n.d.).
Contact: Epilepsy Foundation of America. 4351 Garden City Drive,
Landover, MD 20785. (301) 577-0100. FAX: (301) 577-4951.
Summary: Epilepsy: Part of Your Life. Living with Seizure Disorders is a
booklet about day-to-day living with epilepsy and some of the special
issues that may arise. The booklet contains general information based on
the experiences of many people with epilepsy, and its recommendations
are drawn from studies and research. Topics include (1) information
about epilepsy; (2) how to adjust to epilepsy; (4) how to understand your
feeling; (5) staying healthy; (6) living in society with epilepsy; (7) tips for
living with epilepsy in today's world; (8) the Epilepsy Foundation of
America and offers contact information; and (9) selected books, videos,
and pamphlets.
·
Epilepsy: You and Your Treatment
Contact: Epilepsy Foundation of America. 4351 Garden City Drive,
Landover, MD 20785. (800) EFA-1000.
Summary: Epilepsy: You and Your Treatment is a booklet from the
Epilepsy Foundation of America that provides basic information about
tests, diagnosis, and management. Topics include (1) what seizures are
and how physicians will work with individuals who have seizures; (2)
blood tests; (3) electroencephalograph tests; (4) brain imaging techniques;
(5) tests during treatment; (6) drugs prescribed to prevent seizures; (7)
things to do to help treatment work; (8) side effects of drugs; (9)
pregnancy; (10) the effect of taking more than one anticonvulsant drug;
(11) the benefits of brain surgery for certain types of epilepsy; and (12)
other treatments, such as the ketogenic diet, biofeedback, ACTH
injection, vitamin therapy, and experimental medicines.
·
Management by Common Sense: A Frank Look at Epilepsy in the
Workplace
Source: Landover, MD, Epilepsy Foundation of America, Training and
Placement Service, 3-fold brochure, 7-page pocket insert, 1987.
Landover, MD 20785. (800) 332-1000; (301) 459-3700.
Summary: Information about epilepsy is presented in the format of a
manager explaining epilepsy to peers. Topics discussed include seizure
management, epidemiology and causes, seizure types, workplace
Guidelines 55
accommodations, and understanding the individual with epilepsy.
Managers are encouraged to treat all employees equally. About 1 percent
of the population has epilepsy. It can be caused by birth defects,
childhood illness, tumor, head injury, or neural infection. Often no cause
is found. There are more than 20 different types of seizures; they can
cause impaired consciousness, involuntary movements, or brief lapses in
attention. Tonic-clonic seizures affect the whole brain and cause the
person to lose consciousness, fall, and experience stiffening and jerking
for 2 to 5 minutes. First aid measures include clearing the area of
onlookers and hard objects, turning the individual on his or her side and
loosening their collar. Absence seizures are brief lapses in consciousness
and do not require first aid. Simple partial seizures do not impair
consciousness and do not require first aid; symptoms are related to the
portion of the brain that is affected. Complex partial seizures are variable
and may be difficult to understand. The individual having a seizure may
appear disoriented and dazed. First aid measures include gently guiding
the individual away from hazards and providing reassurance until the
seizure is over. Workplace accommodations vary but may include stable
shifts, regular breaks, and sensitivity from coworkers. Safety issues are
related to the particular seizure type. Special concerns addressed include
driving, work absences, medication side effects, stress-induced seizures,
working with equipment and machinery, workers' compensation
premium rates, and customer or client reactions.
·
Women and Epilepsy
Source: North York, Ontario, Canada, Epilepsy Ontario, 8 p., (n.d.).
Contact: Epilepsy Ontario, P.O. Box 58515, 197 Sheppard Avenue East,
North York, Ontario, Canada. (905) 764-5099. (416) 229-2291. (800) 4631119.
Summary: Women and Epilepsy, a brochure from Epilepsy Ontario,
presents information on how seizure disorders relate to the various
phases of a woman's life, from puberty to menopause. The first section
focuses on adolescence, highlighting (1) menstruation, (2) relationships
and disclosure, (3) and birth control. The second section discusses
prepregnancy planning, focusing on fertility and libido as they relate to
epilepsy. The third section looks at pregnancy, examining (1) the role of
heredity, (2) seizures during pregnancy, (3) possible complications
during pregnancy, (4) drugs and the developing fetus, (5) nutrition, (6)
labor and delivery, and (7) breast feeding. The fourth section focuses on
practical concerns for women with small children, including
recommended safety precautions. The fifth section discusses epilepsy and
menopause. The brochure opens out into a poster entitled Women and
Epilepsy.
·
Seizures
Source: Charleston, WV: Division of Handicapped Children's Services,
West Virginia Bureau of Public Health. n.d. 2 pp.
Contact: Available from Division of Handicapped Children's Services,
West Virginia Department of Health and Human Resources, Office of
Maternal and Child Health, 1411 Virginia Street, East, Charleston, WV
25301. Telephone: (304) 558-0030 / fax: (304) 558-2183.
Summary: This brochure is given to parents of children who have had
seizures and have visited a West Virginia health clinic. It includes
instructions regarding the child's medication and what the parent should
do if their child has another seizure.
The National Guideline Clearinghouse™
The National Guideline Clearinghouse™ offers hundreds of evidence-based
clinical practice guidelines published in the United States and other
countries. You can search their site located at http://www.guideline.gov by
using the keyword “seizures and epilepsy” or synonyms. The following was
recently posted:
·
Practice parameter: long-term treatment of the child with simple febrile
seizures.
Source: American Academy of Pediatrics.; 1999 June; 3 pages
http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00
1183&sSearch_string=Seizures+and+Epilepsy
Healthfinder™
Healthfinder™ is an additional source sponsored by the U.S. Department of
Health and Human Services which offers links to hundreds of other sites that
contain healthcare information. This Web site is located at
http://www.healthfinder.gov. Again, keyword searches can be used to find
guidelines. The following was recently found in this database:
·
An Epilepsy Education
Summary: A general overview about epilepsy seizures written fro
children.
Guidelines 57
Source: Nemours Foundation
http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R
ecordID=5532
·
Epilepsy and Seizures
Summary: A general overview of epilepsy and seizures that includes a
description of the disorder, and treatment, prognosis and research
information.
Source: National Institute of Neurological Disorders and Stroke, National
Institutes of Health
ecordID=746
·
Epilepsy: Taming the Seizures, Dispelling the Myths
Summary: This FDA Consumer magazine article discusses epileptic
seizures and their control and treatment. Includes information about
drugs that the FDA has approved for treatment and control of the
disorder.
Source: U.S. Food and Drug Administration
ecordID=4426
The NIH Search Utility
After browsing the references listed at the beginning of this chapter, you
may want to explore the NIH Search Utility. This allows you to search for
documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis.
Your search will produce a list of various documents, all of which will relate
in some way to seizures and epilepsy. The drawbacks of this approach are
that the information is not organized by theme and that the references are
often a mix of information for professionals and patients. Nevertheless, a
large number of the listed Web sites provide useful background information.
We can only recommend this route, therefore, for relatively rare or specific
disorders, or when using highly targeted searches. To use the NIH search
utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources
A number of Web sites that often link to government sites are available to
the public. These can also point you in the direction of essential information.
The following is a representative sample:
·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google:
http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project:
http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder
The material in this chapter may have contained a number of unfamiliar
words. The following Vocabulary Builder introduces you to terms used in
this chapter that have not been covered in the previous chapter:
Accommodation:
distances. [EU]
Adjustment, especially that of the eye for various
Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major
transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic
effector junctions, a subset of sympathetic effector junctions, and at many
sites in the central nervous system. It is generally not used as an
administered drug because it is broken down very rapidly by
cholinesterases, but it is useful in some ophthalmological applications. [NIH]
ACTH: Adrenocorticotropic hormone. [EU]
Adolescence: The period of life beginning with the appearance of secondary
sex characteristics and terminating with the cessation of somatic growth. The
years usually referred to as adolescence lie between 13 and 18 years of age.
[NIH]
Amniocentesis: Percutaneous transabdominal puncture of the uterus
during pregnancy to obtain amniotic fluid. It is commonly used for fetal
Guidelines 59
karyotype determination in order to diagnose abnormal fetal conditions. [NIH]
Anemia: A reduction in the number of circulating erythrocytes or in the
quantity of hemoglobin. [NIH]
Anesthesia: A state characterized by loss of feeling or sensation. This
depression of nerve function is usually the result of pharmacologic action
and is induced to allow performance of surgery or other painful procedures.
[NIH]
Anticonvulsant: An agent that prevents or relieves convulsions. [EU]
Antidepressant: An agent that stimulates the mood of a depressed patient,
including tricyclic antidepressants and monoamine oxidase inhibitors. [EU]
Antiepileptic: An agent that combats epilepsy. [EU]
Anxiety: The unpleasant emotional state consisting of psychophysiological
responses to anticipation of unreal or imagined danger, ostensibly resulting
from unrecognized intrapsychic conflict. Physiological concomitants include
increased heart rate, altered respiration rate, sweating, trembling, weakness,
and fatigue; psychological concomitants include feelings of impending
danger, powerlessness, apprehension, and tension. [EU]
Apnea: A transient absence of spontaneous respiration. [NIH]
Arrhythmia: Any variation from the normal rhythm of the heart beat,
including sinus arrhythmia, premature beat, heart block, atrial fibrillation,
atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU]
Aura: A subjective sensation or motor phenomenon that precedes and
marks the of a paroxysmal attack, such as an epileptic attack on set. [EU]
Automatism: Aimless and apparently undirected behaviour that is not
under conscious control and is performed without conscious knowledge;
seen in psychomotor epilepsy, catatonic schizophrenia, psychogenic fugue,
and other conditions. Called also automatic behaviour. [EU]
Benign: Not malignant; not recurrent; favourable for recovery. [EU]
Biochemical: Relating to biochemistry; characterized by, produced by, or
involving chemical reactions in living organisms. [EU]
Blinking: Brief closing of the eyelids by involuntary normal periodic
closing, as a protective measure, or by voluntary action. [NIH]
Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
particularly of the pentahydric and hexahydric alcohols. They are so named
because the hydrogen and oxygen are usually in the proportion to form
water, (CH2O)n. The most important carbohydrates are the starches, sugars,
celluloses, and gums. They are classified into mono-, di-, tri-, poly- and
heterosaccharides. [EU]
Cardiac: Pertaining to the heart. [EU]
Cardiovascular: Pertaining to the heart and blood vessels. [EU]
Cerebral: Of or pertaining of the cerebrum or the brain. [EU]
Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain.
[EU]
Clonazepam: An anticonvulsant used for several types of seizures,
including myotonic or atonic seizures, photosensitive epilepsy, and absence
seizures, although tolerance may develop. It is seldom effective in
generalized tonic-clonic or partial seizures. The mechanism of action appears
to involve the enhancement of GABA receptor responses. [NIH]
Clonic: Pertaining to or of the nature of clonus. [EU]
Conception: The onset of pregnancy, marked by implantation of the
blastocyst; the formation of a viable zygote. [EU]
Confusion: Disturbed orientation in regard to time, place, or person,
sometimes accompanied by disordered consciousness. [EU]
Consciousness: Sense of awareness of self and of the environment. [NIH]
Contraceptive:
conception. [EU]
An agent that diminishes the likelihood of or prevents
Convulsion: A violent involuntary contraction or series of contractions of
the voluntary muscles. [EU]
Cortex: The outer layer of an organ or other body structure, as distinguished
from the internal substance. [EU]
Dehydration: The condition that results from excessive loss of body water.
Called also anhydration, deaquation and hypohydration. [EU]
Deprivation: Loss or absence of parts, organs, powers, or things that are
needed. [EU]
Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]
Dizziness: An imprecise term which may refer to a sense of spatial
disorientation, motion of the environment, or lightheadedness. [NIH]
Dysplasia: Abnormality of development; in pathology, alteration in size,
shape, and organization of adult cells. [EU]
Eclampsia: Convulsions and coma occurring in a pregnant or puerperal
woman, associated with preeclampsia, i.e., with hypertension, edema,
and/or proteinuria. [EU]
Encephalitis: Inflammation of the brain. [EU]
Encephalopathy: Any degenerative disease of the brain. [EU]
Enzyme: A protein molecule that catalyses chemical reactions of other
substances without itself being destroyed or altered upon completion of the
reactions. Enzymes are classified according to the recommendations of the
Guidelines 61
Nomenclature Committee of the International Union of Biochemistry. Each
enzyme is assigned a recommended name and an Enzyme Commission (EC)
number. They are divided into six main groups; oxidoreductases,
transferases, hydrolases, lyases, isomerases, and ligases. [EU]
Ethosuximide: An anticonvulsant especially useful in the treatment of
absence seizures unaccompanied by other types of seizures. [NIH]
Fatigue: The state of weariness following a period of exertion, mental or
physical, characterized by a decreased capacity for work and reduced
efficiency to respond to stimuli. [NIH]
Febrile: Pertaining to or characterized by fever. [EU]
GABA: The most common inhibitory neurotransmitter in the central
nervous system. [NIH]
Gestures:
Movement of a part of the body for the purpose of
communication. [NIH]
Gluten: The protein of wheat and other grains which gives to the dough its
tough elastic character. [EU]
Hemiplegia: Paralysis of one side of the body. [EU]
Hemorrhage: Bleeding or escape of blood from a vessel. [NIH]
Heredity: 1. The genetic transmission of a particular quality or trait from
parent to offspring. 2. The genetic constitution of an individual. [EU]
Hormonal: Pertaining to or of the nature of a hormone. [EU]
Hydrocephalus: A condition marked by dilatation of the cerebral ventricles,
most often occurring secondarily to obstruction of the cerebrospinal fluid
pathways, and accompanied by an accumulation of cerebrospinal fluid
within the skull; the fluid is usually under increased pressure, but
occasionally may be normal or nearly so. It is typically characterized by
enlargement of the head, prominence of the forehead, brain atrophy, mental
deterioration, and convulsions; may be congenital or acquired; and may be
of sudden onset (acute h.) or be slowly progressive (chronic or primary b.).
[EU]
Idiopathic: Of the nature of an idiopathy; self-originated; of unknown
causation. [EU]
Immunization: The induction of immunity. [EU]
Infantile: Pertaining to an infant or to infancy. [EU]
Inflammation: A pathological process characterized by injury or destruction
of tissues caused by a variety of cytologic and chemical reactions. It is
usually manifested by typical signs of pain, heat, redness, swelling, and loss
of function. [NIH]
Leprosy:
A chronic granulomatous infection caused by Mycobacterium
leprae. The granulomatous lesions are manifested in the skin, the mucous
membranes, and the peripheral nerves. Two polar or principal types are
lepromatous and tuberculoid. [NIH]
Lesion: Any pathological or traumatic discontinuity of tissue or loss of
function of a part. [EU]
Libido: Sexual desire. [EU]
Lobe: A more or less well-defined portion of any organ, especially of the
brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective
tissue, and by their shape. [EU]
Membrane: A thin layer of tissue which covers a surface, lines a cavity or
divides a space or organ. [EU]
Meningitis: Inflammation of the meninges. When it affects the dura mater,
the disease is termed pachymeningitis; when the arachnoid and pia mater
are involved, it is called leptomeningitis, or meningitis proper. [EU]
Menopause: Cessation of menstruation in the human female, occurring
usually around the age of 50. [EU]
Menstruation: The cyclic, physiologic discharge through the vagina of
blood and mucosal tissues from the nonpregnant uterus; it is under
hormonal control and normally recurs, usually at approximately four-week
intervals, in the absence of pregnancy during the reproductive period
(puberty through menopause) of the female of the human and a few species
of primates. It is the culmination of the menstrual cycle. [EU]
Mental: 1. Pertaining to the mind; psychic. 2. (L. mentum chin) Pertaining to
the chin. [EU]
Monotherapy: A therapy which uses only one drug. [EU]
Nausea: An unpleasant sensation, vaguely referred to the epigastrium and
abdomen, and often culminating in vomiting. [EU]
Neonatal: Pertaining to the first four weeks after birth. [EU]
Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of
the spinal axis, as the neutral arch. [EU]
Neurology: A medical specialty concerned with the study of the structures,
functions, and diseases of the nervous system. [NIH]
Neuronal: Pertaining to a neuron or neurons (= conducting cells of the
nervous system). [EU]
Neurons: The basic cellular units of nervous tissue. Each neuron consists of
a body, an axon, and dendrites. Their purpose is to receive, conduct, and
transmit impulses in the NERVOUS SYSTEM. [NIH]
Neurotransmitter: Any of a group of substances that are released on
excitation from the axon terminal of a presynaptic neuron of the central or
Guidelines 63
peripheral nervous system and travel across the synaptic cleft to either excite
or inhibit the target cell. Among the many substances that have the
properties of a neurotransmitter are acetylcholine, norepinephrine,
epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance
P, enkephalins, endorphins, and serotonin. [EU]
Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at
nicotinic cholinergic receptors where it dramatically stimulates neurons and
ultimately blocks synaptic transmission. Nicotine is also important medically
because of its presence in tobacco smoke. [NIH]
Pacemaker: An object or substance that influences the rate at which a certain
phenomenon occurs; often used alone to indicate the natural cardiac
pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance
whose rate of reaction sets the pace for a series of interrelated reactions. [EU]
Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU]
Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or
located near the parietal bone, as the parietal lobe. [EU]
Pediatrics: A medical specialty concerned with maintaining health and
providing medical care to children from birth to adolescence. [NIH]
Perinatal: Pertaining to or occurring in the period shortly before and after
birth; variously defined as beginning with completion of the twentieth to
twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU]
Phenobarbital: A barbituric acid derivative that acts as a nonselective
central nervous system depressant. It promotes binding to inhibitory GABA
subtype receptors, and modulates chloride currents through receptor
channels. It also inhibits glutamate induced depolarizations. [NIH]
Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is
also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic
action is not clear, although several cellular actions have been described
including effects on ion channels, active transport, and general membrane
stabilization. The mechanism of its muscle relaxant effect appears to involve
a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has
been proposed for several other therapeutic uses, but its use has been limited
by its many adverse effects and interactions with other drugs. [NIH]
Poisoning: A condition or physical state produced by the ingestion,
injection or inhalation of, or exposure to a deleterious agent. [NIH]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from
cortisone. It is biologically inert and converted to prednisolone in the liver.
[NIH]
Prejudice: A preconceived judgment made without adequate evidence and
not easily alterable by presentation of contrary evidence. [NIH]
Prenatal: Existing or occurring before birth, with reference to the fetus. [EU]
Progressive:
Advancing; going forward; going from bad to worse;
increasing in scope or severity. [EU]
Proteins: Polymers of amino acids linked by peptide bonds. The specific
sequence of amino acids determines the shape and function of the protein.
[NIH]
Psychiatric: Pertaining to or within the purview of psychiatry. [EU]
Psychogenic: Produced or caused by psychic or mental factors rather than
organic factors. [EU]
Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU]
Puberty: The period during which the secondary sex characteristics begin to
develop and the capability of sexual reproduction is attained. [EU]
Radiology: A specialty concerned with the use of x-ray and other forms of
radiant energy in the diagnosis and treatment of disease. [NIH]
Receptor: 1. A molecular structure within a cell or on the surface
characterized by (1) selective binding of a specific substance and (2) a
specific physiologic effect that accompanies the binding, e.g., cell-surface
receptors for peptide hormones, neurotransmitters, antigens, complement
fragments, and immunoglobulins and cytoplasmic receptors for steroid
hormones. 2. A sensory nerve terminal that responds to stimuli of various
kinds. [EU]
Remission: A diminution or abatement of the symptoms of a disease; also
the period during which such diminution occurs. [EU]
Resection: Excision of a portion or all of an organ or other structure. [EU]
Sclerosis: A induration, or hardening; especially hardening of a part from
inflammation and in diseases of the interstitial substance. The term is used
chiefly for such a hardening of the nervous system due to hyperplasia of the
connective tissue or to designate hardening of the blood vessels. [EU]
Sedative: An agent that allays excitement. [EU]
Seizures: Clinical or subclinical disturbances of cortical function due to a
sudden, abnormal, excessive, and disorganized discharge of brain cells.
Clinical manifestations include abnormal motor, sensory and psychic
phenomena. Recurrent seizures are usually referred to as EPILEPSY or
"seizure disorder." [NIH]
Serum: 1. The clear portion of any body fluid; the clear fluid moistening
serous membranes. 2. Blood serum; the clear liquid that separates from
blood on clotting. 3. Immune serum; blood serum from an immunized
animal used for passive immunization; an antiserum; antitoxin, or antivenin.
[EU]
Spectrum: A charted band of wavelengths of electromagnetic vibrations
Guidelines 65
obtained by refraction and diffraction. By extension, a measurable range of
activity, such as the range of bacteria affected by an antibiotic (antibacterial
s.) or the complete range of manifestations of a disease. [EU]
Tomography: The recording of internal body images at a predetermined
plane by means of the tomograph; called also body section roentgenography.
[EU]
Tone: 1. The normal degree of vigour and tension; in muscle, the resistance
to passive elongation or stretch; tonus. 2. A particular quality of sound or of
voice. 3. To make permanent, or to change, the colour of silver stain by
chemical treatment, usually with a heavy metal. [EU]
Tonic: 1. Producing and restoring the normal tone. 2. Characterized by
continuous tension. 3. A term formerly used for a class of medicinal
preparations believed to have the power of restoring normal tone to tissue.
[EU]
Viral: Pertaining to, caused by, or of the nature of virus. [EU]
Withdrawal: 1. A pathological retreat from interpersonal contact and social
involvement, as may occur in schizophrenia, depression, or schizoid
avoidant and schizotypal personality disorders. 2. (DSM III-R) A substancespecific organic brain syndrome that follows the cessation of use or
reduction in intake of a psychoactive substance that had been regularly used
to induce a state of intoxication. [EU]
Seeking Guidance 67
CHAPTER 2. SEEKING GUIDANCE
Overview
Some patients are comforted by the knowledge that a number of
organizations dedicate their resources to helping people with seizures and
epilepsy. These associations can become invaluable sources of information
and advice. Many associations offer aftercare support, financial assistance,
and other important services. Furthermore, healthcare research has shown
that support groups often help people to better cope with their conditions.8
In addition to support groups, your physician can be a valuable source of
guidance and support. Therefore, finding a physician that can work with
your unique situation is a very important aspect of your care.
In this chapter, we direct you to resources that can help you find patient
organizations and medical specialists. We begin by describing how to find
associations and peer groups that can help you better understand and cope
with seizures and epilepsy. The chapter ends with a discussion on how to
find a doctor that is right for you.
Associations and Seizures and Epilepsy
As mentioned by the Agency for Healthcare Research and Quality,
sometimes the emotional side of an illness can be as taxing as the physical
side.9 You may have fears or feel overwhelmed by your situation. Everyone
has different ways of dealing with disease or physical injury. Your attitude,
your expectations, and how well you cope with your condition can all
Churches, synagogues, and other houses of worship might also have groups that can offer
you the social support you need.
9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm.
8
influence your well-being. This is true for both minor conditions and serious
illnesses. For example, a study on female breast cancer survivors revealed
that women who participated in support groups lived longer and
experienced better quality of life when compared with women who did not
participate. In the support group, women learned coping skills and had the
opportunity to share their feelings with other women in the same situation.
In addition to associations or groups that your doctor might recommend, we
suggest that you consider the following list (if there is a fee for an
association, you may want to check with your insurance provider to find out
if the cost will be covered):
·
American Epilepsy Society
Address: American Epilepsy Society 342 North Main Street, West
Hartford, CT 06117-2507
Telephone: (860) 586-7505 Toll-free: 1800 134 087
Fax: (860) 586- 7550
Email: info@AESnet.org
Web Site: http://www.AESnet.org
Background: The American Epilepsy Society (AES) is a not-for-profit
professional society dedicated to supporting individuals affected by
epilepsy through research, education, and advocacy. Epilepsy is a group
of disorders characterized by episodes of uncontrolled electrical
disturbances in the brain. Established in 1936, the American Epilepsy
Society, one of the oldest neurological professional organizations in the
United States, currently consists of approximately 1,850 members
including clinicians, scientists investigating basic and clinical aspects of
epilepsy, and other professionals interested in seizure disorders. The
Society's goals are to study epilepsy in all phases-biological, clinical, and
psychosocial; to promote better care and treatment for infants, children,
and adults with seizure disorders; to build personal contacts between
medical investigators in epilepsy and those in related fields; to build
contacts between the Society and similar societies throughout the world
facilitating the exchange of scientific and professional information; and to
support peer-review research, grants, and training fellowships in
epilepsy. The Society is also dedicated to being recognized as the
authority on the standards of quality care for those affected with
epilepsy; the primary source for scientific and clinical information on
epilepsy for those involved in developing public and health care policy;
and the leader in developing collaborative relationships that further the
quality of care of those affected with epilepsy. The Society offers a variety
Seeking Guidance 69
of services including providing information on the latest pharmaceuticals
and technologies; offering special interest groups to allow for networking
and sharing of specialized interests; providing programs for Continuing
Medical Education (CME) and nursing credits; offering funding sources
for member- sponsored educational programs and member-initiated
research; and conducting an annual meeting featuring symposia, lectures,
presentations, and exhibitions. Educational materials include
publications on specific topics with scientific focuses and conclusions, the
medical journal 'Epilepsia,' brochures, pamphlets, a regular newsletter,
audiovisuals, and more. AES also has a web site on the Internet at
http://www.AESnet.org.
Relevant area(s) of interest: Epilepsy, Seizures
·
Epilepsy Canada
Address: Epilepsy Canada 1470 Peel Street, Suite 745, Montreal, Quebec,
H3A 1T1, Canada
Telephone: (514) 845-7855 Toll-free: (800) 860-5499
Fax: (514) 845-7866
Email: epilepsy@epilepsy.ca
Web Site: http://www.epilepsy.ca
Background: Epilepsy Canada (EC) is a not-for-profit organization
dedicated to enhancing the quality of life for persons affected by
epilepsy. Epilepsy is a group of disorders of the central nervous system
characterized by repeated uncontrolled electrical disturbances in the
brain. Established in 1966, EC is committed to establishing understanding
and acceptance of epilepsy through the promotion of research, facilitation
of education, and the implementation of awareness initiatives. Consisting
of 21 members, the organization produces educational materials
including a newsletter entitled 'Lumina,' a pamphlet entitled 'Your
Medication for Epilepsy,' and a brochures entitled 'Answers to Your
Questions, Epilepsy,' 'Seizures and First Aid,' 'Seizures and Seniors,' and
'Epilepsy and Children: What Parents Need To Know.' EC maintains a
web site at http://www.epilepsy.ca.
Relevant area(s) of interest: Convulsions, Epilepsy, Seizures
·
Epilepsy Foundation of America
Address: Epilepsy Foundation of America 4351 Garden City Drive,
Landover, MD 20785
Fax: (301) 577-4941
Email: webmaster@efa.org
Web Site: http://www.efa.org/
Background: The Epilepsy Foundation of America is a national not-forprofit voluntary organization that works for people affected by seizures
through programs of research, education, advocacy, and service.
Established in 1968, the Foundation has a national office outside of
Washington, D.C. and a network of over 60 affiliated organizations
offering services in 125 communities nationwide. The Foundation seeks
to improve the quality of life for people affected by seizures; facilitate
access to reliable information about epilepsy; and act as a voice for people
affected by seizures. National programs include a toll-free information
service, research studies, professional education programs, public and
family education programs, legal and legislative advocacy programs, and
career choice and employment assistance. Local programs include
outreach programs to schools and community centers, support groups,
camping trips, employment services, respite care for families, and help
with living arrangements. The Foundation supplies informational
materials to the public and health care professionals. In addition, the
National Epilepsy Library and Resource Center provides authoritative
information to professionals and the public by means of computer access
to major collections of medical information.
·
Epilepsy Foundation of Victoria
Address: Epilepsy Foundation of Victoria 818-824 Burke Road,
Camberwell, Victoria, 3124, Australia
Telephone: (03) 9813 2866 Toll-free: 1800 134 087
Fax: (03) 9882 7159
Email: epinet@epinet.org.au
Web Site: http://www.epinet.org.au
Background: The Epilepsy Foundation of Victoria is a voluntary
organization in Australia dedicated to enhancing the quality of the lives
of people living with epilepsy, a group of neurologic disorders
characterized by sudden, recurrent episodes of uncontrolled
electrochemical activity in the brain (seizures). The Epilepsy Foundation
of Victoria was founded in 1964 and currently consists of six chapters. Its
mission is to provide a comprehensive and responsive range of services
and programs to meet the personal, interpersonal, socio-economic, and
cultural needs of individuals affected by epilepsy. Such programs and
Seeking Guidance 71
services include public education programs, advocacy, referral services,
employment programs, recreational support, and individual and group
counseling. The Foundation also promotes and supports medical and
psychosocial research, conducts parent education workshops and
support groups, and offers group forums that enable affected individuals
and family members to exchange information and support. In addition,
the Epilepsy Foundation of Victoria produces comprehensive brochures,
manuals, and educational videos on epilepsy; publishes a quarterly
newsletter entitled 'Epiletter'; has a lending library containing a collection
of books, journals, and videos concerning epilepsy; and maintains a web
site on the Internet.
·
Rasmussen's Syndrome and Hemispherectomy Support Network
Address: Rasmussen's Syndrome and Hemispherectomy
Network 8235 Lethbridge Road, Millersville, MD 21108
Support
Telephone: (410) 987-5221
Email: rssnlynn@aol.com
Background: The Rasmussen's Syndrome and Hemispherectomy Support
Network is a national not-for-profit organization dedicated to providing
information and support to individuals affected by Rasmussen's
Syndrome
(Rasmussen's
Encephalitis)
and
Hemispherectomy.
Rasmussen's Syndrome is a rare central nervous system disorder
characterized by chronic active inflammation of the brain (encephalitis)
and epileptic seizures of varying degrees of severity. Progressive
symptoms including paralysis (usually of one side of the body) and
mental retardation may also occur. Although the exact cause of this
disorder is not known, it is thought to result from an unidentified viral
infection. Hemispherectomy is a form of surgery commonly used in the
treatment of Rasmussen's Syndrome and other brain disorders. Founded
in 1994 and comprised of 150 members, RSHSN publishes a periodic
newsletter and disseminates reprints of medical journal articles
concerning Rasmussen's Syndrome and its treatments. RSHSN also
maintains a support network that provides encouragement and
information to individuals affected by Rasmussen's Syndrome and their
families.
·
THRESHOLD
Address:
Telephone: (908) 957-0714
Background: THRESHOLD is a not-for-profit self-help organization
affiliated with the Epilepsy Foundation of New Jersey. THRESHOLD is
dedicated to providing information and support to parents of children
with Intractable Seizure Disorder (uncontrolled seizure disorders).
Established in 1988, THRESHOLD publishes a newsletter that is
distributed to over 1,000 affected families and concerned healthcare
professionals across the United States and throughout the world. The
newsletter provides information on uncontrolled seizure disorders as
well as parent-to-parent support information.
·
Tuberous Sclerosis Association (UK)
Address: Tuberous Sclerosis Association (UK) Little Barnsley Farm,
Catshill, Bromsgrove, Worcestershire, B61 0NQ, United Kingdom
Telephone: 01527 871898 Toll-free: (800) 347-0252
Fax: 01527 577390
Email: secretary@tuberous-sclerosis.org
Web Site: http://www.tuberous- sclerosis.org
Background: The Tuberous Sclerosis Association (TSA), an international
self- help organization located in the United Kingdom, was established in
1977 by a group of parents and interested physicians dedicated to
providing support to individuals with Tuberous Sclerosis (TS) and their
families, increasing awareness of the disorder, and promoting
fundraising to support research. Tuberous Sclerosis, a rare genetic
disorder that affects the skin and nervous system, may be characterized
by the development of white skin patches, red or brown birthmarks,
and/or a characteristic facial rash across the cheeks and nose;
developmental delays; episodes of uncontrolled electrical disturbances in
the brain that cause convulsive seizures (epilepsy); mental retardation in
some cases; and/or the development of benign tumors, particularly of the
brain, retina, kidney, heart, and skin. The Tuberous Sclerosis Association
has helped to establish specialist, multidisciplinary TS clinics in Leeds,
Bath, Cambridge, Northern Ireland (Craigavon), and Scotland
(Edinburgh) that offer advice on diagnosis, management, and genetic
counseling and work closely with local medical staff involved with the
individuals and family members in question. The TSA also supports and
promotes research into the causes and management of TS through its
Education and Research Fund; is in touch with over 1,000 affected
families across the world as well as interested professionals from the
medical, social support, and education fields; offers networking
opportunities to affected families that enable them to exchange
information, support, and resources; and provides support to affected
Seeking Guidance 73
individuals, family members, and caregivers through visits and
telephone support. In addition, the Association advises on where to
obtain assistance concerning social services, benefits, and educational
concerns and has a Family Care Worker who engages in patient and
family advocacy. The TSA also has an International TS Research
Symposium every three to four years for physicians who are conducting
research on all aspects of the disorder; organizes regional meetings with
speakers who address local groups; holds an Annual General Meeting for
members, friends, and professionals during which physicians gives
presentations on Tuberous Sclerosis; and has a Family Weekend
Conference when affected families spend time together and benefit from
shared experiences. The Tuberous Sclerosis Assocation offers a variety of
materials including brochures, leaflets, fact sheets, videos, and a regular
newsletter entitled 'TS Scan.'.
·
Tuberous Sclerosis Canada
Address:
Fax: (905) 257-4778
Email: tscst@lara.on.ca
Background: Tuberous Sclerosis Canada Sclerose Tubereuse (TSCST) is a
not-forprofit organization dedicated to raising public awareness of
Tuberous Sclerosis Complex (TSC); encouraging mutual support between
families affected by TSC; and promoting research and education.
Tuberous Sclerosis, a rare genetic disorder that affects the skin and
nervous system, may be characterized by the development of white skin
patches, red or brown birthmarks, and/or a characteristic facial rash
across the cheeks and nose; delays in reaching developmental milestones
(e.g., sitting, crawling, walking); episodes of uncontrolled electrical
disturbances in the brain that cause convulsive seizures (epilepsy);
mental retardation in some cases; and/or the development of benign
tumors, particularly of the brain, retina, kidney, heart, and skin.
Established in 1990 and consisting of 130 members, TSCST facilitates a
self-help network in which families affected by Tuberous Sclerosis
support one another by telephone and share information about local
services that may be available. Educational materials are available in
French and English and include a self-titled quarterly newsletter and
brochures entitled 'There s More You Need to Know About Tuberous
Sclerosis' and 'Tuberous Sclerosis Complex - What To Expect'.
Finding More Associations
There are a number of directories that list additional medical associations
that you may find useful. While not all of these directories will provide
different information than what is listed above, by consulting all of them,
you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC)
The National Health Information Center (NHIC) offers a free referral service
to help people find organizations that provide information about seizures
and epilepsy. For more information, see the NHIC’s Web site at
http://www.health.gov/NHIC/ or contact an information specialist by calling
1-800-336-4797.
DIRLINE
A comprehensive source of information on associations is the DIRLINE
database maintained by the National Library of Medicine. The database
comprises some 10,000 records of organizations, research centers, and
government institutes and associations which primarily focus on health and
biomedicine. DIRLINE is available via the Internet at the following Web site:
http://dirline.nlm.nih.gov/. Simply type in “seizures and epilepsy” (or a
synonym) or the name of a topic, and the site will list information contained
in the database on all relevant organizations.
The Combined Health Information Database
Another comprehensive source of information on healthcare associations is
the Combined Health Information Database. Using the “Detailed Search”
option, you will need to limit your search to “Organizations” and “seizures
and epilepsy”. Type the following hyperlink into your Web browser:
http://chid.nih.gov/detail/detail.html. To find associations, use the drop
boxes at the bottom of the search page where “You may refine your search
by.” For publication date, select “All Years.” Then, select your preferred
language and the format option “Organization Resource Sheet.” By making
these selections and typing in “seizures and epilepsy” (or synonyms) into the
“For these words:” box, you will only receive results on organizations
dealing with seizures and epilepsy. You should check back periodically with
this database since it is updated every 3 months.
Seeking Guidance 75
The National Organization for Rare Disorders, Inc.
The National Organization for Rare Disorders, Inc. has prepared a Web site
that provides, at no charge, lists of associations organized by specific
diseases. You can access this database at the following Web site:
http://www.rarediseases.org/search/orgsearch.html. Select the option called
“Organizational Database (ODB)” and type “seizures and epilepsy” (or a
synonym) in the search box.
Online Support Groups
In addition to support groups, commercial Internet service providers offer
forums and chat rooms for people with different illnesses and conditions.
WebMDÒ, for example, offers such a service at their Web site:
http://boards.webmd.com/roundtable. These online self-help communities
can help you connect with a network of people whose concerns are similar to
yours. Online support groups are places where people can talk informally. If
you read about a novel approach, consult with your doctor or other
healthcare providers, as the treatments or discoveries you hear about may
not be scientifically proven to be safe and effective.
Finding Doctors
One of the most important aspects of your treatment will be the relationship
between you and your doctor or specialist. All patients with seizures and
epilepsy must go through the process of selecting a physician. While this
process will vary from person to person, the Agency for Healthcare Research
and Quality makes a number of suggestions, including the following:10
·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as
hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these
services usually refer you to doctors on staff at that particular hospital.
The services do not have information on the quality of care that these
doctors provide.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
·
Some local medical societies offer lists of member doctors. Again, these
lists do not have information on the quality of care that these doctors
provide.
Additional steps you can take to locate doctors include the following:
·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at
http://www.docboard.org. This Web site is run by “Administrators in
Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is
board certified. “Certified” means that the doctor has completed a
training program in a specialty and has passed an exam, or “board,” to
assess his or her knowledge, skills, and experience to provide quality
patient care in that specialty. Primary care doctors may also be certified
as
specialists.
The
AMBS
Web
site
is
located
at
http://www.abms.org/newsearch.asp.11 You can also contact the ABMS
by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882
for information on training, specialties, and board certification for many
licensed doctors in the United States. This information also can be found
in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Neurologist
The American Academy of Neurology allows you to search for member
neurologists by name or location. To use this service, go to
http://www.aan.com/, select “Find a Neurologist” from the toolbar. Enter
your search criteria, and click “Search.” To find out more information on a
particular neurologist, click on the physician’s name.
If the previous sources did not meet your needs, you may want to log on to
the Web site of the National Organization for Rare Disorders (NORD) at
http://www.rarediseases.org/. NORD maintains a database of doctors with
expertise in various rare diseases. The Metabolic Information Network
(MIN), 800-945-2188, also maintains a database of physicians with expertise
in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to
receive quality care from doctors who are not board certified.
11
Seeking Guidance 77
Selecting Your Doctor12
When you have compiled a list of prospective doctors, call each of their
offices. First, ask if the doctor accepts your health insurance plan and if he or
she is taking new patients. If the doctor is not covered by your plan, ask
yourself if you are prepared to pay the extra costs. The next step is to
schedule a visit with your chosen physician. During the first visit you will
have the opportunity to evaluate your doctor and to find out if you feel
comfortable with him or her. Ask yourself, did the doctor:
·
Give me a chance to ask questions about seizures and epilepsy?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for seizures
and epilepsy?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But
remember, it might take time for the relationship to develop. It takes more
than one visit for you and your doctor to get to know each other.
Working with Your Doctor13
Research has shown that patients who have good relationships with their
doctors tend to be more satisfied with their care and have better results. Here
are some tips to help you and your doctor become partners:
·
You know important things about your symptoms and your health
history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes
you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ:
www.ahrq.gov/consumer/qntascii/qntdr.htm.
13 This section has been adapted from the AHRQ:
www.ahrq.gov/consumer/qntascii/qntdr.htm.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the
appointment, or you can bring a list of your medications including
dosage and frequency information. Talk about any allergies or reactions
you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are
taking.
·
Bring other medical information, such as x-ray films, test results, and
medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood
everything that was said.
·
Write down your questions before your visit. List the most important
ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask
questions. This person can also help you understand and/or remember
the answers.
·
Ask your doctor to draw pictures if you think that this would help you
understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help
you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day,
perhaps you can speak to a nurse or physician assistant on staff or
schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may
also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you
have questions, call. If your symptoms get worse or if you have problems
with your medication, call. If you had tests and do not hear from your
doctor, call for your test results. If your doctor recommended that you
have certain tests, schedule an appointment to get them done. If your
doctor said you should see an additional specialist, make an
appointment.
By following these steps, you will enhance the relationship you will have
with your physician.
Seeking Guidance 79
Broader Health-Related Resources
In addition to the references above, the NIH has set up guidance Web sites
that can help patients find healthcare professionals. These include:14
·
Caregivers:
http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service:
http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv
ice.html
·
Hospitals and Health Facilities:
http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder
The following vocabulary builder provides definitions of words used in this
chapter that have not been defined in previous chapters:
Chronic: Persisting over a long period of time. [EU]
Retina: The ten-layered nervous tissue membrane of the eye. It is
continuous with the optic nerve and receives images of external objects and
transmits visual impulses to the brain. Its outer surface is in contact with the
choroid and the inner surface with the vitreous body. The outer-most layer is
pigmented, whereas the inner nine layers are transparent. [NIH]
You can access this information at:
http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Clinical Trials 81
CHAPTER 3. CLINICAL TRIALS AND SEIZURES AND
EPILEPSY
Overview
Very few medical conditions have a single treatment. The basic treatment
guidelines that your physician has discussed with you, or those that you
have found using the techniques discussed in Chapter 1, may provide you
with all that you will require. For some patients, current treatments can be
enhanced with new or innovative techniques currently under investigation.
In this chapter, we will describe how clinical trials work and show you how
to keep informed of trials concerning seizures and epilepsy.
What Is a Clinical Trial?15
Clinical trials involve the participation of people in medical research. Most
medical research begins with studies in test tubes and on animals.
Treatments that show promise in these early studies may then be tried with
people. The only sure way to find out whether a new treatment is safe,
effective, and better than other treatments for seizures and epilepsy is to try
it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI:
www.nei.nih.gov/netrials/ctivr.htm.
15
What Kinds of Clinical Trials Are There?
Clinical trials are carried out in three phases:
·
Phase I. Researchers first conduct Phase I trials with small numbers of
patients and healthy volunteers. If the new treatment is a medication,
researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients
to find out the effect of a new treatment on seizures and epilepsy.
·
Phase III. Finally, researchers conduct Phase III trials to find out how
new treatments for seizures and epilepsy compare with standard
treatments already being used. Phase III trials also help to determine if
new treatments have any side effects. These trials--which may involve
hundreds, perhaps thousands, of people--can also compare new
treatments with no treatment.
How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals,
universities, and doctors’ offices across the United States. The “principal
investigator” is the researcher in charge of the study at each facility
participating in the clinical trial. Most clinical trial researchers are medical
doctors, academic researchers, and specialists. The “clinic coordinator”
knows all about how the study works and makes all the arrangements for
your visits.
All doctors and researchers who take part in the study on seizures and
epilepsy carefully follow a detailed treatment plan called a protocol. This
plan fully explains how the doctors will treat you in the study. The
“protocol” ensures that all patients are treated in the same way, no matter
where they receive care.
Clinical trials are controlled. This means that researchers compare the effects
of the new treatment with those of the standard treatment. In some cases,
when no standard treatment exists, the new treatment is compared with no
treatment. Patients who receive the new treatment are in the treatment
group. Patients who receive a standard treatment or no treatment are in the
“control” group. In some clinical trials, patients in the treatment group get a
new medication while those in the control group get a placebo. A placebo is
a harmless substance, a “dummy” pill, that has no effect on seizures and
epilepsy. In other clinical trials, where a new surgery or device (not a
medicine) is being tested, patients in the control group may receive a “sham
Clinical Trials 83
treatment.” This treatment, like a placebo, has no effect on seizures and
epilepsy and does not harm patients.
Researchers assign patients “randomly” to the treatment or control group.
This is like flipping a coin to decide which patients are in each group. If you
choose to participate in a clinical trial, you will not know which group you
will be appointed to. The chance of any patient getting the new treatment is
about 50 percent. You cannot request to receive the new treatment instead of
the placebo or sham treatment. Often, you will not know until the study is
over whether you have been in the treatment group or the control group.
This is called a “masked” study. In some trials, neither doctors nor patients
know who is getting which treatment. This is called a “double masked”
study. These types of trials help to ensure that the perceptions of the patients
or doctors will not affect the study results.
Natural History Studies
Unlike clinical trials in which patient volunteers may receive new
treatments, natural history studies provide important information to
researchers on how seizures and epilepsy develops over time. A natural
history study follows patient volunteers to see how factors such as age, sex,
race, or family history might make some people more or less at risk for
seizures and epilepsy. A natural history study may also tell researchers if
diet, lifestyle, or occupation affects how a disease or disorder develops and
progresses. Results from these studies provide information that helps answer
questions such as: How fast will a disease or disorder usually progress? How
bad will the condition become? Will treatment be needed?
What Is Expected of Patients in a Clinical Trial?
Not everyone can take part in a clinical trial for a specific disease or disorder.
Each study enrolls patients with certain features or eligibility criteria. These
criteria may include the type and stage of disease or disorder, as well as, the
age and previous treatment history of the patient. You or your doctor can
contact the sponsoring organization to find out more about specific clinical
trials and their eligibility criteria. If you are interested in joining a clinical
trial, your doctor must contact one of the trial’s investigators and provide
details about your diagnosis and medical history.
If you participate in a clinical trial, you may be required to have a number of
medical tests. You may also need to take medications and/or undergo
surgery. Depending upon the treatment and the examination procedure, you
may be required to receive inpatient hospital care. Or, you may have to
return to the medical facility for follow-up examinations. These exams help
find out how well the treatment is working. Follow-up studies can take
months or years. However, the success of the clinical trial often depends on
learning what happens to patients over a long period of time. Only patients
who continue to return for follow-up examinations can provide this
important long-term information.
Recent Trials on Seizures and Epilepsy
The National Institutes of Health and other organizations sponsor trials on
various diseases and disorders. Because funding for research goes to the
medical areas that show promising research opportunities, it is not possible
for the NIH or others to sponsor clinical trials for every disease and disorder
at all times. The following lists recent trials dedicated to seizures and
epilepsy.16 If the trial listed by the NIH is still recruiting, you may be eligible.
If it is no longer recruiting or has been completed, then you can contact the
sponsors to learn more about the study and, if published, the results. Further
information on the trial is available at the Web site indicated. Please note that
some trials may no longer be recruiting patients or are otherwise closed.
Before contacting sponsors of a clinical trial, consult with your physician
who can help you determine if you might benefit from participation.
·
Brain Infusion of Muscimol to Treat Epilepsy
Condition(s): Epilepsy
Study Status: This study is currently recruiting patients.
Sponsor(s): National Institute of Neurological Disorders and Stroke
(NINDS)
Purpose - Excerpt: This study will examine the safety and effectiveness of
infusing a chemical called muscimol into the brain to control seizures in
patients with intractable epilepsy (frequent seizures that persist despite
therapy). Muscimol, which is similar to a naturally occurring brain
chemical called GABA, has been shown to reduce seizures in rats. After
the infusion study, patients will undergo a standard surgical procedure
for controlling seizures. Patients 18 years of age or older with intractable
epilepsy may be eligible for this study. Candidates will be screened
under protocol (75-N-0124 - Monitoring of Seizures, EEG and Serum
Antiepileptic Drug Concentrations in Patients with Uncontrolled
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 85
Epilepsy) with a medical history, physical and neurologic examination,
chest
X-ray,
electrocardiogram,
blood
and
urine
tests,
electroencephalographic (EEG) monitoring and magnetic resonance
imaging (MRI) of the head. Patients enrolled in this study will have the
following procedures: 1. Computerized tomography (CT) and magnetic
resonance imaging (MRI) of the head to guide catheter/electrode
placement (see #2). 2. Depth catheter/electrode placement into the
presumed or possible location of the seizure focus (the part of the brain
where the seizures originate) - Small holes are drilled through the skull.
Electrodes with a hole in the center of the tubing that holds them are
passed through the brain into the structures usually involved in
intractable epilepsy. MRI will be done to check electrode placement.
Video-EEG monitoring will continue for 5 days in patients in whom the
location of the seizure focus is known but longer (up to 33 days) in
patients in whom the seizure focus is difficult to locate. Patients will be
tested for their ability to understand and produce speech, see normally,
move their arms and legs, distinguish sharp and dull objects, and put
pegs in a pegboard. They will be questioned about headache, weakness,
numbness or sleepiness. The electrodes will be left in place for muscimol
infusion (see #3), except in patients in whom a seizure focus cannot be
located. Patients in whom a seizure focus cannot be located will not
receive muscimol infusion or undergo surgery. 3. Muscimol infusion Into the seizure focus, patients will be given two infusions-one of saline
(salt water) alone and one of muscimol diluted in saline. Each infusion
will be given over a period of 5 1/2 days, infused at the rate of 0.1 ml
(1/50th of a teaspoon) per hour. During the infusions video-EEG
recordings will continue and patients will be interviewed and examined
as described in #2 above). 4. Blood testing - About 2 tablespoons of blood
will be drawn daily during the testing period and for the first 2 days after
surgery (see #5). 5. Surgery - Temporal lobectomy or topectomy (removal
of a small, specific area of brain tissue) is the standard surgical treatment
for medically intractable epilepsy whose seizure focus is not in a critical
brain region, such as an area that controls language, movement, or
sensation. If the patient's seizures arise from one of these areas, an
alternative procedure called multiple subpial transection will be offered.
In this procedure, vertical cuts are made in the seizure focus to prevent
neurons (nerve cells that transmit electrical impulses) in the focus from
spreading the seizure to the rest of the brain. 6. Surgery follow-up Patients will be monitored in the surgical intensive care unit for 24 to 48
hours and then in the NINDS nursing unit for 4 to 8 days before being
discharged to home. Another visit in the NINDS outpatient clinic will be
scheduled for 6-12 weeks after surgery.
Phase(s): Phase I
Study Type: Interventional
Contact(s): Maryland; National Institute of Neurological Disorders and
Stroke (NINDS), 9000 Rockville Pike, Bethesda, Maryland, 20892, United
States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222 prpl@mail.cc.nih.gov; TTY 1-866-411-1010
Web Site:
http://clinicaltrials.gov/ct/gui/show/NCT00005925;jsessionid=EDD480
749438722A453C398FE99C1577
·
Brain Tissue Swelling and Seizure Activity in Inactive Cysticercosis
Condition(s): Cysticercosis; Cysts; Seizures
Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID)
Purpose - Excerpt: This study will examine what causes seizures in
patients with cysticercosis (pork tapeworm infection). A better
understanding of this could lead to improved methods of controlling or
preventing seizures. In humans, the pork tapeworm (Taenia solium) lives
in the small intestine. The parasite's microscopic eggs travel around the
body-including to the brain-where they develop into cysts. Usually, the
cysts don't cause symptoms until they die. Then, they provoke an
inflammatory reaction that irritates the brain, causing seizures and other
symptoms. The inflammation eventually goes away, but the dead cysts
remain. Calcium deposits often form where the cysts are. Some of the
calcified cysts develop swelling around them that seem to be associated
with the development of seizures. This study will explore how and why
these dead, calcified cysts continue to cause seizures. In so doing, it will
try to determine: 1) the best diagnostic imaging method for detecting
swelling around the cysts; 2) how often swelling occurs; and 3) what
makes some cysts prone to swelling and related seizure activity, while
others are not. Patients with cysticercosis who have had seizures or who
have known or possible swelling around calcified cysts will be studied
with various tests, including magnetic resonance imaging (MRI),
computed tomography (CT) scans, electroencephalography (EEG), blood
tests, and possibly lumbar puncture. Patients will be studied for two
cycles of seizures (during active and quiet periods) or a maximum 4
years.
Study Type: Observational
Contact(s): Maryland; National Institute of Allergy and Infectious
Diseases (NIAID), 9000 Rockville Pike, Bethesda, Maryland, 20892,
Clinical Trials 87
United States; Recruiting; Patient Recruitment and Public Liaison Office
1-800-411-1222 prpl@mail.cc.nih.gov; TTY 1-866-411-1010
Web Site:
749438722A453C398FE99C1577
·
Does gabapentin and lamotrigine have significantly fewer side-effects
while providing equal or better seizure control than the current drug
choice, carbamazepine, for the treatment of seizures in the elderly.
Condition(s): Seizures
Sponsor(s): Department of Veterans Affairs; Department of Veterans
Affairs Cooperative Studies Program; Parke-Davis; Glaxo Wellcome
Purpose - Excerpt: New onset epilepsy in the elderly occurs in 45,00050,000 elderly patients each year. These patients are especially vulnerable
to side effects from medications because of changes caused by the aging
process and the fact that these patients often have many common
diseases for which they are already receiving medications for so that the
likelihood of drug interactions is increased. Two new drugs, gabapentin
and lamotrigine, have recently been approved by the FDA as
antiepileptic drugs. These drugs have demonstrated efficacy in the
treatment of partial onset seizures, the most common seizures in the
elderly. These new compounds also have favorable side effect profiles
and infrequent drug-drug interactions and, therefore, would be expected
to be well-tolerated in the elderly.
Phase(s): Phase III
Contact(s): see Web site below
Web Site:
749438722A453C398FE99C1577
·
Double-blind, placebo-controlled trial of vitamin E as add-on therapy
for children with epilepsy
Sponsor(s): National Center for Research Resources (NCRR)
Purpose - Excerpt: This is a study to see if vitamin E helps children with
epilepsy have fewer seizures. About 20-30% of children with epilepsy do
not have adequate seizure control with established antiepileptic drugs
(AEDs). Other options for patients with uncontrolled epilepsy are newer
antiepileptic medications, ketogenic diet and surgery. However, a small
percentage of patients are candidates for these options. Therefore,
additional treatments are needed to improve seizure control in patients
with uncontrolled epilepsy. Animal studies have shown an association
between vitamin E supplementation and seizure reduction. A study in
children also showed that vitamin E helped reduce seizures. However, a
similar study in adults did not show a reduction in seizures with vitamin
E supplementation. Therefore, this research study is being done to help
define vitamin E's usefulness and safety as a treatment for epilepsy. Fifty
patients will be recruited from the Children's Epilepsy Program at The
Children's Hospital in Denver, Colorado. Qualifying patients will have a
confirmed diagnosis of epilepsy that is currently uncontrolled with
standard AEDs. The study period is 6 months and includes the following:
Baseline period (1 month), Arm I (2 months), Wash-out period (1 month),
and Arm II (2 months). Patients must have been on the same AEDs for 2
months before enrollment. All medications and complementary therapies
must remain constant throughout the study. If at any point the physician
feels it is not best for the patient to continue the study they will be
discontinued. Before the study starts, study participants will be asked
about seizure activity, what they eat and about any complementary
and/or alternative medicine they may use. The study is two phases.
Study participants will be given either vitamin E or placebo (fake
pill/liquid) in each phase of the study. They will receive both vitamin E
and placebo during the study. Which phase they receive vitamin E and
placebo will be decided by chance (similar to rolling dice). Study
participants will take liquid vitamin E or placebo two times per day. The
study participants and study doctors will not know who is taking
vitamin E and who is taking placebo. Study participants will come to the
hospital for 3 outpatient and 2 inpatient visits. Health-related quality of
life questionnaires will be filled out and blood will be drawn at three of
the visits. Seizure diaries will be maintained throughout the study.
Phase(s): Phase IV
Contact(s): Rebecca Barnhurst, R.D. 1-303-864-5710; Colorado; The
Children's Hospital, Neurology B155, Denver, Colorado, 80218, United
States; Recruiting; Rebecca Barnhurst, R.D. 303-864-5642. Study chairs or
principal investigators: Paul Levisohn, M.D., Principal Investigator
Web Site:
749438722A453C398FE99C1577
Clinical Trials 89
·
Evaluation and Treatment of Patients with Epilepsy
(NINDS)
Purpose - Excerpt: This protocol has three purposes: 1) to screen patients
with seizures for participation in research studies of NINDS's Clinical
Epilepsy Section (CES), 2) to follow the natural course of seizure
disorders, and 3) to train CES fellows in evaluating and treating epilepsy.
Only standard diagnostic tests and treatments will be used in this study.
Patients of any age with seizures who are referred to CES may participate
in this study. At the end of the study, patients may be discharged to the
care of their referring physician, offered participation in another NINDS
research protocol, or followed for teaching purposes. Participants will
undergo standard diagnostic procedures used to determine the type of
their seizures, what part of the brain they are coming from, what is
causing them, and whether standard drug treatments can help them.
These may include some or all of the following: - Physical and
neurological examination - Neuropsychological tests - tests of learning
and memory - Electroencephalography (EEG) - brain wave recording Evoked potentials - tests of nerve reactions to lights and sounds Polysomnography - simultaneous recordings of brain waves, breathing
and eye movements - Video-EEG monitoring - simultaneous recording of
seizures using a video camera and brain waves - Video-EEG monitoring
with extra electrodes to record muscle activity, breathing and eye
movements for analyzing sleep patterns - Imaging studies, such as
magnetic resonance imaging (MRI) and positron emission tomography
(PET) scans to examine the structure and function of the brain - Frequent
blood tests to measure blood levels of anti-seizure drugs
Web Site:
749438722A453C398FE99C1577
·
Human Epilepsy Genetics--Neuronal Migration Disorders Study
Condition(s): Epilepsy;
Migration Disorders
Seizures;
Cognition
Disorders;
Neuronal
(NINDS)
Purpose - Excerpt: The purpose of this study is to identify genes
responsible for epilepsy and disorders of human cognition.
Contact(s):
Adria
Bodell,
MS,
CGC
617-667-8035
abodell@caregroup.harvard.edu; Massachusetts; Beth Israel Deaconess
Medical Center, Harvard Institutes of Medicine, Boston, Massachusetts,
02115, United States; Recruiting; Adria Bodell, MS, CGC 617-667-8035
abodell@caregroup.harvard.edu; Christopher A. Walsh, M.D., Ph.D.,
Principal Investigator. Study chairs or principal investigators:
Christopher A. Walsh, M.D., Ph.D., Principal Investigator; Harvard
Institutes of Medicine
Web Site:
749438722A453C398FE99C1577
·
Ketogenic Diet for Child Epilepsy and Seizure Control
Condition(s): Epilepsy; Seizures; Lennox-Gastaut Syndrome
(NINDS)
Purpose - Excerpt: Twenty to thirty percent of children with epilepsy
continue to suffer from seizures, even when treated with currently
available anticonvulsant medications. Children with Lennox-Gastaut
Syndrome (LGS) are particularly handicapped by atonic-myoclonic
seizures. Preliminary data suggest that even when other medications
have failed, these seizures may respond rapidly and dramatically to a
high-fat-low-carbohydrate ketogenic diet. The purpose of the study is to
assess if the classic ketogenic diet is efficacious in reducing seizure
frequency, medication toxicity, and improves quality of life.
Contact(s): Heather Hladky
1-410-955-9100 hhladky@jhmi.edu;
Maryland; Johns Hopkins Hospital, Baltimore, Maryland, 21287, United
Clinical Trials 91
States; Recruiting. Study chairs or principal investigators: John M.
Freeman, Principal Investigator; Johns Hopkins University
Web Site:
749438722A453C398FE99C1577
·
Multicenter trial for adults with partial seizures
Sponsor(s): IVAX Research
Purpose - Excerpt: This study is to see if talampanel helps and is safe to
use on adults with partial seizures.
Web Site:
749438722A453C398FE99C1577
·
Neuropsychological Evaluation of Psychiatric and Neurological
Patients
Condition(s): Anxiety
Schizophrenia; Seizures
Disorder;
Head
Injury;
Mood
Disorder;
Sponsor(s): National Institute of Mental Health (NIMH)
Purpose - Excerpt: This study will allow researchers to use various types
of tests to evaluate cognitive and sensory functions. These tests, referred
to as "batteries" will evaluate attention, executive functions, general
intellectual functioning, language, memory, motor functions, orientation,
personality, selected sensory and perceptual functions, vigilance
(alertness), and visual-spatial functions. Children and adult patient will
receive different test batteries. The goals of this research study are to; 1.
Create descriptions based on the performance of each patient on the test
batteries. Then use this information to relate patient behavior to their
neurophysiological, neuroradiological, and biochemical descriptions. 2.
Define subgroups of patients based on their neurobehavior in order to
decrease the variability of psychiatric diagnoses, treatments, and
prognoses.
Contact(s): Maryland; National Institute of Mental Health (NIMH), 9000
Rockville Pike, Bethesda, Maryland, 20892, United States; Recruiting;
Patient Recruitment and Public Liaison Office 1-800-411-1222
prpl@mail.cc.nih.gov; TTY 1-866-411-1010
Web Site:
749438722A453C398FE99C1577
·
Pediatric Epilepsy Study
Condition(s): Epilepsy: partial seizures
Sponsor(s): Novartis Pharmaceuticals
Purpose - Excerpt: This study will evaluate the safety and effectiveness of
oxcarbazepine (Trileptal) as monotherapy in the treatment of partial
seizures in pediatric patients 1 month to 16 years of age. Oxcarbazepine
(Trileptal) is approved by the FDA for use as monotherapy in adults.
Phase(s): Phase III; MEDLINEplus consumer health information
Web Site:
749438722A453C398FE99C1577
·
Pediatric Epilepsy Trial
Condition(s): Epilepsy - partial seizures
Purpose - Excerpt: This study is to evaluate the effectiveness and safety of
an investigational medication to treat pediatric patients age 1-24 months
old with partial seizures. The medication used in this study has been
approved by FDA for use in patients 2 years and older.
Web Site:
749438722A453C398FE99C1577
Clinical Trials 93
·
Role of Hormones in Susceptibility to Seizures in Women with
Epilepsy
(NINDS)
Purpose - Excerpt: This study will measure and compare hormone levels
in women with catamenial epilepsy (epilepsy in which seizures are more
frequent during menstrual periods), women with seizures not related to
their menstrual cycle, and normal control subjects. It will determine
whether there are differences among the three groups in their hormone
levels or in how fast the levels change. It will also examine what
relationship, if any, exists between hormone changes and seizures in
women with catamenial epilepsy. The hormones under study include the
gonadal hormones estrone, estradiol and progesterone, and the
neuroactive
steroids
allopregnanolone,
pregnenolone,
and
dehydroepiandrosterone. Women who meet the following criteria may be
eligible for this 3-month study: - Between 18 and 45 years of age, with
catamenial epilepsy - Between 18 and 45 years of age, with seizures, but
not catamenial epilepsy - Between 18 and 45 years of age, without
seizures All participants will have a physical examination at the
beginning of the study, at each clinic visit, and at completion or
withdrawal from the study. In addition, they will undergo the following
procedures: Baseline Monitoring For the first 2 months, all participants
will keep a diary of their temperature and onset of menses. Women with
epilepsy will also record their seizures. Electroencephalography (EEG)
Healthy volunteers will have a 45-minute EEG (recording of the electrical
activity of the brain) at the beginning of each menstrual cycle and each
day during the menses. Women with epilepsy will have continuous EEG
monitoring for 8 days, beginning 5 days before their menstrual period is
expected. The continuous monitoring can be done on an outpatient basis,
using a portable EEG recording device, or as an inpatient, with admission
to the hospital for the 8 days of recording. Blood Sampling All
participants will have a small blood sample (2 teaspoons) drawn once a
day on days 10, 14, 17, 19 and 21 of their menstrual cycle and three times
a day on day 6 and for a period of 8 days, starting 5 days before the
expected menses and continuing for 3 days of the next cycle. For the days
with three blood draws, a small needle that can stay in place for up to 72
hours will be placed in the arm to avoid the discomfort of multiple needle
sticks.
Web Site:
749438722A453C398FE99C1577
·
Search for Genes Influencing Childhood Absence Epilepsy Study
Condition(s): Childhood Absence Epilepsy; Epilepsy; Seizures
(NINDS)
Purpose - Excerpt: The purpose of our study is to identify gene(s)
involved in the cause of childhood absence epilepsy (CAE).
Contact(s): Alissa Rottenstein
212-342-0482; New York; Columbia
University, Division of Statistical Genetics, New York, New York, 10032,
United States; Recruiting; Alissa Rottenstein 212-342-0482; Martina
Durner, M.D., Principal Investigator. Study chairs or principal
investigators: Martina Durner, M.D., Principal Investigator; Columbia
University
Web Site:
749438722A453C398FE99C1577
·
Serotonin Receptors in Seizure Disorders
Condition(s): Partial Epilepsy
(NINDS)
Purpose - Excerpt: Patients in this study will undergo PET scans (a type
of nuclear imaging test) to look for abnormalities in certain brain proteins
associated with seizures. Studies in animals have shown that serotonin-a
chemical messenger produced by the body-attaches to proteins on brain
cells called 5HT1A receptors and changes them in some way that may
help control seizures. There is little information on these changes,
however. A new compound that is highly sensitive to 5HT1A, will be
used in PET imaging to measure the level of activity of these receptors
Clinical Trials 95
and try to detect abnormalities. Changes in receptor activity may help
determine where in the brain the seizures are originating. Additional PET
scans will be done to measure the amount of blood flow to the brain and
the rate at which the brain uses glucose-a sugar that is the brain's main
fuel. Blood flow measurement is used to calculate the distribution of
serotonin receptors, and glucose use helps determine how seizures affect
brain function. The information gained from the study will be used to try
to help guide the patient's therapy and determine if surgery might be
beneficial in controlling the patient's seizures.
Web Site:
749438722A453C398FE99C1577
·
Temperature Response to a Head-Neck Cooling System
Condition(s): Healthy
(NINDS)
Purpose - Excerpt: This study will evaluate the effectiveness of a specially
designed head-neck cooling system for way lowering the body's central,
or core, temperature and cooling the brain. Brain cooling has an effect on
stopping seizure discharges in the brain as well as the seizures
themselves. If this system works to cool the brain, a similar study may be
tried in patients with epilepsy. Normal volunteers 21 years of age and
older who have no medical or neurological condition and do not use any
medications may be eligible for this study. Candidates will be screened
with an interview. Women will have a pregnancy test. Those enrolled
will be hospitalized twice for overnight stays, with the admissions 2 to 3
days apart. Participants will have a medical history, physical and
neurological
examinations,
electroencephalogram
(EEG)
and
electrocardiogram (EKG). Then, electrodes will be attached to their scalp,
forearm and calf to measure temperatures in those locations. Intestinal
(core) temperature will be measured with a temperature-sensing pill,
which will be swallowed earlier), and a hand-held infrared thermometer
will be used to measure temperatures from the ear canal, face, head, arms
legs, and abdomen. Electrodes on the scalp will also measure changes in
blood volume in the brain for a study of brain blood flow. Subjects will be
seated in a comfortable chair and fitted with the cooling system, a
portable unit with a circulating coolant. Cooling will last 30 minutes for
the first session and 60 minutes for the second. Participants will be
monitored for at least 30 minutes after each session to track temperature
changes and have a post-cooling EEG recording.
Phase(s): Phase I; MEDLINEplus consumer health information
Web Site:
749438722A453C398FE99C1577
·
Transcranial Magnetic Stimulation to Treat Epilepsy
(NINDS)
Purpose - Excerpt: This study will use transcranial magnetic stimulation,
or TMS (described below), to treat epilepsy in certain patients whose
seizures persist despite optimum medical treatment. TMS used in this
study is intended to lessen the number of seizures a patient has by
decreasing excitability of the brain in the region where the seizures
originate. Patients between 5 and 65 years of age who have had epilepsy
for two or more years and have had at least one seizure a week for at
least 6 months may be eligible for this 18-week study. Their seizures must
come from a neocortical focus-that is, near the surface of the brain.
Candidates will be selected from the NIH Epilepsy clinic and will be
screened with an electroencephalogram (EEG), magnetic resonance
imaging (MRI) scans, and blood tests. Participants will keep a diary of the
seizures they experience over an 8-week period. After the 8 weeks, they
will come to the NIH outpatient clinic for 6 consecutive days for the
following procedures: - Day 1: A regular clinic visit, plus 6 hours of
video-EEG recording (described below) - Days 2 through 5: Video-EEG
monitoring and TMS as follows: 8:00 - 11: 00 a.m. 3 hours video-EEG
monitoring 11:00 - 12:30 p.m. TMS (includes set-up time; actual
stimulation time lasts 30 minutes) 12:30 - 3:00 p.m. Lunch + rest 3:00 - 4:30
p.m. TMS 4:30 - 7:30 p.m. 3 hours video-EEG monitoring (On the fifth
day, subjects will have 6 hours of video-EEG monitoring in the afternoon
Clinical Trials 97
instead of 3 hours.) Participants will be randomly assigned to one of two
TMS groups. One group will have TMS delivered in a way that is thought
to have a chance of reducing seizures; the other will have sham, or
placebo, stimulation. When the TMS sessions are completed, participants
will keep a diary of their seizures for another 8 weeks. Transcranial
Magnetic Stimulation For TMS, an insulated wire coil is placed on the
subject's scalp. A brief electrical current passes through the coil, creating
a magnetic pulse that travels through the scalp and skull and causes
small electrical currents in the cortex, or outer part of the brain. The
stimulation may cause muscle, hand or arm twitching, or may cause
twitches or temporary tingling in the forearm, head, or face muscles.
During the stimulation, electrical activity of muscles is recorded with a
computer or other recording device, using electrodes attached to the skin
with tape. Some TMS sessions may be videotaped. Video-EEG
Recordings The EEG recording device is housed in a small pouchlike
container that is worn below the shoulder, attached to a belt worn around
the waist.
Phase(s): Phase II; MEDLINEplus consumer health information
Web Site:
749438722A453C398FE99C1577
·
Treatment Of Primary Generalized Tonic-Clonic Seizures With An
Investigational New Drug
Purpose - Excerpt: The purpose of this study is to evaluate the
effectiveness and safety of an investigational new drug for supplemental
therapy in subjects with primary generalized tonic-clonic seizures.
Web Site:
749438722A453C398FE99C1577
·
Metabolic Abnormalities in Children with Epilepsy
Condition(s): Generalized Epilepsy; Infantile Spasms; Metabolic Disease;
Partial Epilepsy; Seizures
Study Status: This study is no longer recruiting patients.
(NINDS)
Purpose - Excerpt: This study is designed to use positron emission
tomography to measure brain energy use. Positron Emission
Tomography (PET) is a technique used to investigate the functional
activity of the brain. The PET technique allows doctors to study the
normal processes of the brain (central nervous system) of normal
individuals and patients with neurologic illnesses without physical /
structural damage to the brain. When a region of the brain is active, it
uses more fuel in the form of oxygen and sugar (glucose). As the brain
uses more fuel it produces more waste products, carbon dioxide and
water. Blood carries fuel to the brain and waste products away from the
brain. As brain activity increases blood flow to and from the area of
activity increases also. Researchers can label a sugar with a small
radioactive molecule called FDG (fluorodeoxyglucose). As areas of the
brain use more sugar the PET scan will detect the FDG and show the
areas of the brain that are active. By using this technique researchers
hope to answer the following questions; 4. Are changes in brain energy
use (metabolism) present early in the course of epilepsy 5. Do changes in
brain metabolism match the severity of patient's seizures 6. Do changes in
metabolism occur over time or in response to drug therapy
States
Web Site:
749438722A453C398FE99C1577
·
Drug Interaction Study of Tegretol (Carbamazepine) and St. John's
Wort in Normal Volunteers
Condition(s): Healthy
Study Status: This study is completed.
Sponsor(s): Warren G Magnuson Clinical Center (CC)
Purpose - Excerpt: St. John's Wort is a popular dietary supplement that
many patients-including those with epilepsy or seizures-take in addition
Clinical Trials 99
to their regular medicines to elevate mood or relieve stress. Preliminary
research indicates that this supplement can speed the metabolism of the
anti-seizure drug Tegretol, causing reduced blood levels of the drug.
Patients who take Tegretol to control their seizures may have more
frequent seizures if the blood level of the drug drops too low. A recent
study shows that this effect is not seen when Tegretol is taken for at least
3 weeks. The present study will examine whether there is a medically
important drug interaction between St. John's wort and Tegretol when
Tegretol is taken for 1 day. Normal healthy volunteers between 21 and 65
years old who are not taking medicines that can affect the metabolism of
drugs in the liver and have not used St. John's wort for at least 30 days
may be eligible for this 25-day study. Participants will take a 400-mg dose
of Tegretol after fasting overnight. Blood samples will be drawn the next
day during a 12-hour clinic stay at the following intervals: just before the
Tegretol dose and at 1, 2, 4, 6, 8, 10, 24, 34, 48 and 72 hours after the dose.
A catheter will be placed in the vein to prevent the need for multiple
needle sticks until after the 10-hour sample. After completing the blood
sampling, participants will take 300 mg of St. John's wort 3 times a day
with meals for 2 weeks. After 2 weeks, another fasting dose of Tegretol
will be given and the 72-hour blood study will be repeated. This study
may provide information important for the care of patients with epilepsy
who take both Tegretol and St. John's Wort.
Phase(s): Phase IV; MEDLINEplus consumer health information
Contact(s): Maryland; Warren G. Magnuson Clinical Center (CC), 9000
Rockville Pike, Bethesda, Maryland, 20892, United States
Web Site:
749438722A453C398FE99C1577
·
Early Randomized Surgical Epilepsy Trial
Condition(s): Epilepsy; Epilepsy, Temporal Lobe; Seizures
Study Status: This study is not yet open for patient recruitment.
(NINDS)
Purpose - Excerpt: The purpose of this trial is to compare the
effectiveness of early surgical intervention for mesial temporal lobe
epilepsy to continued treatment with antiepileptic drugs.
Phase(s): Phase III
Web Site:
749438722A453C398FE99C1577
·
Effect of Levetiracetam on Brain Excitability
Condition(s): Healthy; Myoclonic Epilepsy
(NINDS)
Purpose - Excerpt: This study will examine the effect of the newly
developed anti-epileptic drug, levetiracetam, on excitability of the cortex
(surface layer) of the brain. Levetiracetam works differently from other
anti-seizure drugs, but its mechanism is not well understood. This study
may provide insight into a new protection mechanism against seizures as
well as the effect of the drug on cortical excitability. Healthy normal
volunteers 18 years of age and older may be eligible for this study.
Candidates will have a medical history taken and undergo physical and
neurological examinations. Participants will undergo two different
procedures in four separate sessions. One procedure (cortical excitability)
involves taking either levetiracetam or placebo (a look-alike inactive
substance) and having transcranial magnetic stimulation (TMS). The
other procedure (pinch-training related changes) involves taking
levetiracetam or placebo, doing a motor exercise called pinch training,
and having transcranial magnetic stimulation. For TMS, a very brief
electrical current is passed through an insulated coil wire placed on the
scalp. The magnetic pulse travels through the scalp and skull, causing
small electrical currents in the cortex that may cause muscle, hand, or
arm twitching or it may affect movements or reflexes. During the study,
subjects may be asked to make movements, do simple tasks or tense
muscles. Electrical activity of the muscles will be recorded using
electrodes taped to the skin over the muscle. For the pinch training, the
subject makes a brief, brisk pinch after each beat of a metronome every
two seconds and then completely relaxes the hand until the next beat.
Subjects will be tested on four different days at least 72 hours apart. Each
session will last about 3 to 4 hours. Approximate schedule for cortical
excitability testing: TMS (study 1) Take levetiracetam or placebo TMS
(study 2) < 60 minutes after drug or placebo TMS (study 3) < 120 minutes
after drug or placebo Approximate schedule for pinch-training related
changes: Take levetiracetam or placebo TMS and pinch power
measurement < 60 minutes after drug or placebo Pinch training for 30
Clinical Trials 101
minutes TMS and pinch power measurement Sample schedule: Session 1
< LTC and cortical excitability testing Session 2 < Placebo and cortical
excitability testing Session 3 < LTC and pinch-training related changes
Session 4 < Placebo and pinch-training related changes
States
Web Site:
749438722A453C398FE99C1577
·
Mapping the Areas of the Brain Associated with Language in Children
with Epilepsy
Condition(s): Epilepsy; Seizures
(NINDS)
Purpose - Excerpt: Researchers are interested in studying if magnetic
resonance imaging (MRI) is practical for locating the areas of the brain
associated with language in children with epilepsy. When a region of the
brain is active, it uses more fuel in the form of oxygen and sugar
(glucose). As the brain uses more fuel it produces more waste products,
carbon dioxide and water. Blood carries fuel to the brain and waste
products away from the brain. As brain activity increases blood flow to
and from the area of activity increases also. Patients participating in the
study will be asked to perform tasks designed to test language skills
while undergoing an MRI to detect areas of the brain using oxygen and
receiving blood flow.
States
Web Site:
749438722A453C398FE99C1577
·
Monitoring Patients with Uncontrolled Epilepsy
Condition(s): Epilepsy; Seizures
(NINDS)
Purpose - Excerpt: This study is designed to evaluate patients with
uncontrolled seizures. Seizures can be associated with and monitored by
abnormal electrical activity in the brain. In this study researchers will use
video-electroencephalography (EEG) to monitor patients with
uncontrolled or suspected seizures. EEG works by measuring electrical
activity in different areas of the brain. The video-EEG allows researchers
to examine changes in the EEG along with the clinical features of seizures
as they occur. In addition to monitoring electrical activity of the brain,
researchers will take frequent antiepileptic drug blood levels. These
measures will allow researchers to learn more about how each drug is
absorbed and metabolized in the body. The information collected in the
study will be used to place patients into other scientific studies testing
new therapies for epilepsy.
States
Web Site:
749438722A453C398FE99C1577
·
Phase II Randomized Study of Early Surgery vs Multiple Sequential
Antiepileptic Drug Therapy for Infantile Spasms Refractory to
Standard Treatment
Condition(s): Spasms, Infantile; Epilepsy
Sponsor(s): National Center for Research Resources (NCRR); National
Institute of Neurological Disorders and Stroke (NINDS); University of
California, Los Angeles
Purpose - Excerpt: Objectives: I. Evaluate the efficacy of surgical resection
of an identifiable zone of cortical abnormality versus multiple drug
therapy in children with infantile spasms refractory to standard therapy.
II. Assess how infantile spasms interfere with development and whether
this is partially reversible. III. Determine the predictors of good surgical
outcome and whether surgery permanently controls seizures and
improves development.
Phase(s): Phase II
Clinical Trials 103
Web Site:
749438722A453C398FE99C1577
·
Phase III Double Blind Trial of Valproate Sodium for Prophylaxis of
Post Traumatic Seizures
Condition(s): Post-Traumatic Seizure Disorder; Head Injuries
(NINDS); Harborview Medical Center
Purpose - Excerpt: Objectives: I. Determine whether treating head injured
patients with valproate sodium will reduce the risk of developing
seizures as a result of the head injury. II. Determine the safety of
valproate, the appropriate dose, and the effect valproate may have on the
recovery of the brain's ability to compute numbers, solve problems,
remember information, and control the movement of limbs after head
injury.
Phase(s): Phase III
Contact(s):. Study chairs or principal investigators: H. Richard Winn,
Study Chair; Harborview Medical Center
Web Site:
749438722A453C398FE99C1577
·
Randomized Study of Nimodipine versus Magnesium Sulfate in the
Prevention of Eclamptic Seizures in Patients with Severe Preeclampsia
Condition(s): Pre-Eclampsia
Sponsor(s): FDA Office of Orphan Products Development; University of
Utah
Purpose - Excerpt: Objectives: I. Determine the effectiveness of
nimodipine versus magnesium sulfate in the prevention of eclamptic
seizures in patients with severe preeclampsia.
Contact(s):. Study chairs or principal investigators: Michael Anthony
Belfort, Study Chair; University of Utah
Web Site:
749438722A453C398FE99C1577
·
Transcranial Magnetic Stimulation for the Treatment of Poorly
Controlled Partial Epilepsy
Condition(s): Partial Epilepsy; Seizures
(NINDS)
Purpose - Excerpt: Transcranial Magnetic Stimulation (TMS) is a noninvasive technique that can be used to stimulate brain activity and gather
information about brain function. It is very useful when studying the
areas of the brain related to motor activity (motor cortex, corticospinal
tract, and corpus callosum). Epilepsy is a condition associated with
seizures as a result of an over excitable cerebral cortex. Despite the
introduction of several new antiepileptic medications, less than half of
the patients diagnosed with partial epilepsy are well controlled.
However, studies have shown that non-invasive stimulation of the brain
can decrease the excitability of the cerebral cortex. Researchers are
interested in the potential therapeutic effects of TMS on patients with
epilepsy that have responded poorly to standard medication. This study
will use TMS to decrease the excitability of the areas of the brain
responsible for seizures.
States
Web Site:
749438722A453C398FE99C1577
Clinical Trials 105
Benefits and Risks17
What Are the Benefits of Participating in a Clinical Trial?
If you are interested in a clinical trial, it is important to realize that your
participation can bring many benefits to you and society at large:
·
A new treatment could be more effective than the current treatment for
seizures and epilepsy. Although only half of the participants in a clinical
trial receive the experimental treatment, if the new treatment is proved to
be more effective and safer than the current treatment, then those patients
who did not receive the new treatment during the clinical trial may be
among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent
diseases or disorders.
·
Clinical trial patients receive the highest quality of medical care. Experts
watch them closely during the study and may continue to follow them
after the study is over.
·
People who take part in trials contribute to scientific discoveries that may
help other people with seizures and epilepsy. In cases where certain
diseases or disorders run in families, your participation may lead to
better care or prevention for your family members.
The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an
“informed consent.” This document explains a clinical trial’s risks and
benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks?
Clinical trials may involve risks as well as benefits. Whether or not a new
treatment will work cannot be known ahead of time. There is always a
chance that a new treatment may not work better than a standard treatment.
There is also the possibility that it may be harmful. The treatment you
receive may cause side effects that are serious enough to require medical
attention.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes
of Health:
http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291.
17
How Is Patient Safety Protected?
Clinical trials can raise fears of the unknown. Understanding the safeguards
that protect patients can ease some of these fears. Before a clinical trial
begins, researchers must get approval from their hospital’s Institutional
Review Board (IRB), an advisory group that makes sure a clinical trial is
designed to protect patient safety. During a clinical trial, doctors will closely
watch you to see if the treatment is working and if you are experiencing any
side effects. All the results are carefully recorded and reviewed. In many
cases, experts from the Data and Safety Monitoring Committee carefully
monitor each clinical trial and can recommend that a study be stopped at any
time. You will only be asked to take part in a clinical trial as a volunteer
giving informed consent.
What Are a Patient’s Rights in a Clinical Trial?
If you are eligible for a clinical trial, you will be given information to help
you decide whether or not you want to participate. As a patient, you have
the right to:
·
Information on all known risks and benefits of the treatments in the
study.
·
Know how the researchers plan to carry out the study, for how long, and
where.
·
Know what is expected of you.
·
Know any costs involved for you or your insurance provider.
·
Know before any of your medical or personal information is shared with
other researchers involved in the clinical trial.
·
Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to:
·
Leave the study at any time. Participation is strictly voluntary. However,
you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
·
Continue to ask questions and get answers.
Clinical Trials 107
·
Maintain your privacy. Your name will not appear in any reports based
on the study.
·
Know whether you participated in the treatment group or the control
group (once the study has been completed).
What about Costs?
In some clinical trials, the research facility pays for treatment costs and other
associated expenses. You or your insurance provider may have to pay for
costs that are considered standard care. These things may include inpatient
hospital care, laboratory and other tests, and medical procedures. You also
may need to pay for travel between your home and the clinic. You should
find out about costs before committing to participation in the trial. If you
have health insurance, find out exactly what it will cover. If you don’t have
health insurance, or if your insurance company will not cover your costs,
talk to the clinic staff about other options for covering the cost of your care.
What Questions Should You Ask before Deciding to Join a Clinical
Trial?
Questions you should ask when thinking about joining a clinical trial include
the following:
·
What is the purpose of the clinical trial?
·
What are the standard treatments for seizures and epilepsy? Why do
researchers think the new treatment may be better? What is likely to
happen to me with or without the new treatment?
·
What tests and treatments will I need? Will I need surgery? Medication?
Hospitalization?
·
How long will the treatment last? How often will I have to come back for
follow-up exams?
·
What are the treatment’s possible benefits to my condition? What are the
short- and long-term risks? What are the possible side effects?
·
Will the treatment be uncomfortable? Will it make me feel sick? If so, for
how long?
·
How will my health be monitored?
·
Where will I need to go for the clinical trial? How will I get there?
·
How much will it cost to be in the study? What costs are covered by the
study? How much will my health insurance cover?
·
Will I be able to see my own doctor? Who will be in charge of my care?
·
Will taking part in the study affect my daily life? Do I have time to
participate?
·
How do I feel about taking part in a clinical trial? Are there family
members or friends who may benefit from my contributions to new
medical knowledge?
Keeping Current on Clinical Trials
Various government agencies maintain databases on trials. The U.S. National
Institutes of Health, through the National Library of Medicine, has
developed ClinicalTrials.gov to provide patients, family members, and
physicians with current information about clinical research across the
broadest number of diseases and conditions.
The site was launched in February 2000 and currently contains
approximately 5,700 clinical studies in over 59,000 locations worldwide, with
most studies being conducted in the United States. ClinicalTrials.gov
receives about 2 million hits per month and hosts approximately 5,400
visitors daily. To access this database, simply go to their Web site
(www.clinicaltrials.gov) and search by “seizures and epilepsy” (or
synonyms).
While ClinicalTrials.gov is the most comprehensive listing of NIH-supported
clinical trials available, not all trials are in the database. The database is
updated regularly, so clinical trials are continually being added. The
following is a list of specialty databases affiliated with the National Institutes
of Health that offer additional information on trials:
·
For clinical studies at the Warren Grant Magnuson Clinical Center
located in Bethesda, Maryland, visit their Web site:
http://clinicalstudies.info.nih.gov/
·
For clinical studies conducted at the Bayview Campus in Baltimore,
Maryland, visit their Web site:
http://www.jhbmc.jhu.edu/studies/index.html
·
For trials on neurological disorders and stroke, visit and search the Web
site sponsored by the National Institute of Neurological Disorders and
Stroke of the NIH:
Clinical Trials 109
http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinica
l_Trials
General References
The following references describe clinical trials and experimental medical
research. They have been selected to ensure that they are likely to be
available from your local or online bookseller or university medical library.
These references are usually written for healthcare professionals, so you may
consider consulting with a librarian or bookseller who might recommend a
particular reference. The following includes some of the most readily
available references (sorted alphabetically by title; hyperlinks provide
rankings, information and reviews at Amazon.com):
·
A Guide to Patient Recruitment : Today’s Best Practices & Proven
Strategies by Diana L. Anderson; Paperback - 350 pages (2001),
CenterWatch, Inc.; ISBN: 1930624115;
http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S.,
OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub;
ISBN: 0763715697;
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch;
Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935;
·
The Complete Guide to Informed Consent in Clinical Trials by Terry
Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information
Services, Inc.; ISBN: 0970153309;
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999),
John Wiley & Sons; ISBN: 0471985961;
·
Extending Medicare Reimbursement in Clinical Trials by Institute of
Medicine Staff (Editor), et al; Paperback 1st edition (2000), National
Academy Press; ISBN: 0309068886;
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001),
Remedica Pub Ltd; ISBN: 1901346293;
Vocabulary Builder
The following vocabulary builder gives definitions of words used in this
Abdomen: That portion of the body that lies between the thorax and the
pelvis. [NIH]
Auditory: Pertaining to the sense of hearing. [EU]
Autonomic: Self-controlling; functionally independent. [EU]
Biopsy: The removal and examination, usually microscopic, of tissue from
the living body, performed to establish precise diagnosis. [EU]
Carbamazepine: An anticonvulsant used to control grand mal and
psychomotor or focal seizures. Its mode of action is not fully understood, but
some of its actions resemble those of PHENYTOIN; although there is little
chemical resemblance between the two compounds, their three-dimensional
structure is similar. [NIH]
Catheter: A tubular, flexible, surgical instrument for withdrawing fluids
from (or introducing fluids into) a cavity of the body, especially one for
introduction into the bladder through the urethra for the withdraw of urine.
[EU]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU]
Ceroid:
A naturally occurring lipid pigment with histochemical
characteristics similar to lipofuscin. It accumulates in various tissues in
certain experimental and pathological conditions. [NIH]
Conduction: The transfer of sound waves, heat, nervous impulses, or
electricity. [EU]
Electroencephalography: The recording of the electric currents developed in
the brain, by means of electrodes applied to the scalp, to the surface of the
brain (intracranial e.) or placed within the substance of the brain (depth e.).
[EU]
Estradiol: The most potent mammalian estrogenic hormone. It is produced
in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH]
Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as
dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the
normal blood of all animals. It is the end product of carbohydrate
metabolism and is the chief source of energy for living organisms, its
utilization being controlled by insulin. Excess glucose is converted to
glycogen and stored in the liver and muscles for use as needed and, beyond
that, is converted to fat and stored as adipose tissue. Glucose appears in the
urine in diabetes mellitus. [EU]
Clinical Trials 111
Gonadal: Pertaining to a gonad. [EU]
Hormones: Chemical substances having a specific regulatory effect on the
activity of a certain organ or organs. The term was originally applied to
substances secreted by various endocrine glands and transported in the
bloodstream to the target organs. It is sometimes extended to include those
substances that are not produced by the endocrine glands but that have
similar effects. [NIH]
Infusion: The therapeutic introduction of a fluid other than blood, as saline
solution, solution, into a vein. [EU]
Intestinal: Pertaining to the intestine. [EU]
Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or
incision of the skin or insertion of an instrument or foreign material into the
body; said of diagnostic techniques. [EU]
Lumbar: Pertaining to the loins, the part of the back between the thorax and
the pelvis. [EU]
Muscimol: Neurotoxic isoxazole isolated from Amanita muscaria and A.
phalloides and also obtained by decarboxylation of ibotenic acid. It is a
potent agonist at GABA-A receptors and is used mainly as an experimental
tool in animal and tissue studies. [NIH]
Nimodipine: A calcium channel blockader with preferential cerebrovascular
activity. It has marked cerebrovascular dilating effects and lowers blood
pressure. [NIH]
Ophthalmology: A surgical specialty concerned with the structure and
function of the eye and the medical and surgical treatment of its defects and
diseases. [NIH]
Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU]
Preeclampsia: A toxaemia of late pregnancy characterized by hypertension,
edema, and proteinuria, when convulsions and coma are associated, it is
called eclampsia. [EU]
Progesterone:
Pregn-4-ene-3,20-dione. The principal progestational
hormone of the body, secreted by the corpus luteum, adrenal cortex, and
placenta. Its chief function is to prepare the uterus for the reception and
development of the fertilized ovum. It acts as an antiovulatory agent when
administered on days 5-25 of the menstrual cycle. [NIH]
Prophylaxis: The prevention of disease; preventive treatment. [EU]
Refractory: Not readily yielding to treatment. [EU]
Saline: Salty; of the nature of a salt; containing a salt or salts. [EU]
Schizophrenia:
A severe emotional disorder of psychotic depth
characteristically marked by a retreat from reality with delusion formation,
hallucinations, emotional disharmony, and regressive behavior. [NIH]
Skull: The skeleton of the head including the bones of the face and the
bones enclosing the brain. [NIH]
Steroid:
A group name for lipids that contain a hydrogenated
cyclopentanoperhydrophenanthrene ring system. Some of the substances
included in this group are progesterone, adrenocortical hormones, the
gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol),
toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]
Taenia: A genus of large tapeworms. [NIH]
Toxicity: The quality of being poisonous, especially the degree of virulence
of a toxic microbe or of a poison. [EU]
Urinalysis: Examination of urine by chemical, physical, or microscopic
means. Routine urinalysis usually includes performing chemical screening
tests, determining specific gravity, observing any unusual color or odor,
screening for bacteriuria, and examining the sediment microscopically. [NIH]
113
PART II: ADDITIONAL RESOURCES AND
ADVANCED MATERIAL
ABOUT PART II
In Part II, we introduce you to additional resources and advanced research
on seizures and epilepsy. All too often, patients who conduct their own
research are overwhelmed by the difficulty in finding and organizing
information. The purpose of the following chapters is to provide you an
organized and structured format to help you find additional information
resources on seizures and epilepsy. In Part II, as in Part I, our objective is not
to interpret the latest advances on seizures and epilepsy or render an
opinion. Rather, our goal is to give you access to original research and to
increase your awareness of sources you may not have already considered. In
this way, you will come across the advanced materials often referred to in
pamphlets, books, or other general works. Once again, some of this material
is technical in nature, so consultation with a professional familiar with
seizures and epilepsy is suggested.
Studies 115
CHAPTER 4. STUDIES ON SEIZURES AND EPILEPSY
Overview
Every year, academic studies are published on seizures and epilepsy or
related conditions. Broadly speaking, there are two types of studies. The first
are peer reviewed. Generally, the content of these studies has been reviewed
by scientists or physicians. Peer-reviewed studies are typically published in
scientific journals and are usually available at medical libraries. The second
type of studies is non-peer reviewed. These works include summary articles
that do not use or report scientific results. These often appear in the popular
press, newsletters, or similar periodicals.
In this chapter, we will show you how to locate peer-reviewed references
and studies on seizures and epilepsy. We will begin by discussing research
that has been summarized and is free to view by the public via the Internet.
We then show you how to generate a bibliography on seizures and epilepsy
and teach you how to keep current on new studies as they are published or
undertaken by the scientific community.
The Combined Health Information Database summarizes studies across
numerous federal agencies. To limit your investigation to research studies
and seizures and epilepsy, you will need to use the advanced search options.
First, go to http://chid.nih.gov/index.html. From there, select the “Detailed
Search” option (or go directly to that page with the following hyperlink:
http://chid.nih.gov/detail/detail.html). The trick in extracting studies is
found in the drop boxes at the bottom of the search page where “You may
refine your search by.” Select the dates and language you prefer, and the
format option “Journal Article.” At the top of the search form, select the
number of records you would like to see (we recommend 100) and check the
box to display “whole records.” We recommend that you type in “seizures
and epilepsy” (or synonyms) into the “For these words:” box. Consider
using the option “anywhere in record” to make your search as broad as
possible. If you want to limit the search to only a particular field, such as the
title of the journal, then select this option in the “Search in these fields” drop
box. The following is a sample of what you can expect from this type of
search:
·
Developmental Language Disorders and Epilepsy
Source: Journal of Paediatrics and Child Health. 33(3): 277-280. June 1997.
Contact: Available from Blackwell Science Pty Ltd. P.O. Box 378, Carlton,
Victoria 3053, Australia. 61 3 9347 0300. Fax 61 3 9349 3016.
Summary: This article reviews studies connecting developmental
language disorders and epilepsy. The association of speech and language
disorders with epilepsy is well known in children with acquired epileptic
aphasia, involving such entities as Landau-Kleffner syndrome (LKS),
continuous spike wave in slow wave sleep (CSWSS) epilepsy, and benign
partial epilepsy with centro temporal spikes (BPECTS). The possible
association between epilepsy and a subgroup of children with
developmental dysphasia is reported less frequently. Lack of controlled
prospective studies of sleep electroencephalograms (EEG), and the use of
medication, in children with developmental dysphagia, may deny
appropriate treatment strategies to children with severe developmental
speech and language disorders. The authors recommend that before antiepileptic medication is tried in individual children, limitations should be
discussed with the parents: the treatment duration should be determined;
goals should be set for continuation of therapy; pretreatment measures of
speech and language should be carried out, including use of video
records and standardized tests; the treatment should be at dosage levels
used to control seizures; and there should be close monitoring for side
effects. 1 table. 38 references.
·
Direct Medical Costs of Refractory Epilepsy Incurred by Three
Different Treatment Modalities: A Prospective Assessment
Source: Epilepsia. 43(1):96-102, January 2002.
Summary: Researchers prospectively compared epilepsy-related direct
medical costs (ERDMC's) incurred by different treatment modalities for
people with refractory seizures, including conservative polytherapy
with/without novel antiepileptic drugs (AED's), epilepsy surgery (ES), or
Studies 117
vagus nerve stimulation (VNS). A group of 84 patients in Belgium
completed a presurgical evaluation protocol. Twenty-four were treated
with continued AED polytherapy only, 35 underwent ES, and 25 had
VNS. Researchers prospectively calculated the annual costs in the 2 years
preceding the therapeutic decision and during the followup period. They
also prospectively compared (1) frequency of complex partial seizures
with/without secondary generalization; (2) dosage and number of
AED's; and (3) number of hospital admission days, clinic visits, and
laboratory tests prior to and following the therapeutic decision. Results
indicated that ongoing daily treatment of people who underwent
resective surgery cost significantly less than more conservative
treatments. Among people who could not have resective surgery,
ERDMC showed a significant decrease in people treated with VNS
compared to those treated conservatively. The researchers conclude that
by offering ES and VNS to patients, the costs of the most expensive
patient group are reduced to the mean cost level of patients with
refractory epilepsy. 2 tables, 16 references.
·
Diet Enriched With Omega-3 Fatty Acids Alleviates Convulsion
Symptoms in Epilepsy Patients
Source: Epilepsia. 43(1):103-104, January 2002.
Summary: Researchers investigated whether taking a dietary supplement
that contained omega-3 polyunsaturated fatty acids (n-3 PUFA's) would
alleviate and/or reduce the frequency of epileptic seizures in people with
central nervous system diseases who were taking anticonvulsant drugs.
Participants were patients hospitalized in Israel, all of whom had
profound mental retardation and epilepsy secondary to another primary
central nervous system disease. Researchers developed a spread
containing 65 percent n-3 PUFA's that was added to the daily diet. Of the
21 patients, only 5 were willing to eat the spread. They ate it at breakfast
for 6 consecutive months. Researchers examined their medical features,
drug therapy, and seizure frequency before and after the 6-month trial.
All five patients showed significant improvement and alleviation in
seizure frequency and strength. There were no adverse effects noted
among any of the participants. The researchers conclude that n-3 PUFA's
can alleviate symptoms of human epilepsy, although the biologic
mechanism of this activity remains unknown. 1 table, 11 references.
·
Coping With the Challenge of Transition in Older Adolescents With
Epilepsy
Source: Seizure. 11(1):33-39, January 2002.
Summary: Researchers investigated the effects of epilepsy on
psychological adjustment, coping behavior, and transition to adulthood
among 36 people age 16 to 21 years with epilepsy and a control group of
31 of their peers. Participants were recruited from neurologists' offices.
Each participant received a mailed questionnaire that measured
psychological adjustment (self-efficacy, negative and positive affect, use
of coping style, self-esteem, and strategy related to transition to
adulthood) and adolescent coping. Participants with epilepsy also
provided information on acceptance of illness, seizure severity, use of
coping style, perception of control over seizures, and strategy related to
epilepsy. Data analysis indicated that there were no statistically
significant differences between the groups on measures of self-esteem,
affect, and self-efficacy. Members of the group with epilepsy had
significantly more non-productive coping than members of the control
group. The control group had significantly more problem-solving coping
and significantly more bias toward using problem solving than the group
with epilepsy. There were no significant differences between the two
groups on measures of psychological adjustment, although psychological
adjustment was found to be related to coping response in the group with
epilepsy. The researchers conclude that the experience of having epilepsy
among older adolescents has no significantly detrimental effect on
psychological adjustment unless combined with a stressful situation,
such as transition to adulthood. 4 tables, 26 references.
·
Clinical Conundrum of Neonatal Seizures
Source: Archives of Disease in Childhood. 86(2):F75-F77, March 2002.
Summary: The author reviews and discusses the clinical aspects of
neonatal seizures. The discussion considers the characteristics of seizures
in patients with neonatal epilepsy, clinical monitoring of neonatal
seizures, and managing neonatal seizures. The incidence of seizures in
the neonatal period is considerably higher than in any other time of life.
Laboratory animal studies have shown that the immature brain is more
prone to seizure activity, but, paradoxically, the immature brain appears
to be less vulnerable than the adult brain to neuronal damage resulting
from seizures. There is increasing evidence that neonatal seizures have an
adverse effect on neurodevelopmental progression and may predispose
to cognitive, behavioral, and epilepsy-related complications later in life.
A new electroencephalographic (EEG) technique, known as amplitude
integrated EEG (aEEG) monitoring, has been shown to accurately predict
Studies 119
outcomes after severe birth asphyxia in full-term infants and can be used
to interpret seizure activity lasting at least 20 seconds or to identify
abnormal interseizure activity. The author notes that aEEG monitoring
can be used in neonatal medicine to monitor pharmacologically
paralyzed infants to detect seizure activity that would be missed
clinically and to predict the outcome in neurologically compromised
infants. Phenobarbitone has been the major antiepileptic drug (AED)
used to treat neonatal seizures, but its efficacy remains uncertain. The
few clinical trials have produced equivocal evidence of phenobarbitone's
ability to control seizures, although some have suggested that the drug
has a partial effect, being able to control seizures in infants with relatively
mild seizures. Phenobarbitone has been reported to have adverse effects
on the developing brain when administered to young animals. Very little
is known about the efficacy and side effects of other commonly used
AED's, aside from anecdotal reports. A practical approach for managing
neonatal seizures is based on avoiding over treatment and minimizing
the number of AED's used. AED treatment should be stopped as soon as
possible. 28 references.
·
Psychostimulants and Epilepsy
Source: Epilepsia. 43(Supplement 2):28-31, 2002.
Summary: Researchers performed a review of studies examining the
effects of psychostimulants on seizure frequency in epilepsy patients. The
following drugs are included: Cocaine, amphetamine and related agents,
caffeine, cannabinoids, and psychedelic drugs. Few epidemiologic
studies examining the prevalence of drug-induced seizures have been
conducted. Among individual drugs, cocaine use is clearly associated
with seizures. The frequency ranged from 1 to 40 percent, depending on
the type of study conducted. Amphetamines and related drugs rarely
induce epileptic seizures at therapeutic doses, but seizures may occur
after the first doses. Caffeine may cause seizures at high doses; its
seizure-inducing activity is attributed to its adenosine receptor
antagonizing properties. Marijuana, unlike other psychostimulants, has
been shown experimentally to produce a serotonin-mediated
anticonvulsant action. Psychedelic drugs such as lysergic acid
diethylamide
(LSD),
seldom
cause
seizures.
Ingestion
of
methylenedioxymethamphetamine (ecstasy) and phencyclidine (PCP),
however, have been associated with seizures. 22 references.
·
Memory Complaints in Medically Refractory Epilepsy: Relationship to
Epilepsy-related Factors
Source: Epilepsy and Behavior. 3(2):165-172, April 2002.
Summary: Researchers conducted a multicenter study on memory
complaints in patients with epilepsy who presented with subjective
complaints about memory problems in daily life. Participants included
252 patients with refractory seizures in the Netherlands; about 79 percent
had some type of partial seizure, and 70 percent had complex partial
seizures. Researchers measured memory complaints with a standardized
memory questionnaire (GKLE). They analyzed the type of memory
complaints and examined the relationship between subjective complaints
and several epilepsy-related factors. These include (1) seizure type, (2)
lateralization and location of the focus, (3) etiology, (4) duration, (5) age
at onset, and (6) antiepileptic medication. Patients experienced
significantly more memory complaints than normal controls. Patients of
older age and higher intelligence level complained more about their
memory functioning. Neuroticism showed a significant relationship to
the total complaint score. Results indicated that the amount of subjective
complaints is not related to the localization nor lateralization of the
epileptic disturbances. Patients with a longer duration of epilepsy
complained significantly more about memory problems, especially about
retrieving information from memory. All other epilepsy-related factors
showed no relationship to memory complaints. 7 tables, 19 references.
·
Refractory Epilepsy: A Progressive, Intractable but Preventable
Condition?
Source: Seizure. 11(2):77-84, March 2002.
Summary: The authors propose a hypothesis for the conceptual
understanding and prevention of refractory epilepsy based on
accumulated laboratory findings and an improved knowledge of the
natural history of treated epilepsy. Refractory epilepsy can be recognized
as a distinct condition with multifaceted dimensions, including
neurobiochemical plastic changes, cognitive decline and psychosocial
dysfunction, leading to dependent behavior and a restrictive lifestyle.
The biological basis of refractoriness may be multifactorial, and may
include the severity of the syndrome and/or underlying neuropathology,
abnormal reorganization of neuronal circuitry, alteration in
neurotransmitter receptors, ion channelopathies, reactive autoimmunity,
and impaired antiepileptic drug (AED) penetration to the seizure focus.
Recurrent seizures may be the cause of some of these changes. The
authors hypothesize that refractory epilepsy may be prevented by
interrupting this self-perpetuating progression. Patients identified early
in the clinical course can be targeted early for effective therapeutic
intervention. Failure of two first line AED's due to lack of efficacy or poor
tolerability should prompt consideration of epilepsy surgery in a patient
Studies 121
with a resectable brain abnormality. For the majority of patients not
suitable for curative surgery, AED's should be combined with the aim of
achieving synergism. This strategy has the potential to improve outcome
by preventing the insidious progression to intractable refractoriness and
a downward spiraling quality of life. 2 tables, 95 references.
·
Temporal Lobe Epilepsy of Adult Age of Possible Idiopathic Nature
Source: Seizure. 11(2):131-135, March 2002.
Summary: Researchers attempted to verify the existence of sporadic cases
of temporal lobe epilepsy (TLE) of possible idiopathic nature with onset
in adult life and to define their characteristics. They examined all patients
with focal seizures suggestive of a temporal lobe origin who attended an
epilepsy center in Genoa, Italy, between 1990 and 1998, and who were
age 18 to 50 years at onset. Of 237 patients with a clinical diagnosis of
TLE, 159 were included in the study; 14 (8.8 percent) identified as having
idiopathic TLE (Group 1) were compared with the remaining 145 subjects
(Group 2). The main characteristics of Group 1 were (1) a high familial
incidence of epilepsy (42.8 percent), (2) the prevalence of autonomic
seizures, (3) low seizure frequency at onset, and (4) good prognosis. The
difference between the two groups was statistically significant for family
history for epilepsy and for freedom from seizures after medication. The
researchers conclude that the distinctive features of the subjects identified
suggest that at least some of these patients may have familial TLE.
Whether this disorder may be present in sporadic form remains a matter
of debate which must await the identification of the gene responsible for
this disorder. Till then, the authors note that it is worthwhile to underline
the better prognosis of these patients compared to those that did not meet
these criteria. 2 tables, 12 references.
·
Controversy of Birth Order as a Risk Factor for Epilepsy: A Study From
Saudi Arabia
Source: Acta Neurologica Scandinavia. 105(3):174-178, March 2002.
Summary: Researchers examined the relationship between birth order
and epilepsy to determine if birth order is a risk factor for epilepsy in a
community where large families are very common. They enrolled in the
study all patients with epilepsy seen at King Fahad National Guard
Hospital, Saudi Arabia, between January 1994 and December 1997 and
their siblings. The patients met the following criteria: (1) They were the
first member in a given family to be diagnosed with epilepsy, (2) they
were at least age 15 years, and (3) all their siblings were alive at the time
of the study. Siblings with epilepsy and half siblings were excluded from
the analysis. Researchers analyzed the data by arranging the patients by
birth order and stratifying them by sibship size. Odds ratios (OR's) for
birth order being a risk factor for epilepsy were computed using standard
case-control statistical techniques. The analysis included 336 patients
with epilepsy and 1,961 siblings. The mean age of the patients at study
enrollment was 30 years. Clinical records showed that 43 patients had
idiopathic epilepsy, 112 had cryptogenic epilepsy, and 77 had
unclassifiable epilepsy. Family size varied from 1 to 11, with a mean of
6.8. Lower birth order was significantly associated with an increased risk
of epilepsy and the risk decreased with higher birth orders. For birth
order one, the OR was 2.08; for birth order two, the OR was 1.51; for birth
order three, the OR was 1.64; for birth order four, the OR was 1.10; for
birth order five, the OR was 0.95; for birth orders six and higher, the OR's
ranged from 0.25 to 0.5. The OR's for birth orders one through three
represented statistically significant increases in epilepsy risk. The OR's
for birth order six and higher represented significantly decreased
epilepsy risks. An analysis of the influence of seizure type and epilepsy
syndrome conducted in 259 patients and 1,313 siblings for whom this
type of information was available indicated that first birth order was
significantly associated with partial seizures and cryptogenic epilepsy.
No significant association between birth order and seizure or epilepsy
type was found for the other epilepsy syndromes or generalized seizures.
Researchers conclude that lower birth order does seem to be associated
with an increased risk of epilepsy, especially for cryptogenic epilepsy. 3
tables, 24 references.
·
Is Refractory Epilepsy Preventable?
Source: Epilepsia. 43(4):437-444, April 2002.
Summary: The authors discuss refractory epilepsy and the question of
whether it is preventable. The discussion is based on a review of the
published literature and addresses the following topics: (1) Basic
research; (2) clinical, epidemiologic, and pediatric data relevant to the
issue of whether refractory epilepsy is progressive; (3) early identification
of refractory epilepsy; (4) the issue of whether progressive epilepsy can
be halted; and (5) pediatric issues in refractory epilepsy. The majority (60
to 70 percent) of epilepsy patients will have their seizures controlled with
a single antiepileptic drug (AED) whose selection is determined by the
type of seizure disorder. For the remaining patients, their seizures will
not be controlled by AED's. They will typically have frequent and
disabling seizures. Patients who suffer frequent recurrent seizures are
commonly referred to as having refractory epilepsy. These patients will
undergo multiple drug trials, which typically do not achieve complete
seizure remission. Refractory epilepsy is also associated with increased
Studies 123
morbidity (from seizures and AED's), social isolation, unemployment,
and an overall diminished quality of life. There is some evidence that
refractory epilepsy is a progressive disorder, which if controlled early
enough, might be prevented from developing into a full syndrome. The
problem lies in identifying at an early stage patients whose disease is
likely to progress to intractability. Although there are some epileptic
syndromes, such as medial temporal lobe epilepsy, that appear to be
progressive and if allowed to progress presents a risk of becoming
refractory, there exist no known markers that can enable clinicians to
identify with confidence cases that are likely to progress to intractability.
It may be possible, however, to predict refractory epilepsy early by using
epidemiologic data, genetic analysis, neuroimaging techniques, and
syndrome classification. Predicting intractability in children is not as easy
as in adults, where lack of a satisfactory response to a second AED is
usually taken as indicative of intractability. Predicting intractability as
soon as the first seizure occurs is considered extremely important in
children, because early seizure control is likely to improve cognitive
outcome. Some of the newer drugs can be used as a first-line treatment
for specific syndromes. Epilepsy surgery may be offered at progressively
younger ages, allowing some epileptic syndromes previously considered
to be highly refractory to be controlled. 97 references.
Federally Funded Research on Seizures and Epilepsy
The U.S. Government supports a variety of research studies relating to
seizures and epilepsy and associated conditions. These studies are tracked
by the Office of Extramural Research at the National Institutes of Health.18
CRISP (Computerized Retrieval of Information on Scientific Projects) is a
searchable database of federally funded biomedical research projects
conducted at universities, hospitals, and other institutions. Visit CRISP at
http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen. You can
perform targeted searches by various criteria including geography, date, as
well as topics related to seizures and epilepsy and related conditions.
For most of the studies, the agencies reporting into CRISP provide
summaries or abstracts. As opposed to clinical trial research using patients,
many federally funded studies use animals or simulated models to explore
18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance
Abuse and Mental Health Services (SAMHSA), Health Resources and Services
Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control
and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office
of Assistant Secretary of Health (OASH).
seizures and epilepsy and related conditions. In some cases, therefore, it may
be difficult to understand how some basic or fundamental research could
eventually translate into medical practice. The following sample is typical of
the type of information found when searching the CRISP database for
·
Project Title: AN IMPLANTABLE DEVICE TO PREDICT AND
PREVENT SEIZURES
Principal Investigator & Institution: Dichter, Marc A.; Professor;
Neurology; University of Pennsylvania 3451 Walnut Street Philadelphia,
Pa 191046205
Timing: Fiscal Year 2001; Project Start 5-AUG-2001; Project End 1-JUL2006
Summary: Epilepsy affects 50 million people worldwide, and 2.5 million
in the United States alone. Fully 25 percent of those with recurrent
seizures cannot be controlled by current medical or surgical treatment,
and must resort to high doses of sedating medications or experimental
therapy. Even when seizures are controlled, patients bear a significant
burden of neurological and medication side effects. We propose to
assemble an ensemble of accomplished investigators from the University
of Pennsylvania, Georgia Institute of Technology, Children's Hospital of
Philadelphia and IntelliMedix, a small start-up company through the GIT
and Penn, in an intensive five to ten year effort to create a novel therapy
for refractory epilepsy: an implantable closed loop system capable of
predicting epileptic seizures prior to electrical and behavioral onset and
triggering intervention to abort them before clinical expression. This
diverse group of investigators represents multiple disciplines and areas
of expertise including bioengineering, computer science, computational
modeling of neuronal networks, image processing, clinical adult and
pediatric epilepsy, cellular and molecular neuroscience, neurophysiology
and neuropharmacology. The work will have three major thrusts: (1)
Seizure Prediction: Developing and refining seizure prediction
algorithms derived from data obtained from implanted biosensors in
adults, children and in animal models of human epilepsy, capable of
predicting seizures hours to minutes prior to electrical and clinical onset,
(2) Mechanisms of ictogenesis: Unraveling the cellular, molecular,
neurophysiologic and neuronal network mechanisms underlying the
observed signal changes identified by these algorithms through in-vitro
and in-vivo experiments in animals, recordings in human candidates for
epilepsy surgery, and modeling these findings via computer simulations
in order to refine predictive and intervention strategies, (3) Therapeutics:
Developing strategies aimed at specific points in the "ictogenic" process,
Studies 125
as discovered above, consisting of electrophysiological and
pharmacological interventions to disrupt the cascade of events which
lead to seizures, in ways which do not interfere with normal brain
function. This work will directly give rise to commercially viable
intellectual property including: implantable biosensors, miniaturized
biocompatible electrical stimulation and drug infusion hardware,
stimulation paradigms, customized pharmacologic agents, customized
software/hardware interfaces for signal acquisition, processing and
synchronization with algorithms for driving therapeutic interventions. It
is hoped that a closed loop seizure prediction and prevention device will
be implementable in a 5-10 year period and will significantly improve the
quality of life of individuals with epilepsy.
Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
·
Project Title: CASPASES MEDIATE SEIZURE-INDUCED BRAIN
INJURY
Principal Investigator & Institution: Henshall, David C.; ; Emanuel
Hospital and Health Center 2801 N Gantenbein Ave Portland, or 97227
Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2005
Summary: Progressive hippocampal atrophy has been demonstrated in
humans with epilepsy. Such seizure-induced neurodegeneration may be
under the control of the caspase family of cell death regulating enzymes,
as our recent studies in brains of patients with intractable epilepsy
showed the presence and activation of the programmed cell
death/apoptosis pathway. initiator caspases begin the cell death process:
following activation of surface- expressed death receptors - the extrinsic
pathway, or following mitochondrion-based events within the cell - the
intrinsic pathway. Subsequently these caspases activate downstream
effector caspases, which carry out the execution and disassembly of the
cell. Intervention in this cell death cascade has considerable implications
for the therapeutic treatment of neurodegenerative diseases to which
epilepsy may now be added. Therefore the broad, long-term goals of this
proposal are to characterize the contribution of the caspase family of cell
death-controlling enzymes in mediating seizure-induced brain injury.
They hypotheses to be tested are (A) Neuronal death occurs following
seizures and is initiated by caspases 2, 8 and/or 10 of the extrinsic death
receptor pathway. (B) Caspase 2, 8 and/or 10 activation requires
recruitment to death receptors by adaptor proteins in response to death
ligands. (C) Activation of the intrinsic, mitochondrion-dependent
caspase-9 pathway is co- dependent on the death receptor pathway via
the cytochrome c releasing factor Bid. (D) Novel effector caspases 6 and 7
are activated by seizures via these extrinsic and intrinsic pathways and
contribute to neuronal death. The specific aims are: 1) Characterize the
expression, processing and consequences of activation of the extrinsic
death-signaling pathway caspases 2, 8 and 10 using an in vivo rat model
of brief limbic seizures. 2) Characterize the expression and functional
interaction of death receptors with their adaptor protein(s) in the signal
transduction and recruitment of caspases 2, 8 and 10 following seizures.
3) Characterize the expression, processing and consequences of activation
of the intrinsic caspase-9-dependent pathway in seizure-induced brain
injury. 4) Characterize the activation of the novel death effector caspases
6 and 7 in response to the extrinsic and/or intrinsic initiator pathways
following seizures. 5) Characterize the involvement of extrinsic, intrinsic
and death effector caspases mediating apoptosis induced by seizure-like
activity in neuronal cultures in vitro. Elucidation of the molecular control
of seizure-induced cell death will further our understanding of brain
injury processes and take a significant step toward therapeutic
approaches to reduce brain injury in epilepsy.
·
Project Title: CHILDHOOD EPILEPSY-- FACTORS AFFECTING
ADAPTATION
Principal Investigator & Institution: Austin, Joan K.; Distinguished
Professor; None; Indiana Univ-Purdue Univ at Indianapolis 355 N
Lansing Indianapolis, in 46202
Timing: Fiscal Year 2001; Project Start 1-FEB-1986; Project End 0-APR2004
Summary: Description (adapted from investigator's abstract): Children
with epilepsy experience higher rates of mental health disturbances and
academic problems than children with other chronic physical conditions.
Until recently, one assumption has been that many of these problems
result from poor psychosocial adjustment to living with seizures.
However, in our current study we found high rates of behavior problems
already existing at the time of the first recognized seizure, especially in
children with previously unrecognized seizures. This important finding
suggests that, at least in some children, epilepsy is a pervasive condition
in which seizures are accompanied by behavioral disturbances.
Moreover, it suggests that neurological variables should be studied in
relation to behavior problems, beginning at the time of the child's first
recognized seizures. The major purpose of this continuation request is to
determine how neurological variables (brain structure and function,
neuropsychological functions, intelligence, and seizure characteristics)
interact with other child (age, gender, and temperament) and family
Studies 127
variables (e.g., parenting and family resources) to predict child mental
health disturbances and academic problems over the first year following
the first recognized seizure. The sample will be 360 children (ages 6-14
years, IQ > 70) with a first recognized seizure and 240 healthy siblings
(ages 6-17 years). There also will be a pilot sample of 60 children with
seizures who have IQs between 55 and 70. Neurobiological data will
include results from MRI, EEG, and individualized tests of academic
achievement, intelligence, and neuropsychological functioning. Data on
child and family variables will be obtained from the major caregiver and
from children who are at least 8 years old. Data analyses will include
repeated measures analysis of covariance, multiple regression, and
structural equation modeling. No previous studies have investigated all
of these important variables together within the context of childhood
epilepsy, especially those with low IQ. Findings will greatly increase
understanding of the natural history of adaptation problems in childhood
epilepsy that is needed for effective interventions.
·
Project Title: CHRONOBIOLOGY OF PARTIAL EPILEPSY
Principal Investigator & Institution: Quigg, Mark S.; Assistant Professor;
Neurology; University of Virginia Charlottesville Box 400195
Charlottesville, Va 22904
Timing: Fiscal Year 2001; Project Start 0-SEP-1997; Project End 1-MAY2003
Summary: (provided by applicant): Mesial temporal lobe epilepsy
(MTLE), the most common partial epilepsy, accounts for the majority of
patients with uncontrolled seizures. Seizures in MTLE do not strike
randomly but occur in daily patterns. Possible influences on the timing of
seizures include those factors that underlie circadian oscillation and that
facilitate or inhibit seizures. Influences provided by the
hypothalamicpituitaryadrenal axis (HPAA) are logical candidates to
modulate seizures and will be the focus of the proposed experiments.
This proposal examines the temporal distribution of spontaneous, limbic
seizures in a unique animal model of partial epileps~ that shares clinical,
electrographic, histological, and timing similarities with MTLE. The
specific aim of this proposal is to evaluate the role of endogenous
rhythmicity of the HPAA in the circadian modulation of experimental
limbic epilepsy. Hypothesis 1. Rhythmicity of the HPAA is intact in
experimental epilepsy. Hypothesis 2. Corticosterone releasing hormone
(CRH) is differentially affected within the hypothalamus and limbic
system by lesions at different levels of the clockHPAA system. Our data
suggests that circadian mechanisms continue to function in the epileptic
rat and that neuronal density in regions important in HPAA regulation is
normal. We will evaluate whether CRH expression remains rhythmic in
intact animals as well as in animals that have lesions of the clock or of the
HPAA. Hypothesis 3. The normal variations of CRH and corticosterone
are necessary for circadian recurrence of limbic seizures. We predict that
alterations of inputs into the HPAA will cause changes in the circadian
distribution of seizures. Previous results show that seizures occur in an
endogenously mediated circadian rhythm.. In summary, these studies
will provide insight into the chronoblological factors that facilitate partial
seizure expression and may provide new perspectives into treatments for
poorly controlled partial epilepsy.
·
Project Title: DEVELOPMENTAL PLASTICITY AND CHRONIC
EPILEPSY
Principal Investigator & Institution: Swann, John; Research Scientist;
Pediatrics; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030
Timing: Fiscal Year 2001; Project Start 5-JAN-1999; Project End 0-NOV2002
Summary: The effects of early-life seizures on the developing nervous
system remain controversial. Clinical indications are that severe and
repeated seizures may contribute to chronic epilepsy and impairment of
learning in children. However, few experimental studies have explored
this possibility. Recent studies obtained in rats suggest this may be the
case since tetanus toxin-induced seizures in infancy lead of chronic focal
epilepsy in hippocampus and impairment in the acquisition of spatial
memory. In other experiments, recordings in adulthood from in vitro
slices demonstrate abnormal epileptiform discharges arising from
hippocampal area CA/3C. Morphological studies show a dramatic loss of
dendritic spines on CA/3C pyramidal cells in these same chronically
epileptic rats. Surprisingly the alterations seen in adulthood are not
present in early- life when recurrent seizures are so frequent. These and a
number of other observations lead us to propose a "two hit" model of
epileptogenesis. During Stage 1 of this hypothetical scheme, the
developing dendrites of hippocampal pyramidal cells likely undergo a
transient but significant excitotoxic insult. Thereafter, the dendrites
recover, but during stage 2 high frequency interictal discharging of
hippocampal networks produces a progressive epileptogenesis in which
epileptic foci are strengthened and dendritic spines gradually decrease in
density. In proposed electrophysiological experiments, we will
systematically examine the ontogeny of the focal epilepsy in an attempt
to support this hypothetical scheme. At the same time, anatomical studies
Studies 129
will describe the development of dendritic abnormalities. Other
experiments will examine how seizures produced these effects. During
early postnatal life, patterns of connectivity in the central nervous system
are anatomically remodeled. Widespread projections are pruned and
adult patterns of connectivity result form an elaboration of synapses at
selected target sites. This process of remodeling is known to rely on
action potential based neuronal activity. Thus, it seems plausible that the
abnormal activity that accompanies frequent seizures may activate
remodeling mechanisms to produced abnormal patterns of connectivity.
Since seizures in area CA3 are mediated by recurrent excitatory synapses,
they likely undergo long term potentiation (LTP). However, afferents
projects to these cells but not participating in seizures may undergo
heterosynaptic long term depression (LTD). Experiments in in vitro slices
support this notion. Thus, LTP of recurrent excitation could lead to
persistent epileptiform activity while heterosynaptic LTD may lead to
synapse loss. Dendritic spine loss could be a consequence of a partial
deafferentation of pyramidal cell dendrites. Preliminary results appear to
support this idea since the highly specialized dendritic spines and
presynaptic terminals of the mossy fiber pathway are both reduced in
number in epileptic rats. Proposed studies will verify these anatomical
alterations and examine their physiological impact. Other experiments
will attempt to prevent the development of epilepsy by chronically
treating rats with NMDA receptor antagonists.
·
Project Title: EARLY RANDOMIZED SURGICAL EPILEPSY TRIAL
Principal Investigator & Institution: Engel, Jerome J.; Professor;
Neurology; University of California Los Angeles 10920 Wilshire Blvd.,
Suite 1200 Los Angeles, Ca 90024
Timing: Fiscal Year 2002; Project Start 1-SEP-2002; Project End 0-JUN2007
Summary: (provided by applicant): This grant application for an early
randomized surgical epilepsy trial (ERSET) was originally prepared with
the help of planning grant R21 NS37897, awarded in recognition of the
fact that mesial temporal lobe epilepsy (MTLE) is a surgically remediable
syndrome, that surgical treatment for this disorder is underutilized, and
that true equipoise exists concerning the relative benefits of surgery vs.
continued treatment with new antiepileptic drugs, early in the course of
the disorder. We now submit a revised proposal for a multicenter
randomized controlled trial (RCT) to compare the efficacy of early
surgical
intervention
for
MTLE
with
continued
optimal
pharmacotherapy. The primary outcome measure will be freedom from
disabling epileptic seizures (complex partial and secondarily generalized
seizures, and simple partial seizures that are apparent to an observer).
Patients aged 12 years and older with suspected MTLE will be candidates
for recruitment if disabling seizures: 1) have not responded to two or
more antiepileptic drugs, one of which must be either Dilantin, Tegretol,
or Carbatrol, and 2) have not persisted, according to defined criteria, for
more than two years. Fifteen epilepsy surgery centers spaced evenly
across the country will actively recruit patients meeting these criteria.
These patients will undergo a rigid presurgical evaluation protocol,
standardized across centers, and 200 surgical candidates will then be
randomized to either anteromesial temporal resection or two years of
additional pharmacotherapy. Studies will test five hypotheses: 1) Surgical
treatment will be more effective than medical treatment in reducingthe
frequency and severity of epileptic seizures; 2) Surgical treatment will be
more effective than medical treatment in improving quality of life; 3)
Surgical treatment will be more effective than medical treatment in
improving psychological and social function; 4) Morbidity and mortality
associated with surgical treatment will be no greater than that associated
with medical treatment; and 5) Progressive hippocampal atrophy and
mesial temporal hypometabolism will occur only in patients who
continue to have frequent complex partial and generalized tonic-clonic
seizures.
·
Project Title: EFFECTS OF TREATING OBSTRUCTIVE SLEEP
APNEA IN EPILEPSY
Principal Investigator & Institution: Malow, Beth A.; Associate Professor;
Neurology; University of Michigan at Ann Arbor 3003 South State, Room
1044 Ann Arbor, Mi 48109
Timing: Fiscal Year 2002; Project Start 5-SEP-2002; Project End 1-JUL-2005
Summary: (provided by applicant): Epilepsy affects approximately 2.5
million Americans, resulting in substantial disability. Because up to 30%
of patients with epilepsy continue to have seizures despite appropriate
treatment with antiepileptic medications, additional interventions to
improve seizure control are needed. One approach to improving seizure
control is to treat coexisting sleep disorders, such as obstructive sleep
apnea. Obstructive sleep apnea (OSA) may exacerbate seizures via sleep
fragmentation, sleep deprivation, or other pathophysiological processes
that have not yet been determined. The investigators recently
documented that OSA is common in epilepsy patients with seizures
refractory to medical treatment. In addition, preliminary data in the form
of retrospective case series by the investigators and others have
Studies 131
suggested that treatment of OSA may improve seizure control. However,
no prospective studies have been done to verify these findings. Proof that
treating OSA is effective in reducing seizure frequency will require a
multicenter Randomized Clinical Trial (RCT). This large RCT will test the
hypothesis that treatment of OSA in patients with epilepsy refractory to
medical treatment will reduce seizure frequency. In addition, the RCT
will assess the impact of treating OSA on health-related quality of life
and on daytime sleepiness, common concerns in epilepsy patients that
are often attributable to antiepileptic medications or to frequent seizures
rather than to a coexisting sleep disorder. The proposed aims of the Pilot
Clinical Trial (PCT) are to determine critical information for the design of
the RCT to allow for the testing of the above hypotheses in the RCT. In
the PCT subjects 18 years and older with 4 or more seizures per month
who meet survey criteria for OSA and other study criteria will be
recruited at 3 different sites from epilepsy patients seen in clinical
settings. A total of 60 subjects will be observed longitudinally through
PSG confirmation and treatment of OSA and randomized to either
therapeutic continuous positive airway pressure (CPAP) or subtherapeutic (placebo or sham) CPAP in order to determine tolerability.
Rates of adherence to therapeutic and sham CPAP and dropout rates due
to antiepileptic drug changes during the treatment phase will be
estimated. Specifically, the proposed PCT will: 1. Evaluate screening
ranges on the Sleep Apnea scale of the Sleep Disorders Questionnaire
(DA/SDQ), a survey instrument that is used to determine whether
subjects are eligible for inclusion into the RCT. 2. Determine the necessity
of performing two nights of PSG in patients with epilepsy. A second
night of study increases the cost and may decrease recruitment in the
RCT, but may be important to include given the night-to-night variability
in the PSG and the potential for seizure occurrence during recordings.
The working hypothesis is that one night of PSG will be sufficient for the
RCT. 3. Determine rates of adherence to therapeutic and sham CPAP,
dropout rates due to antiepileptic drug changes, and response rates will
provide valuable data for planning the RCT. 4. Develop quality control
measures to ensure accurate and consistent data collection among sites in
the RCT, including aspects related to remote data entry and
standardization of performance and interpretation of PSG studies across
sites.
·
Project Title: EVOLUTION OF ALTERED INHIBITION IN EPILEPSY
Principal Investigator & Institution: Mangan, Patrick S.; Neurology;
University of Virginia Charlottesville Box 400195 Charlottesville, Va
22904
Timing: Fiscal Year 2001; Project Start 1-MAR-1998; Project End 8-FEB2003
Summary: Temporal lobe epilepsy (TLE), the most common form of
partial epilepsy, remains the cause of seizures most resistant to treatment.
Understanding the pathophysiological factors inducing chronic seizure
development is a necessary prerequisite to devising more effective
therapies. Human TLE is marked by major pathology of the mesial
temporal lobe, particularly the hippocampal formation and
parahippocampal structures. A mesial temporal lobe epilepsy syndrome
has been described which is often typified by a nervous system insult
followed by a seizure-free interval and eventual onset of chronic
epilepsy. It is generally agreed that an increased propensity for
epileptiform activity arises from a disequilibrium between neuronal
excitation and inhibition, particularly that mediated by the inhibitory
neurotransmitter gamma-aminobutyric acid (GABA). A fundamental
question which remains unanswered is the nature of the process
occurring during the post-status epilepticus, seizure-free interval which
may reduce GABAergic inhibition and lead to an increased propensity
for epileptiform activity. This proposal examines the evolution of
impairments to GABAA receptor-mediated inhibition during the period
preceding the onset of spontaneous seizures using an animal model of
chronic epilepsy. Three hypotheses are considered: 1. The changes in
GABAA receptor-mediated inhibition in hippocampal region CA1 appear
incrementally following status epilepticus and precede the appearance of
chronic epilepsy. 2. Alterations in the pharmacology of the GABAA
receptor evolve and are complete before the onset of spontaneous
seizures. 3. The properties of spontaneous inhibitory postsynaptic
currents alter between the induction of status epilepticus and the onset of
spontaneous seizures. The information gained in these studies will better
define development of GABAergic deficiencies preceding seizures and
will aid in the development of new anti-epileptogenic therapies.
·
Project Title: GENE MAPPING OF
EPILEPSY: MOVEMENT DISORDERS
JUVENILE
MYOCLONIC
Principal Investigator & Institution: Olson, Jane M.; ; Case Western
Reserve University 10900 Euclid Ave Cleveland, Oh 44106
Timing: Fiscal Year 2001
Summary: The word "epilepsy" derives from the Greek "to be seized" and
refers to a condition characterized by recurrent epileptic seizures.
Generalized epilepsies are manifested by seizures with clinical and
electroencephalograph (EEG) features indicating bilateral synchronous
Studies 133
onsets. Various epileptic seizure types observed in generalized epilepsies
are absence seizures, tonic-clonic seizures (grand mal), myoclonic
seizures, and tonic and atonic seizures. Idiopathic epilepsies are those
epilepsies that have no underlying cause other than a possible genetic
predisposition and are associated with normal intelligence and normal
neurological status. Results from genetic linkage studies demonstrate that
an epilepsy locus exists in chromosome 6p11 whose phenotype consists
of classic juvenile myoclonic epilepsy (JME) with convulsions and/or
EEG multispike wave complexes. Further studies into 22 JME families
provide the first statistical evidence that genetic heterogeneity is present
in the autosomal dominant form of JME. We propose to map gene(s) and
analyze mutations of gene(s) for juvenile myoclonic epilepsy and to
identify the chr.6p JME1 gene.
·
Project Title: HIPPOCAMPAL PLASTICITY IN EPILEPSY
Principal Investigator & Institution: Sutula, Thomas P.; Neurology;
University of Wisconsin Madison 750 University Ave Madison, Wi 53706
Timing: Fiscal Year 2001; Project Start 1-DEC-1999; Project End 0-NOV2003
Summary: Temporal lobe epilepsy is a common form of epilepsy that
frequently becomes resistant to anticonvulsant drugs and is sometimes
progressive. The evolving physiological and neuropathological processes
that eventually made chronic susceptibility to recurring seizures,
development of anticonvulsant drug resistance, and progression to
intractable temporal lobe epilepsy are not well understood are not well
understand. Limbic kindling has been studied as a model of temporal
lobe epilepsy because kindled seizures have many features that resemble
human partial complex seizures arising from the temporal lobe. Repeated
brief seizures evoked by kindling, which gradually increase susceptibility
to additional seizures and eventually induce spontaneous seizures in the
absence of an initial participating injury, provide an opportunity to study
how repeated seizures may contribute to intractable temporal lobe
epilepsy. In the dentate gyrus, kindling induces neuronal loss and mossy
fiber sprouting, which are also observed in the human epileptic temporal
lobe. Seizure- induced cellular alterations such as neuronal loss and
formation of recurrent circuits formed by sprouted mossy fibers could
increase susceptibility to additional seizures by modifying the balance of
excitation and inhibition of hippocampal pathways. Recent studies in our
lab have revealed that the development of spontaneous seizures during
kindling coincides with loss of inhibition in the dentate gyrus. The
proposed experiments. utilize anatomical and physiological methods to
investigate the relationship between repeated seizures, reduction of
inhibition, and chronic seizure-induced cellular alterations in the dentate
gyrus that contribute to spontaneous seizures and intractable epilepsy.
The results of these studies will be important for understanding how
poorly controlled seizures in people may contribute to recurring seizures
and intractable temporal lobe epilepsy.
·
Project Title: MECHANISMS OF EPILEPTOGENESIS
Principal Investigator & Institution: Bertram, Edward H.; Associate
Professor; Neurology; University of Virginia Charlottesville Box 400195
Charlottesville, Va 22904
Timing: Fiscal Year 2001; Project Start 1-FEB-1988; Project End 0-NOV2002
Summary: Epilepsy is a chronic neurological condition that affects about
1% of the population in the United States. Although it is usually readily
treatable with medications, about 25-30% of epileptic patients continue to
experience recurrent seizures in spite of multiple drug therapy. A very
common form of difficult to control human epilepsy is the mesial
temporal lope epilepsy syndrome, which involves limbic structures such
as the hippocampus, entorhinal cortex and amygdala. Understanding the
pathophysiological basis for this condition is essential for the
development of improved treatments. Human studies have suggested
that the process of seizure initiation may involve multiple sites. In these
situations the seizures often begin simultaneously at several of the limbic
sites. These observations raise the possibility that seizure onset may be
triggered in part through a subcortical mechanism that has input to
multiple limbic structures. Testing this idea has not been possible until
recently with the development of several new rat models of limbic
epilepsy that have similarities to the human condition. These limbic
epilepsy models are characterized by spontaneous seizures as well as
limbic pathology and seizure physiology on EEG that are
morphologically similar to the human condition (mesial temporal lobe
epilepsy). Work completed or nearing completion has suggested that all
of the limbic sites demonstrated to participate in seizure onset have
hyperexcitable responses to stimulation. More importantly, we have
recently discovered that the midline thalamic nuclei have significant
excitatory input to these areas (amygdala, hippocampus and entorhinal
cortex). We have also found that the midline thalamic nuclei participate
in, and may regulate, the seizure activity in the limbic system. These
observations suggest that these thalamic regions may have an important
role in seizure initiation and modulation. In this project we propose to
Studies 135
evaluate the role of the midline thalamic nuclei in limbic seizures and
epilepsy to answer the following questions: 1) What role does the midline
thalamic nuclei play in limbic seizures and epilepsy to answer the
following questions: 2) How are the interactions between the midline
thalamic nuclei and its limbic targets altered in limbic epilepsy? 3) How
is the physiology of the midline thalamic nuclei changed in chronic
limbic epilepsy? These experiments will combine in vitro and in vivo
physiology of several rat models of limbic seizures, including chronic
limbic seizures, to examine these issues, which are the first steps to
understanding the role of this region in limbic epilepsy. These results will
provide new insights into the network changes and basis for these
conditions.
·
Project Title: POPULATION BASED STUDY OF SEIZURES IN
BLACKS AND WHITES
Principal Investigator & Institution: Rich, Stephen S.; Professor and ViceChair; University of Minnesota Twin Cities Twin Cities Minneapolis, Mn
55455
Timing: Fiscal Year 2001
Summary: Seizures and epilepsy are among the most common neurologic
disorders in the elderly. Seizure can occur in many ways, including
uncontrollable tonic and/or clonic jerks and/or a momentary loss of
consciousness and/or altered mental state. The etiology of the seizure
may
be
recognized
(symptomatic)
or
unrecognized
(idiopathic/cryogenic), and the initial event may occur at any stage of
life. Classification schemes for epileptic seizures according to clinical and
EEG features and recognized syndromes have been proposed that allows
comparison of results across studies. To date, however, few studies have
been focused on non-Caucasians or on the elderly. The goal of this
population-based study is to determine the prevalence and incidence of
seizures and epilepsy among older African-Americans and Caucasians
participating in the ARIC (Atherosclerosis Risk in Communities) study.
We propose to analyze data collected as part of the ARIC study, a
prospective cohort study consisting of 15,792 free-living residents from
Forsyth County, NC, Jackson, MS, Minneapolis/St. Paul, MN, and
Washington County, MD. The ARIC baseline examination was conducted
between 1987-1989, during which trained interviewers collected
information on medical history and risk factors, blood pressure
measurements, pulmonary function studies, and other associated
measurements. Data from the second ARIC visit (1990- 1992) have
similarly been collected. ARIC visit three data are currently being
collected (1993-1995), and ARIC visit four data will be collected during
the period of this study (1996-1999). Using these data, we propose to (1)
Determine the frequency of seizures by estimating the prevalence in this
populations bey ethnicity and describing the prevalence within
subgroups defined by age, sex, and location; (2) Compare the prevalence
with respect to selected epilepsy and VCD risk factors; and (3) Determine
the incidence of seizures among this population of African-American and
Caucasians. Age- adjusted incidence rates by sex and by ethnic group
will be estimated and we will compare the cumulative incidence rates in
ARIC with that in Rochester, MN. This study focuses on two
understudied groups with respect to seizures -- the elderly and AfricanAmericans. Studies of the prevalence and incidence of seizures in the
ARIC data, especially when coupled with the extensive, already
collected, CVD risk factor data, can provide data of importance to
understanding the etiology of seizures and epilepsy, and complement the
medical information obtained in other projects.
·
Project Title: PROGESTERONE THERAPY FOR WOMEN WITH
EPILEPSY
Principal Investigator & Institution: Herzog, Andrew G.; Associate
Professor of Neurology; Beth Israel Deaconess Medical Center E/Es-214
Boston, Ma 02215
Timing: Fiscal Year 2001; Project Start 0-SEP-2000; Project End 1-AUG2003
Summary: (Applicant's Abstract): This randomized, placebo-controlled,
double-blind, multicenter clinical trial will assess the efficacy of
adjunctive cyclic progesterone therapy in lessening the frequency of
intractable seizures in women with localization related epilepsy. There is
considerable scientific evidence to suggest that estrogen generally
increases while progesterone decreases neuronal excitability and
seizures. Preliminary open trials suggest that the cyclic administration of
adjunctive natural progesterone supplement may lessen seizure
frequency by over 50% in the majority of women with catamenially
exacerbated intractable seizures. Oral synthetic progestins, in contrast,
have not shown significant efficacy. Progesterone is not widely used as
an adjunct to seizure management because its benefits have yet to be
definitively demonstrated. The proposed clinical trial will require 640
subjects. During the baseline phase, seizure/menstrual charts will
document baseline seizure frequency and determine if seizure occurrence
shows a catamenial pattern of exacerbation. The subjects will be divided
into catamenial and non-catamenial groups. Each group will be
Studies 137
randomized in a 2:1 ratio into progesterone and placebo treatment
groups. Seizure frequency during 3 months of treatment will be
compared to baseline, while monitoring antiepileptic drug and hormone
levels. The proposed clinical trial has considerable potential significance
for women with epilepsy. Approximately 30% of women with epilepsy
have refractory seizures, that is persistent seizures despite trials of
antiepileptic drug, use. It is estimated that 35% of these women have
catamenial seizure exacerbation. If, on the basis of preliminary
observations, this group responds favorably to hormonal therapy, one
would expect that progesterone may benefit approximately (1,000,000 x
.30 x .35) 100,000 women with catamenial epilepsy and perhaps many
more women with no a priori demonstrated hormonal sensitivity to
seizure occurrence.
·
Project Title: PROGRESSION OF TEMPORAL LOBE EPILEPSY
Principal Investigator & Institution: Dudek, Francis Edward.; Professor;
Anatomy and Neurobiology; Colorado State University Fort Collins, Co
80523
Timing: Fiscal Year 2003; Project Start 1-DEC-2002; Project End 0-NOV2007
Summary: (provided by applicant): Although epidemiological studies
have provided valuable perspectives on temporal lobe epilepsy, the
ethical limitations of human research prevent a definitive answer to the
important question: is antiepileptic drug (AED) therapy purely
symptomatic, or does it affect the natural history of the epilepsy? The
proposed experiments use an animal model of temporal lobe epilepsy to
determine whether spontaneous epileptic seizures damage the brain and
increase the likelihood of more seizures (i.e., promote epileptogenesis),
and conversely, whether decreasing the number of seizures with AEDs
significantly reduces brain damage and epileptogenesis. The central
hypothesis is that prolonged treatment with an AED, which significantly
reduces spontaneous epileptic seizures, causes long-term reductions in
the frequency and severity of subsequent epileptic seizures after AED
withdrawal. The kainate-treated rat, a well-characterized animal model
of temporal lobe epilepsy, will be used to determine whether the
progressive increase in the frequency ofspontaneous seizures during the
months after status epilepticus continues to damage the hippocampus
and contributes to epileptogenesis. AEDs (i.e., phenytoin, phenobarbital,
and valproate) will be used to block spontaneous epileptic seizures for
prolonged periods to determine whether AED therapy reduces
epileptogenesis and results in a long-term decrease in spontaneous
seizure frequency (i.e., a decrease in frequency that persists after the AED
therapy has been withdrawn). A related hypothesis is that prolonged
AED treatment reduces neuronal death and other potential markers of
hippocampal epileptogenesis. Chronic recording of electrographic
seizures, quantitative histopathological studies, and in vitro
electrophysiological recording of synaptic and epileptiform events in
hippocampal slices will be used to determine if prolonged AED
treatment decreases neuronal damage, reorganization of neural circuits,
and epileptogenesis. These experiments will provide precise and valuable
information regarding the influence of seizure frequency on brain
damage and on the propensity for future seizures, which will be
important for understanding the mechanisms of epileptogenesis and for
making clinical decisions regarding AED therapy and epilepsy surgery.
·
Project Title: RNA BINDING PROTEINS IN EPILEPSY AND
NEUROLOGIC DISEASE
Principal Investigator & Institution: Toth, Miklos; Associate Professor;
Pharmacology; Weill Medical College of Cornell Univ of Cornell
University New York, Ny 10021
Timing: Fiscal Year 2001; Project Start 3-DEC-1995; Project End 1-MAY2003
Summary: (from applicant's abstract): This is a competing continuation
proposal of a grant funded to study the novel Jerky protein and its role in
epilepsy. The mouse line defective in the jerky gene shows epileptic
seizures and our work has shown that consistent with its mutant
phenotype, jerky is transcribed at a relatively high level in neurons of the
central nervous system and that Jerky binds mRNA. We also showed that
antibodies recognizing Jerky are present in sera of patients suffering of a
certain from of autoimmune neuronal degeneration (paraneoplastic
disorders, PND). Other studies suggested that the human jerky gene is a
candidate for childhood absence epilepsy (CAE). We now understand
Jerky to be a prototypic member of an evolutionarily conserved family of
RNA binding proteins (RNPs) containing a novel RNA binding motif.
RNPs are trans-acting factors mediating posttranscriptional processing of
mRNAs and pre-mRNAs, including splicing, polyadenylation, transport,
targeting, stability and translation. We hypothesize that lack of Jerky in
mutant mice leads to a deficiency in the processing of certain mRNAs
compromising neuronal functions that results in seizures. We also show
that lack of FMRP (Fragile X Mental Retardation Protein), another RNP
whose inactivation causes fragile X syndrome and which is believed to be
involved in mRNA processing, also results in seizures in mice. This
Studies 139
finding is consistent with the high incidence of seizures in fragile X
patients. Since FMRP-deficient animals represent a second example of a
situation in which abnormalities in an RNP result in seizures, we suggest
that RNP dysfunction may be more general disease mechanism in
epilepsy. Due to the potential importance of RNPs in epilepsy, the focus
of our current grant application is to study the cellular role of Jerky,
Jerky-like proteins, and FMRP. We propose I) to analyze the RNA
binding properties of the human JERKY protein and a similar human
protein HHJRK, II) to identify the cellular binding targets of JERKY and
FMRP (by a method recently developed in our laboratory) and to assign
functions for these targets, and 3) to employ Jerky autoantibodies as tool
to study Jerky-RNA complexes. These proposed experiments will
establish the jerky family as a distinct group of RNPs with a novel RNA
binding motif. Also, specifying targets for JERKY and FMRP will allow
us to link these targets to cellular pathways and ascertain how these
pathways contribute to the overall function of these proteins. Finally,
these experiments will aid in our understanding of certain aspects of the
pathogenesis of epilepsy and autoimmune diseases.
E-Journals: PubMed Central19
PubMed Central (PMC) is a digital archive of life sciences journal literature
developed and managed by the National Center for Biotechnology
Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access
to this growing archive of e-journals is free and unrestricted.21 To search, go
to http://www.pubmedcentral.nih.gov/index.html#search, and type
“seizures and epilepsy” (or synonyms) into the search box. This search gives
you access to full-text articles. The following is a sample of items found for
seizures and epilepsy in the PubMed Central database:
·
Grafts of adenosine-releasing cells suppress seizures in kindling
epilepsy. by Huber A, Padrun V, Deglon N, Aebischer P, Mohler H,
Boison D.; 2001 Jun 19;
Adapted from the National Library of Medicine:
http://www.pubmedcentral.nih.gov/about/intro.html.
20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open
access to electronic literature, just as NLM has done for decades with printed biomedical
literature. PubMed Central aims to become a world-class library of the digital age.
21 The value of PubMed Central, in addition to its role as an archive, lies the availability of
data from diverse sources stored in a common format in a single repository. Many journals
already have online publishing operations, and there is a growing tendency to publish
material online only, to the exclusion of print.
19
http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti
d=34716
·
Nitric Oxide Mediates the Increase in Local Cerebral Blood Flow
During Focal Seizures. by de Vasconcelos AP, Baldwin RA, Wasterlain
CG.; 1995 Apr 11;
http://www.pubmedcentral.gov/articlerender.fcgi?rendertype=abstract
&artid=42128
·
Role of Nitric Oxide in the Enhancement of PentylenetetrazoleInduced Seizures Caused by Shigella dysenteriae. by Balter-Seri J,
Yuhas Y, Weizman A, Nofech-Mozes Y, Kaminsky E, Ashkenazi S.; 1999
Dec;
http://www.pubmedcentral.gov/articlerender.fcgi?rendertype=external
&artid=97043
·
Role of the Y5 neuropeptide Y receptor in limbic seizures. by Marsh DJ,
Baraban SC, Hollopeter G, Palmiter RD.; 1999 Nov 9;
http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti
d=23980
The National Library of Medicine: PubMed
One of the quickest and most comprehensive ways to find academic studies
in both English and other languages is to use PubMed, maintained by the
National Library of Medicine. The advantage of PubMed over previously
mentioned sources is that it covers a greater number of domestic and foreign
references. It is also free to the public.22 If the publisher has a Web site that
offers full text of its journals, PubMed will provide links to that site, as well
as to sites offering other related data. User registration, a subscription fee, or
some other type of fee may be required to access the full text of articles in
some journals.
To generate your own bibliography of studies dealing with seizures and
epilepsy, go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed.
Type “seizures and epilepsy” (or synonyms) into the search box, and click
“Go.” The following is the type of output you can expect from PubMed for
“seizures and epilepsy” (hyperlinks lead to article summaries):
PubMed was developed by the National Center for Biotechnology Information (NCBI) at
the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The
PubMed database was developed in conjunction with publishers of biomedical literature as
a search tool for accessing literature citations and linking to full-text journal articles at Web
sites of participating publishers. Publishers that participate in PubMed supply NLM with
their citations electronically prior to or at the time of publication.
22
Studies 141
·
Cellular prion protein: implications in seizures and epilepsy.
Author(s): Walz R, Castro RM, Velasco TR, Carlotti CG Jr, Sakamoto AC,
Brentani RR, Martins VR.
Source: Cellular and Molecular Neurobiology. 2002 June; 22(3): 249-57.
Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=12469868&dopt=Abstract
·
Classifying seizures and epilepsy: a synopsis.
Author(s): Sirven JI.
Source: Seminars in Neurology. 2002 September; 22(3): 237-46.
·
Demystifying seizures and epilepsy: introduction to the symposium on
seizures.
Author(s): Sirven JI.
Source: Mayo Clinic Proceedings. 2002 September; 77(9): 977-9.
·
Retrospective
study
of
febrile
seizures:
subsequent
electroencephalogram findings, unprovoked seizures and epilepsy in
adolescents.
Author(s): Piperidou HN, Heliopoulos IN, Maltezos ES, Stathopoulos
GA, Milonas IA.
Source: J Int Med Res. 2002 November-December; 30(6): 560-5.
·
1H and 31P spectroscopy and bioenergetics in the lateralization of
seizures in temporal lobe epilepsy.
Author(s): Hetherington HP, Pan JW, Spencer DD.
Source: Journal of Magnetic Resonance Imaging : Jmri. 2002 October;
16(4): 477-83. Review.
·
A locus for simple pure febrile seizures maps to chromosome 6q22-q24.
Author(s): Nabbout R, Prud'homme JF, Herman A, Feingold J, Brice A,
Dulac O, LeGuern E.
Source: Brain; a Journal of Neurology. 2002 December; 125(Pt 12): 266880.
·
A nonsense mutation of the MASS1 gene in a family with febrile and
afebrile seizures.
Author(s): Nakayama J, Fu YH, Clark AM, Nakahara S, Hamano K,
Iwasaki N, Matsui A, Arinami T, Ptacek LJ.
Source: Annals of Neurology. 2002 November; 52(5): 654-7.
·
Adverse effects of phenytoin given for late-onset seizures in adults
with Down syndrome.
Author(s): Tsiouris JA, Patti PJ, Tipu O, Raguthu S.
Source: Neurology. 2002 September 10; 59(5): 779-80.
·
An overview of surgery for chronic seizures.
Author(s): Zimmerman RS, Sirven JI.
Source: Mayo Clinic Proceedings. 2003 January; 78(1): 109-17.
·
Antibodies against GluR3 peptides are not specific for Rasmussen's
encephalitis but are also present in epilepsy patients with severe, early
onset disease and intractable seizures.
Author(s): Mantegazza R, Bernasconi P, Baggi F, Spreafico R, Ragona F,
Antozzi C, Bernardi G, Granata T.
Source: Journal of Neuroimmunology. 2002 October; 131(1-2): 179-85.
·
Association analysis between the human interleukin 1beta (-511) gene
polymorphism and susceptibility to febrile convulsions.
Author(s): Tilgen N, Pfeiffer H, Cobilanschi J, Rau B, Horvath S, Elger
CE, Propping P, Heils A.
Studies 143
Source: Neuroscience Letters. 2002 December 6; 334(1): 68-70.
·
Asymmetric ending of secondarily generalized seizures: a lateralizing
sign in TLE.
Author(s): Leutmezer F, Woginger S, Antoni E, Seidl B, Baumgartner C.
Source: Neurology. 2002 October 22; 59(8): 1252-4.
·
Asymmetric termination of secondarily generalized tonic-clonic
seizures in temporal lobe epilepsy.
Author(s): Trinka E, Walser G, Unterberger I, Luef G, Benke T, Bartha L,
Eibl G, Ortler M, Bauer G.
Source: Neurology. 2002 October 22; 59(8): 1254-6.
·
Benign familial infantile convulsions: a clinical study of seven Dutch
families.
Author(s): Callenbach PM, de Coo RF, Vein AA, Arts WF, Oosterwijk J,
Hageman G, ten Houten R, Terwindt GM, Lindhout D, Frants RR,
Brouwer OF.
Source: European Journal of Paediatric Neurology : Ejpn : Official Journal
of the European Paediatric Neurology Society. 2002; 6(5): 269-83.
·
Benign familial infantile seizures: further delineation of the syndrome.
Author(s): Caraballo RH, Cersosimo RO, Amartino H, Szepetowski P,
Fejerman N.
Source: Journal of Child Neurology. 2002 September; 17(9): 696-9.
·
Bupropion-methylphenidate combination and grand mal seizures.
Author(s): Ickowicz A.
Source: Canadian Journal of Psychiatry. Revue Canadienne De
Psychiatrie. 2002 October; 47(8): 790-1.
·
Carbamazepine-induced seizures: a case report and review of the
literature.
Author(s): Gansaeuer M, Alsaadi TM.
Source: Clin Electroencephalogr. 2002 October; 33(4): 174-7.
·
Childhood absence epilepsy and febrile seizures: a family with a
GABA(A) receptor mutation.
Author(s): Marini C, Harkin LA, Wallace RH, Mulley JC, Scheffer IE,
Berkovic SF.
Source: Brain; a Journal of Neurology. 2003 January; 126(Pt 1): 230-40.
·
Childhood febrile convulsions--which factors determine the
subsequent epilepsy syndrome? A retrospective study.
Author(s): Trinka E, Unterrainer J, Haberlandt E, Luef G, Unterberger I,
Niedermuller U, Haffner B, Bauer G.
Source: Epilepsy Research. 2002 August; 50(3): 283-92.
·
Chronic alcohol use and first symptomatic epileptic seizures.
Author(s): Leone M, Tonini C, Bogliun G, Monaco F, Mutani R, Bottacchi
E, Gambaro P, Rocci E, Tassinari T, Cavestro C, Beghi E.
Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002
November; 73(5): 495-9.
·
Clinical features of benign convulsions with mild gastroenteritis.
Author(s): Uemura N, Okumura A, Negoro T, Watanabe K.
Source: Brain & Development. 2002 December; 24(8): 745-9.
Studies 145
·
Clinical
indications
and
diagnostic
yield
of
videoelectroencephalographic monitoring in patients with seizures and
spells.
Author(s): Cascino GD.
Source: Mayo Clinic Proceedings. 2002 October; 77(10): 1111-20. Review.
·
Clinical study of catastrophic infantile epilepsy with focal seizures.
Author(s): Ishii K, Oguni H, Hayashi K, Shirakawa S, Itoh Y, Osawa M.
Source: Pediatric Neurology. 2002 November; 27(5): 369-77.
·
Crossed cerebellar diaschisis secondary to refractory frontal seizures in
childhood.
Author(s): MEWASINGH LD, CHRISTIAENS F, AEBY A, CHRISTOPHE
C, DAN B.
Source: Seizure : the Journal of the British Epilepsy Association. 2002
December; 11(8): 489-93.
·
Differences in hippocampal mitotic activity within the dorsal and
ventral hippocampus following flurothyl seizures in mice.
Author(s): Ferland RJ, Gross RA, Applegate CD.
Source: Neuroscience Letters. 2002 October 31; 332(2): 131-5.
·
Effect of topiramate following recurrent and prolonged seizures during
early development.
Author(s): Cha BH, Silveira DC, Liu X, Hu Y, Holmes GL.
Source: Epilepsy Research. 2002 October; 51(3): 217-32.
·
Effectiveness
of
muscimol-containing
microparticles
against
pilocarpine-induced focal seizures.
Author(s): Kohane DS, Holmes GL, Chau Y, Zurakowski D, Langer R,
Cha BH.
Source: Epilepsia. 2002 December; 43(12): 1462-8.
·
Effects of fluoxetine and TFMPP on spontaneous seizures in rats with
pilocarpine-induced epilepsy.
Author(s): Hernandez EJ, Williams PA, Dudek FE.
Source: Epilepsia. 2002 November; 43(11): 1337-45.
·
Effects of hemispheric lateralization and site specificity on immune
alterations induced by kindled temporal lobe seizures.
Author(s): Goldstein KR, Bhatt R, Barton BE, Zalcman SS, Rameshwar P,
Siegel A.
Source: Brain, Behavior, and Immunity. 2002 December; 16(6): 706-19.
·
Febrile seizures.
Author(s): Varma RR.
Source: Indian J Pediatr. 2002 August; 69(8): 697-700.
·
Frequency evolution during tonic-clonic seizures.
Author(s): Quiroga RQ, Garcia H, Rabinowicz A.
Source: Electromyogr Clin Neurophysiol. 2002 September; 42(6): 323-31.
·
Frequent seizures with elevated interleukin-6 at the eruptive stage of
exanthema subitum.
Author(s): Go T, Nakamura K.
Source: European Journal of Paediatric Neurology : Ejpn : Official Journal
of the European Paediatric Neurology Society. 2002; 6(4): 221-3.
·
Functional and biochemical analysis of a sodium channel Beta 1
subunit mutation responsible for generalized epilepsy with febrile
seizures plus type 1.
Studies 147
Author(s): Meadows LS, Malhotra J, Loukas A, Thyagarajan V, KazenGillespie KA, Koopman MC, Kriegler S, Isom LL, Ragsdale DS.
Source: The Journal of Neuroscience : the Official Journal of the Society
for Neuroscience. 2002 December 15; 22(24): 10699-709.
·
Functional and morphological changes in the hippocampal neuronal
circuits associated with epileptic seizures.
Author(s): Maru E, Kanda M, Ashida H.
Source: Epilepsia. 2002; 43 Suppl 9: 44-9. Review.
·
Gabapentin in late-onset poststroke seizures.
Author(s): Alvarez-Sabin J, Montaner J, Padro L, Molina CA, Rovira R,
Codina A, Quintana M.
Source: Neurology. 2002 December 24; 59(12): 1991-3.
·
GnRH-immunoreactive fiber changes with unilateral amygdalakindled seizures.
Author(s): Friedman MN, Geula C, Holmes GL, Herzog AG.
Source: Epilepsy Research. 2002 December; 52(2): 73-7.
·
Headache associated with epileptic seizures: epidemiology and clinical
characteristics.
Author(s): Forderreuther S, Henkel A, Noachtar S, Straube A.
Source: Headache. 2002 July-August; 42(7): 649-55.
·
Heart rate and EKG changes in 102 seizures: analysis of influencing
factors.
Author(s): Opherk C, Coromilas J, Hirsch LJ.
Source: Epilepsy Research. 2002 December; 52(2): 117-27.
·
Hyperventilation-induced high-amplitude rhythmic slowing with
altered awareness: a video-EEG comparison with absence seizures.
Author(s): Lum LM, Connolly MB, Farrell K, Wong PK.
·
Ictal
onset
localization
of
epileptic
seizures
by
magnetoencephalography.
Author(s): Tilz C, Hummel C, Kettenmann B, Stefan H.
Source: Acta Neurologica Scandinavica. 2002 October; 106(4): 190-5.
·
Ictal vomiting in association with left temporal lobe seizures in a left
hemisphere language-dominant patient.
Author(s): Schauble B, Britton JW, Mullan BP, Watson J, Sharbrough FW,
Marsh WR.
·
Ictogenesis: the origin of seizures in humans. A new look at an old
theory.
Author(s): Doman G, Pelligra R.
Source: Medical Hypotheses. 2003 January; 60(1): 129-32.
·
Incidence of seizures in patients with multiple sclerosis: a populationbased study.
Author(s): Nyquist PA, Cascino GD, McClelland RL, Annegers JF,
Rodriguez M.
Source: Mayo Clinic Proceedings. 2002 September; 77(9): 910-2.
·
Interleukin-4 intron 3 polymorphism is not related to susceptibility to
febrile seizures.
Author(s): Tsai FJ, Chou IC, Hsieh YY, Lee CC, Lin CC, Tsai CH.
Source: Pediatric Neurology. 2002 October; 27(4): 271-4.
Studies 149
·
Involvement of the neuropeptide nociceptin/orphanin FQ in kainate
seizures.
Author(s): Bregola G, Zucchini S, Rodi D, Binaschi A, D'Addario C,
Landuzzi D, Reinscheid R, Candeletti S, Romualdi P, Simonato M.
for Neuroscience. 2002 November 15; 22(22): 10030-8.
·
Lidocaine-induced seizures in patients with history of epilepsy: effect
of antiepileptic drugs.
Author(s): DeToledo JC, Minagar A, Lowe MR.
Source: Anesthesiology. 2002 September; 97(3): 737-9.
·
Low-dose topiramate in adults with treatment-resistant partial-onset
seizures.
Author(s): Guberman A, Neto W, Gassmann-Mayer C.
Source: Acta Neurologica Scandinavica. 2002 October; 106(4): 183-9.
·
Masking synchronous GABA-mediated potentials controls limbic
seizures.
Author(s): Barbarosie M, Louvel J, D'Antuono M, Kurcewicz I, Avoli M.
·
Medication interaction causing seizures in a patient with bipolar
disorder and cystic fibrosis.
Author(s): Munera PA, Perel JM, Asato M.
Source: Journal of Child and Adolescent Psychopharmacology. 2002 Fall;
12(3): 275-6.
·
Mefloquine: contraindicated in patients with mood, psychotic or
seizure disorders.
Author(s): Wooltorton E.
Source: Cmaj : Canadian Medical Association Journal = Journal De
L'association Medicale Canadienne. 2002 November 12; 167(10): 1147.
·
Molecular genetics of febrile seizures.
Author(s): Iwasaki N, Nakayama J, Hamano K, Matsui A, Arinami T.
Source: Epilepsia. 2002; 43 Suppl 9: 32-5.
·
NAALADase (GCP II) inhibition prevents cocaine-kindled seizures.
Author(s): Witkin JM, Gasior M, Schad C, Zapata A, Shippenberg T,
Hartman T, Slusher BS.
Source: Neuropharmacology. 2002 September; 43(3): 348-56.
·
New onset seizures in HIV-infected patients without intracranial mass
lesions or meningitis--a clinical, radiological and SPECT scan study.
Author(s): Modi G, Modi M, Martinus I, Vangu M.
Source: Journal of the Neurological Sciences. 2002 October 15; 202(1-2):
29-34.
·
No evidence for a susceptibility locus for idiopathic generalized
epilepsy on chromosome 5 in families with typical absence seizures.
Author(s): Windemuth C, Schulz H, Saar K, Gennaro E, Bianchi A, Zara
F, Bulteau C, Kaminska A, Ville D, Cieuta C, Nabbout-Tarantino R,
Prud'homme JF, Dulac O, Bate L, Gardiner RM, Lindhout D, Wienker TF,
Janz D, Sander T.
Source: Epilepsy Research. 2002 September; 51(1-2): 23-9.
Studies 151
·
Parietal circuits and conversion seizures.
Author(s): Vardi J, Finkelstein Y, Zlotogorski Z.
Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2002
Fall; 14(4): 468.
·
Pathophysiology of altered consciousness during seizures: Subtraction
SPECT study.
Author(s): Lee KH, Meador KJ, Park YD, King DW, Murro AM, Pillai JJ,
Kaminski RJ.
Source: Neurology. 2002 September 24; 59(6): 841-6.
·
Pilomotor seizures: symptomatic vs. idiopathic report of two cases and
literature review.
Author(s): Sa'adah MA, Shawabkeh A, Sa'adah LM, Inshasi J.
October; 11(7): 455-9. Review.
·
Preventing and treating eclamptic seizures.
Author(s): Roberts JM, Villar J, Arulkumaran S.
Source: Bmj (Clinical Research Ed.). 2002 September 21; 325(7365): 609-10.
·
Pyridoxine-dependent seizures: long-term follow-up of two cases with
clinical and MRI findings, and pyridoxine treatment.
Author(s): Ulvi H, Mungen B, Yakinci C, Yoldas T.
Source: Journal of Tropical Pediatrics. 2002 October; 48(5): 303-6.
·
Rectal diazepam gel for treatment of acute repetitive seizures in adults.
Author(s): Cereghino JJ, Cloyd JC, Kuzniecky RI.
Source: Archives of Neurology. 2002 December; 59(12): 1915-20.
·
Recurrent seizures and behavior problems in children with first
recognized seizures: a prospective study.
Author(s): Austin JK, Dunn DW, Caffrey HM, Perkins SM, Harezlak J,
Rose DF.
·
Relationship of epileptic seizures to sleep stage and sleep depth.
Author(s): Minecan D, Natarajan A, Marzec M, Malow B.
Source: Sleep. 2002 Dec15; 25(8): 899-904.
·
Role and limitations of routine and ambulatory scalp
electroencephalography in diagnosing and managing seizures.
Author(s): Worrell GA, Lagerlund TD, Buchhalter JR.
Source: Mayo Clinic Proceedings. 2002 September; 77(9): 991-8. Review.
·
Seizures after alendronate.
Author(s): Maclsaac RJ, Seeman E, Jerums G.
Source: Journal of the Royal Society of Medicine. 2002 December; 95(12):
615-6.
·
Seizures and the basal ganglia: a review of the clinical data.
Author(s): Vercueil L, Hirsch E.
Source: Epileptic Disord. 2002 July; 4 Suppl 3: 47-54.
·
Seizures on emergence from sevoflurane anaesthesia for Caesarean
section in a healthy parturient.
Author(s): Kuczkowski KM.
Source: Anaesthesia. 2002 December; 57(12): 1234-5.
Studies 153
·
Singing seizures.
Author(s): Doherty MJ, Wilensky AJ, Holmes MD, Lewis DH, Rae J, Cohn
GH.
Source: Neurology. 2002 November 12; 59(9): 1435-8.
·
Sleep complaints and epilepsy: the role of seizures, antiepileptic drugs
and sleep disorders.
Author(s): Foldvary-Schaefer N.
Source: Journal of Clinical Neurophysiology : Official Publication of the
American Electroencephalographic Society. 2002 December; 19(6): 514-21.
·
Sodium-channel defects in benign familial neonatal-infantile seizures.
Author(s): Heron SE, Crossland KM, Andermann E, Phillips HA, Hall AJ,
Bleasel A, Shevell M, Mercho S, Seni MH, Guiot MC, Mulley JC, Berkovic
SF, Scheffer IE.
Source: Lancet. 2002 September 14; 360(9336): 851-2.
·
Stimulation of the nervous system for the management of seizures:
current and future developments.
Author(s): Murphy JV, Patil A.
Source: Cns Drugs. 2003; 17(2): 101-15.
·
Study of factors responsible for recurrence of seizures in controlled
epileptics for more than 1 years after withdrawal of antiepileptic drugs.
Author(s): Lamdhade SJ, Taori GM.
Source: Neurology India. 2002 September; 50(3): 295-300.
·
Suppressive effect of callosotomy on epileptic seizures is due to the
blockade of enhancement of cortical reactivity by transcallosal volleys.
Author(s): Ono T, Fujimura K, Yoshida S, Ono K.
Source: Epilepsy Research. 2002 September; 51(1-2): 117-21.
·
Systematic review and meta-analysis of incidence studies of epilepsy
and unprovoked seizures.
Author(s): Kotsopoulos IA, van Merode T, Kessels FG, de Krom MC,
Knottnerus JA.
Source: Epilepsia. 2002 November; 43(11): 1402-9. Review.
·
The contribution of the lateral posterior and anteroventral thalamic
nuclei on spontaneous recurrent seizures in the pilocarpine model of
epilepsy.
Author(s): Scorza FA, Arida RM, Priel M, Calderazzo L, Cavalheiro EA.
Source: Arquivos De Neuro-Psiquiatria. 2002 September; 60(3-A): 572-5.
·
The control of seizures by the basal ganglia? A review of experimental
data.
Author(s): Deransart C, Depaulis A.
Source: Epileptic Disord. 2002 July; 4 Suppl 3: 61-72.
·
The correlation of seizures in newborn infants with significant acidosis
at birth with umbilical artery cord gas values.
Author(s): Williams KP, Singh A.
Source: Obstetrics and Gynecology. 2002 September; 100(3): 557-60.
·
The first reported presentation of rickets with metabolic seizures.
Author(s): Stebbing C, Mansy S, Kanabar D.
Source: Hosp Med. 2002 November; 63(11): 690-1. No Abstract Available.
·
The relevance of poststroke seizures.
Author(s): Pohlmann-Eden B, Hennerici MG, Hoch DB.
Studies 155
Source: Archives of Neurology. 2002 November; 59(11): 1831; Author
Reply 1831-2.
·
The role of chloride-dependent inhibition and the activity of fastspiking neurons during cortical spike-wave electrographic seizures.
Author(s): Timofeev I, Grenier F, Steriade M.
Source: Neuroscience. 2002; 114(4): 1115-32.
·
The role of the temporal pole in the genesis of temporal lobe seizures.
Author(s): Kahane P, Chabardes S, Minotti L, Hoffmann D, Benabid AL,
Munari C.
Source: Epileptic Disord. 2002 September; 4 Suppl 1: S51-8.
·
The structural consequences of newly diagnosed seizures.
Author(s): Liu RS, Lemieux L, Bell GS, Sisodiya SM, Bartlett PA, Shorvon
SD, Sander JW, Duncan JS.
Source: Annals of Neurology. 2002 November; 52(5): 573-80.
·
Tonic-clonic seizures in patients taking sildenafil.
Author(s): Gilad R, Lampl Y, Eshel Y, Sadeh M.
Source: Bmj (Clinical Research Ed.). 2002 October 19; 325(7369): 869.
Vocabulary Builder
Acidosis: A pathologic condition resulting from accumulation of acid or
depletion of the alkaline reserve (bicarbonate content) in the blood and body
tissues, and characterized by an increase in hydrogen ion concentration. [EU]
Adenosine: A nucleoside that is composed of adenine and d-ribose.
Adenosine or adenosine derivatives play many important biological roles in
addition to being components of DNA and RNA. Adenosine itself is a
neurotransmitter. [NIH]
Alendronate:
A nonhormonal medication for the treatment of
postmenopausal osteoporosis in women. This drug builds healthy bone,
restoring some of the bone loss as a result of osteoporosis. [NIH]
Algorithms: A procedure consisting of a sequence of algebraic formulas
and/or logical steps to calculate or determine a given task. [NIH]
Amphetamine:
A powerful central nervous system stimulant and
sympathomimetic. Amphetamine has multiple mechanisms of action
including blocking uptake of adrenergics and dopamine, stimulation of
release of monamines, and inhibiting monoamine oxidase. Amphetamine is
also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are
included here. The l-form has less central nervous system activity but
stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH]
Amygdala: Almond-shaped group of basal nuclei anterior to the inferior
horn of the lateral ventricle of the brain, within the temporal lobe. The
amygdala is part of the limbic system. [NIH]
Anaesthesia: Loss of feeling or sensation. Although the term is used for loss
of tactile sensibility, or of any of the other senses, it is applied especially to
loss of the sensation of pain, as it is induced to permit performance of
surgery or other painful procedures. [EU]
Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU]
Anesthesiology: A specialty concerned with the study of anesthetics and
anesthesia. [NIH]
Aphasia: Defect or loss of the power of expression by speech, writing, or
signs, or of comprehending spoken or written language, due to injury or
disease of the brain centres. [EU]
Asphyxia: A pathological condition caused by lack of oxygen, manifested in
impending or actual cessation of life. [NIH]
Autoimmunity: Process whereby the immune system reacts against the
body's own tissues. Autoimmunity may produce or be caused by
autoimmune diseases. [NIH]
Bilateral: Having two sides, or pertaining to both sides. [EU]
Cannabinoids:
Compounds extracted from Cannabis sativa L. and
metabolites having the cannabinoid structure. The most active constituents
are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH]
Caspases: A family of intracellular cysteine endopeptidases. They play a key
role in inflammation and mammalian apoptosis. They are specific for
aspartic acid at the P1 position. They are divided into two classes based on
the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10
Studies 157
have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-.
[NIH]
Caudal: Denoting a position more toward the cauda, or tail, than some
specified point of reference; same as inferior, in human anatomy. [EU]
Cerebellar: Pertaining to the cerebellum. [EU]
Chronobiology: The study of biological systems as affected by time. Aging,
biological rhythms, and cyclic phenomena are included. Statistical,
computer-aided mathematical procedures are used to describe, in
mathematical terminology, various biological functions over time. [NIH]
Cocaine: An alkaloid ester extracted from the leaves of plants including
coca. It is a local anesthetic and vasoconstrictor and is clinically used for that
purpose, particularly in the eye, ear, nose, and throat. It also has powerful
central nervous system effects similar to the amphetamines and is a drug of
abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain
catecholaminergic neurons; the mechanism of its reinforcing effects is
thought to involve inhibition of dopamine uptake. [NIH]
Curative: Tending to overcome disease and promote recovery. [EU]
Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to
chemical compounds that contain a ring of atoms in the nucleus. [EU]
Dendrites: Extensions of the nerve cell body. They are short and branched
and receive stimuli from other neurons. [NIH]
Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites.
[EU]
Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position
more toward the back surface than some other object of reference; same as
posterior in human anatomy; superior in the anatomy of quadrupeds. [EU]
Dysphagia: Difficulty in swallowing. [EU]
Electrophysiological: Pertaining to electrophysiology, that is a branch of
physiology that is concerned with the electric phenomena associated with
living bodies and involved in their functional activity. [EU]
Endogenous: Developing or originating within the organisms or arising
from causes within the organism. [EU]
Epidemiological: Relating to, or involving epidemiology. [EU]
Exanthema: Exanthem; an eruptive disease or its symptomatic eruption. [EU]
Excitation: An act of irritation or stimulation or of responding to a stimulus;
the addition of energy, as the excitation of a molecule by absorption of
photons. [EU]
Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU]
Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as
an antidepressant and often has a more acceptable side-effects profile than
traditional antidepressants. [NIH]
Flurothyl: A convulsant primarily used in experimental animals. It was
formerly used to induce convulsions as a alternative to electroshock therapy.
[NIH]
Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely
organized connective tissue located outside the central nervous system. [NIH]
Gastroenteritis: An acute inflammation of the lining of the stomach and
intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain,
and weakness, which has various causes, including food poisoning due to
infection with such organisms as Escherichia coli, Staphylococcus aureus,
and Salmonella species; consumption of irritating food or drink; or
psychological factors such as anger, stress, and fear. Called also
enterogastritis. [EU]
Gynecology: A medical-surgical specialty concerned with the physiology
and disorders primarily of the female genital tract, as well as female
endocrinology and reproductive physiology. [NIH]
Hypothalamus: Ventral part of the diencephalon extending from the region
of the optic chiasm to the caudal border of the mammillary bodies and
forming the inferior and lateral walls of the third ventricle. [NIH]
Hysteria: Historical term for a chronic, but fluctuating, disorder beginning
in early life and characterized by recurrent and multiple somatic complaints
not apparently due to physical illness. This diagnosis is not used in
contemporary practice. [NIH]
Indicative: That indicates; that points out more or less exactly; that reveals
fairly clearly. [EU]
Induction: The act or process of inducing or causing to occur, especially the
production of a specific morphogenetic effect in the developing embryo
through the influence of evocators or organizers, or the production of
anaesthesia or unconsciousness by use of appropriate agents. [EU]
Ingestion: The act of taking food, medicines, etc., into the body, by mouth.
[EU]
Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU]
Limbic: Pertaining to a limbus, or margin; forming a border around. [EU]
Lithium: Lithium. An element in the alkali metals family. It has the atomic
symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are
used in treating manic-depressive disorders. [NIH]
Localization: 1. The determination of the site or place of any process or
lesion. 2. Restriction to a circumscribed or limited area. 3. Prelocalization. [EU]
Magnetoencephalography: The measurement of magnetic fields over the
Studies 159
head generated by electric currents in the brain. As in any electrical
conductor, electric fields in the brain are accompanied by orthogonal
magnetic fields. The measurement of these fields provides information about
the localization of brain activity which is complementary to that provided by
electroencephalography. Magnetoencephalography may be used alone or
together with electroencephalography, for measurement of spontaneous or
evoked activity, and for research or clinical purposes. [NIH]
Methylphenidate:
A central nervous system stimulant used most
commonly in the treatment of attention-deficit disorders in children and for
narcolepsy. Its mechanisms appear to be similar to those of
dextroamphetamine. [NIH]
Neuropharmacology: The branch of pharmacology dealing especially with
the action of drugs upon various parts of the nervous system. [NIH]
Neurophysiology: The scientific discipline concerned with the physiology
of the nervous system. [NIH]
Neurosciences: The scientific disciplines concerned with the embryology,
anatomy, physiology, biochemistry, pharmacology, etc., of the nervous
sytem. [NIH]
Neurosurgery: A surgical specialty concerned with the treatment of diseases
and disorders of the brain, spinal cord, and peripheral and sympathetic
Obstetrics: A medical-surgical specialty concerned with management and
care of women during pregnancy, parturition, and the puerperium. [NIH]
Octreotide: A potent, long-acting somatostatin octapeptide analog which
has a wide range of physiological actions. It inhibits growth hormone
secretion, is effective in the treatment of hormone-secreting tumors from
various organs, and has beneficial effects in the management of many
pathological states including diabetes mellitus, orthostatic hypertension,
hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH]
Paediatric: Of or relating to the care and medical treatment of children;
belonging to or concerned with paediatrics. [EU]
Pentylenetetrazole: A pharmaceutical agent that displays activity as a
central nervous system and respiratory stimulant. It is considered a noncompetitive GABA antagonist. Pentylenetetrazole has been used
experimentally to study seizure phenomenon and to identify
pharmaceuticals that may control seizure susceptibility. [NIH]
Phenotype: The outward appearance of the individual. It is the product of
interactions between genes and between the genotype and the environment.
This includes the killer phenotype, characteristic of YEASTS. [NIH]
Picrotoxin: A noncompetitive antagonist at GABA-A receptors and thus a
convulsant. Picrotoxin blocks the GABA-activated chloride ionophore.
Although it is most often used as a research tool, it has been used as a CNS
stimulant and an antidote in poisoning by CNS depressants, especially the
barbiturates. [NIH]
Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic
effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH]
Polytherapy: A therapy which uses more than one drug. [EU]
Posterior: Situated in back of, or in the back part of, or affecting the back or
dorsal surface of the body. In lower animals, it refers to the caudal end of the
body. [EU]
Postnatal: Occurring after birth, with reference to the newborn. [EU]
Predisposition: A latent susceptibility to disease which may be activated
under certain conditions, as by stress. [EU]
Presynaptic: Situated proximal to a synapse, or occurring before the
synapse is crossed. [EU]
Prevalence: The total number of cases of a given disease in a specified
population at a designated time. It is differentiated from INCIDENCE, which
refers to the number of new cases in the population at a given time. [NIH]
Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a
molecular weight of about 23,000. It is essential in the induction of lactation
in mammals at parturition and is synergistic with estrogen. The hormone
also brings about the release of progesterone from lutein cells, which renders
the uterine mucosa suited for the embedding of the ovum should
fertilization occur. [NIH]
Psychiatry: The medical science that deals with the origin, diagnosis,
prevention, and treatment of mental disorders. [NIH]
Psychopharmacology: The study of the effects of drugs on mental and
behavioral activity. [NIH]
Pulmonary: Pertaining to the lungs. [EU]
Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]
Rickets: A condition caused by deficiency of vitamin D, especially in
infancy and childhood, with disturbance of normal ossification. The disease
is marked by bending and distortion of the bones under muscular action, by
the formation of nodular enlargements on the ends and sides of the bones,
by delayed closure of the fontanelles, pain in the muscles, and sweating of
the head. Vitamin D and sunlight together with an adequate diet are
curative, provided that the parathyroid glands are functioning properly. [EU]
Secretion: 1. The process of elaborating a specific product as a result of the
activity of a gland; this activity may range from separating a specific
Studies 161
substance of the blood to the elaboration of a new chemical substance. 2. Any
substance produced by secretion. [EU]
Sporadic: Neither endemic nor epidemic; occurring occasionally in a
random or isolated manner. [EU]
Symptomatic: 1. Pertaining to or of the nature of a symptom. 2. Indicative
(of a particular disease or disorder). 3. Exhibiting the symptoms of a
particular disease but having a different cause. 4. Directed at the allying of
symptoms, as symptomatic treatment. [EU]
Temperament: Predisposition to react to one's environment in a certain
way; usually refers to mood changes. [NIH]
Tetanus: A disease caused by tetanospasmin, a powerful protein toxin
produced by clostridium tetani. Tetanus usually occurs after an acute injury,
such as a puncture wound or laceration. Generalized tetanus, the most
common form, is characterized by tetanic muscular contractions and
hyperreflexia. Localized tetanus presents itself as a mild condition with
manifestations restricted to muscles near the wound. It may progress to the
generalized form. [NIH]
Toxin: A poison; frequently used to refer specifically to a protein produced
by some higher plants, certain animals, and pathogenic bacteria, which is
highly toxic for other living organisms. Such substances are differentiated
from the simple chemical poisons and the vegetable alkaloids by their high
molecular weight and antigenicity. [EU]
Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position
more toward the belly surface than some other object of reference; same as
anterior in human anatomy. [EU]
Patents 163
CHAPTER 5. PATENTS ON SEIZURES AND EPILEPSY
Overview
You can learn about innovations relating to seizures and epilepsy by reading
recent patents and patent applications. Patents can be physical innovations
(e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g.
treatments or diagnostic procedures). The United States Patent and
Trademark Office defines a patent as a grant of a property right to the
inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are
intellectual property. For the United States, the term of a new patent is 20
years from the date when the patent application was filed. If the inventor
wishes to receive economic benefits, it is likely that the invention will
become commercially available to patients with seizures and epilepsy within
20 years of the initial filing. It is important to understand, therefore, that an
inventor’s patent does not indicate that a product or service is or will be
commercially available to patients with seizures and epilepsy. The patent
implies only that the inventor has “the right to exclude others from making,
using, offering for sale, or selling” the invention in the United States. While
this relates to U.S. patents, similar rules govern foreign patents.
In this chapter, we show you how to locate information on patents and their
inventors. If you find a patent that is particularly interesting to you, contact
the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office:
http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
Patents on Seizures and Epilepsy
By performing a patent search focusing on seizures and epilepsy, you can
obtain information such as the title of the invention, the names of the
inventor(s), the assignee(s) or the company that owns or controls the patent,
a short abstract that summarizes the patent, and a few excerpts from the
description of the patent. The abstract of a patent tends to be more technical
in nature, while the description is often written for the public. Full patent
descriptions contain much more information than is presented here (e.g.
claims, references, figures, diagrams, etc.). We will tell you how to obtain
this information later in the chapter. The following is an example of the type
of information that you can expect to obtain from a patent search on seizures
and epilepsy:
·
Detecting seizure
Inventor(s): Tanouye; Mark A. (El Cerrito, CA); Kuebler; Daniel
(Kensington, CA); Zhang; HaiGuang (Berkeley, CA)
Assignee(s): The Regents of the University of California (Oakland, CA)
Patent Number: 6,521,462
Date filed: May 16, 2000
Abstract: Methods and composition for inducing, detecting and
modulating seizure in animal systems are provided. Methods for
inducing seizure comprise (1) electrically stimulating an unanesthetized
fly and detecting seizure induction in the fly (2) electrically stimulating a
fly with less than 10V and detecting seizure induction in the fly; (3)
electrically stimulating a population of wild-type flies and detecting
seizure induction in most of the flies and (4) electrically stimulating a
population of flies and quantitatively detecting seizure induction in the
flies across genotypes or experience. Methods for modulating seizure
induction comprise changing the activity of a novel seizure regulator in
an animal system and confirming a resultant change in seizure
inducibility of the system.
Web site: http://www.delphion.com/details?pn=US06521462__
·
Method of treating epilepsy
Inventor(s): Hamm; Robert (Crozier, VA); Deford; S. Michelle (Richmond,
VA); Shiotani; Tadashi (Tokyo, JP)
Assignee(s): Daiichi Pharmaceutical Co., Ltd. (Tokyo, JP)
Patents 165
Date filed: June 22, 2001
Abstract: A method for treatment of neuronal disorders and traumatic
brain injury is provided which involves timely administration to a subject
in need thereof of an effective amount of nefiracetam.
·
Method and apparatus for treating seizure disorders by stimulating the
olfactory senses
Inventor(s): Rise; Mark T. (Monticello, MN)
Assignee(s): Medtronic, Inc. (Minneapolis, MN)
Date filed: April 30, 1998
Abstract: The present invention discloses techniques for preventing a
possible onset of a seizure using a sensor, a signal generator and at least
one implantable electrode. The electrodes are positioned to stimulate the
olfactory nervous system. The sensor senses a parameter of the body
indicative of the possible onset of a seizure. The sensor generates a
sensing signal which is processed and an algorithm is utilized to
determine whether the sensing signal shows a pattern indicative of a
possible seizure onset. If such a pattern is recognized, the signal
generator provides electrical stimulation via electrodes to generate an
olfactory sensory stimulus. The patient is thereby alerted, the electrical
activity of the brain is desynchronized and the likelihood of a seizure
occurring is reduced.
Excerpt(s): A preferred form of the invention consists of a sensing portion
capable of detecting the onset of a seizure, a signal processing portion,
and a therapy delivery portion. The sensing portion may be an electrical
sensor, chemical sensor, and/or a sensor for sensing physiological
changes. The particular structure and parameter to measure may be
selected from any known techniques which provide indication of the
possible onset of a seizure. The signal processing portion processes and
analyzes the sensed signal using an algorithm for recognizing a pattern
scheme indicative of the onset of a seizure. If a pattern indicative of the
onset of a seizure is recognized, the therapy delivery portion is triggered.
The therapy delivery portion is preferably a stimulation electrode which
delivers sensory stimulation to the olfactory sensory system of the patient
thereby decreasing the likelihood that a seizure will occur.
Under another embodiment, the invention includes a therapy delivery
portion. Under this embodiment, the therapy delivery portion provides
sensory stimulation to the olfactory sensory system of the patient in a
continuous or periodic manner to thereby decrease the likelihood that a
seizure will occur.
By using the foregoing techniques, seizure disorders, including epilepsy,
can be treated and seizures can be alleviated or prevented using olfactory
sensory stimulation. Examples of the more important features of this
invention have been broadly outlined above in order that the detailed
description that follows may be better understood and so that
contributions which this invention provides to the art may be better
appreciated. There are, of course, additional features of the invention
which will be described herein and which will be included within the
subject matter of the claims appended hereto.
·
Method of controlling epilepsy by brain stimulation
Inventor(s): Benabid; Alim L. (Meylan, FR); Marescaux; Christian
(Strasbourg, FR)
Assignee(s): Medtronic, Inc. (Minneapolis, MN)
Date filed: November 1, 1996
Abstract: A method of preventing seizures as experienced by persons
with Epilepsy. High frequency electrical stimulation pulses are supplied
to the subthalamic nucleus thereby blocking neural activity in the
subthalamic nucleus and reducing excitatory input to the substantia nigra
which leads to a reduction in the occurrence of seizures.
Patent Applications on Seizures and Epilepsy
As of December 2000, U.S. patent applications are open to public viewing.24
Applications are patent requests which have yet to be granted (the process to
achieve a patent can take several years). The following patent applications
have been filed since December 2000 relating to seizures and epilepsy:
24
This has been a common practice outside the United States prior to December 2000.
Patents 167
·
Carotid sinus nerve stimulation for epilepsy control
Inventor(s): Patwardhan, Ravish Vinay; (Birmingham, AL); Tubbs,
Richard Shane; (Mt. Olive, AL)
Correspondence: Benjamin Aaron Adler; Adler & Associates; 8011
Candle Lane; Houston, TX 77071 US
Patent Application Number: 20020103516
Date filed: September 20, 2001
Abstract: The present invention describes a method of treating,
controlling or preventing epilepsy, comprising the steps of attaching at
least one electrode to at least one of a patient's carotid sinus nerves, and
applying or modulating electric signals to or recording from at least one
of the patient's carotid sinus nerves through the at least one electrode, so
as to treat, control, or prevent epilepsy.
Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
·
Method and medical system for monitoring a patient suffering from
epilepsy
Inventor(s): Schmidt, Volker; (Erlangen, DE) ; Striebel, Werner;
(Schwarzenbruck, DE)
Correspondence: Schiff Hardin & Waite; 6600 Sears Tower; 233 S Wacker
Dr; Chicago, IL 60606-6473 US
Assignee(s): Siemens Aktiengesellschaft
Date filed: January 24, 2002
Abstract: In a method and a medical system for monitoring a patient
suffering from epilepsy located outside a medical establishment, at least
one measured value of the patient relating to the epilepsy is acquired and
is supplied to and analyzed with an analysis device and is stored in a
central data bank. An alarm generator triggers an alarm signal of a first
type if the analyzed measured value is classified as critical for the state of
health of the patient or triggers an alarm signal of a second type if the
measured value of the patient fails to arrive.
·
Agmatine and agmatine analogs in the treatment of epilepsy, seizure,
and electroconvulsive disorders
Inventor(s): Crooks, Peter A.; (Lexington, KY) ; Bence, Aimee K.;
(Lexington, KY) ; Worthen, David R.; (Lexington, KY)
Correspondence: Mcdermott, Will & Emery; 600 13th Street, N.W.;
Washington, DC 20005-3096 US
Date filed: June 15, 2001
Abstract: Pharmaceutical preparations containing of agmatine,
congeners, analogs or derivatives thereof for use in preventing or treating
epilepsy, seizures and other electroconvulsive disorders are provided.
Embodiments include administering an effective amount of agmatine, an
agmatine analog or a pharmaceutically acceptable salt thereof to a human
subject in need of treatment or prevention of epilepsy, seizure or other
electroconvulsive disorder to treat, reduce, or prevent the disorder in the
subject.
·
Epilepsy treatment
Inventor(s): Donovan, Stephen; (Capistrano Beach, CA)
Correspondence: Stephen Donovan; Allergan, Inc. T2 7H; Tower Two,
Seventh Floor; 2525 Dupont Drive; Irvine, CA 92612 US
Date filed: July 12, 2001
Abstract: Methods for treating a movement disorder by intracranial
administration to a human patient of a therapeutically effective amount
of a neurotoxin, such as a botulinum toxin type A.
Keeping Current
In order to stay informed about patents and patent applications dealing with
seizures and epilepsy, you can access the U.S. Patent Office archive via the
Internet at no cost to you. This archive is available at the following Web
address: http://www.uspto.gov/main/patents.htm. Under “Services,” click
on “Search Patents.” You will see two broad options: (1) Patent Grants, and
(2) Patent Applications. To see a list of granted patents, perform the
Patents 169
following steps: Under “Patent Grants,” click “Quick Search.” Then, type
“seizures and epilepsy” (or synonyms) into the “Term 1” box. After clicking
on the search button, scroll down to see the various patents which have been
granted to date on seizures and epilepsy. You can also use this procedure to
view pending patent applications concerning seizures and epilepsy. Simply
go back to http://www.uspto.gov/main/patents.htm. Under “Services,” click
on “Search Patents.” Select “Quick Search” under “Patent Applications.”
Then proceed with the steps listed above.
Books 171
CHAPTER 6. BOOKS ON SEIZURES AND EPILEPSY
Overview
This chapter provides bibliographic book references relating to seizures and
epilepsy. You have many options to locate books on seizures and epilepsy.
The simplest method is to go to your local bookseller and inquire about titles
that they have in stock or can special order for you. Some patients, however,
feel uncomfortable approaching their local booksellers and prefer online
sources (e.g. www.amazon.com and www.bn.com). In addition to online
booksellers, excellent sources for book titles on seizures and epilepsy include
the Combined Health Information Database and the National Library of
Medicine. Once you have found a title that interests you, visit your local
public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies
The Combined Health Information Database collects various book abstracts
from a variety of healthcare institutions and federal agencies. To access these
summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use
the “Detailed Search” option. To find book summaries, use the drop boxes at
the bottom of the search page where “You may refine your search by.” Select
the dates and language you prefer. For the format option, select
“Monograph/Book.” Now type “seizures and epilepsy” (or synonyms) into
the “For these words:” box. You will only receive results on books. You
should check back periodically with this database which is updated every 3
months. The following is a typical result when searching for books on
·
Epilepsy and the Family: A New Guide
Source: Cambridge, MA, Harvard University Press, 264 p., 1999.
Contact: Harvard University Press, Cambridge, MA.
Web site: www.hup.harvard.edu
Summary: Epilepsy and the Family: A New Guide is an update of a
classic handbook for people with seizure disorders and their families. The
author wrote this book to educate people with epilepsy, but he cautions
the reader not to use this as a substitute for medical advice. Using
references to actual cases, the author provides coping strategies for the
practical and emotional challenges that epilepsy brings to the family. The
author devotes chapters to special issues, such as (1) marital problems, (2)
sexual activity, (3) childbearing and inheritance, (4) personality changes
and violence, (5) treatment options, and (6) what to do when a seizure
occurs. This new guide (1) addresses questions that adults with epilepsy
may not ask their physicians; (2) provides chapters tailored to the special
needs of spouses, parents, children, and siblings of people with epilepsy;
and (3) discusses some medical conditions that can cause seizure
disorders in children and adults, while addressing the issue that the
cause of many seizure disorders is not known. Health professionals can
benefit from this book by learning how to treat patients with epilepsy
better by recognizing the needs of the entire family.
·
Epilepsy: Patient and Family Guide. Second Edition
Source: Philadelphia, PA, F.A. Davis Company, 446 p., 2002.
Contact: F.A. Davis Company, 1915 Arch Street, Philadelphia, PA 19103.
Web site: http://www.fadavis.com
Summary: Epilepsy: Patient and Family Guide is an updated resource
that addresses all aspects (psychosocial, financial, legal, and medical) of
epilepsy to help adult patients with epilepsy or parents of children with
epilepsy understand the disorder and to enable them to better cope with
the problems it causes. It is written in a style that the general reader can
easily follow. The first section is entitled Medical Aspects of Epilepsy and
consists of six chapters that cover topics including (1) brain anatomy and
epilepsy, (2) seizures and epileptic syndromes, and (3) seizure provoking
factors. The second section is entitled Diagnosis and Treatment of
Epilepsy and is divided into seven chapters that (1) describe the health
care team for a patient with epilepsy, (2) discuss how epilepsy is
diagnosed, (3) discuss providing first aid for seizures, (4) summarize the
Books 173
principles of drug therapy, (5) discuss anticonvulsants, (6) discuss
surgical therapies, and (7) describe other epilepsy therapies. The third
section is entitled Epilepsy in Children and consists of 10 chapters that
discuss (1) epilepsy in infancy, (2) Epilepsy in childhood, (3) epilepsy in
adolescence, (4) outgrowing epilepsy, (5) intellectual and behavioral
development, (6) how to tell children and others about epilepsy, (7) how
to live an active life, (8) the education of children with epilepsy, (9)
mental handicaps and cerebral palsy, and (10) how children can cope
with epilepsy after their parents are gone. The fourth section is entitled
Epilepsy in Adults and consists of six chapters that address (1) living
with epilepsy, (2) pregnancy and menopause, (3) parenting by people
with epilepsy, (4) employment issues for people with epilepsy, (5) mental
health in adult patients with epilepsy, and (6) epilepsy in the elderly. The
fifth sections entitled Legal and Financial Issues in Epilepsy, consists of
two chapters that discuss (1) legal rights of people with epilepsy and (2)
insurance and government assistance for patients with epilepsy. The
sixth section entitled Resources for People with Epilepsy consists of three
chapters that describe the Epilepsy Foundation and other resources for
people with epilepsy and discuss the prospects for curing epilepsy. The
book also contains five appendices: (1) Epilepsy-related terminology, (2)
anticonvulsants, (3) drug interactions, (4) resources for people with
epilepsy, and (5) references and suggested readings.
·
Brain Plasticity and Epilepsy
Source: San Diego, CA, Academic Press, 625 p., 2001.
Contact: Academic Press, 525 B Street, Suite 1900, San Diego, CA 921014495.
Web site: http://www.academicpress.com
Summary: Brain Plasticity and Epilepsy is based on the proceedings of
the Morrell Symposium on Brain Plasticity and Epilepsy held March 26 to
28, 1999, at the Marine Biology Laboratory, Woods Hole, Massachusetts.
Morrell's work had unusually broad scope, ranging from fundamental
mechanisms of acquired behavior, through the neuronal substrates of
epileptogenesis and its influence on brain function, to surgical treatment
of epilepsy and its consequences. The book is a state-of-the-art review of
brain plasticity and epilepsy. The chapters cover these topics in relation
to (1) maturation of the nervous system, (2) secondary epileptogenesis,
(3) normal and nonepileptic abnormal behavior, and (4) functional
neurosurgery (specifically multiple subpial transection). Chapter titles
include (1) Mechanisms of Brain Plasticity: From Normal Brain Function
to Pathology; (2) Brain Development and Generation of Brain
Pathologies; (3) Maturation of Channels and Receptors: Consequences for
Excitability; (4) Neuronal Activity and the Establishment of Normal and
Epileptic Circuits During Brain Development; (5) The Effects of Seizures
on the Hippocampus of the Immature Brain; (6) Abnormal Development
and Catastrophic Epilepsies: The Clinical Picture and the Relation to
Neuroimaging; (7) Cortical Reorganization and Seizure Generation in
Dysplastic Cortex; (8) Rasmussen's Syndrome with Particular Reference
to Cerebral Plasticity; (9) Structural Reorganization of Hippocampal
Networks Caused by Seizure Activity; (10) Epilepsy-associated Plasticity
in gamma-Aminobutyric Acid Receptor Expression, Function, and
Inhibitory Synaptic Properties; (11) Synaptic Plasticity and Secondary
Epileptogenesis; (12) Synaptic Plasticity in Epileptogenesis: Cellular
Mechanisms Underlying Long-lasting Synaptic Modifications That
Require New Gene Expression; (13) Cellular Correlates of Behavior; (14)
Mechanisms of Neuronal Conditioning; (15) Plasticity in the Aging
Central Nervous System; (16) Secondary Epileptogenesis, Kindling, and
Intractable Epilepsy: A Reappraisal from the Perspective of Neural
Plasticity; (17) Kindling and the Mirror Focus; (18) Partial Kindling and
Behavioral Pathologies; (19) The Mirror Focus and Secondary
Epileptogenesis; (20) Hippocampal Lesions in Epilepsy: A Historical
Review; (21) Clinical Evidence for Secondary Epileptogenesis; (22)
Epilepsy as a Progressive Disorder; (23) Pathophysiological Aspects of
Landau-Kleffner Syndrome: From the Active Epileptic Phase to Recovery;
(24) Local Pathways of Seizure Propagation in Neocortex; (25) Multiple
Subpial Transection: A Clinical Assessment; and (26) The Legacy of Frank
Morrell.
·
Limbic Seizures in Children
Source: London, England, John Libbey and Company Ltd., 264 p., 2001.
Contact: John Libbey and Company Ltd., P.O. Box 276, Eastleight, SO50
5YS, England. 44 (0)23 8065 0208. FAX: 44 (0)23 8065 0259.
Web site: www.fondazione-mariani.org
E-mail: info@fondazione-mariani.org
Summary: Limbic Seizures in Children is the product of a colloquium
intended to outline the specific expression of epilepsies involving the
limbic structures in children and establish a consensus on the evidence
relevant to the clinical management of these epilepsies. Topics include (1)
the limbic system, (2) mesial temporal sclerosis, (3) impairment of
consciousness, (4) neuro-vegetative manifestations, (5) language and
Books 175
speech disturbances, (6) motor automatisms, (7) postural disturbances, (8)
perisylvian cortex involvement, (9) mesio-temporal seizures, (10) limbic
seizures, (11) febrile convulsive attacks, (12) mental disturbances, (13)
focal seizures, (14) diagnostic tests, (15) medical therapy, and (16) surgical
therapy.
·
Ketogenic Diet: A Treatment for Epilepsy. Third Edition
Source: New York, NY, Demos Medical Publishing, 210 p., 2000.
Contact: Demos Medical Publishing, Inc., 386 Park Avenue South, New
York, NY 10016. (800) 532-8663. FAX: (212) 683-0118.
E-mail: keto@pennycorner.com
Summary: The Ketogenic Diet: A Treatment for Epilepsy introduces the
ketogenic diet as a means of seizure control in epilepsy. It is intended for
physicians, dieticians, and parents of children with epilepsy who might
benefit from the treatment. The book is based on the experience acquired
in using the ketogenic diet at the Johns Hopkins Pediatric Epilepsy
Center. The book is divided into six sections. The 12 chapters (1) provide
an introduction to the ketogenic diet, (2) provide answers to common
questions about the diet, (3) present a historical overview of the ketogenic
diet, (4) provide information on starting the diet, (5) describe how to fine
tune the diet, (6) describe how to make the diet work at home and on the
road, (7) discuss going off the diet, (8) describe how to make the
necessary calculations for the diet, (9) discuss adapting the diet to liquid
formulas and tube feedings, (10) provide sample meal plans, (11) discuss
the results of new research studies of the diet, and (12) presents a general
summary/conclusion about the diet and its future prospects in
controlling seizures in infants and children. The appendices provide
information on (1) epilepsy medications and medications normally used
with the ketogenic diet, (2) Johns Hopkins Hospital Nursing Critical
Pathways, (3) selected references, and (4) the nutritional content of
various foods.
·
Plasticity in Epilepsy: Dynamic Aspects of Brain Function
Source: Philadelphia, PA, Lippincott Williams and Wilkins, 396 p., 1999.
Contact: Lippincott Williams and Wilkins, 227 East Washington Square,
Philadelphia, PA 19106-3780.
Web site: http://www.lww.com/
Summary: Plasticity in Epilepsy: Dynamic Aspects of Brain Function
considers plasticity, epilepsy, and dynamic aspects of brain function that
are of great importance for basic research and clinical work in neurology,
neuropediatry, epileptology, neurosurgery, neuropsychology, and
psychiatry. Some specific topics addressed include (1) whether seizures
cause cerebral damage; (2) whether interictal epileptic activity can be
associated with progressive mental deterioration, cognitive problems, or
the loss of memory; (3) what the relations are among febrile convulsions,
the development of temporal lobe epilepsy, and inheritance; and (4) what
the mechanisms are of plasticity involved in progressive dynamic
changes and running down phenomenon. Findings of animal
experiments, the analysis of signal processing, functional reorganization,
maturation, neurochemistry, and pharmacology are combined and these
data discussed along with the results of clinical investigations on changes
of brain function and the practical consequences for diagnosis and
therapeutic strategies.
·
Psychiatric Comorbidity in Epilepsy: Basic Mechanisms, Diagnosis,
and Treatment
Source: Washington, DC, American Psychiatric Press, Inc., 427 p., 1998.
Contact: American Psychiatric Press, Inc., 1400 K Street, N.W.,
Washington, DC 20005.
Web site: www.appi.org
Summary: Psychiatric Comorbidity in Epilepsy: Basic Mechanisms,
Diagnosis, and Treatment describes epilepsy as it is intertwined with
advances in both neurology and psychiatry. These advances include
increasing knowledge of brain mechanisms, improved and more clearly
targeted medical and surgical treatments, and an increased awareness of
psychological and social consequences of the disorder. The focus of the
book is on the diagnosis and treatment of psychiatric illness in people
with epilepsy. Chapters one through four deal with historical overlap in
the fields of neurology and psychiatry, mechanisms by which people
with epilepsy may experience behavioral disturbances, and identification
of the etiology of these disturbances and psychiatric comorbidity from
both neuropsychiatric and neuropsychological standpoints. Chapter five
considers the subject of sleep in the differential diagnosis of seizures and
its possible neurophysiological relationships with epilepsy. Chapters six,
seven, and eight show the wide array of psychiatric presentations of
people with epilepsy. These chapters include a comprehensive review of
the incidence, possible causes, and treatment of depression in people
Books 177
with epilepsy from an eclectic perspective as well as the discussion of
possible neural mechanisms of behavior, diagnostic considerations, and
the use of multidisciplinary management of patients having nonepileptic
events. Chapters nine through eleven deal with the importance of the
appropriate selection of antiepileptic drugs, the treatment of psychiatric
comorbidity with reference to the selection of appropriate psychotropics,
and the importance of family therapy in people with epilepsy. Chapter
twelve is a first person account of epilepsy which reflects the wide range
of psychosocial and treatment issues encountered by those with epilepsy.
In the preface, emphasis was placed on viewing quality of life as a
measurable treatment outcome in the care of patients with epilepsy,
understanding the economics of epilepsy and health care reforms, and
addressing stigmas forced on people with epilepsy.
·
Brainstorms Healer: Epilepsy in Our Experience
Source: Philadelphia, PA, Lippincott-Raven Publishers, 196 p., 1998.
Contact: Lippincott-Raven Publishers, 227 East Washington Square,
Philadelphia, PA, 19106-3780.
Summary: The Brainstorms Healer: Epilepsy in Our Experience is the
fourth in a series of books about the personal aspects of seizures and
epilepsy. The book presents the perspectives of health care professionals
from around the world who help patients with epilepsy or who
experience seizures themselves. The book is intended to strengthen
communication and understanding between patients with epilepsy and
providers of care. The book's anecdotes reveal an array of emotions,
among them frustration in failing to control seizures, inspiration, the
sadness of loss, gratitude for lessons learned on the meaning of life, and
the elation that marks the achievement of one's potential. Practitioners
who have epilepsy share how they have come to understand firsthand
the perspectives of patients who struggle similarly. The book begins with
a tribute to the late Kiffin Penry, M.D., who established the Antiepileptic
Drug Development Program and inspired scores of professionals and
patients alike. An appendix provides a list of contributors.
·
Seizure Free: from Epilepsy, to Brain Surgery, I Survived, and You Can,
Too!
Source: English Press Publications, Austin, TX, 134 p., 1998.
Contact: English Press Publications, P.O. Box 5435, Austin, TX 787635435.
Summary: Seizure Free: from Epilepsy, to Brain Surgery, I Survived, and
You Can, Too!, is the author's personal account of her own journey
through epilepsy and brain surgery, describes what people have to go
through, and how surgery can save lives. The author, who is strongly in
favor of surgery as a treatment for epilepsy, acknowledges that it is not
always a cure or even an option. Prior to seeking surgery as treatment,
she emphasizes the importance of (1) proving that the seizures are not
psychosomatic, (2) trying medication to control the seizures, and (3)
seeking psychological counseling. The author describes in detail what is
involved in the stages of testing for brain surgery and how long it takes
to progress through these stages. The three stages for the author were (1)
electroencephalography (EEG) video monitoring with scalp electrodes,
(2) EEG video monitoring with depth electrodes, and (3) surgery. The
author discusses how she made the decision to have the surgery and
what to expect before and after surgery, including postoperative
depression and posttraumatic stress. The author concludes by sharing
what her life was like for the two and a half years after her surgery.
Although she remained free of seizures after her surgery, she experienced
anger and depression over how epilepsy had affected her life, while she
was also relieved to be free of seizures and able to help others.
·
Epilepsy
Source: Springfield, NJ, Enslow Publishers, Inc., 112p., 1998.
Contact: Enslow Publishers, Inc., 44 Fadem Road, Box 699, Springfield, NJ
07081.
Summary: Epilepsy is a book that discusses the causes of and treatment
options for epilepsy in popular style, to be easily read and understood by
the layperson. The book, a volume in the series Diseases and People,
consists of seven chapters dealing with (1) electrochemical storms in the
brain, (2) epilepsy through the ages, (3) what is epilepsy, (4) diagnosing
epilepsy, (5) treating epilepsy, (6) coping with epilepsy, and (7) a future
without epilepsy. The chapters include case summaries of persons with
epilepsy to illustrate the topics that are discussed. The book also presents
a discussion of issues associated with epilepsy such as how seizures
affect the quality of life of persons with epilepsy and what causes
seizures. An epilepsy timeline, a glossary of terms used in describing
epilepsy, a bibliography for each chapter, and a list of books and articles
for further reading are also included.
Books 179
·
Reflex Epilepsies and Reflex Seizures
Source: Philadelphia, PA, Lippincott-Raven Publishers, Advances in
Neurology, Volume 75, 310 p., 1998.
Contact: Lippincott-Raven Publishers, 227 East Washington Square,
Philadelphia, PA 19106-3780.
Summary: Reflex Epilepsies and Reflex Seizures is a review intended for
a mainly clinical audience of neurologists and trainees in the clinical
neurosciences. However, the authors hope it will also be of interest to
basic neuroscientists and neuropsychologists. They assume that most
readers are familiar with basic clinical notions of epilepsy and
electroencephalography. The book opens with a review of the modern
history of reflex seizures, then considers classification and some
applications of basic clinical neurophysiology to reflex seizures and the
reflex epilepsies. The largest part of the book consists of discussions of
the different forms of clinical reflex epilepsy and reflex seizures,
organized according to the triggering stimulus. They note that reflex
epilepsy is regarded by some as a clinical curiosity and an interest such as
butterfly collecting, an attractive thing of no great consequence. They are
convinced that this idea is wrong, and hope that this book will stand as a
testament to that fact. While reflex epilepsy is not common, when
properly studied it teaches the reader about the brain in general and
about epilepsy in particular. 68 figures, 25 tables, 1,251 references.
·
Erica Has a Problem: Epilepsy
Source: New York, NY, Vantage Press, Inc., 89 p., 1998.
Contact: Vantage Press, Inc., 516 West 34th Street, New York, NY 10001.
Summary: Erica Has a Problem: Epilepsy is about a young girl who
learns that she has epilepsy. Written by a woman who personally dealt
with epilepsy and whose goal is to help children learn about epilepsy,
this story describes Erica's step-by-step response to this illness. Erica first
starts to show warning signs, like daydreaming in school. Then she gets
hit by a baseball during physical education class. One of her classmates
noticed that she was jerking her arms and legs and making grunting
noises before it happened. The school notifies Erica's parents about what
happened, commenting that Erica started jerking her arms before getting
hit. After Erica's parents get another call from school regarding another
seizure, they take Erica to a doctor who then refers her to a neurologist.
The process of finding the right doctor is frustrating for Erica's parents,
but they finally find a doctor who can help. He talks with Erica and her
parents,
learns
about
Erica's symptoms, and orders an
electroencephalogram (EEG). The EEG confirms that Erica has absence
seizure s and complex partial seizures. Absence seizures occur without
warning, have few visible symptoms, and are often mistaken for
daydreaming. Complex partial seizures alter consciousness and are
characterized by arm and leg movement and grunting. The doctor
prescribes valproic acid and cautions that there will be side effects. Erica's
mother takes her to school the next day and tells the school nurse, who
then takes Erica to all of her teachers to explain that she has epilepsy.
Erica also tells her friends and classmates. Once Erica and her parents
learn to adjust the medication properly, Erica lives a normal life.
·
Neuropharmacology Methods in Epilepsy Research
Source: Boca Raton, FL, CRC Press, 282 p., 1998.
Contact: CRC Press LLC, 2000 Corporate Blvd., NW., Boca Raton, FL
33431. (561)994-0555. FAX: (800)374-3401.
Web site: http://www.crcpress.com
Summary: Neuropharmacology Methods in Epilepsy Research describes
the fundamental methodology and procedures used in the modern study
of experimental models of epilepsy. The book consists of 12 chapters: (1)
Electroshock; (2) Chemoconvulsants; (3) The Kindling Model of Temporal
Lobe Epilepsy; (4) Rapid Kindling: Behavioral and Electrographic; (5)
Experimental Models of Status Epilepticus; (6) Audiogenic Seizures in
Mice and Rats; (7) Models of Focal Epilepsy in Rodents; (8) Evaluation of
Associated Behavioral and Cognitive Deficits in Anticonvulsant Drug
Testing; (9) Gene Targeting Models of Epilepsy: Technical and Analytical
Considerations; (10) The Hippocampal Slice Preparation; (11)
Microdialysis Techniques for Epilepsy Research; and (12) Methodologies
for Determining Rhythmic Expression of Seizures. Each chapter is written
by authors with extensive experience in using the techniques described
and who actively employ the technology in their own laboratories. Each
chapter contains the basic steps required for the technique, and describes
how the results of the experiments should be interpreted so that they will
contribute to a better understanding of epilepsy.
Book Summaries: Online Booksellers
Commercial Internet-based booksellers, such as Amazon.com and Barnes &
Noble.com, offer summaries which have been supplied by each title’s
Books 181
publisher. Some summaries also include customer reviews. Your local
bookseller may have access to in-house and commercial databases that index
all published books (e.g. Books in PrintÒ). The following have been recently
listed with online booksellers as relating to seizures and epilepsy (sorted
alphabetically by title; follow the hyperlink to view more details at
Amazon.com):
·
Neuropharmacology of Epilepsy: Pathophysiology and Drug
Mechanisms by Robert A. Gross (Editor), et al; Humana Press (January
2004); ISBN: 0896035220;
http://www.amazon.com/exec/obidos/asin/0896035220/icongroupinte
rna
·
Surgical Treatment of Epilepsy by Josef Zentner (Editor), Wolfgang
Seeger (Editor); September 2003; ISBN: 3211837701;
http://www.amazon.com/exec/obidos/tg/detail//3211837701/icongroupinterna
·
Seizures and Epilepsy in Childhood: A Guide by John M., Md Freeman,
et al; December 2002; ISBN: 080187050X;
http://www.amazon.com/exec/obidos/tg/detail//080187050X/icongroupinterna
The National Library of Medicine Book Index
The National Library of Medicine at the National Institutes of Health has a
massive database of books published on healthcare and biomedicine. Go to
the following Internet site, http://locatorplus.gov/, and then select “Search
LOCATORplus.” Once you are in the search area, simply type “seizures and
epilepsy” (or synonyms) into the search box, and select “books only.” From
there, results can be sorted by publication date, author, or relevance. The
following was recently catalogued by the National Library of Medicine:25
·
Advisory Commission on Epilepsy and its Consequences. Hearing ...
Ninety-third Congress, second session, on H. R. 13405 ... bills to
In addition to LOCATORPlus, in collaboration with authors and publishers, the National
Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The
books may be accessed in two ways: (1) by searching directly using any search term or
phrase (in the same way as the bibliographic database PubMed), or (2) by following the
links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a
facsimile of the abstract in which some phrases are hypertext links. These phrases are also
found in the books available at NCBI. Click on hyperlinked results in the list of books in
which the phrase is found. Currently, the majority of the links are between the books and
PubMed. In the future, more links will be created between the books and other types of
information, such as gene and protein sequences and macromolecular structures. See
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
25
provide for the establishment of a national advisory commission to
develop a national plan for the controlof epilepsy... Author: United
States. Congress. House. Committee on Interstate and Foreign
Commerce. Subcommittee on Public Health and Environment; Year:
1974; Washington, U. S. Govt. Print. Off., 1974.
·
Alcohol and seizures: basic mechanisms and clinical concepts. Author:
editors, Roger J. Porter ... [et al.]; technical editor, Devera G. Schoenberg;
Year: 1990; Philadelphia: Davis, c1990. ISBN: 0803670087
http://www.amazon.com/exec/obidos/ASIN/0803670087/icongroupin
terna
·
Atlas of epileptic seizures and syndromes. Author: Hans O. Lüders,
Soheyl Noachtar; translated from the German by Judy K. Benson; Year:
2001; Philadelphia: Saunders, c2001. ISBN: 0721669468
terna
·
Benign childhood partial seizures and related epileptic syndromes.
Author: C.P. Panayiotopoulos; Year: 1999; London: John Libbey, c1999.
ISBN: 0861965779
terna
·
Cerebellar stimulation for spasticity and seizures. Author: editors, Ross
Davis, James R. Bloedel; Year: 1984; Boca Raton, Fla.: CRC Press, c1984.
ISBN: 0849360676
terna
·
Complex partial seizures and their treatment. Author: Editors, J. Kiffin
Penry, David D. Daly; Year: 1975; New York: Raven Press, c1975. ISBN:
0890040400
terna
·
Diagnosis and management of epilepsy in adults. A national clinical
guideline recommended for use in Scotland. Scottish Intercollegiate
Guidelines Network. Pilot edition. Author: Moore, David P; Year: 1997;
Edinburgh, Scotland: SIGN, 1997. ISBN: 1899893016
·
Diagnosis and management of seizures in children. Author: Gregory L.
Holmes; Year: 1987; Philadelphia: Saunders, 1987. ISBN: 0721611885
terna
·
Epilepsies: etiologies and prevention. Author: edited by Prakash
Kotagal, Hans O. Lüders; Year: 1999; San Diego: Academic Press, c1999.
ISBN: 0124221505
Books 183
terna
·
Epilepsy: models, mechanisms, and concepts. Author: edited by Philip
A. Schwartzkroin; Year: 1993; Cambridge [England]; New York, NY:
Cambridge University Press, 1993. ISBN: 0521392985
terna
·
Epileptic seizures and syndromes: with some of their theoretical
implications. Author: edited by Peter Wolf; Year: 1994; London: John
Libbey, c1994. ISBN: 0861964306
·
Fits and faints. Author: John B.P. Stephenson; Year: 1990; London: Mac
Keith Press; Philadelphia: J.B. Lippincott, 1990. ISBN: 0632028114
terna
·
Frontal lobe seizures and epilepsies. Author: editors, Patrick Chauvel ...
[et al.]; Year: 1992; New York: Raven Press, c1992. ISBN: 0881678279
terna
·
Neurotransmitters, seizures, and epilepsy II. Author: editors, Ruggero
G. Fariello ... [et al.]; Year: 1984; New York: Raven Press, c1984. ISBN:
088167057X
http://www.amazon.com/exec/obidos/ASIN/088167057X/icongroupi
nterna
·
Neurotransmitters, seizures, and epilepsy III.
Author: editors,
Giuseppe Nisticò ... [et al.]; Year: 1986; New York: Raven Press, c1986.
ISBN: 0881672297
terna
·
Neurotransmitters, seizures, and epilepsy.
Author: editors, P.L.
Morselli [et al.]; Year: 1981; New York: Raven Press, c1981. ISBN:
0890047537
terna
·
Occipital seizures and epilepsies in children: colloquium of the
Pierfranco e Luisa Mariani Foundation.
Author: edited by F.
Andermann ... [et al.]; Year: 1993; London: John Libbey, c1993. ISBN:
0861963857
·
On epilepsy and epileptiform seizures. Their causes, pathology and
treatment. Author: Sieveking, Edward Henry, Sir, 1816-1904; Year: 1861;
London, Churchill, 1861.
·
Partial seizures and interictal disorders: the neuropsychiatric elements.
Author: David P. Moore; Year: 1997; Boston: Butterworth-Heinemann,
c1997. ISBN: 0750699310
terna
·
Reflex epilepsies and reflex seizures. Author: editors, Benjamin G.
Zifkin ... [et. al.]; Year: 1998; Philadelphia: Lippincott-Raven, c1998. ISBN:
0397516274
terna
·
Reflex seizures and reflex epilepsies. Author: International Symposium
on Reflex Seizures and Reflex Epilepsies, Genève, juin, 1988; Year: 1989;
Genève: Editions Médecine & hygiène, 1989. ISBN: 2880490448
·
Seizure recognition and treatment. Author: Richard Lechtenberg; Year:
1990; New York: Churchill Livingstone, 1990. ISBN: 0443087016
terna
·
Seizures and convulsions in infants, children, and adolescents:
practical informative guide for parents, teachers, and paramedical
personnel. Author: Leonardo Garcia-Mendez; Year: 1994; Columbia:
Lemar Publishers, c1994. ISBN: 096392690X
nterna
·
Seizures and epilepsy in childhood: a guide. Author: John M. Freeman,
Eileen P.G. Vining, Diana J. Pillas; Year: 2002; Baltimore, Md.: Johns
Hopkins University Press, 2002. ISBN: 080187050X
nterna
·
Seizures and epilepsy in the elderly. Author: [edited by] A. James
Rowan, R. Eugene Ramsay; Year: 1997; Boston: Butterworth-Heinemann,
c1997. ISBN: 0750696222
terna
·
Seizures and epilepsy.
Author: Jerome Engel, Jr; Year: 1989;
Philadelphia: F.A. Davis Co., c1989. ISBN: 0803632010
terna
·
Seizures and other paroxysmal disorders in infants and children [by]
Manuel R. Gomez [and] Donald W. Klass. Author: Gomez, Manuel R.,
1928-; Year: 1972; Chicago, Year Book Medical Publishers, 1972.
Books 185
·
Seizures of childhood: a population-based and clinic-based study.
Author: Takayuki Tsuboi; Year: 1986; Copenhagen: Munksgaard, [1986].
ISBN: 8716063635
·
Seizures, epilepsy, and your child; a handbook for parents, teachers,
and epileptics of all ages. Author: Lagos, Jorge C., 1933-; Year: 1974;
New York, Harper & Row [c1974]. ISBN: 0060125047
terna
Chapters on Seizures and Epilepsy
Frequently, seizures and epilepsy will be discussed within a book, perhaps
within a specific chapter. In order to find chapters that are specifically
dealing with seizures and epilepsy, an excellent source of abstracts is the
Combined Health Information Database. You will need to limit your search
to book chapters and seizures and epilepsy using the “Detailed Search”
option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html.
To find book chapters, use the drop boxes at the bottom of the search page
where “You may refine your search by.” Select the dates and language you
prefer, and the format option “Book Chapter.” By making these selections
and typing in “seizures and epilepsy” (or synonyms) into the “For these
words:” box, you will only receive results on chapters in books. The
following is a typical result when searching for book chapters on seizures
and epilepsy:
·
Mental Health of Adults with Epilepsy
Source: in Epilepsy: Patient and Family Guide. Second Edition. Devinsky,
O. Philadelphia, PA, F.A. Davis Company, pp. 324-331, 2002.
Summary: Mental Health of Adults With Epilepsy, a chapter in Epilepsy:
Patient and Family Guide, discusses the mental and behavioral aspects of
epilepsy in adult patients. Behavioral disturbances in people with
epilepsy may be unrelated to epilepsy, or related to the person's
emotional reactions to having epilepsy, the effect of medications, or
epilepsy. The chapter discusses (1) personality and epilepsy, (2)
depression in epilepsy and in the general population, (3) causes of
depression in people with epilepsy, (4) treating depression, (5) anxiety
disorders in patients with epilepsy and in the general population, (6)
irritability, (7) psychoses in patients with epilepsy, and (8) unusual and
bizarre phenomena associated with seizures.
·
Epilepsy in the Elderly
Source: in Epilepsy: Patient and Family Guide. Second Edition. Devinsky,
O. Philadelphia, PA, F.A. Davis Company, pp. 332-335, 2002.
Summary: Epilepsy in the Elderly, a chapter in Epilepsy: Patient and
Family Guide, discusses issues associated with managing epilepsy in
elderly people. Epilepsy can begin at any age and may continue to old
age, and the rate of newly diagnosed epilepsy is higher in the elderly
than in middle-age adults. The chapter discusses (1) general health
problems faced by elderly people; (2) seizure diagnosis and classification
in elderly patients with epilepsy; (3) special concerns about the effects of
seizures in older people; and (4) the effects of antiepileptic drugs (AED's)
and other medications in elderly patients with epilepsy. The section on
the effects of AED's and other medications includes a case report which
illustrates several important concerns in providing AED therapy for
elderly patients with epilepsy, including increased sensitivity to
medications, increased risk of adverse side effects, and increased risk of
interactions with other drugs.
·
Neonatal Seizures
Source: in Merritt's Neurology. Tenth Edition. Rowland, L.P.; ed.
Philadelphia, PA, Lippincott Williams and Wilkins, pp. 834-836, 2000.
Contact: Lippincott Williams and Wilkins, 530 Walnut Street,
Philadelphia, PA 19106.
Web site: http://www.LWW.com
Summary: Neonatal Seizures, a chapter in Merritt's Neurology, reviews
the classification, etiology, evaluation, treatment, and prognosis of
neonatal seizures. The clinical symptoms and electroencephalographic
(EEG) features of neonatal seizures differ significantly from those of older
children and adults. Focal clonic, focal tonic, and some myoclonic
seizures are accompanied by characteristic EEG discharges. Generalized
tonic seizures, most motor automatisms, and some myoclonic seizures
have inconsistent EEG changes. Hypoxic-ischemic encephalopathy is the
main cause of neonatal seizures. Infants at highest risk for developing
seizures secondary to asphyxia have low Apgar scores, require intubation
in the delivery room, and have severe acidemia. Other causes of neonatal
Books 187
seizures include intracranial hemorrhage, infection, metabolic
abnormalities, and developmental defects. Family history and details of
the infant's gestation and delivery are important components of the
neurologic examinations of infants with seizures. Seizures should be
treated with antiepileptic drugs (AED's), but AED's are likely to be
ineffective in seizures that are not associated with an EEG discharge.
Phenobarbital is the most frequently used AED in newborns. Phenytoin
is the alternative if phenobarbital fails. The long-term prognosis of
neonatal seizures is related to the underlying cause of the seizures.
·
Surgery for Neocortical Temporal and Frontal Epilepsy
Source: in Neocortical Epilepsies. Williamson, P.D.; Siegel, A.M.; Roberts,
D.W.; Thadani, V.M.; Gazzaniga, M.S.; eds. Philadelphia, PA, Lippincott
Williams and Wilkins, pp. 595-603, September 2000.
Philadelphia, PA 19106-3621. (215) 521-8300. FAX: (215) 521-8902.
Web site: www.wwilkins.com/home/index.html
Summary: Surgery for Neocortical Temporal and Frontal Epilepsy, a
chapter in Neocortical Epilepsies, is a review of the evaluation, surgical
strategy, and results of a series of patients with neocortical frontal lobe
epilepsy (NFLE) and temporal lobe epilepsy with neocortical origin
(NTLE). Researchers reviewed 79 NFLE cases and 51 NTLE cases. Each
patient had intractable epilepsy for at least 1 year, adequate trials of at
least two first-line antiepileptic drugs (AED's), and continuous
noninvasive video scalp electroencephalography (EEG) monitoring. The
indication for invasive recordings in these patients was based on
conflicting or noncongruent magnetic resonance imaging, EEG, and
seizure semiology findings. In all patients, interictal activity and a
minimum of two seizures were recorded before the indication for surgery
was established. Lesionectomies in most cases were accompanied by
corticectomy of the surrounding cortex if the lesion was not close to a
functionally important area. In the NFLE cases, simple or complex partial
seizures were most frequent, and in 45 cases, they were associated with
grand mal seizures. In the NTLE cases, complex partial seizures were
most frequent, followed by partial seizures with grand mal activity. In
the NFLE group, mean age at operation was 27.0 years, ranging from 2 to
60 years. In the NTLE group, mean age at operation was 26.5 years,
ranging from 6 to 60 years. Average age at seizure onset was 12.8 years.
Duration of the seizure disorder was 14.0 years. Almost twice as many
males were affected. Worthwhile improvement occurred in 82 percent of
cases overall, 90 percent of NTLE cases, and 76 percent of NFLE cases.
Outcome was better in neoplastic cases compared with nonneoplastic
cases. There was no mortality associated with surgery, and all
complications resolved without permanent morbidity. The authors
conclude that many patients with NFLE and NTLE can achieve freedom
from seizures through surgery.
·
Interplay Between Neocortical and Limbic Temporal Lobe Epilepsy
Summary: Interplay Between Neocortical and Limbic Temporal Lobe
Epilepsy, a chapter in Neocortical Epilepsies, is an examination of the
relation between neocortical and limbic forms of temporal lobe epilepsy
(TLE). Neocortical is defined as evidence of lateral temporal involvement
in the epileptogenic zone. Limbic is defined as medial temporal
involvement. Pathologic findings in TLE frequently involve both. The
author identified the sites of seizure onset in 70 patients with TLE
between 1991 and 1998 at the University of Washington Epilepsy Center.
Additional electrophysiologic evaluation of the hippocampus was
available for 42 of these patients. Of the 70 patients, 22 had various types
of lesions, 20 had previous temporal resections with persisting seizures,
and 28 had no previous lesions or resections. Of the patients with lesions,
the location of the lesion did not indicate the site of the seizure onset;
lesions that involved lateral temporal neocortex often had seizure onsets
in mesial structures. Of the 28 patients with no previous lesions, 19 had
hippocampal interictal spikes. In all but one of the patients with previous
temporal resections, there was evidence of mesial temporal involvement
in the epileptogenic zone. Surgery outcome was less favorable in patients
with dual pathophysiology. The author concludes that some patients
with TLE have dual pathophysiology, which appears to be an
unfavorable prognostic factor for the outcome of resective surgery, even
when resection includes all sites of identified epileptogenic abnormalities
and all lesions.
·
Multiple Subpial Transection in Neocortical Epilepsy: Part I
Books 189
Summary: Multiple Subpial Transection in Neocortical Epilepsy: Part I, a
chapter in Neocortical Epilepsies, describes multiple subpial transection
(MST), a surgical technique designed for use in patients in whom the
epileptic zone resides or encroaches on eloquent neocortex (primary
sensory, motor, and language cortex). MST is designed to transect
horizontal nerve fibers while preserving the intrinsic columnar
organization of the brain. The authors have performed MST in more than
100 patients, usually in combination with a cortical resection.
Electrocorticography is critical in demarcating the area to be transected in
order to preserve the eloquent cortex. The acute effects of MST show mild
cortical edema, subarachnoid blood, and lines of intracortical bleeding at
the transection site. Of the 100 cases of MST at the authors' facility with at
least 2 years of followup, two-thirds had a combination of resection and
transection. Of the 32 patients in whom the authors performed MST
without resection, half were children with epileptic aphasia. At followup,
79 percent of these patients were seizure free, and 21 percent suffered
recurrent seizures. Of 16 patients who underwent MST alone for the
treatment of intractable partial epilepsy, 75 percent had a worthwhile
outcome. The authors conclude that MST allows surgical treatment of
epilepsy in areas previously untouchable because of risk of loss of
function of eloquent cortex.
·
Multiple Subpial Transections in Neocortical Epilepsy: Part II
Summary: Multiple Subpial Transections in Neocortical Epilepsy: Part II,
a chapter in Neocortical Epilepsies, discusses the rationale and
indications for multiple subpial transection (MST) and defines the
syndrome of central neocortical epilepsy (CNE). Partial seizures originate
from a region of cortex considered to be the focus. Partial seizures are
associated with periods of increased synchrony between cortical neurons
as well as between cortex and subcortical nuclei. The rationale for MST is
that, if this intracortical synchronization can be disrupted, the
epileptogenic potential of the focus can be reduced or eliminated.
Because neocortex is organized in linear functional columnar units, MST
cuts at right angles to the pial surface should spare cortex-subcortex
input-output interactions. MST is indicated for (1) epileptogenic foci in
cortex serving indispensable function, (2) bilateral seizure foci for cases
otherwise considered nonsurgical, and (3) surgical treatment for LandauKleffner syndrome. The author defines CNE, a syndrome in which
patients have normal-appearing magnetic resonance imaging scans
despite having an epileptogenic focus in suprasylvian neocortex. The
author has successfully treated several patients with CNE with MST.
·
Parietal Lobe Epilepsy
Summary: Parietal Lobe Epilepsy, a chapter in Neocortical Epilepsies,
focuses on parietal lobe epilepsy, which has proven to be difficult to
define. The chapter looks at (1) epidemiology (incidence, age at onset,
and etiology), (2) clinical features of parietal lobe epilepsy (clinical
characteristics of seizures originating from different parietal regions,
spread pathways of parietal lobe seizures, electroencephalographic
findings, and neuropsychologic examination), and (3) three illustrative
case reports. Health professionals should suspect parietal lobe seizure
origin when there are symptoms such as lateralized paresthesias or pain
prominently and early in partial seizures. Most people with parietal lobe
seizures have no symptoms or signs that suggest the parietal lobe. If they
do not have detectable epileptogenic lesions, patients without clinical
seizure characteristics suggesting parietal lobe origin can present with
misleading findings. This can result in erroneous localization and
ineffective surgical intervention. Even when health professionals suspect
parietal lobe seizure origin, without a structural lesion, it is difficult to
document it with invasive monitoring. The parietal lobes are large,
diffuse structures, and there is a high potential for sampling error. Spread
patterns are unpredictable and can lead to false localization. Due to the
rarity of the condition, the lack of correct recognition, and the difficulty of
localization, there are no well-document studies of patients with
nonlesional parietal lobe epilepsy who have been cured by surgery in the
modern literature.
Books 191
·
Semiology of Neocortical Temporal Lobe Epilepsy
Summary: Semiology of Neocortical Temporal Lobe Epilepsy, a chapter
in Neocortical Epilepsies, presents information on neocortical temporal
lobe epilepsy (NTLE) and explains that its semiology is controversial.
Temporal lobe (TL) seizures and epileptic syndromes are divided into
three areas: (1) The syndrome of mesiotemporal lobe epilepsy (MTLE),
which is widely accepted, often drug resistant, and surgically remediable;
(2) so-called cryptogenic TL epilepsy, for which it is difficult to estimate
incidence; and (3) lateral NTLE, which is much rarer than seizures
originating in the mesial TL structures. The author compares the signs
and symptoms of seizures originating in the neocortical TL cortex. The
author concludes that although the repertoire of the ictal signs and
symptoms of NTLE and MTLE are similar because of the spread of ictal
discharges within and outside of the TL, researchers must carefully
analyze early symptoms, the order of symptom appearance, and the
preferential spread patterns in order to gain ideas for distinguishing
seizures of mesial versus lateral-neocortical TL onset. Often, definitive
proof may require the intracranial recording from neocortical and mesial
TL structures.
·
Frontal Lobe Epilepsy
Summary: Frontal Lobe Epilepsy, a chapter in Neocortical Epilepsies,
focuses on (1) general features of frontal lobe seizures; (2) specific types
of frontal lobe seizures (supplementary motor area seizures, focal motor
clonic seizures, frontal lobe seizures resembling temporal lobe seizures,
frontal lobe absence, frontal opercular seizures, and anterior cingulate
gyrus seizures); (3) diagnosis of frontal lobe epilepsy (clinical seizure
characteristics, scalp electroencephalography, imaging studies, and
intracranial electrode investigations); and (4) eight illustrative case
reports that demonstrate both the different types of frontal lobe seizures
and the types of presurgical evaluations undertaken that lead to
successful surgery. The authors note that although frontal lobe epilepsy is
common, its clinical presentation can differ significantly. Although no
one seizure type stands out as specifically diagnostic or of frontal lobe
seizure origin, some are suggestive. They conclude that (1) frontal lobe
seizures with agitated, aggressive, complex motor behavior often
accompanied by vocalization can be identified solely by the clinical
presentation; (2) brief, explosive seizures consisting of varied patterns of
asymmetric tonic posturing, often with preservation of consciousness, are
highly suggestive of seizure origin in the supplementary motor area; (3)
seizures starting in the frontal lobes, especially the orbital frontal region,
can spread to the temporal lobes; (4) focal clonic motor seizures always
imply involvement of the primary motor gyrus; (5) seizures resembling
absence seizures and absence status can be seen in people with frontal
lobe seizure origin; (6) frontal opercular seizures consisting of prominent
face and jaw motor activity, deglutition, profuse salivation, and Broca's
aphasia are probably a recognizable form of frontal lobe seizures; and (7)
anterior cingulate gyrus seizures cannot be distinguished from more
generic frontal lobe seizures with complex behaviors that can originate in
several frontal lobe regions. Surgery for frontal lobe seizures may be less
successful than it is for temporal lobe epilepsy, although there has been
improvement in recent years.
·
Intracranial EEG Investigation in Neocortical Epilepsy
Summary: Intracranial EEG Investigation in Neocortical Epilepsy, a
chapter in Neocortical Epilepsies, begins by discussing problems and
pitfalls in the electroencephalographic (EEG) localization of neocortical
epilepsy, focusing on (1) undersampling and nearsightedness of
recording electrodes; (2) large epileptogenic zones restricted to
neocortical structures, involving neocortical as well as deep sulcal or
mesial structures, and bilobar or multilobar distribution; (3) rapid seizure
propagation; (4) seizure generator located in a clinically silent area; and
(5) low incidence of specific neuroimaging abnormalities. The next
section focuses on coregistration with intracerebral and epidural
Books 193
electrodes in neocortical epilepsy (the Montreal Neurological Institute
approach), describing research materials and methods. Participants were
23 people with neocortical epilepsy investigated with intracranial
electrodes following an unsuccessful attempt to localize the ictal
generator by serial 24-hour extracranial EEG-video monitoring sessions.
All participants underwent computed tomography (CT) or magnetic
resonance imaging (MRI) examination and neuropsychological testing.
Intracranial EEG investigation was done in an attempt to localize the
epileptogenic zone in the absence of CT or MRI abnormalities. Results
indicated that the success of localizing neocortical seizures depended
upon the anatomic location of their onset. Electrographic seizure onset in
the beta or gamma frequency band strongly correlated with an ictal
generator located in the neocortical mantle of the frontal lobe.
·
Invasive EEG in Neocortical Epilepsy: Seizure Onset
Summary: Invasive EEG in Neocortical Epilepsy: Seizure Onset, a chapter
in Neocortical Epilepsies, describes a study that examined 53 people with
refractory neocortical epilepsy at the Yale Epilepsy Center. The patients
were studied with implanted intracranial electrodes, had their seizure
onset recorded and stored for review, and had subsequent resective
surgery with pathological analysis and at least 1 year of followup.
Researchers used outcome and pathology to judge the success or failure
of localization by the detected signals, analyzing characteristics of seizure
onset in the neocortex. Data analysis indicated that slow onset alone did
not predict poor outcome, nor did regional seizure onset. There was no
significant relationship between distribution or frequency of onset and
outcome or pathology. However, frequency and distribution of seizure
onset in neocortex recorded with implanted electrodes were characteristic
of the anatomic region itself. Researchers found two particular
morphologies of seizure onset (low voltage fast activity and rhythmic
sinusoidal waves) that predicted good surgical outcome, although they
were not associated with specific substrates. A preictal periodic spike
discharge, previously characterized as typical of mesial temporal
sclerosis, was seen in 14 people with neocortical seizures. The researchers
hypothesize that the frequency, lobe, and distribution of seizure onset
recorded by implanted electrodes in medically uncontrolled neocortical
epilepsy significantly correlate with each other but not with outcome or
pathology, which suggests that such features are determined by the
anatomic location and its networks or connections, independent of the
epilepsy etiology, cellular alterations, or mechanism of epileptogenesis.
However, the morphology or waveform of seizure onset, the underlying
pathology, and surgical outcome significantly relate with each other. This
suggests that waveform is a characteristic of specific pathophysiology
and may be used in predicting the underlying substrate.
General Home References
In addition to references for seizures and epilepsy, you may want a general
home medical guide that spans all aspects of home healthcare. The following
list is a recent sample of such guides (sorted alphabetically by title;
hyperlinks provide rankings, information, and reviews at Amazon.com):
· Adams & Victor’s Principles Of Neurology by Maurice Victor, et al;
Hardcover - 1692 pages; 7th edition (December 19, 2000), McGraw-Hill
Professional Publishing; ISBN: 0070674973;
· Clinical Neuroanatomy Made Ridiculously Simple (MedMaster Series,
2000 Edition) by Stephen Goldberg; Paperback: 97 pages; 2nd edition
(February 15, 2000), Medmaster; ISBN: 0940780461;
· It’s Not a Tumor!: The Patient’s Guide to Common Neurological
Problems by Robert Wiedemeyer; Paperback: (January 1996), Boxweed
Pub; ISBN: 0964740796;
· Neurology for the Non-Neurologist by William J. Weiner (Editor),
Christopher G. Goetz (Editor); Paperback (May 1999), Lippincott, Williams
& Wilkins Publishers; ISBN: 0781717078;
Vocabulary Builder
Comorbidity: The presence of co-existing or additional diseases with
reference to an initial diagnosis or with reference to the index condition that
is the subject of study. Comorbidity may affect the ability of affected
individuals to function and also their survival; it may be used as a prognostic
Books 195
indicator for length of hospital stay, cost factors, and outcome or survival.
[NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular
spaces, most commonly present in subcutaneous tissue. [NIH]
Electroshock: Induction of a stress reaction in experimental subjects by
means of an electrical shock; applies to either convulsive or non-convulsive
states. [NIH]
Epidural: Situated upon or outside the dura mater. [EU]
Gestation: The period of development of the young in viviparous animals,
from the time of fertilization of the ovum until birth. [EU]
Intubation: The insertion of a tube into a body canal or hollow organ, as
into the trachea or stomach. [EU]
Microdialysis: A technique for measuring extracellular concentrations of
substances in tissues, usually in vivo, by means of a small probe equipped
with a semipermeable membrane. Substances may also be introduced into
the extracellular space through the membrane. [NIH]
Neocortex: The largest portion of the cerebral cortex. It is composed of
NEURONS arranged in six layers. [NIH]
Neuroanatomy: Study of the anatomy of the nervous system as a specialty
or discipline. [NIH]
Neuropsychology:
A branch of psychology which investigates the
correlation between experience or behavior and the basic neurophysiological
processes. The term neuropsychology stresses the dominant role of the
nervous system. It is a more narrowly defined field than physiological
psychology or psychophysiology. [NIH]
Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball).
[EU]
Postoperative: Occurring after a surgical operation. [EU]
Postural: Pertaining to posture or position. [EU]
Psychosomatic: Pertaining to the mind-body relationship; having bodily
symptoms of psychic, emotional, or mental origin; called also
psychophysiologic. [EU]
Psychotropic: Exerting an effect upon the mind; capable of modifying
mental activity; usually applied to drugs that effect the mental state. [EU]
Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva).
[EU]
Spasticity: A state of hypertonicity, or increase over the normal tone of a
muscle, with heightened deep tendon reflexes. [EU]
Subarachnoid: Situated or occurring between the arachnoid and the pia
mater. [EU]
Substrate: A substance upon which an enzyme acts. [EU]
Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning
involuntarily or unconsciously, as the vegetative nervous system. 3. Resting;
denoting the portion of a cell cycle during which the cell is not involved in
replication. 4. Of, pertaining to, or characteristic of plants. [EU]
Multimedia 197
CHAPTER 7. MULTIMEDIA ON SEIZURES AND EPILEPSY
Overview
Information on seizures and epilepsy can come in a variety of formats.
Among multimedia sources, video productions, slides, audiotapes, and
computer databases are often available. In this chapter, we show you how to
keep current on multimedia sources of information on seizures and epilepsy.
We start with sources that have been summarized by federal agencies, and
then show you how to find bibliographic information catalogued by the
National Library of Medicine. If you see an interesting item, visit your local
medical library to check on the availability of the title.
Video Recordings
Most diseases do not have a video dedicated to them. If they do, they are
often rather technical in nature. An excellent source of multimedia
information on seizures and epilepsy is the Combined Health Information
Database. You will need to limit your search to “video recording” and
“seizures and epilepsy” using the “Detailed Search” option. Go directly to
the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video
productions, use the drop boxes at the bottom of the search page where “You
may refine your search by.” Select the dates and language you prefer, and
the format option “Videorecording (videotape, videocassette, etc.).” By
making these selections and typing “seizures and epilepsy” (or synonyms)
into the “For these words:” box, you will only receive results on video
productions. The following is a typical result when searching for video
recordings on seizures and epilepsy:
·
Seizures in Later Life
Source: Landover, MD, Epilepsy Foundation of America, 14:40-minute
VHS videotape, 1994.
Landover, MD 20785. (800) 332-1000; (301) 459-3700.
Summary: Seizures in Later Life, a videotape, is for older persons with
epilepsy, their families, and others interested in the impact of epilepsy on
senior citizens. Epilepsy and seizures are as likely to begin occurring in a
person's 60's, 70's, or 80's as they are in the first 10 years of life; there are
about 300,000 older Americans with epilepsy today. People can develop
seizures in later life due to head injuries, brain tumors, stroke, or for no
apparent reason. The videotape features a neuropsychologist and a
clinical pharmacist who help educate people about the nature of epilepsy
in later life including causes, treatment, and the appropriate response to
seizures. Four older persons share what they have learned about coping
with lifestyle changes, safety issues, and overcoming negative feelings
about epilepsy. Persons with epilepsy must know that medicines can
produce side effects and these should be reported to their doctors.
Complex partial seizures are the most common in older persons.
Episodes can mimic Alzheimer's, including apparent confusion, loss of
time, and memory loss. Safety precautions include cooking with a
microwave instead of on a stove, and wearing rubber gloves while
washing dishes. One older woman explains that she first hid from the
world, but her family helped her learn to go out and volunteer in the
community. Another man is feeling too protected by his wife because he
cannot drive or do some things for himself any longer. He wears a
medical I.D. and works on his memory loss with memory aids. The
viewer is told basic safety steps to take when seeing a person having a
seizure, such as turn the person on his/her side, do not restrain them, put
nothing in their mouth, and put a soft item under their head.
·
Driving and Epilepsy: Information for People with Seizure Disorders
Source: Landover, MD, Epilepsy Foundation of America, 13-minute VHS
videotape, 1993.
Landover, MD 20785. (800) 332-1000; (301) 459-3700.
Summary: Representatives of the Epilepsy Foundation of America use a
13-minute video to provide information in order to help individuals with
epilepsy obtain and maintain their driving status. Individuals with
epilepsy relate their experiences and offer support and practical
alternatives to others with epilepsy who cannot drive because their
Multimedia 199
seizures are not controlled. Issues discussed include state regulations
about driving and epilepsy, the appeals process if a license is denied,
safety, physician and personal reporting responsibilities, the role of the
physician in the licensing process, and personal feelings about driving.
Individuals with epilepsy discuss their attitudes and experiences with the
licensing process, loss of driving privileges, and inability to drive. An
attorney and physician discuss state requirements, physician
responsibility, and information available from the Epilepsy Foundation
of America. Individuals with epilepsy are encouraged to report seizures
to their physician so that medication adjustments can be made to control
seizures. When seizures cannot be controlled transportation alternatives
include public transportation, walking, riding with friends, and riding a
bicycle.
·
School Planning for Children with Seizure Disorders
videotape, 1992.
Landover, MD 20785. (301) 459-3700.
Summary: School Planning for Children With Seizure Disorders, a 14minute video produced by the Epilepsy Foundation of America,
encourages parents whose children experience seizure disorders to know
their rights regarding special educational services for their children. The
most common problems these children exhibit are in the areas of
attention, concentration, and memory. Under Public Law 94.142 and the
Individuals with Disabilities Education Act, children with special
educational needs are entitled to have an individualized educational
program (IEP) written for them. Parents can initiate the IEP, which details
the learning and social objectives for the child, the teaching
plan/timetable, and any related services that are needed. The IEP should
be reviewed each year. Parents have the right to (1) an evaluation of their
child's disability, (2) be present at meetings, (3) an explanation of records
and approval of who sees the records, (4) a written copy of the IEP, (5)
written notification if the school wants to change the IEP, and (6) appeal
through due process if they disagree with the program. Children's rights
include the right to free and appropriate education in the least restrictive
environment and to a reevaluation of skills and needs at least every 3
years. The least restrictive environment is usually the regular classroom
(with special assistance if necessary) or as much time in a regular
classroom as possible. The child's teacher and a school administrator
must attend the IEP meeting; other key personnel who work with the
child should attend also. Parents have the right to bring a guest or
advocate with them. School planning should be a team effort with
parents being an equal partner with school personnel. Parents and
teachers need to establish how seizures will be managed, how medicine
will be administered, and how epilepsy will be explained to the other
children. During the IEP, children's test results are presented and
explained; they form the basis for determining whether the school needs
to provide related services. Related services include (1) classroom aides,
(2) speech therapy, (3) occupational therapy, (4) physical therapy, (5)
transportation, and (6) counseling if emotional needs interfere with
school work. Parents and teachers are encouraged to work together to
reach consensus on the most appropriate learning environment for the
child with epilepsy.
·
Seizure Disorders and the School I (Elementary)
videotape, 1991.
Landover, MD 20785. (301) 459-3700. (800) 332-1000.
Summary: Seizure Disorders and the School I (Elementary) describes the
types of seizures and what to do when a seizure takes place, and
discusses the role of the teacher who has a child with epilepsy in the
classroom. Teachers can (1) recognize seizures when they occur,
especially those with subtle symptoms; (2) perform appropriate first aid
for seizures; (3) help the child achieve his or her full academic potential;
and (4) promote the child's self-esteem. The seizure types most
commonly seen in school are absence, which the teacher may be the first
to notice; simple or complex partial; and generalized tonic-clonic.
Absence seizures are brief and frequent, and may be mistaken for
daydreaming. Teachers encountering this type of seizure in the classroom
should report their observations to the child's parents if the symptoms
are seen for the first time. First aid is not generally required for absence
seizures, but the teacher may need to repeat information the student has
missed. During complex partial seizures, the teacher should (1) remain
calm, (2) protect the child from harm, (3) reassure the child, and (4)
reorient the child after the seizure. Generalized tonic-clonic seizures are
not life-threatening. During this type of seizure, the teacher should (1)
turn the child on his or her side, (2) loosen the child's clothing, (3) protect
his or her head, and (4) not restrain the child or put anything into his or
her mouth. Teachers should be aware of the possible psychological and
social effects of seizure disorders. The child with a seizure disorder does
not want to be treated differently from other children. The teacher should
encourage acceptance of the child with epilepsy and model a caring
Multimedia 201
attitude. Many children with seizure disorders do well in class and their
seizures are controlled by medication. However, the teacher should be
aware that seizure disorders and medication may affect the child's
memory and other learning skills. The teacher can help the child with
epilepsy grow, mature, and learn.
·
How to Recognize and Classify Seizures and Epilepsy
Landover, MD 20785. (301) 459-3700.
Summary: How to Recognize and Classify Seizures and Epilepsy, a 25minute video produced by the Epilepsy Foundation of America, is a
resource for physicians and other health professionals which details the
different types of seizures and depicts their effects using taped segments
of persons experiencing epileptic seizures. Epilepsy can be diagnosed by
obtaining a thorough medical history; talking with the patient, family,
and other observers; electroencephalography (EEG); and magnetic
resonance imaging. In symptomatic epilepsy, the epilepsy arises from an
underlying condition; blood and cerebral spinal fluid studies may
provide evidence of infection or other inflammatory processes that can be
treated with antibiotics or other anti-inflammatory drugs. The
International Classification of Epileptic Seizures divides them into two
major categories: (1) Partial, which is characterized by focal onset that
may or may not affect consciousness and may be simple, i.e., motor,
somatosensory, psychic, or autonomic, or other subjective symptoms or
complex and associated with impaired consciousness and (2)
Generalized, which involve both brain hemispheres, cause a loss of
consciousness, and are characterized as absence, myoclonic, clonic, tonic,
tonic-clonic, and atonic. Among persons with epilepsy, there is a
hierarchy of diagnosis that consists of an etiologic diagnosis (found for 25
percent of persons with epilepsy) and a descriptive diagnosis, which
includes characterization of seizure type and, in most descriptive
diagnoses, determination of an epileptic syndrome. Features of an
epileptic syndrome include (1) seizure type, (2) associated clinical
features, (3) natural history, (4) EEG, (5) precipitating factors, (6)
inheritance pattern, and (7) response to antiepileptic drugs. The clinician
should approach the diagnosis by considering the patient's entire clinical
picture over time. Followup evaluation is essential to ensure the patient's
seizures are accurately defined.
·
Seizure Disorders and the School II (Secondary)
videotape, 1991.
Landover, MD 20785. (301) 459-3700.
Summary: Seizure Disorders and the School II (Secondary) is a 14-minute
videotape that aims to educate secondary school teachers about epilepsy.
Epilepsy appears in many different forms, and most teachers will have a
student with a seizure disorder in class at some point in their teaching
career. It is important that teachers be able to recognize seizures, provide
first aid to students having seizures, and promote the education and selfesteem of students who experience seizures. Seizures are a disruption of
neuronal discharges in the brain and they come in many different forms.
The most common types of seizures in schools include absence seizures,
complex partial seizures, and generalized tonic-clonic seizures. The
videotape explains what each of these seizures is and discusses how to
recognize them in students. The most important things for a teacher to do
when a student is having a seizure include (1) remaining calm, (2)
keeping the student safe, (3) reassuring the student, and (4) reorienting
the student when the seizure is over. If a student has a generalized
seizure, the teacher should know to (1) lay the student on the floor and
turn the student on his or her side, (2) loosen the student's clothing, (3)
protect the student's head, (4) not restrain the student, (5) put nothing in
the mouth of the student, and (6) call an ambulance only if the seizure
lasts longer than 5 minutes or if the student has no prior history of
seizures. First seizures should be reported to the student's parents and
the school nurse. Teachers should realize that some students will recover
from their seizures quickly and can stay in class, while others may need
to be excused for a recuperation period. It is important for teachers to
address the psychological and social issues confronted by students with
epilepsy. Teachers should immediately explain to the rest of the class
what seizures are, that they are not contagious or a mental illness, and
should reassure the student who has seizures. Unless restrictions are
imposed by the student's physician, students who experience seizures
should not be excluded from classroom or outdoor activities or
overprotected because of their condition. The teacher should keep track
of the student's performance, and if academic or social problems appear,
refer them for testing and treatment.
Multimedia 203
·
Understanding Complex Partial Seizures
Source: Landover, MD, Epilepsy Foundation of America, Family Video
Library, 14-minute VHS videotape, 1991.
Landover, MD 20785. (301) 459-3700.
Summary: Understanding Complex Partial Seizures is a 14-minute
videotape about the nature of complex partial epileptic seizures.
Complex partial seizures are often different from the typical tonic-clonic
generalized seizures that people often associate with epilepsy. Because of
this, they may be difficult to recognize or diagnose as seizures. Complex
partial seizures are caused by brief electrical disturbances in the brain
and are characterized by a loss of awareness, sometimes accompanied by
specific or repeated motor activities or verbal activity. Studies of
individuals with complex partial seizures have led to an increased
awareness and understanding of the condition, but complex partial
seizures are so varied they can be misdiagnosed. Each individual tends to
have his or her own characteristic pattern of activity during seizures.
Sometimes this is easily recognized as a seizure, but often it is not.
Complex partial seizures are sometimes misinterpreted as behavior
problems or substance abuse. The most important things to do when
someone is experiencing a complex partial seizure include (1) remaining
calm, (2) keeping the person out of harm, and (3) waiting for the seizure
to pass and then reorienting the individual. Seizures will pass in a few
minutes. The videotape presents testimony from persons with complex
partial epileptic seizures concerning how the seizures affect their lives
and how they cope. It is critical that those who experience complex
partial seizures do not let the condition negatively affect their lives and
self-esteem, but rather remain positive and assured of their abilities.
·
Epilepsy in the Teen Years
Landover, MD 20785. (800) 332-1000; (301) 459-3700.
Summary: Epilepsy in the Teen Years, a videotape, is aimed at helping
teenagers with epilepsy learn about their disorder and how to cope with
it. Four teens discuss what living with epilepsy is like for them.
Adolescence is difficult enough for most teenagers, and learning to live
with a chronic illness that often sets one apart can be hard. Some teens
are not compliant with medication at first, believing they do not really
need it or rejecting that they have epilepsy; this complicates their lives
further. Peers need to be educated about what to expect if a person has a
seizure and how to handle an episode, so that they become less afraid to
include the teen with epilepsy on social occasions. Driving can be a
problem, so teens often learn to get rides from friends and contribute gas
money. Students with epilepsy need support, understanding, and people
to react to them as normal people. A social worker who leads a teen
support group on epilepsy speaks about the effectiveness of such groups.
Teens in support groups can discuss coping problems, depression, skills,
medication side effects, and other concerns. Adolescents with epilepsy
must learn that alcohol and other drugs, especially cocaine, can trigger
seizures so it is best to avoid them. Learning what other conditions
precipitate seizures is also helpful; teens must learn to get adequate rest,
adhere to a good diet, and take medications on time. This gives them
more responsibility for their own care and helps them learn to grow up
dealing with epilepsy. Parents should not be overprotective. The teens in
the tape say they have learned that epilepsy is not who they are, just part
of what they have to handle in life, and that there is much more to life
than having a seizure disorder.
·
And Life Goes On: Severe Seizures of Early Childhood
Landover, MD 20785. (800) 332-1000; (301) 459-3700.
Summary: And Life Goes On: Severe Seizures of Early Childhood is a
videotape about serious seizure disorders that occur in young children.
Such a disorder can be very shocking and painful to parents, but despite
this it is important to learn to cope and to help their child live a full life.
One severe seizure disorder seen in children is Lenox-Gasteau, which is
characterized by both tonic and myoclonic seizures. Children with the
disorder can have hundreds of seizures a day. In some children,
treatment causes the seizures to go away, while in others, the disorder
comes back months or years later. Counseling for parents of children
with Lenox-Gasteau often helps because of the frequency and disruptive
nature of the seizures. Counseling can also help parents become better
educated about the condition, which is vital to helping them understand
all aspects of epilepsy and give their child the best care possible. Because
a condition like Lenox-Gasteau requires such time-intensive care, parents
must realize that often they cannot provide all the care that their child
needs. Residential treatment programs can help both the parents and the
child better cope with the condition. Traditionally, treatment of LenoxGasteau included only special medication or diet options. More recently,
Multimedia 205
however, physicians can perform a new procedure that severs some of
the nerve fibers between the two halves of the brain and stops the spread
of discharges from one side of the brain to the other.
·
Question of Epilepsy
Source: Landover, MD, Epilepsy Foundation of America, 1 30-minute
Landover, MD 20785. (301) 459-3700. (800) 332-4050.
Summary: Question of Epilepsy is a 30-minute VHS videotape presenting
seven dramatizations of questions about epilepsy. In the first scene, an
extended family is gathered for a family event and casually discusses the
epilepsy of Paul, an adolescent family member. They mention its
psychosocial impact on others and how they and he have adjusted to
coping with epilepsy. The second dramatization deals with the causes of
epilepsy. After a children's bicycle race, two young boys go riding
without their helmets. The father of one boy calls him back and reminds
him to wear a helmet whenever he rides a bicycle. The father tells the
other boy's mother about a child who rode a bike without a helmet and
received a head injury that caused epilepsy. The father mentions that
anyone can develop epilepsy at any age; other causes of epilepsy include
rare diseases, birth defects, and alcoholism. In the third scene, a man and
a woman are editing a videotape showing elementary school students
enacting what to do when a person has a seizure. The editors discuss
what to do and not to do when someone has a seizure, such as never
putting something in the person's mouth. After the editors edit the tape,
they show it in its entirety. The fourth dramatization asks the question,
Are all seizures the same? Coworkers in a floral shop discuss types of
seizures, including whole brain involvement and partial seizures. In the
fifth scene, a retirement group discusses anticonvulsants and their use. A
woman mentions that she is concerned because her elderly husband
recently had to start taking anticonvulsants. A retired pharmacist says
that it is not uncommon for people over age 60 to develop epilepsy, that
the anticonvulsant drugs help people with epilepsy live normal lives, and
that the Epilepsy Foundation of America is a good source of additional
information about epilepsy. In the sixth scene, a boys' high school
basketball team practices in the gym. One boy talks about his seizures
and describes being on anticonvulsant drugs. The boy's parents and the
coach met and discussed the boy's epilepsy before he joined the team.
The coach read material from the Epilepsy Foundation of America and
was convinced that the young man could do anything anyone else could
do. The boy says that the coach's belief in him has given him self-
confidence. The seventh scene is entitled what is the biggest problem
people with epilepsy face. Two office workers discuss applicants for a
position. One has stated on her application that she has epilepsy, which
causes one of the workers to drop her from further consideration for the
job. The other worker convinces him to call the woman and find out more
about her epilepsy and if it will interfere with her work. This worker
states that the company wants to hire the best person for the job, and that
may be the person with epilepsy.
·
Epilepsy in Children: A Primary Care Perspective
Landover, MD 20785. (301) 459-3700.
Summary: Epilepsy in Children: A Primary Care Perspective, a
videotape, reviews the diagnosis and management of childhood seizures.
Most childhood seizures can be successfully controlled; the keys are
accurate diagnosis and administration of the most appropriate
anticonvulsant medication. A seizure is a symptom of an underlying
neurological disorder, which may be epilepsy or an epileptic syndrome.
Syndromes are defined by the clinical event, electroencephalography
(EEG) characteristics, age at onset, evolution and prognosis, family
history, clinical history, and physical findings. Many conditions mimic
epilepsy in children, including breath holding, pallid infantile syncope,
night terrors, sleep walking, syncope, cardiac arrhythmia, and movement
disorders. Once the physician has established that a seizure has occurred,
it is important to take a clinical history, especially a detailed description
of the event. Diagnosis is based on clinical, not EEG, data, but EEG's may
suggest a seizure type. If possible, EEG's should be recorded with the
child awake, asleep, hyperventilating, and with photic stimulation. When
planning the management of a child with epilepsy, the physician should
consider the certainty of the diagnosis, the nature of the lesion (if any),
the child's age, and the risk of seizure recurrence. Video-EEG recordings
of some of the most common seizure types in children are shown:
Complex partial, absence, infantile spasms, tonic, and atonic. Commonlyused anticonvulsant
drugs are carbamazepine, clonazepam,
ethosuximide, phenobarbital, phenytoin, primidone, and valproic acid.
The narrators explain which drugs are used for which types of seizures
and discuss the danger of toxicity, which can change with age. The
physician should prescribe the correct medication for the type of seizure,
and refer children with epilepsy whose seizures are difficult to manage to
a center specializing in epilepsy. Parents should be involved in the
Multimedia 207
treatment plan, and encouraged to allow the child with epilepsy to
participate in activities with other children.
·
Understanding Seizure Disorders
videotape, 1989.
Landover, MD 20785. (301) 459-3700.
Summary: Understanding Seizure Disorders, an 11-minute video
produced by the Epilepsy Foundation of America, examines the human
brain and uses testimonials from persons with epilepsy and videotapes of
persons having seizures to explain epilepsy. Epilepsy is defined as
seizures that are not related to an explained cause and which tend to
recur over time in an unpredictable fashion. There are two types of
seizures: Generalized and partial. In a generalized seizure, the electrical
disturbance affects the entire brain all at once. In a partial seizure, only
one part of the brain is affected at the start; the electrical disturbance may
remain localized or spread throughout the brain. Partial seizures may be
characterized by strange changes in sense of taste or smell or feeling of
movement outside the body or back in time. Some people experience
only one kind of seizure, while others experience several kinds. Doctors
can attempt to determine the cause and treatment for seizures by (1)
taking the patient's personal and family history; (2) talking with the
patient and the patient's family and friends about the patient's behavior
prior to and during the seizure; and (3) performing diagnostic tests such
as an electroencephalogram to measure electrical signals in the brain,
brain imaging scans (magnetic resonance imaging or computed
tomography) to detect scarring or malformations, and blood tests to
detect chemical imbalances. No one cause is usually responsible for the
epilepsy, and the etiology of the disorder is not always discovered. More
than 100,000 people develop epilepsy every year. By focusing on their
time not spent in seizures, and with acceptance and understanding from
others, persons with epilepsy can lead productive lives.
·
Epilepsy: Quality of Life
Source: Landover, MD, Epilepsy Foundation of America, 1 VHS
videotape, 41:24 minutes, 1987.
Landover, MD 20785. (301) 459-3700. (800) 332-1000.
Summary: Epilepsy: Quality of Life is a 41-minute videotape about the
importance of considering quality of life in the treatment of epilepsy. The
videotape presents case studies on four children with epilepsy: Aaron,
Danny, David, and Sabrina. In each case, the video describes how a
reevaluation of treatment improved the quality of life of the individual.
In the case of Aaron, who experienced complex partial seizures, new
drugs that treated his partial seizures rather than generalized seizures
more effectively controlled his epilepsy. Danny's case represents the
importance of a multidisciplinary approach to epilepsy treatment. In
Danny's case, his difficulty coping with epilepsy had caused him to have
stomach problems and learning difficulties. Part of his treatment
involved switching schools to one where a learning disabilities teacher
was able to work with him. In the case of David, his medications were
causing him to have personality changes and made him speak and think
very slowly. A change to a new medication greatly improved his
personality and quality of life. In the case of Sabrina, her epilepsy had
never been properly diagnosed. A reevaluation of her disorder, which
consisted primarily of absence seizures, allowed better specific treatment
for her disorder and improved her quality of life. Overall, the video
stressed the importance of a holistic approach to the treatment of
epilepsy and demonstrated the value of reevaluation of epilepsy
treatment as new treatments become available.
·
Epilepsy: The Child and the Family
Landover, MD 20785. (800) 332-1000; (301) 459-3700.
Summary: The Epilepsy Foundation of America presents information
about childhood seizures for parents. Topics discussed include seizure
classification, causes, drug therapy, drug side effects, and special
concerns of parents. Seizures occur when brain cells continue to fire.
Seizures that affect both sides of the brain are classified as generalized
seizures and include tonic-clonic, absence, and myoclonic seizures. Those
seizures that affect only one part of the brain are classified as either
simple or complex partial seizures. During the diagnostic process,
physicians look for possible causes related to pregnancy, falls, or
infection and try to rule out any illness that may cause seizures. There is
no identifiable cause in about half of all cases of epilepsy. Diagnostic
tools include blood work, computed tomography scans, and
electroencephalography. Physicians select antiepileptic drugs (AED's) to
treat specific kinds of seizures. The physician may prescribe several
AED's before finding the one that results in good seizure control with few
side effects. Individuals with epilepsy are encouraged to take
Multimedia 209
medications regularly to maintain steady levels of the drug in their blood.
Common AED side effects include staggering, sleepiness, learning
difficulties, and behavior problems. Drug allergies may cause aggression,
rash, blood changes, or liver changes. There is no evidence that chronic
AED use leads to experimenting with illegal drugs, though teenagers
may rebel against regular use of AED's. Parents should communicate
with the physician and explore their child's feelings about epilepsy.
Parents are encouraged to discuss epilepsy frankly with other children,
babysitters, grandparents, and teachers. School problems such as
inattention or difficulty with certain subjects should be addressed; they
may or may not relate to epilepsy. Children with epilepsy are encouraged
to lead normal, active lives. Parents are cautioned to avoid seizure
triggers and not overprotect their children.
Bibliography: Multimedia on Seizures and Epilepsy
The National Library of Medicine is a rich source of information on
healthcare-related multimedia productions including slides, computer
software, and databases. To access the multimedia database, go to the
following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.”
Once in the search area, simply type in seizures and epilepsy (or synonyms).
Then, in the option box provided below the search box, select “Audiovisuals
and Computer Files.” From there, you can choose to sort results by
publication date, author, or relevance. The following multimedia has been
indexed on seizures and epilepsy. For more information, follow the
hyperlink indicated:
·
Brain surgery. Source: produced by Advanced Medical Education, Inc.
for the Learning Channel; Year: 1993; Format: Videorecording; Princeton,
N.J: Films for the Humanities; Sciences, c1993.
·
Care & reporting of seizures (Richmond State School, Staff
Development). Year: 1989; Format: Videorecording; [Austin, Tex.]: Texas
Dept. of Mental Health and Mental Retardation, c1989.
·
Convulsive and allied conditions. Source: by S. Philip Goodhart and
Benjamin H. Balser; Year: 1944; Format: Motion picture; [New York]:
Neuropsychiatric Division, Montefiore Hospital [1944]
·
Diagnosis and medical management of epileptic seizures. Source:
Ayerst Medical Information Service; produced by Intermedica
Incorporated; Year: 1975; Format: Videorecording; New York: Ayerst,
c1975.
·
Emergency treatment of seizures.
Source: Dept. of Continuing
Education, Harvard Medical School and the Massachusetts General
Hospital, Emergency Training Course; produced by Health Education
Programs, Inc; Year: 1973; Format: Videorecording; [Minneapolis]:
Institute for Continuing Physician Education, c1973.
·
Epilepsy: breaking the barrier. Source: a presentation of Films for the
Humanities & Sciences; a presentation of OETA and Medstar
Communications, Inc; Year: 1995; Format: Videorecording; Princeton,
N.J.: Films for the Humanities and Sciences, c1995.
·
Epilepsy: the storm within. Source: a presentation of Films for the
Humanities & Sciences; a production of WLIW21, Long Island Public
Television; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for
the Humanities Sciences, c1998.
·
Epilepsy. Year: 1985; Format: Slide; [Columbus, Ohio]: Center for
Continuing Education, the Ohio State University College of Medicine,
[1985]
·
Epilepsy and pregnancy.
Source: Marshfield Video Network, in
cooperation with Marshfield Clinic, St. Joseph's Hospital, and Marshfield
Medical Research Foundation; Year: 1988; Format: Videorecording;
Marshfield, WI: The Network, c1988.
·
Epilepsy. Source: a presentation of Films for the Humanities & Sciences;
a production of Dartmouth-Hitchcock Medical Center; Year: 1993;
Format: Videorecording; Lebanon, N.H.: DHMC, c1993.
·
Evaluation of different types of seizures. Source: Gregory O. Walsh,
Zina Mirsky; Year: 1977; Format: Videorecording; San Francisco: AVC
Corporation, c1977.
·
Febrile seizures: controversies. Source: presented by the Department of
Pediatrics, Emory University School of Medicine; Year: 1983; Format:
Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1983.
·
Febrile seizures in children. Source: with Arnold P. Gold; Year: 1986;
Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical
Education, 1986.
·
How to recognize and classify seizures and epilepsy. Source: produced
by the Epilepsy Foundation of America; Year: 1991; Format:
Videorecording; Landover, Md.: The Foundation, c1991.
·
How to recognize and classify seizures. Source: presented by the
Epilepsy Foundation of America; produced by Borland-Coogan
Associates, Inc. for the Epilepsy Foundation; Year: 1981; Format:
Videorecording; [Landover, Md.]: EFA, c1981.
·
Illustrated classification of seizures. Source: written and presented by
L. William McLain, Jr; Year: 1981; Format: Videorecording; Minneapolis,
MN: University of Minnesota, c1981.
Multimedia 211
·
Modern concepts of epilepsy. Source: presented by Ayerst Laboratories;
produced by Sturgis-Grant Productions, Inc; Year: 1956; Format: Motion
picture; United States: Ayerst, c1956.
·
Petit mal seizures. Source: Mayo Clinic; Year: 1962; Format: Motion
picture; Rochester, Minn.: The Clinic, [1962]
·
Seizure and movement disorders in children. Source: [presented by
Ross Laboratories, developed in cooperation and coordination with the
American Academy of Pediatrics]; Year: 1987; Format: Videorecording;
Columbus, Ohio: The Laboratories, c1987.
·
Seizure clinic: management of the patient with epilepsy. Source: with
Arnold P. Gold and Stanley R. Resor; Year: 1988; Format: Videorecording;
Secaucus, N.J.: Network for Continuing Medical Education, 1988.
·
Seizure disorders in children: a report. Source: Robert C. Vannucci;
[made by] Penn Sate Television; Year: 1976; Format: Videorecording;
University Park, Pa.: Pennsylvania State University: [for loan or sale by
its Audio-Visual Services], c1976.
·
Seizure disorders. Part 1.
Carrollton, TX: HSTN, c1999.
Year: 1999; Format: Videorecording;
·
Seizure disorders. Part 2.
Carrollton, TX: HSTN, c1999.
Year: 1999; Format: Videorecording;
·
Seizures and epilepsy in children. Source: John M. Freeman, Eileen P.G.
Vining; Year: 1992; Format: Videorecording; Secaucus, N.J.: Network for
Continuing Medical Education, 1992.
·
Spellbound: epilepsy surgery and the family a presentation of Films
for the Humanities & Sciences; produced with the participation of
SaskFILM, produced with the participation of Saskatchewan
Communications Network; a co-production bet. Year: 1996; Format:
Videorecording; Princeton, N.J.: Films for the Humanities Sciences, c1996.
·
Understanding seizure disorders. Source: a presentation of the Office of
Clinical Center Communications; produced by Medical Arts and
Photography Branch, NCRR; Year: 1990; Format: Videorecording;
[Bethesda, Md.]: National Institutes of Health, 1990.
·
Working up the patient with seizures: a neurological evaluation.
Source: written and presented by Ilo E. Leppik; Year: 1981; Format:
Videorecording; [Minneapolis, Minn.]: University of Minnesota, c1981.
Vocabulary Builder
Antibiotic: A chemical substance produced by a microorganism which has
the capacity, in dilute solutions, to inhibit the growth of or to kill other
microorganisms. Antibiotics that are sufficiently nontoxic to the host are
used as chemotherapeutic agents in the treatment of infectious diseases of
man, animals and plants. [EU]
Malformation: A morphologic defect resulting from an intrinsically
abnormal developmental process. [EU]
Psychic: Pertaining to the psyche or to the mind; mental. [EU]
Recuperation: The recovery of health and strength. [EU]
Stomach: An organ of digestion situated in the left upper quadrant of the
abdomen between the termination of the esophagus and the beginning of the
duodenum. [NIH]
Syncope: A temporary suspension of consciousness due to generalized
cerebral schemia, a faint or swoon. [EU]
Periodicals and News 213
CHAPTER 8. PERIODICALS AND NEWS ON SEIZURES AND
EPILEPSY
Overview
Keeping up on the news relating to seizures and epilepsy can be challenging.
Subscribing to targeted periodicals can be an effective way to stay abreast of
recent developments on seizures and epilepsy. Periodicals include
newsletters, magazines, and academic journals.
In this chapter, we suggest a number of news sources and present various
periodicals that cover seizures and epilepsy beyond and including those
which are published by patient associations mentioned earlier. We will first
focus on news services, and then on periodicals. News services, press
releases, and newsletters generally use more accessible language, so if you
do chose to subscribe to one of the more technical periodicals, make sure that
it uses language you can easily follow.
News Services & Press Releases
Well before articles show up in newsletters or the popular press, they may
appear in the form of a press release or a public relations announcement.
One of the simplest ways of tracking press releases on seizures and epilepsy
is to search the news wires. News wires are used by professional journalists,
and have existed since the invention of the telegraph. Today, there are
several major “wires” that are used by companies, universities, and other
organizations to announce new medical breakthroughs. In the following
sample of sources, we will briefly describe how to access each service. These
services only post recent news intended for public viewing.
PR Newswire
Perhaps the broadest of the wires is PR Newswire Association, Inc. To access
this archive, simply go to http://www.prnewswire.com. Below the search
box, select the option “The last 30 days.” In the search box, type “seizures
and epilepsy” or synonyms. The search results are shown by order of
relevance. When reading these press releases, do not forget that the sponsor
of the release may be a company or organization that is trying to sell a
particular product or therapy. Their views, therefore, may be biased. The
following is typical of press releases that can be found on PR Newswire:
·
Foundation Says FDA Action Gives Doctors New Option for Treating
Difficult Seizures in Children
Summary: WASHINGTON, Jan.
the Epilepsy Foundation said
Administration's clearance of
therapy in pediatric patients
struggling with the disorder.
20 /PRNewswire/ -- Representatives of
today that the U.S. Food and Drug
lamotrigine (Lamictal) as adjunctive
brings new hope to many families
"When uncontrolled, partial seizures may severely impact a child's
intellectual and social development. They are also among the most
difficult seizures to treat," said Patricia Osborn-Shafer, R.N., M.N., Chair
of the Foundation's Professional Advisory Board. Shafer is Coordinator,
Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center in
Boston.
"We're extremely pleased that clinicians now have another therapeutic
option for helping to bring these types of seizures in children under
better control," she said.
The FDA clearance is for the use of lamotrigine as add-on therapy for
partial seizures in children age two and over. The medication, which is
manufactured by GlaxoSmithKline, under the brand name Lamictal was
approved in 1994 for use in adult patients.
Partial seizures are brief involuntary sensations, movements or behaviors
that occur in clear consciousness or with impaired consciousness. They
may involve distortions of feeling, perception, mood, vision, hearing or
touch.
Or they may cause loss of awareness, repetitive movements and
verbalizations, confused walking about, and other behaviors that are not
under conscious control.
The Epilepsy Foundation, with national offices in metropolitan
Washington, D.C., is the non-profit voluntary agency devoted to
research, education, advocacy, and service in the community for 2.3
million Americans with seizure disorders and their families.
Reuters
The Reuters’ Medical News database can be very useful in exploring news
archives relating to seizures and epilepsy. While some of the listed articles
are free to view, others can be purchased for a nominal fee. To access this
archive, go to http://www.reutershealth.com/frame2/arch.html and search
by “seizures and epilepsy” (or synonyms). The following was recently listed
in this archive for seizures and epilepsy:
·
Seizures stop after brain monitoring for epilepsy
Source: Reuters Health eLine
Date: November 08, 2001
http://www.reuters.gov/archive/2001tail/11/08/eline/links/20011108elin010.html
·
Seizures often unrecognized in young children, teens
http://www.reuters.gov/archive/2000/11/07/eline/links/20001107elin
009.html
·
Seizures in elderly a significant, severe problem
Source: Reuters Medical News
Date: December 18, 1998
http://www.reuters.gov/archive/1998/12/18/professional/links/19981
218clin011.html
·
Vaccine-Related Seizures Not Tied To Epilepsy
Date: May 01, 1998
013.html
·
Fever Seizures Linked To Later Epilepsy
Date: April 24, 1998
010.html
·
Epilepsy Expert Urges Regulation To Prevent TV-Induced Seizures
Date: March 03, 1998
303rglt001.html
·
Two Unprovoked Seizures Constitute Epilepsy
Date: February 12, 1998
212clin007.html
·
Implant Controls Epileptic Seizures
003.html
·
Sports Seizures Don't Cause Epilepsy
Date: January 17, 1997
010.html
·
Hispanic Kids Suffer More Seizures
002.html
·
Vagus Nerve Stimulation Effective Adjunctive Treatment For Patients
With Intractable Seizures
119clin005.html
·
Surgery Cuts Epilepsy Seizures
Date: August 13, 1996
002.html
·
Hypnosis Useful In Differentiating Epileptic From Non-Epileptic
Seizures
207clin012.html
The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York
Times Syndicate, the AP News Service, and Reuters to deliver news that can
be
browsed
by
the
public.
Search
news
releases
at
http://www.nlm.nih.gov/medlineplus/alphanews_a.html.
MEDLINEplus
allows you to browse across an alphabetical index. Or you can search by date
at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news
items are indexed by MEDLINEplus within their search engine. The
following was recently indexed as relating to seizures and epilepsy:
·
Abbott Once-daily Epilepsy Drug Approved in US
http://www.nlm.nih.gov/medlineplus/news/fullstory_10962.html
Business Wire
Business Wire is similar to PR Newswire. To access this archive, simply go to
http://www.businesswire.com. You can scan the news by industry category
or company name.
Internet Wire
Internet Wire is more focused on technology than the other wires. To access
this site, go to http://www.internetwire.com and use the “Search Archive”
option. Type in “seizures and epilepsy” (or synonyms). As this service is
oriented to technology, you may wish to search for press releases covering
diagnostic procedures or tests that you may have read about.
Search Engines
Free-to-view news can also be found in the news section of your favorite
search
engines
(see
the
health
news
page
at
Yahoo:
http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s
general news search page http://news.yahoo.com/. Type in “seizures and
epilepsy” (or synonyms). If you know the name of a company that is
relevant to seizures and epilepsy, you can go to any stock trading Web site
(such as www.etrade.com) and search for the company name there. News
items across various news sources are reported on indicated hyperlinks.
BBC
Covering news from a more European perspective, the British Broadcasting
Corporation (BBC) allows the public free access to their news archive located
at http://www.bbc.co.uk/. Search by “seizures and epilepsy” (or synonyms).
Newsletter Articles
If you choose not to subscribe to a newsletter, you can nevertheless find
references to newsletter articles. We recommend that you use the Combined
Health Information Database, while limiting your search criteria to
“newsletter articles.” Again, you will need to use the “Detailed Search”
option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html.
Go to the bottom of the search page where “You may refine your search by.”
Select the dates and language that you prefer. For the format option, select
“Newsletter Article.”
By making these selections, and typing in “seizures and epilepsy” (or
synonyms) into the “For these words:” box, you will only receive results on
newsletter articles. You should check back periodically with this database as
it is updated every 3 months. The following is a typical result when
searching for newsletter articles on seizures and epilepsy:
Academic Periodicals covering Seizures and Epilepsy
Academic periodicals can be a highly technical yet valuable source of
information on seizures and epilepsy. We have compiled the following list of
periodicals known to publish articles relating to seizures and epilepsy and
which are currently indexed within the National Library of Medicine’s
PubMed database (follow hyperlinks to view more information, summaries,
etc., for each). In addition to these sources, to keep current on articles written
on seizures and epilepsy published by any of the periodicals listed below,
you can simply follow the hyperlink indicated or go to the following Web
site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the
search box to find the latest studies published.
If you want complete details about the historical contents of a periodical, you
can visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi.
Here, type in the name of the journal or its abbreviation, and you will receive
an index of published articles. At http://locatorplus.gov/ you can retrieve
more indexing information on medical periodicals (e.g. the name of the
publisher). Select the button “Search LOCATORplus.” Then type in the name
of the journal and select the advanced search option “Journal Title Search.”
The following is a sample of periodicals which publish articles on seizures
and epilepsy:
·
Acta Neurologica Scandinavica. (Acta Neurol Scand)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Ac
ta+Neurologica+Scandinavica&dispmax=20&dispstart=0
·
American Journal of Medical Genetics. (Am J Med Genet)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=A
merican+Journal+of+Medical+Genetics&dispmax=20&dispstart=0
·
Bmj (Clinical Research Ed. . (BMJ)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=B
mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
·
Brain Research. (Brain Res)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Br
ain+Research&dispmax=20&dispstart=0
·
Epilepsy Research. (Epilepsy Res)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Ep
ilepsy+Research&dispmax=20&dispstart=0
·
Experimental Neurology. (Exp Neurol)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Ex
perimental+Neurology&dispmax=20&dispstart=0
·
Journal of Neuroimmunology. (J Neuroimmunol)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Jo
urnal+of+Neuroimmunology&dispmax=20&dispstart=0
·
Journal of Tropical Pediatrics. (J Trop Pediatr)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Jo
urnal+of+Tropical+Pediatrics&dispmax=20&dispstart=0
·
Neuroscience Letters. (Neurosci Lett)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Ne
uroscience+Letters&dispmax=20&dispstart=0
·
Obstetrics and Gynecology. (Obstet Gynecol)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Ob
stetrics+and+Gynecology&dispmax=20&dispstart=0
·
Pediatric Neurology. (Pediatr Neurol)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Pe
diatric+Neurology&dispmax=20&dispstart=0
·
Synapse (New York, N. . . (Synapse)
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0&regexp=Sy
napse+(New+York,+N.+.+&dispmax=20&dispstart=0
Vocabulary Builder
Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and
some non-leukocytic cells, that act as intercellular mediators. They differ
from classical hormones in that they are produced by a number of tissue or
cell types rather than by specialized glands. They generally act locally in a
paracrine or autocrine rather than endocrine manner. [NIH]
Disorientation: The loss of proper bearings, or a state of mental confusion
as to time, place, or identity. [EU]
Lupus: A form of cutaneous tuberculosis. It is seen predominantly in
women and typically involves the nasal, buccal, and conjunctival mucosa.
[NIH]
Mediator: An object or substance by which something is mediated, such as
(1) a structure of the nervous system that transmits impulses eliciting a
specific response; (2) a chemical substance (transmitter substance) that
induces activity in an excitable tissue, such as nerve or muscle; or (3) a
substance released from cells as the result of the interaction of antigen with
antibody or by the action of antigen with a sensitized lymphocyte. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU]
Physician Guidelines and Databases 223
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES
Overview
Doctors and medical researchers rely on a number of information sources to
help patients with their conditions. Many will subscribe to journals or
newsletters published by their professional associations or refer to
specialized textbooks or clinical guides published for the medical profession.
In this chapter, we focus on databases and Internet-based guidelines created
or written for this professional audience.
NIH Guidelines
For the more common diseases, The National Institutes of Health publish
guidelines that are frequently consulted by physicians. Publications are
typically written by one or more of the various NIH Institutes. For physician
guidelines, commonly referred to as “clinical” or “professional” guidelines,
you can visit the following Institutes:
·
Office of the Director (OD); guidelines consolidated across agencies
available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets
available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M.,
Inc.) with guidelines:
http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Neurological Disorders and Stroke (NINDS);
neurological disorder information pages available at
http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
NIH Databases
In addition to the various Institutes of Health that publish professional
guidelines, the NIH has designed a number of databases for professionals.26
Physician-oriented resources provide a wide variety of information related
to the biomedical and health sciences, both past and present. The format of
these resources varies. Searchable databases, bibliographic citations, full text
articles (when available), archival collections, and images are all available.
The following are referenced by the National Library of Medicine:27
·
Bioethics: Access to published literature on the ethical, legal and public
policy issues surrounding healthcare and biomedical research. This
information is provided in conjunction with the Kennedy Institute of
Ethics located at Georgetown University, Washington, D.C.:
http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated
to HIV/AIDS research:
http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of
Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html.
Additional resources for historical scholarship in medicine:
http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National
Center for Biotechnology Information conducts research in
computational biology, develops software tools for analyzing genome
data, and disseminates biomedical information for the better
understanding of molecular processes affecting human health and
disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides
access to worldwide coverage of population, family planning, and related
health issues, including family planning technology and programs,
fertility, and population law and policy:
http://www.nlm.nih.gov/databases/databases_population.html
·
Cancer Information: Access to caner-oriented databases:
http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the
databases referenced in MEDLINEplus (http://medlineplus.gov/ or
http://www.nlm.nih.gov/medlineplus/databases.html).
27 See http://www.nlm.nih.gov/databases/databases.html.
26
·
Profiles in Science: Offering the archival collections of prominent
twentieth-century biomedical scientists to the public through modern
digital technology: http://www.profiles.nlm.nih.gov/
·
Chemical Information: Provides links to various chemical databases and
references: http://sis.nlm.nih.gov/Chem/ChemMain.html
·
Clinical Alerts: Reports the release of findings from the NIH-funded
clinical trials where such release could significantly affect morbidity and
mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
·
Space Life Sciences: Provides links and information to space-based
research (including NASA):
http://www.nlm.nih.gov/databases/databases_space.html
·
MEDLINE: Bibliographic database covering the fields of medicine,
nursing, dentistry, veterinary medicine, the healthcare system, and the
pre-clinical sciences:
http://www.nlm.nih.gov/databases/databases_medline.html
·
Toxicology and Environmental Health Information (TOXNET):
Databases covering toxicology and environmental health:
http://sis.nlm.nih.gov/Tox/ToxMain.html
·
Visible Human Interface: Anatomically detailed, three-dimensional
representations of normal male and female human bodies:
http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study
and treat seizures and epilepsy, the following are particularly noteworthy.
A comprehensive source of information on clinical guidelines written for
professionals is the Combined Health Information Database. You will need
to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information
Package” and seizures and epilepsy using the “Detailed Search” option. Go
directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To
find associations, use the drop boxes at the bottom of the search page where
“You may refine your search by.” For the publication date, select “All
Years,” select your preferred language, and the format option “Fact Sheet.”
By making these selections and typing “seizures and epilepsy” (or
synonyms) into the “For these words:” box above, you will only receive
results on fact sheets dealing with seizures and epilepsy. The following is a
sample result:
·
Entitled to Respect: A National Survey of Teens' Attitudes and
Behaviors About Epilepsy and Acceptance: Executive Summary
Source: Landover, MD, Epilepsy Foundation, 13 p., November 2001.
Contact: Epilepsy Foundation, 4351 Garden City Drive, Landover, MD
20785-7223. INTERNET/EMAIL:
http://www.entitledtorespect.org/etr/survey/pdf.
Summary: Entitled to Respect: A National Survey of Teens' Attitudes and
Behaviors About Epilepsy and Acceptance: Executive Summary
summarizes the results of a survey of teens' attitudes and behaviors
about epilepsy. The survey consisted of a questionnaire that was
distributed to teens throughout the United States by 20 affiliates of the
Epilepsy Foundation from March through July 2001 in schools selected
by the affiliates. The questionnaire asked about respondents' (1)
demographics; (2) awareness of epilepsy; (3) knowledge of epilepsy; (4)
perceived stigmas associated with epilepsy; and (5) awareness of
muscular dystrophy, human immunodeficiency virus infection/acquired
immunodeficiency syndrome, arthritis, diabetes, breast cancer, and
Parkinson's Disease. Results are based on 19,441 usable questionnaires.
Thirty-six percent of the respondents felt that kids with epilepsy are
likely to get picked on or bullied more than other kids. Only 25 percent
felt this is unlikely to happen. Thirty-one percent were not sure whether
they would tell their friends if they had epilepsy. Although 31 percent of
the respondents reported they would date a person with epilepsy, 44
percent were not sure, and 11 percent said that they would not date
someone with epilepsy. Approximately half (49 percent) of the
respondents have never heard or read about epilepsy and only 20 percent
knew someone with epilepsy. Nearly half (49 percent) think epilepsy is
contagious or do not have enough knowledge to know that epilepsy is
not a contagious disease. Awareness and understanding of epilepsy
tended to be higher among girls, older students, and whites. More than
half (52 percent) of the respondents say people die from seizures and 19
percent say epilepsy is a mental illness. Based on awareness, only 34
percent of the respondents are informed about epilepsy and only 16
percent have high awareness scores. Most (62 percent) have low
awareness scores. Of all the chronic health conditions asked about, the
respondents were least familiar with epilepsy. Epilepsy was also the least
feared. Over two thirds (68 percent) did not know what to do if someone
had a seizure.
·
Epilepsy and Driving Licence Regulations
Source: Heemstede, The Netherlands, International Bureau for Epilepsy.
Heemstede, The Netherlands, International League Against Epilepsy, 91
p., September 1992.
Contact: International Bureau for Epilepsy, P.O. Box 21, 2100 AA
Heemstede, The Netherlands.
Summary: Epilepsy and Driving Licence Regulations, a report, promotes
the goal of uniformity in driver's license regulations in order to stimulate
the search for solutions to the many problems that still remain
unresolved. The report is divided into seven sections, and is based on the
efforts of seven physicians who work in separate parts of the world and
are recognized as having a special interest and experience in the field of
epilepsy and driving. The first section presents an introduction to the
controversy over driving license regulations for persons with histories of
epilepsy and the role physicians should play in these regulations. The
second section describes current driving license regulations in (1) Europe
(the European community, other western and northern European
countries, and eastern European countries); (2) the Middle East and Asian
countries; (3) Australasia (Australia and New Zealand); (4) Africa; (5)
North America (the United States and Canada); and (6) South America.
The third section reviews selected data from the large volume of
literature on the topic of epilepsy accident rates and recurrence risks. The
fourth section discusses some of the mainly clinical problems that arise
with respect to epilepsy and suggests ways in which they can be
addressed: (1) Prognosis, (2) single unprovoked seizures, (3) epilepsies
and seizures, (4) provoked seizures, (5) trauma and craniotomy, and (6)
cerebrovascular disorders. The fifth section addresses the question of
medical fitness to undertake commercial driving. The sixth section
examines legal considerations with regard to physician and patient
responsibility. The final section offers guidelines for granting driving
licenses. Items and remarks that could not be included in the main body
of the report are provided in an appendix.
·
Measurement of Physiologic Health for Children: Volume 3: Seizure
Disorders
Source: Santa Monica, CA, Rand Corporation, Health Insurance
Experiment Series, 60 p., January 1983.
Contact: RAND, Distribution Services, 1700 Main Street, P.O. Box 2138,
Santa Monica, CA 90407-2138. (310) 393-0411, ext. 6686. RAND/R2898/3-HHS.
Summary: Measurement of Physiologic Health for Children: Volume 3,
Seizure Disorders describes the enrollment results of the child health
portion of the Rand Health Insurance Experiment, a large-scale social
experiment that was designed to assess how varying the cost to the
patient of health services affects the use of services, quality of care,
patient satisfaction, and health status. It was also designed to study how
the provision of services in either the fee-for-service system or a prepaid
group practice affects those same variables. Chapters include (1) an
introduction; (2) definitions and measurement issues for febrile and
epileptic seizures; (3) justification for selecting seizure disorders for
health insurance experiment analyses, including a discussion of general
considerations and the incidence and prevalence, morbidity and
mortality, and effects on medical care of febrile seizures and epilepsy; (4)
health insurance experiment methods, including a discussion of the
prevalence of seizure disorders among children, criteria for classification,
the impact of the disease, and the effects of generous insurance; (5) health
insurance experiment enrollment results, including the enrollment
sample, the prevalence of seizures according to the Medical History
Questionnaire, the impact of the disease, and the prevalence of seizures
according to health insurance experiment insurance plans to which they
were assigned; and (6) criteria for evaluating the quality of care rendered
to children with seizure disorders. Appendixes include lists of the
common types of seizure disorders, seizure disorders batteries from the
Medical History Questionnaire, the distribution of responses to disease
impact questions, and quality-of-care criteria for seizure disorders in
children.
·
Epilepsy Foundation of America Materials
Source: Landover, MD: Epilepsy Foundation of America. 1990. 19 pp.
Contact: Available from Epilepsy Foundation , 4351 Garden City Drive,
Landover, MD 20785. Telephone: (301) 459-3700 or (800) EFA-1000 / fax:
(301) 577-2684 / e-mail: postmaster@efa.org / Web site:
http://www.efa.org. Available at no charge.
Summary: This catalog lists materials available form the Epilepsy
Foundation of America including educational materials produced as part
of the foundation's transcultural education campaign. Materials have
been produced in both English and Spanish and include brochures,
posters, a psychosocial seizures inventory, and slides and cassettes.
Selected English-language brochures have been revised with special
relevance for black communities.
The NLM Gateway28
The NLM (National Library of Medicine) Gateway is a Web-based system
that lets users search simultaneously in multiple retrieval systems at the U.S.
National Library of Medicine (NLM). It allows users of NLM services to
initiate searches from one Web interface, providing “one-stop searching” for
many of NLM’s information resources or databases.29 One target audience
for the Gateway is the Internet user who is new to NLM’s online resources
and does not know what information is available or how best to search for it.
This audience may include physicians and other healthcare providers,
researchers, librarians, students, and, increasingly, patients, their families,
and the public.30 To use the NLM Gateway, simply go to the search site at
http://gateway.nlm.nih.gov/gw/Cmd. Type “seizures and epilepsy” (or
synonyms) into the search box and click “Search.” The results will be
presented in a tabular form, indicating the number of references in each
database category.
Results Summary
Category
Items Found
Journal Articles
355308
Books / Periodicals / Audio Visual
2595
Consumer Health
294
Meeting Abstracts
2575
Other Collections
96
Total
360868
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
The NLM Gateway is currently being developed by the Lister Hill National Center for
Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the
National Institutes of Health (NIH).
30 Other users may find the Gateway useful for an overall search of NLM’s information
resources. Some searchers may locate what they need immediately, while others will utilize
the Gateway as an adjunct tool to other NLM search services such as PubMed® and
MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while
also providing a search interface for its own collections. These collections include various
types of information that do not logically belong in PubMed, LOCATORplus, or other
established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal
citations). The Gateway will provide access to the information found in an increasing
number of NLM retrieval systems in several phases.
28
29
HSTAT31
HSTAT is a free, Web-based resource that provides access to full-text
documents used in healthcare decision-making.32 HSTAT’s audience
includes healthcare providers, health service researchers, policy makers,
insurance companies, consumers, and the information professionals who
serve these groups. HSTAT provides access to a wide variety of publications,
including clinical practice guidelines, quick-reference guides for clinicians,
consumer health brochures, evidence reports and technology assessments
from the Agency for Healthcare Research and Quality (AHRQ), as well as
AHRQ’s Put Prevention Into Practice.33 Simply search by “seizures and
epilepsy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists34
Some patients may wish to have access to a general healthcare site that takes
a scientific view of the news and covers recent breakthroughs in biology that
may one day assist physicians in developing treatments. To this end, we
recommend “Coffee Break,” a collection of short reports on recent biological
discoveries. Each report incorporates interactive tutorials that demonstrate
how bioinformatics tools are used as a part of the research process.
Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about
400 words and is usually based on a discovery reported in one or more
articles from recently published, peer-reviewed literature.36 This site has new
Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.
The HSTAT URL is http://hstat.nlm.nih.gov/.
33 Other important documents in HSTAT include: the National Institutes of Health (NIH)
Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS
Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental
Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT)
Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention
(SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health
Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the
independent, nonfederal Task Force on Community Services Guide to Community Preventive
Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health
Care Commission (MHCC) health technology evaluations.
34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
35 The figure that accompanies each article is frequently supplied by an expert external to
NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that
tells a biological story.
36 After a brief introduction that sets the work described into a broader context, the report
focuses on how a molecular understanding can provide explanations of observed biology
and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext
links that lead to a series of pages that interactively show how NCBI tools and resources are
used in the research process.
31
32
articles every few weeks, so it can be considered an online magazine of sorts,
and intended for general background information. You can access the Coffee
Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases
In addition to resources maintained by official agencies, other databases exist
that are commercial ventures addressing medical professionals. Here are a
few examples that may interest you:
·
CliniWeb International: Index and table of contents to selected clinical
information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that
integrates a wide range of digitized clinical images with textual data
stored in the University of Pittsburgh Medical Center’s MARS electronic
medical
record
system;
see
the
following
Web
site:
http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected
medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential
diagnoses for any list of signs and symptoms, to search medical
literature,
and
to
explore
relevant
Web
sites;
see
http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers
and medical records personnel. It converts the informal language
generally used by caregivers into terms from formal, controlled
vocabularies; see http://www.lexical.com/Metaphrase.html.
The Genome Project and Seizures and Epilepsy
With all the discussion in the press about the Human Genome Project, it is
only natural that physicians, researchers, and patients want to know about
how human genes relate to seizures and epilepsy. In the following section,
we will discuss databases and references used by physicians and scientists
who work in this area.
Online Mendelian Inheritance in Man (OMIM)
The Online Mendelian Inheritance in Man (OMIM) database is a catalog of
human genes and genetic disorders authored and edited by Dr. Victor A.
McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was
developed for the World Wide Web by the National Center for
Biotechnology Information (NCBI).37 The database contains textual
information, pictures, and reference information. It also contains copious
links to NCBI’s Entrez database of MEDLINE articles and sequence
information.
Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the
database. Type “seizures and epilepsy” (or synonyms) in the search box, and
click “Submit Search.” If too many results appear, you can narrow the search
by adding the word “clinical.” Each report will have additional links to
related research and databases. By following these links, especially the link
titled “Database Links,” you will be exposed to numerous specialized
databases that are largely used by the scientific community. These databases
are overly technical and seldom used by the general public, but offer an
abundance of information. The following is an example of the results you
can obtain from the OMIM for seizures and epilepsy:
·
Alopecia-mental Retardation Syndrome with
Hypergonadotropic Hypogonadism
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601217
·
Benign Familial Infantile Convulsions
·
Febrile Seizures
Convulsions
and
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource
for molecular biology information, NCBI creates public databases, conducts research in
computational biology, develops software tools for analyzing genome data, and
disseminates biomedical information--all for the better understanding of molecular
processes affecting human health and disease.
37
·
Generalized Epilepsy with Febrile Seizures Plus
·
Kifafa Seizure Disorder
Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for
Biotechnology Information of the National Library of Medicine at the
National Institutes of Health. This Web site categorizes each disorder by the
system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and
browse the system pages to have a full view of important conditions linked
to human genes. Since this site is regularly updated, you may wish to re-visit
it from time to time. The following systems and associated disorders are
addressed:
·
Muscle and Bone: Movement and growth.
Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome,
Marfan syndrome, myotonic dystrophy, spinal muscular atrophy.
Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body.
Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman
syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor,
Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome,
Spinocerebellar atrophy, Williams syndrome.
Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages.
Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome,
Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg
syndrome, Werner syndrome.
Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
Entrez
Entrez is a search and retrieval system that integrates several linked
databases at the National Center for Biotechnology Information (NCBI).
These databases include nucleotide sequences, protein sequences,
macromolecular structures, whole genomes, and MEDLINE through
PubMed. Entrez provides access to the following databases:
·
PubMed: Biomedical literature (PubMed),
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank):
Web site:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database:
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank,
Web site:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO),
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results:
Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To
access
the
Entrez
system
at
the
NCBI,
go
to
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom
e, and then select the database that you would like to search. The databases
available are listed in the drop box next to “Search.” In the box next to “for,”
enter “seizures and epilepsy” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation
(MCA/MR) Syndromes Database38
This online resource can be quite useful. It has been developed to facilitate
the identification and differentiation of syndromic entities. Special attention
is given to the type of information that is usually limited or completely
omitted in existing reference sources due to space limitations of the printed
form.
At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you
can also search across syndromes using an alphabetical index. Search by
keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html.
The Genome Database39
Established at Johns Hopkins University in Baltimore, Maryland in 1990, the
Genome Database (GDB) is the official central repository for genomic
mapping data resulting from the Human Genome Initiative. In the spring of
1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for
Sick Children in Toronto, Ontario assumed the management of GDB. The
Human Genome Initiative is a worldwide research effort focusing on
structural analysis of human DNA to determine the location and sequence of
the estimated 100,000 human genes. In support of this project, GDB stores
and curates data generated by researchers worldwide who are engaged in
the mapping effort of the Human Genome Project (HGP). GDB’s mission is
to provide scientists with an encyclopedia of the human genome which is
continually revised and updated to reflect the current state of scientific
knowledge. Although GDB has historically focused on gene mapping, its
focus will broaden as the Genome Project moves from mapping to sequence,
and finally, to functional analysis.
To access the GDB, simply go to the following hyperlink:
http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type
“seizures and epilepsy” (or synonyms) into the search box, and review the
Adapted from the National Library of Medicine:
http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
39 Adapted from the Genome Database:
http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
38
results. If more than one word is used in the search box, then separate each
one with the word “and” or “or” (using “or” might be useful when using
synonyms). This database is extremely technical as it was created for
specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact
names are also accessible to non-professionals.
Specialized References
The following books are specialized references written for professionals
interested in seizures and epilepsy (sorted alphabetically by title, hyperlinks
provide rankings, information, and reviews at Amazon.com):
· The Behavioral Neurology of White Matter by Christopher M. Filley;
Paperback - 279 pages; 1st edition (September 15, 2001), Oxford University
Press; ISBN: 019513561X;
http://www.amazon.com/exec/obidos/ASIN/019513561X/icongroupintern
a
· The Cerebellum and Its Disorders by Mario-Ubaldo Manto, Massimo
Pandolfo; Hardcover - 1st edition (January 2002), Cambridge University
Press; ISBN: 0521771560;
· Clinical Neurology by David A. Greenberg, et al; Paperback - 390 pages;
5th edition (February 9, 2002), Appleton & Lange; ISBN: 0071375430;
· Clinical Neurology for Psychiatrists by David M. Kaufman; Hardcover 670 pages, 5th edition (January 15, 2001), W. B. Saunders Co.; ISBN:
0721689957;
· Comprehensive Neurology by Roger N. Rosenberg (Editor), David E.
Pleasure (Editor); 1280 pages, 2nd edition (April 1998), Wiley-Liss; ISBN:
0471169587;
· Emergent and Urgent Neurology by William J. Weiner (Editor), Lisa M.
Shulman (Editor); Hardcover - 571 pages; 2nd edition (January 15, 1999),
Lippincott, Williams & Wilkins Publishers; ISBN: 0397518579;
· Neurology in Clinical Practice: Volume I: Principles of Diagnosis and
Management, Volume II: The Neurological Disorders (2-Volume Set,
Includes a 12-Month Subscription to the Online Edition) by W. G.
Bradley, et al; Hardcover - 2413 pages, 3rd edition, Vol 1-2 (January 15,
2000), Butterworth-Heinemann; ISBN: 0750699736;
· Neuroscience: Exploring the Brain by Mark F. Bear, et al; Hardcover - 855
pages, 2nd edition (January 15, 2001), Lippincott, Williams & Wilkins
Publishers; ISBN: 0683305964;
· Office Practice of Neurology by Martain A. Samuels, Steven F. Feske;
Hardcover, Churchill Livingstone; ISBN: 0443065578;
· Patient-Based Approaches to Cognitive Neuroscience by Martha J. Farah
(Editor), Todd E. Feinberg (Editor); Paperback - 425 pages (April 3, 2000),
MIT Press; ISBN: 0262561239;
· Principles of Neural Science by Eric R. Kandel (Editor), et al; Hardcover 1414 pages, 4th edition (January 5, 2000), McGraw-Hill Professional
Publishing; ISBN: 0838577016;
· Review Manual for Neurology in Clinical Practice by Karl E. Misulis, et
al; Paperback, Butterworth-Heinemann Medical; ISBN: 0750671920;
Vocabulary Builder
Alopecia: Baldness; absence of the hair from skin areas where it normally is
present. [EU]
Cerebellum: Part of the metencephalon that lies in the posterior cranial
fossa behind the brain stem. It is concerned with the coordination of
movement. [NIH]
Dystrophy: Any disorder arising from defective or faulty nutrition,
especially the muscular dystrophies. [EU]
Hypogonadism: A condition resulting from or characterized by abnormally
decreased functional activity of the gonads, with retardation of growth and
sexual development. [EU]
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin
plays a major role in the regulation of glucose metabolism, generally
promoting the cellular utilization of glucose. It is also an important regulator
of protein and lipid metabolism. Insulin is used as a drug to control insulin-
dependent diabetes mellitus. [NIH]
Nervousness: Excessive excitability and irritability, with mental and
physical unrest. [EU]
Perspiration: Sweating; the functional secretion of sweat. [EU]
Dissertations 239
CHAPTER 10. DISSERTATIONS ON SEIZURES AND EPILEPSY
Overview
University researchers are active in studying almost all known diseases. The
result of research is often published in the form of Doctoral or Master’s
dissertations. You should understand, therefore, that applied diagnostic
procedures and/or therapies can take many years to develop after the thesis
that proposed the new technique or approach was written.
In this chapter, we will give you a bibliography on recent dissertations
relating to seizures and epilepsy. You can read about these in more detail
using the Internet or your local medical library. We will also provide you
with information on how to use the Internet to stay current on dissertations.
Dissertations on Seizures and Epilepsy
ProQuest Digital Dissertations is the largest archive of academic dissertations
available. From this archive, we have compiled the following list covering
dissertations devoted to seizures and epilepsy. You will see that the
information provided includes the dissertation’s title, its author, and the
author’s institution. To read more about the following, simply use the
Internet address indicated. The following covers recent dissertations dealing
with seizures and epilepsy:
·
A Study of Subjective Symptoms Associated with Seizure Disorders in
Adolescents by Elaine Fletcher-Janzen, EDD from the College of William
and Mary, 1993, 115 pages
http://wwwlib.umi.com/dissertations/fullcit/9414206
Keeping Current
As previously mentioned, an effective way to stay current on dissertations
dedicated to seizures and epilepsy is to use the database called ProQuest
Digital Dissertations via the Internet, located at the following Web address:
http://wwwlib.umi.com/dissertations. The site allows you to freely access
the last two years of citations and abstracts. Ask your medical librarian if the
library has full and unlimited access to this database. From the library, you
should be able to do more complete searches than with the limited 2-year
access available to the general public.
241
PART III. APPENDICES
ABOUT PART III
Part III is a collection of appendices on general medical topics which may be
of interest to patients with seizures and epilepsy and related conditions.
Researching Your Medications 243
APPENDIX A. RESEARCHING YOUR MEDICATIONS
Overview
There are a number of sources available on new or existing medications
which could be prescribed to patients with seizures and epilepsy. While a
number of hard copy or CD-Rom resources are available to patients and
physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of
medications. We will then proceed to outline official recommendations on
how you should view your medications. You may also want to research
medications that you are currently taking for other conditions as they may
interact with medications for seizures and epilepsy. Research can give you
information on the side effects, interactions, and limitations of prescription
drugs used in the treatment of seizures and epilepsy. Broadly speaking,
there are two sources of information on approved medications: public
sources and private sources. We will emphasize free-to-use public sources.
Your Medications: The Basics40
The Agency for Health Care Research and Quality has published extremely
useful guidelines on how you can best participate in the medication aspects
of seizures and epilepsy. Taking medicines is not always as simple as
swallowing a pill. It can involve many steps and decisions each day. The
AHCRQ recommends that patients with seizures and epilepsy take part in
treatment decisions. Do not be afraid to ask questions and talk about your
concerns. By taking a moment to ask questions early, you may avoid
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
problems later. Here are some points to cover each time a new medicine is
prescribed:
·
Ask about all parts of your treatment, including diet changes, exercise,
and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you
might receive.
·
Ask how often you or your doctor will check for side effects from a given
medication.
Do not hesitate to ask what is important to you about your medicines. You
may want a medicine with the fewest side effects, or the fewest doses to take
each day. You may care most about cost, or how the medicine might affect
how you live or work. Or, you may want the medicine your doctor believes
will work the best. Telling your doctor will help him or her select the best
treatment for you.
Do not be afraid to “bother” your doctor with your concerns and questions
about medications for seizures and epilepsy. You can also talk to a nurse or a
pharmacist. They can help you better understand your treatment plan. Feel
free to bring a friend or family member with you when you visit your doctor.
Talking over your options with someone you trust can help you make better
choices, especially if you are not feeling well. Specifically, ask your doctor
the following:
·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how
long.
·
What food, drinks, other medicines, or activities you should avoid while
taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have
information sheets on your prescription medicines; some even offer
large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently
taking (not just those for seizures and epilepsy). This includes prescription
medicines and the medicines that you buy over the counter. Then your
doctor can avoid giving you a new medicine that may not work well with
the medications you take now. When talking to your doctor, you may wish
to prepare a list of medicines you currently take, the reason you take them,
and how you take them. Be sure to include the following information for
each:
·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as:
·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications
Because of historical investments by various organizations and the
emergence of the Internet, it has become rather simple to learn about the
medications your doctor has recommended for seizures and epilepsy. One
such source is the United States Pharmacopeia. In 1820, eleven physicians
met in Washington, D.C. to establish the first compendium of standard
drugs for the United States. They called this compendium the “U.S.
Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting
of 800 volunteer scientists, eleven elected officials, and 400 representatives of
state associations and colleges of medicine and pharmacy. The USP is located
in Rockville, Maryland, and its home page is located at www.usp.org. The
USP currently provides standards for over 3,700 medications. The resulting
USP DIÒ Advice for the PatientÒ can be accessed through the National
Library of Medicine of the National Institutes of Health. The database is
partially derived from lists of federally approved medications in the Food
and Drug Administration’s (FDA) Drug Approvals database.41
While the FDA database is rather large and difficult to navigate, the
Phamacopeia is both user-friendly and free to use. It covers more than 9,000
prescription and over-the-counter medications. To access this database,
simply type the following hyperlink into your Web browser:
http://www.nlm.nih.gov/medlineplus/druginformation.html.
To
view
examples of a given medication (brand names, category, description,
preparation, proper use, precautions, side effects, etc.), simply follow the
hyperlinks indicated within the United States Pharmacopoeia (USP). It is
important that you take the time to read the disclaimer by the USP
(http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using
the information provided.
Of course, we as editors cannot be certain as to what medications you are
taking. Therefore, we have compiled a list of medications associated with the
treatment of seizures and epilepsy. Once again, due to space limitations, we
only list a sample of medications and provide hyperlinks to ample
documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).
The following drugs have been mentioned in the Pharmacopeia and other
sources as being potentially applicable to seizures and epilepsy:
Anesthetics, General
·
Systemic - U.S. Brands: Amidate; Brevital; Diprivan; Ethrane;
Fluothane; Forane; Ketalar; Penthrane; Pentothal
http://www.nlm.nih.gov/medlineplus/druginfo/anestheticsgene
ralsystemic203043.html
Anticonvulsants, Hydantoin
·
Systemic - U.S. Brands: Cerebyx; Dilantin; Dilantin Infatabs;
Dilantin Kapseals; Dilantin-125; Mesantoin; Peganone; Phenytex
http://www.nlm.nih.gov/medlineplus/druginfo/anticonvulsants
hydantoinsystem202052.html
Though cumbersome, the FDA database can be freely browsed at the following site:
www.fda.gov/cder/da/da.htm.
41
Anticonvulsants, Succinimide
·
Systemic - U.S. Brands: Celontin; Zarontin
http://www.nlm.nih.gov/medlineplus/druginfo/anticonvulsants
succinimidesyst202053.html
Benzodiazepines
·
Systemic - U.S. Brands: Alprazolam Intensol; Ativan; Dalmane;
Diastat; Diazepam Intensol; Dizac; Doral; Halcion; Klonopin;
Librium; Lorazepam Intensol; Paxipam; ProSom; Restoril; Serax;
Tranxene T-Tab; Tranxene-SD; Tranxene-SD Half Strength; Valium;
Xanax
http://www.nlm.nih.gov/medlineplus/druginfo/benzodiazepine
ssystemic202084.html
Bupropion
·
Systemic - U.S. Brands: Wellbutrin; Zyban
http://www.nlm.nih.gov/medlineplus/druginfo/bupropionsyste
mic202098.html
Carbamazepine
·
Systemic - U.S. Brands: Atretol; Carbatrol; Epitol; Tegretol;
Tegretol-XR
http://www.nlm.nih.gov/medlineplus/druginfo/carbamazepines
ystemic202111.html
Carbonic Anhydrase Inhibitors
·
Systemic - U.S. Brands: Ak-Zol; Daranide; Dazamide; Diamox;
Diamox Sequels; MZM; Neptazane; Storzolamide
http://www.nlm.nih.gov/medlineplus/druginfo/carbonicanhydr
aseinhibitorssys202114.html
Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed
·
Systemic - U.S. Brands: Acel-Imune; Certiva; Infanrix; Tripedia
http://www.nlm.nih.gov/medlineplus/druginfo/diphtheriaandte
tanustoxoidsand202201.html
·
Systemic - U.S. Brands: Tetramune
http://www.nlm.nih.gov/medlineplus/druginfo/diphtheriaandte
tanustoxoidsand202911.html
Felbamate
·
Systemic - U.S. Brands: Felbatol
http://www.nlm.nih.gov/medlineplus/druginfo/felbamatesyste
mic202711.html
Gabapentin
·
Systemic - U.S. Brands: Neurontin
http://www.nlm.nih.gov/medlineplus/druginfo/gabapentinsyste
mic202732.html
Lamotrigine
·
Systemic - U.S. Brands: Lamictal
http://www.nlm.nih.gov/medlineplus/druginfo/lamotriginesyst
emic202786.html
Levetiracetam
·
Systemic - U.S. Brands: Keppra
http://www.nlm.nih.gov/medlineplus/druginfo/levetiracetamsy
stemic500101.html
Measles Virus Vaccine Live
·
Systemic - U.S. Brands: Attenuvax
http://www.nlm.nih.gov/medlineplus/druginfo/measlesvirusvac
cinelivesystemi202338.html
Oxcarbazepine
·
Systemic - U.S. Brands: Trileptal
http://www.nlm.nih.gov/medlineplus/druginfo/oxcarbazepines
ystemic500111.html
Primidone
·
Systemic - U.S. Brands: Myidone; Mysoline
http://www.nlm.nih.gov/medlineplus/druginfo/primidonesyste
mic202479.html
Pyridoxine (Vitamin B6)
·
Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex
http://www.nlm.nih.gov/medlineplus/druginfo/pyridoxinevita
minb6systemic202493.html
Tetanus Immune Globulin
·
Systemic - U.S. Brands: BayTet
http://www.nlm.nih.gov/medlineplus/druginfo/tetanusimmune
globulinsystemic202908.html
Tiagabine
·
Systemic - U.S. Brands: Gabitril
http://www.nlm.nih.gov/medlineplus/druginfo/tiagabinesystem
ic203392.html
Topiramate
·
Systemic - U.S. Brands: Topamax
http://www.nlm.nih.gov/medlineplus/druginfo/topiramatesyste
mic203085.html
Valproic Acid
·
Systemic - U.S. Brands: Depacon; Depakene; Depakote; Depakote
Sprinkle
http://www.nlm.nih.gov/medlineplus/druginfo/valproicacidsyst
emic202588.html
Zonisamide
·
Systemic - U.S. Brands: Zonegran
http://www.nlm.nih.gov/medlineplus/druginfo/zonisamidesyst
emic500137.html
Commercial Databases
In addition to the medications listed in the USP above, a number of
commercial sites are available by subscription to physicians and their
institutions. You may be able to access these sources from your local medical
library or your doctor’s office.
Reuters Health Drug Database
The Reuters Health Drug Database can be searched by keyword at the
hyperlink: http://www.reutershealth.com/frame2/drug.html.
Mosby’s GenRx
Mosby’s GenRx database (also available on CD-Rom and book format)
covers 45,000 drug products including generics and international brands. It
provides prescribing information, drug interactions, and patient information.
Information
can
be
obtained
at
the
following
hyperlink:
http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference
The Physicians Desk Reference database (also available in CD-Rom and book
format) is a full-text drug database. The database is searchable by brand
name, generic name or by indication. It features multiple drug interactions
reports. Information can be obtained at the following hyperlink:
http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites
A number of additional Web sites discuss drug information. As an example,
you may like to look at www.drugs.com which reproduces the information
in the Pharmacopeia as well as commercial information. You may also want
to consider the Web site of the Medical Letter, Inc. which allows users to
download articles on various drugs and therapeutics for a nominal fee:
http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers)
Some of the medications mentioned in the previous discussions can be
problematic for patients with seizures and epilepsy--not because they are
used in the treatment process, but because of contraindications, or side
effects. Medications with contraindications are those that could react with
drugs used to treat seizures and epilepsy or potentially create deleterious
side effects in patients with seizures and epilepsy. You should ask your
physician about any contraindications, especially as these might apply to
other medications that you may be taking for common ailments.
Drug-drug interactions occur when two or more drugs react with each other.
This drug-drug interaction may cause you to experience an unexpected side
effect. Drug interactions may make your medications less effective, cause
unexpected side effects, or increase the action of a particular drug. Some
drug interactions can even be harmful to you.
Be sure to read the label every time you use a nonprescription or
prescription drug, and take the time to learn about drug interactions. These
precautions may be critical to your health. You can reduce the risk of
potentially harmful drug interactions and side effects with a little bit of
knowledge and common sense.
Drug labels contain important information about ingredients, uses,
warnings, and directions which you should take the time to read and
understand. Labels also include warnings about possible drug interactions.
Further, drug labels may change as new information becomes available. This
is why it’s especially important to read the label every time you use a
medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins,
botanicals, minerals and herbals you take as well as the foods you eat. Ask
your pharmacist for the package insert for each prescription drug you take.
The package insert provides more information about potential drug
interactions.
A Final Warning
At some point, you may hear of alternative medications from friends,
relatives, or in the news media. Advertisements may suggest that certain
alternative drugs can produce positive results for patients with seizures and
epilepsy. Exercise caution--some of these drugs may have fraudulent claims,
and others may actually hurt you. The Food and Drug Administration (FDA)
is the official U.S. agency charged with discovering which medications are
likely to improve the health of patients with seizures and epilepsy. The FDA
warns patients to watch out for42:
·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t
happen very often; when they do, real scientists do not call them amazing
or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
42
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
If you have any questions about any kind of medical treatment, the FDA
may have an office near you. Look for their number in the blue pages of the
phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at
www.fda.gov.
General References
In addition to the resources provided earlier in this chapter, the following
general references describe medications (sorted alphabetically by title;
hyperlinks provide rankings, information and reviews at Amazon.com):
· Current Therapy in Neurologic Disease by Richard T. Johnson, et al;
Hardcover - 457 pages, 6th edition (January 15, 2002), Mosby-Year Book;
ISBN: 0323014720;
· Emerging Pharmacological Tools in Clinical Neurology by MedPanel Inc.
(Author); Digital - 66 pages, MarketResearch.com; ISBN: B00005RBN8;
http://www.amazon.com/exec/obidos/ASIN/B00005RBN8/icongroupinter
na
· Goodman & Gilman’s The Pharmacological Basis of Therapeutics by Joel
G. Hardman (Editor), Lee E. Limbird; Hardcover - 1825 pages, 10th edition
(August 13, 2001), McGraw-Hill Professional Publishing; ISBN:
0071354697;
· Neurology and General Medicine by Michael J. Aminoff (Editor),
Hardcover - 992 pages, 3rd edition (March 15, 2001), Churchill Livingstone;
ISBN: 0443065713;
· Neurology and Medicine by Hughes Perkins; Hardcover - 415 pages, 1st
edition (December 15, 1999), B. M. J. Books; ISBN: 0727912240;
· Pharmacological Management of Neurological and Psychiatric Disorders
by S. J. Enna (Editor), et al; Hardcover - 736 pages, 1st edition, McGrawHill Professional Publishing; ISBN: 0070217645;
Vocabulary Builder
Benzodiazepines: A two-ring heterocyclic compound consisting of a
benzene ring fused to a diazepine ring. Permitted is any degree of
hydrogenation, any substituents and any H-isomer. [NIH]
Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic,
anticonvulsant, and considerable sedative properties and has been proposed
as a preanesthetic agent. [NIH]
Toxoids: Preparations of pathogenic organisms or their derivatives made
nontoxic and intended for active immunologic prophylaxis. They include
deactivated toxins. [NIH]
Researching Alternative Medicine 255
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE
Overview
Complementary and alternative medicine (CAM) is one of the most
contentious aspects of modern medical practice. You may have heard of
these treatments on the radio or on television. Maybe you have seen articles
written about these treatments in magazines, newspapers, or books. Perhaps
your friends or doctor have mentioned alternatives.
In this chapter, we will begin by giving you a broad perspective on
complementary and alternative therapies. Next, we will introduce you to
official information sources on CAM relating to seizures and epilepsy.
Finally, at the conclusion of this chapter, we will provide a list of readings on
seizures and epilepsy from various authors. We will begin, however, with
the National Center for Complementary and Alternative Medicine’s
(NCCAM) overview of complementary and alternative medicine.
What Is CAM?43
Complementary and alternative medicine (CAM) covers a broad range of
healing philosophies, approaches, and therapies. Generally, it is defined as
those treatments and healthcare practices which are not taught in medical
schools, used in hospitals, or reimbursed by medical insurance companies.
Many CAM therapies are termed “holistic,” which generally means that the
healthcare practitioner considers the whole person, including physical,
mental, emotional, and spiritual health. Some of these therapies are also
known as “preventive,” which means that the practitioner educates and
43
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
treats the person to prevent health problems from arising, rather than
treating symptoms after problems have occurred.
People use CAM treatments and therapies in a variety of ways. Therapies are
used alone (often referred to as alternative), in combination with other
alternative therapies, or in addition to conventional treatment (sometimes
referred to as complementary). Complementary and alternative medicine, or
“integrative medicine,” includes a broad range of healing philosophies,
approaches, and therapies. Some approaches are consistent with
physiological principles of Western medicine, while others constitute healing
systems with non-Western origins. While some therapies are far outside the
realm of accepted Western medical theory and practice, others are becoming
established in mainstream medicine.
Complementary and alternative therapies are used in an effort to prevent
illness, reduce stress, prevent or reduce side effects and symptoms, or
control or cure disease. Some commonly used methods of complementary or
alternative therapy include mind/body control interventions such as
visualization and relaxation, manual healing including acupressure and
massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?44
The list of CAM practices changes continually. The reason being is that these
new practices and therapies are often proved to be safe and effective, and
therefore become generally accepted as “mainstream” healthcare practices.
Today, CAM practices may be grouped within five major domains: (1)
alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy
therapies. The individual systems and treatments comprising these
categories are too numerous to list in this sourcebook. Thus, only limited
examples are provided within each.
Alternative Medical Systems
Alternative medical systems involve complete systems of theory and practice
that have evolved independent of, and often prior to, conventional
biomedical approaches. Many are traditional systems of medicine that are
44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
practiced by individual cultures throughout the world, including a number
of venerable Asian approaches.
Traditional oriental medicine emphasizes the balance or disturbances of qi
(pronounced chi) or vital energy in health and disease, respectively.
Traditional oriental medicine consists of a group of techniques and methods
including acupuncture, herbal medicine, oriental massage, and qi gong (a
form of energy therapy). Acupuncture involves stimulating specific
anatomic points in the body for therapeutic purposes, usually by puncturing
the skin with a thin needle.
Ayurveda is India’s traditional system of medicine. Ayurvedic medicine
(meaning “science of life”) is a comprehensive system of medicine that
places equal emphasis on body, mind, and spirit. Ayurveda strives to restore
the innate harmony of the individual. Some of the primary Ayurvedic
treatments include diet, exercise, meditation, herbs, massage, exposure to
sunlight, and controlled breathing.
Other traditional healing systems have been developed by the world’s
indigenous populations. These populations include Native American,
Aboriginal, African, Middle Eastern, Tibetan, and Central and South
American cultures. Homeopathy and naturopathy are also examples of
complete alternative medicine systems.
Homeopathic medicine is an unconventional Western system that is based
on the principle that “like cures like,” i.e., that the same substance that in
large doses produces the symptoms of an illness, in very minute doses cures
it. Homeopathic health practitioners believe that the more dilute the remedy,
the greater its potency. Therefore, they use small doses of specially prepared
plant extracts and minerals to stimulate the body’s defense mechanisms and
healing processes in order to treat illness.
Naturopathic medicine is based on the theory that disease is a manifestation
of alterations in the processes by which the body naturally heals itself and
emphasizes health restoration rather than disease treatment. Naturopathic
physicians employ an array of healing practices, including the following:
diet and clinical nutrition, homeopathy, acupuncture, herbal medicine,
hydrotherapy (the use of water in a range of temperatures and methods of
applications), spinal and soft-tissue manipulation, physical therapies (such
as those involving electrical currents, ultrasound, and light), therapeutic
counseling, and pharmacology.
Mind-Body Interventions
Mind-body interventions employ a variety of techniques designed to
facilitate the mind’s capacity to affect bodily function and symptoms. Only a
select group of mind-body interventions having well-documented theoretical
foundations are considered CAM. For example, patient education and
cognitive-behavioral approaches are now considered “mainstream.” On the
other hand, complementary and alternative medicine includes meditation,
certain uses of hypnosis, dance, music, and art therapy, as well as prayer and
mental healing.
Biological-Based Therapies
This category of CAM includes natural and biological-based practices,
interventions, and products, many of which overlap with conventional
medicine’s use of dietary supplements. This category includes herbal, special
dietary, orthomolecular, and individual biological therapies.
Herbal therapy employs an individual herb or a mixture of herbs for healing
purposes. An herb is a plant or plant part that produces and contains
chemical substances that act upon the body. Special diet therapies, such as
those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to
prevent and/or control illness as well as promote health. Orthomolecular
therapies aim to treat disease with varying concentrations of chemicals such
as magnesium, melatonin, and mega-doses of vitamins. Biological therapies
include, for example, the use of laetrile and shark cartilage to treat cancer
and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods
This category includes methods that are based on manipulation and/or
movement of the body. For example, chiropractors focus on the relationship
between structure and function, primarily pertaining to the spine, and how
that relationship affects the preservation and restoration of health.
Chiropractors use manipulative therapy as an integral treatment tool.
In contrast, osteopaths place particular emphasis on the musculoskeletal
system and practice osteopathic manipulation. Osteopaths believe that all of
the body’s systems work together and that disturbances in one system may
have an impact upon function elsewhere in the body. Massage therapists
manipulate the soft tissues of the body to normalize those tissues.
Energy Therapies
Energy therapies focus on energy fields originating within the body
(biofields) or those from other sources (electromagnetic fields). Biofield
therapies are intended to affect energy fields (the existence of which is not
yet experimentally proven) that surround and penetrate the human body.
Some forms of energy therapy manipulate biofields by applying pressure
and/or manipulating the body by placing the hands in or through these
fields. Examples include qi gong, reiki and therapeutic touch.
Qi gong is a component of traditional oriental medicine that combines
movement, meditation, and regulation of breathing to enhance the flow of
vital energy (qi) in the body, improve blood circulation, and enhance
immune function. Reiki, the Japanese word representing Universal Life
Energy, is based on the belief that, by channeling spiritual energy through
the practitioner, the spirit is healed and, in turn, heals the physical body.
Therapeutic Touch is derived from the ancient technique of “laying-on of
hands.” It is based on the premises that the therapist’s healing force affects
the patient’s recovery and that healing is promoted when the body’s energies
are in balance. By passing their hands over the patient, these healers identify
energy imbalances.
Bioelectromagnetic-based therapies involve the unconventional use of
electromagnetic fields to treat illnesses or manage pain. These therapies are
often used to treat asthma, cancer, and migraine headaches. Types of
electromagnetic fields which are manipulated in these therapies include
pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment?
A critical issue in pursuing complementary alternatives mentioned thus far
is the risk that these might have undesirable interactions with your medical
treatment. It becomes all the more important to speak with your doctor who
can offer advice on the use of alternatives. Official sources confirm this view.
Though written for women, we find that the National Women’s Health
Information Center’s advice on pursuing alternative medicine is appropriate
for patients of both genders and all ages.45
45
Adapted from http://www.4woman.gov/faq/alternative.htm.
Is It Okay to Want Both Traditional and Alternative or
Complementary Medicine?
Should you wish to explore non-traditional types of treatment, be sure to
discuss all issues concerning treatments and therapies with your healthcare
provider, whether a physician or practitioner of complementary and
alternative medicine. Competent healthcare management requires
knowledge of both conventional and alternative therapies you are taking for
the practitioner to have a complete picture of your treatment plan.
The decision to use complementary and alternative treatments is an
important one. Consider before selecting an alternative therapy, the safety
and effectiveness of the therapy or treatment, the expertise and qualifications
of the healthcare practitioner, and the quality of delivery. These topics
should be considered when selecting any practitioner or therapy.
Finding CAM References on Seizures and Epilepsy
Having read the previous discussion, you may be wondering which
complementary or alternative treatments might be appropriate for seizures
and epilepsy. For the remainder of this chapter, we will direct you to a
number of official sources which can assist you in researching studies and
publications. Some of these articles are rather technical, so some patience
may be required.
National Center for Complementary and Alternative Medicine
The National Center for Complementary and Alternative Medicine
(NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has
created a link to the National Library of Medicine’s databases to allow
patients to search for articles that specifically relate to seizures and epilepsy
and complementary medicine. To search the database, go to the following
Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on
PubMed.” Enter “seizures and epilepsy” (or synonyms) into the search box.
Click “Go.” The following references provide information on particular
aspects of complementary and alternative medicine (CAM) that are related
to seizures and epilepsy:
·
A neurobehavioral treatment for unilateral complex partial seizure
disorders: a comparison of right- and left-hemisphere patients.
Author(s): Joy Andrews D, Reiter JM, Schonfeld W, Kastl A, Denning P.
Source: Seizure: the Journal of the British Epilepsy Association. 2000
April; 9(3): 189-97.
·
Adaptive electric field control of epileptic seizures.
Author(s): Gluckman BJ, Nguyen H, Weinstein SL, Schiff SJ.
for Neuroscience. 2001 January 15; 21(2): 590-600.
·
Anticonvulsant activity of the leaf essential oil of Laurus nobilis
against pentylenetetrazole- and maximal electroshock-induced
seizures.
Author(s): Sayyah M, Valizadeh J, Kamalinejad M.
Source: Phytomedicine : International Journal of Phytotherapy and
Phytopharmacology. 2002 April; 9(3): 212-6.
·
Anticonvulsive and free radical scavenging activities of vanillyl
alcohol in ferric chloride-induced epileptic seizures in Sprague-Dawley
rats.
Author(s): Hsieh CL, Chang CH, Chiang SY, Li TC, Tang NY, Pon CZ,
Hsieh CT, Lin JG.
Source: Life Sciences. 2000; 67(10): 1185-95.
·
Epilepsy and seizure disorders: a review of literature relative to
chiropractic care of children.
Author(s): Pistolese RA.
Source: Journal of Manipulative and Physiological Therapeutics. 2001
March-April; 24(3): 199-205. Review.
·
Epileptic seizures, some dyskinesia and the 'alpha tape'.
Author(s): Blum A, Blum B.
March; 11(2): 138.
·
Generalized convulsions after consuming a large amount of gingko
nuts.
Author(s): Miwa H, Iijima M, Tanaka S, Mizuno Y.
Source: Epilepsia. 2001 February; 42(2): 280-1.
·
Ginkgo biloba precipitating epileptic seizures.
Author(s): Granger AS.
Source: Age and Ageing. 2001 November; 30(6): 523-5.
·
Increased sensitivity to seizures in repeated exposures to hyperbaric
oxygen: role of NOS activation.
Author(s): Chavko M, Xing G, Keyser DO.
Source: Brain Research. 2001 May 11; 900(2): 227-33.
·
Melatonin might be one possible medium of electroacupuncture antiseizures.
Author(s): Chao DM, Chen G, Cheng JS.
Source: Acupunct Electrother Res. 2001; 26(1-2): 39-48.
·
Neurofeedback treatment of pseudoseizure disorder.
Author(s): Swingle PG.
Source: Biological Psychiatry. 1998 December 1; 44(11): 1196-9.
·
Outpatient video EEG recording in the diagnosis of non-epileptic
seizures: a randomised controlled trial of simple suggestion
techniques.
Author(s): McGonigal A, Oto M, Russell AJ, Greene J, Duncan R.
Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 April;
72(4): 549-51.
·
Psychological approaches to the prevention and inhibition of nocturnal
epileptic seizures: a meta-analysis of 70 case studies.
Author(s): Muller B.
Source: Seizure: the Journal of the British Epilepsy Association. 2001
January; 10(1): 13-33.
·
The role of hypnosis in the detection of psychogenic seizures.
Author(s): Martinez-Taboas A.
Source: Am J Clin Hypn. 2002 July; 45(1): 11-20.
·
Vagal nerve stimulation does not unkindle seizures.
Author(s): Dasheiff RM, Sandberg T, Thompson J, Arrambide S.
Source: Journal of Clinical Neurophysiology : Official Publication of the
American Electroencephalographic Society. 2001 January; 18(1): 68-74.
Additional Web Resources
A number of additional Web sites offer encyclopedic information covering
CAM and related topics. The following is a representative sample:
·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
·
·
Chinese Medicine: http://www.newcenturynutrition.com/
·
drkoop.comÒ:
http://www.drkoop.com/InteractiveMedicine/IndexC.html
·
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
·
Google: http://directory.google.com/Top/Health/Alternative/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Alternative/
·
TPN.com: http://www.tnp.com/
·
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
·
WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
·
WellNet: http://www.wellnet.ca/herbsa-c.htm
·
WholeHealthMD.com:
http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to Seizures and Epilepsy; please
note that any particular subject below may indicate either a therapeutic use,
or a contraindication (potential danger), and does not reflect an official
recommendation:
·
General Overview
Alcohol Withdrawal
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Alcohol.htm
Allergic Reaction, Anaphylaxis
Source: Integrative Medicine Communications;
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Ana
phylaxiscc.html
Alzheimer's Disease
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Alz
heimersDiseasecc.html
Anaphylaxis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Ana
phylaxiscc.html
Anorexia Nervosa
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Ano
rexiaNervosacc.html
Autism
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Autism.htm
Blood Sugar, Low
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Hyp
oglycemiacc.html
Brain Cancer
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Can
cerBraincc.html
Brain Inflammation, Meningitis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Me
ningitiscc.html
Brain Inflammation, Viral Encephalitis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Enc
ephalitisViralcc.html
Cancer, Brain
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Can
cerBraincc.html
Celiac Disease
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.ht
m
Cutaneous Drug Reactions
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Cut
aneousDrugReactionscc.html
Dementia
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/De
mentiacc.html
Depression
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Dep
ressioncc.html
Drug Reactions, Cutaneous
www.onemedicine.com
Hyperlink:
Eating Disorders, Anorexia
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Ano
rexiaNervosacc.html
Encephalitis, Viral
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Enc
ephalitisViralcc.html
Endocarditis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/End
ocarditiscc.html
Epilepsy
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Epilepsy.htm
Epilepsy
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Seiz
ureDisorderscc.html
Fainting
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Fain
tingcc.html
Fever of Unknown Origin
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Fev
erofUnknownOrigincc.html
Food Poisoning
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Foo
dPoisoningcc.html
Gout
Source: Prima Communications, Inc.
Hyperlink: http://www.personalhealthzone.com/pg000291.html
Heart Infection, Endocarditis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/End
ocarditiscc.html
Hypoglycemia
www.onemedicine.com
Hyperlink:
oglycemiacc.html
Hypoparathyroidism
www.onemedicine.com
Hyperlink:
oparathyroidismcc.html
Low Blood Sugar
www.onemedicine.com
Hyperlink:
oglycemiacc.html
Lung Cancer
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cancer_Lung.htm
Lupus
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Syst
emicLupusErythematosuscc.html
Malabsorption
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Malabsorption.ht
m
Meningitis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Me
ningitiscc.html
Migraine Headaches
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Migraine.htm
Migraine Headaches
Obesity
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Obe
sitycc.html
Parathyroid, Underactive
www.onemedicine.com
Hyperlink:
oparathyroidismcc.html
Phenylketonuria
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Phenylketonuria.h
tm
Preeclampsia
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Preeclampsia.htm
Preeclampsia
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Pree
clampsiacc.html
Roseola
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Ros
eolacc.html
Rubella
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Rub
ellacc.html
Sarcoidosis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Sarc
oidosiscc.html
Seizure disorders
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/
seizuredisorders.html
Seizure Disorders
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Seiz
ureDisorderscc.html
Senile Dementia
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/De
mentiacc.html
Serum Sickness
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Ser
umSicknesscc.html
Skin Disorders, Drug Reactions
www.onemedicine.com
Hyperlink:
Stroke
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Stroke.htm
Stroke
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Stro
kecc.html
Syncope
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Fain
tingcc.html
Systemic Lupus Erythematosus
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Lupus.htm
Systemic Lupus Erythematosus
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Syst
emicLupusErythematosuscc.html
Varicose Veins
·
Alternative Therapy
Aromatherapy
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsModalities/Aro
matherapycm.html
Magnet therapy
Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
Hyperlink:
http://www.wholehealthmd.com/refshelf/substances_view/0,1525,
715,00.html
·
Chinese Medicine
Baifuzi
Alternative names: Giant Typhonium Rhizome; Rhizoma Typhonii
Source: Chinese Materia Medica
Hyperlink: http://www.newcenturynutrition.com/
Baolong Wan
Alternative names: Baolong Pills
Source: Pharmacopoeia Commission of the Ministry of Health,
People's Republic of China
Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Baolong%20Wa
n&mh=10&sb=---&view_records=View+Records
Chonglou
Alternative names: Paris Root; Rhizoma Paridis
Dilong
Alternative names: Earthworm; Pheretima
Fuzi
Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae
Gouteng
Alternative names: Gambir Plant; Ramulus Uncariae cum Uncis
Hupo Baolong Wan
Alternative names: Hupo Baolong Pills
Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Hupo%20Baolo
ng%20Wan&mh=10&sb=---&view_records=View+Records
Jinmengshi
Alternative names: Mica-schist; Lapis Micas Aureus
Jufang Zhibao San
Alternative names: Jufang Zhibao Powder
Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Jufang%20Zhiba
o%20San&mh=10&sb=---&view_records=View+Records
Niuhuang
Alternative names: Cow-bezoar; Calculus Bovis
Niuhuang Baolong Wan
Alternative names: Niuhuang Baolong Pills
Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Niuhuang%20B
aolong%20Wan&mh=10&sb=---&view_records=View+Records
Niuhuang Zhenjing Wan
Alternative names: Niuhuang Zhenjing Pills
Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Niuhuang%20Z
henjing%20Wan&mh=10&sb=---&view_records=View+Records
Qingdai
Alternative names: Natural Indigo; Indigo Naturalis
Qingmengshi
Alternative names: Chlorite Schist; Lapis Chloriti
Quanxie
Alternative names: Scorpion; Scorpio
Shetui
Alternative names: Snake Slough; Periostracum Serpentis
Shuiniujiao
Alternative names: Buffalo Horn; Cornu Bubali
Suhexiang
Alternative names: Storax; Styrax
Tianma
Alternative names: Tall Gastrodia Tuber; Rhizoma Gastrodiae
Tiannanxing
Alternative names: Jackinthepulpit Tuber; Rhizoma Arisaematis
Wushaoshe
Alternative names: Black-tail Snake; Zaocys
Yangjinhua
Alternative names: Datura Flower; Flos Daturae
·
Herbs and Supplements
Aminoglycosides
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti
bioticMedicationsAminoglycosidescl.html
Anticonvulsants
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Anticonvulsants.htm
Arctostaphylos
Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng.
Source: Alternative Medicine Foundation, Inc.;
www.amfoundation.org
Hyperlink: http://www.herbmed.org/
Astragalus sp
Alternative names: Vetch, Rattlepod, Locoweed; Astragalus sp.
Ava
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/KavaKav
ach.html
Barbiturates
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Barbiturates.htm
Benzodiazepines
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Benzodiazepines.htm
Bisphosphonate Derivatives
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsDepletions/Oste
oporosisMedicationsBisphosphonateDerivativescl.html
Carbamazepine
Alternative names: Atretol, Carbatrol, Epitol, Tegretol, Tegretol XR
Chemotherapy
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Chemotherapy.htm
Coleus
Alternative names: Coleus forskohlii
Hyperlink:
http://www.thedacare.org/healthnotes/Herb/Coleus.htm
EDTA
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsSupplements/Et
hylenediaminetetraaceticAcidEDTAcs.html
Ephedra (Ma huang)
Hyperlink:
777,00.html
Ethylenediaminetetraacetic Acid (EDTA)
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsSupplements/Et
hylenediaminetetraaceticAcidEDTAcs.html
Evening Primrose
Alternative names: Oenothera biennis, Sun Drop
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/Evening
Primrosech.html
Evening Primrose
Alternative names: Oenothera biennis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti
ons/EveningPrimrosech.html
Fiber
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In
teractions/Fibercs.html
Fiber
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsSupplements/Fi
bercs.html
GABA
Hyperlink:
10027,00.html
Ginkgo
Alternative names: Ginkgo biloba
Ginkgo Biloba
Alternative names: Maidenhair Tree
www.onemedicine.com
Hyperlink:
ons/GinkgoBilobach.html
Ginkgo Biloba
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/GinkgoBi
lobach.html
Horse Chestnut
Humulus
Alternative names: Hops; Humulus lupulus L.
Hyssop
Alternative names: Hyssopus officinalis
Hyperlink:
http://www.thedacare.org/healthnotes/Herb/Hyssop.htm
Ispaghula
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps
ylliumcs.html
Ispaghula
Alternative names: Psyllium
www.onemedicine.com
Hyperlink:
teractions/Psylliumcs.html
Kava
Hyperlink:
798,00.html
Kava Kava
Alternative names: Piper methysticum, Ava
www.onemedicine.com
Hyperlink:
ach.html
LOBELIA
Source: The Canadian Internet Directory for Holistic Help, WellNet,
Health and Wellness Network; www.wellnet.ca
Hyperlink: http://www.wellnet.ca/herbsj-l.htm
Loop Diuretics
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsDepletions/Diur
eticsLoopDiureticscl.html
Mad-dog Skullcap
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcap
ch.html
Maidenhair Tree
Alternative names: Ginkgo Biloba
www.onemedicine.com
Hyperlink:
ons/GinkgoBilobach.html
Maidenhair Tree
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/GinkgoBi
lobach.html
Melatonin
Hyperlink:
http://www.thedacare.org/healthnotes/Supp/Melatonin.htm
Mistletoe
Hyperlink:
10109,00.html
N-Acetyl Cysteine
Hyperlink:
http://www.thedacare.org/healthnotes/Supp/N_Acetyl_Cysteine.ht
m
Oenothera biennis
www.onemedicine.com
Hyperlink:
Primrosech.html
Oenothera biennis
Alternative names: Evening Primrose
www.onemedicine.com
Hyperlink:
Oregano/Wild Marjoram
Alternative names: Origanum vulgare
Hyperlink:
http://www.thedacare.org/healthnotes/Herb/Oregano.htm
Passiflora
Alternative names: Passion Flower; Passiflora alata L.
Passiflora incarnata
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/Passionfl
owerch.html
Passionflower
Alternative names: Passiflora incarnata
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/Passionfl
owerch.html
Pennyroyal
Alternative names: Hedeoma pulegoides, Mentha pulegium
Hyperlink:
http://www.thedacare.org/healthnotes/Herb/Pennyroyal.htm
Perphenazine
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Perphenazine.htm
Phenobarbital
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Phenobarbital.htm
Phenobarbital
Alternative names: Bellatal, Solfoton
Pimpinella
Alternative names: Anise; Pimpinella anisum (L)
Piper methysticum
www.onemedicine.com
Hyperlink:
ach.html
Piper nigrum
Alternative names: Black Pepper
Plantago isphagula
Alternative names: Psyllium
www.onemedicine.com
Hyperlink:
Plantago isphagula
www.onemedicine.com
Hyperlink:
ylliumcs.html
Pregnenolone
Hyperlink:
http://www.thedacare.org/healthnotes/Supp/Pregnenolone.htm
Primidone
Alternative names: Mysoline
Psyllium
Alternative names: Ispaghula,Plantago isphagula
www.onemedicine.com
Hyperlink:
ylliumcs.html
Psyllium
Alternative names: Ispaghula
www.onemedicine.com
Hyperlink:
Rosemary
Alternative names: Rosmarinus officinalis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/Rosemar
ych.html
Rosmarinus officinalis
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsHerbs/Rosemar
ych.html
Sage
Alternative names: Salvia officinalis
Hyperlink: http://www.thedacare.org/healthnotes/Herb/Sage.htm
Scutellaria lateriflora
www.onemedicine.com
Hyperlink:
ch.html
Skullcap
Alternative names: Scutellaria lateriflora, Mad-dog Skullcap
www.onemedicine.com
Hyperlink:
ch.html
Skullcap
Source: The Canadian Internet Directory for Holistic Help, WellNet,
Health and Wellness Network; www.wellnet.ca
Hyperlink: http://www.wellnet.ca/herbss-v.htm
Sun Drop
www.onemedicine.com
Hyperlink:
Primrosech.html
Sun Drop
Alternative names: Evening Primrose
www.onemedicine.com
Hyperlink:
Syzygium Clove
Alternative names: Clove, Jamun; Syzygium sp.
Thiazide Diuretics
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsDepletions/Diur
eticsThiazideDiureticscl.html
Thioridazine
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Thioridazine.htm
Thuja plicata
Alternative names: Western Red Cedar
Trace minerals
Hyperlink:
10061,00.html
Uncaria asian
Alternative names: Asian species; Uncaria sp.
Uricosuric Agents
www.onemedicine.com
Hyperlink: Uricosuric Agents
Uva ursi
Hyperlink:
10063,00.html
Valerian
Valproic Acid
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Valproic_Acid.htm
Valproic Acid
Wormwood
Alternative names: Artemisia absinthium
Hyperlink:
http://www.thedacare.org/healthnotes/Herb/Wormwood.htm
Zanthoxylum
Alternative names: Prickly Ash; Zanthoxylum sp.
Zizyphus
Alternative names: Jujube; Ziziphus sp.
General References
A good place to find general background information on CAM is the
National Library of Medicine. It has prepared within the MEDLINEplus
system an information topic page dedicated to complementary and
alternative medicine. To access this page, go to the MEDLINEplus site at:
www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site
provides a general overview of various topics and can lead to a number of
general sources. The following additional references describe, in broad
terms, alternative and complementary medicine (sorted alphabetically by
title; hyperlinks provide rankings, information, and reviews at
Amazon.com):
· Alternative and Complementary Treatment in Neurologic Illness by
Michael I. Weintraub (Editor); Paperback - 288 pages (March 23, 2001),
Churchill Livingstone; ISBN: 0443065586;
· Radical Healing: Integrating the World’s Great Therapeutic Traditions to
Create a New Transformative Medicine by Rudolph Ballentine, M.D.,
Linda Funk (Illustrator); Paperback - 612 pages; Reprint edition (March 14,
2000), Three Rivers Press; ISBN: 0609804847;
· The Review of Natural Products by Facts and Comparisons (Editor); CdRom edition (January 2002), Facts & Comparisons; ISBN: 1574391453;
For additional information on complementary and alternative medicine, ask
your doctor or write to:
National Center for Complementary and Alternative Medicine
Clearinghouse
National Institutes of Health
P. O. Box 8218
Silver Spring, MD 20907-8218
Vocabulary Builder
Anaphylaxis: An acute hypersensitivity reaction due to exposure to a
previously encountered antigen. The reaction may include rapidly
progressing urticaria, respiratory distress, vascular collapse, systemic shock,
and death. [NIH]
Anorexia: Lack or loss of the appetite for food. [EU]
Calmodulin: A heat-stable, low-molecular-weight activator protein found
mainly in the brain and heart. The binding of calcium ions to this protein
allows this protein to bind to cyclic nucleotide phosphodiesterases and to
adenyl cyclase with subsequent activation. Thereby this protein modulates
cyclic AMP and cyclic GMP levels. [NIH]
Chemotherapy: The treatment of disease by means of chemicals that have a
specific toxic effect upon the disease - producing microorganisms or that
selectively destroy cancerous tissue. [EU]
Cisplatin: An inorganic and water-soluble platinum complex. After
undergoing hydrolysis, it reacts with DNA to produce both intra and
interstrand crosslinks. These crosslinks appear to impair replication and
transcription of DNA. The cytotoxicity of cisplatin correlates with cellular
arrest in the G2 phase of the cell cycle. [NIH]
Cutaneous: Pertaining to the skin; dermal; dermic. [EU]
Cysteine: A thiol-containing non-essential amino acid that is oxidized to
form CYSTINE. [NIH]
Dementia: An acquired organic mental disorder with loss of intellectual
abilities of sufficient severity to interfere with social or occupational
functioning. The dysfunction is multifaceted and involves memory,
behavior, personality, judgment, attention, spatial relations, language,
abstract thought, and other executive functions. The intellectual decline is
usually progressive, and initially spares the level of consciousness. [NIH]
Dyskinesia: Impairment of the power of voluntary movement, resulting in
fragmentary or incomplete movements. [EU]
Electroacupuncture: A form of acupuncture using low frequency electrically
stimulated needles to produce analgesia and anesthesia and to treat disease.
[NIH]
Endocarditis: Exudative and proliferative inflammatory alterations of the
endocardium, characterized by the presence of vegetations on the surface of
the endocardium or in the endocardium itself, and most commonly
involving a heart valve, but sometimes affecting the inner lining of the
cardiac chambers or the endocardium elsewhere. It may occur as a primary
disorder or as a complication of or in association with another disease. [EU]
Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal
tract and distributed throughout the body. It has bactericidal activity and is
used often as a topical disinfectant. It is widely used as a solvent and
preservative in pharmaceutical preparations as well as serving as the
primary ingredient in alcoholic beverages. [NIH]
Gout: Hereditary metabolic disorder characterized by recurrent acute
arthritis, hyperuricemia and deposition of sodium urate in and around the
joints, sometimes with formation of uric acid calculi. [NIH]
Hyperbaric: Characterized by greater than normal pressure or weight;
applied to gases under greater than atmospheric pressure, as hyperbaric
oxygen, or to a solution of greater specific gravity than another taken as a
standard of reference. [EU]
Hypnotic: A drug that acts to induce sleep. [EU]
Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term
lymphoma often is used alone to denote malignant lymphoma. [EU]
Malabsorption: Impaired intestinal absorption of nutrients. [EU]
Mastocytosis: A group of diseases resulting from proliferation of mast cells.
[NIH]
Perphenazine: An antipsychotic phenothiazine derivative with actions and
uses similar to those of chlorpromazine. [NIH]
Plantago: Three different species of Plantago or plantain, P. psyllium, P.
ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH]
Rubella: An acute, usually benign, infectious disease caused by a togavirus
and most often affecting children and nonimmune young adults, in which
the virus enters the respiratory tract via droplet nuclei and spreads to the
lymphatic system. It is characterized by a slight cold, sore throat, and fever,
followed by enlargement of the postauricular, suboccipital, and cervical
lymph nodes, and the appearances of a fine pink rash that begins on the
head and spreads to become generalized. Called also German measles,
roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU]
Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder
comprised of epithelioid and multinucleated giant cells with little necrosis. It
usually invades the lungs with fibrosis and may also involve lymph nodes,
skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH]
Species: A taxonomic category subordinate to a genus (or subgenus) and
superior to a subspecies or variety, composed of individuals possessing
common characters distinguishing them from other categories of individuals
of the same taxonomic level. In taxonomic nomenclature, species are
designated by the genus name followed by a Latin or Latinized adjective or
noun. [EU]
Testicular: Pertaining to a testis. [EU]
Uricosuric: 1. Pertaining to, characterized by, or promoting uricosuria (= the
excretion of uric acid in the urine). 2. An agent that promotes uricosuria. [EU]
Valerian: Valeriana officinale, an ancient, sedative herb of the large family
Valerianaceae. The roots were formerly used to treat hysterias and other
neurotic states and are presently used to treat sleep disorders. [NIH]
Veins: The vessels carrying blood toward the heart. [NIH]
Researching Nutrition 293
APPENDIX C. RESEARCHING NUTRITION
Overview
Since the time of Hippocrates, doctors have understood the importance of
diet and nutrition to patients’ health and well-being. Since then, they have
accumulated an impressive archive of studies and knowledge dedicated to
this subject. Based on their experience, doctors and healthcare providers may
recommend particular dietary supplements to patients with seizures and
epilepsy. Any dietary recommendation is based on a patient’s age, body
mass, gender, lifestyle, eating habits, food preferences, and health condition.
It is therefore likely that different patients with seizures and epilepsy may be
given different recommendations. Some recommendations may be directly
related to seizures and epilepsy, while others may be more related to the
patient’s general health. These recommendations, themselves, may differ
from what official sources recommend for the average person.
In this chapter we will begin by briefly reviewing the essentials of diet and
nutrition that will broadly frame more detailed discussions of seizures and
epilepsy. We will then show you how to find studies dedicated specifically
to nutrition and seizures and epilepsy.
Food and Nutrition: General Principles
What Are Essential Foods?
Food is generally viewed by official sources as consisting of six basic
elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and
(6) minerals. Consuming a combination of these elements is considered to be
a healthy diet:
·
Fluids are essential to human life as 80-percent of the body is composed
of water. Water is lost via urination, sweating, diarrhea, vomiting,
diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation)
and the bulk of typical diets. They are mostly classified as being either
simple or complex. Simple carbohydrates include sugars which are often
consumed in the form of cookies, candies, or cakes. Complex
carbohydrates consist of starches and dietary fibers. Starches are
consumed in the form of pastas, breads, potatoes, rice, and other foods.
Soluble fibers can be eaten in the form of certain vegetables, fruits, oats,
and legumes. Insoluble fibers include brown rice, whole grains, certain
fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are
high in protein are also high in fat and calories. Food sources for protein
include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain
vitamins. There are many types of fats, with many general publications
recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in
some cases, disease prevention. Most are consumed in your diet (exceptions
being vitamins K and D which are produced by intestinal bacteria and
sunlight on the skin, respectively). Each vitamin and mineral plays a
different role in health. The following outlines essential vitamins:
·
Vitamin A is important to the health of your eyes, hair, bones, and skin;
sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
·
Vitamin B1, also known as thiamine, is important for your nervous
system and energy production; food sources for thiamine include meat,
peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous
system and muscles, but is also involved in the release of proteins from
nutrients; food sources for riboflavin include dairy products, leafy
vegetables, meat, and eggs.
·
Vitamin B3, also known as niacin, is important for healthy skin and helps
the body use energy; food sources for niacin include peas, peanuts, fish,
and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of
cells in the nervous system and is vital for blood formation; food sources
for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of
red blood cells in bone marrow; food sources for vitamin B12 include
yeast, milk, fish, eggs, and meat.
·
Vitamin C allows the body’s immune system to fight various diseases,
strengthens body tissue, and improves the body’s use of iron; food
sources for vitamin C include a wide variety of fruits and vegetables.
·
Vitamin D helps the body absorb calcium which strengthens bones and
teeth; food sources for vitamin D include oily fish and dairy products.
·
Vitamin E can help protect certain organs and tissues from various
degenerative diseases; food sources for vitamin E include margarine,
vegetables, eggs, and fish.
·
Vitamin K is essential for bone formation and blood clotting; common
food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a
pregnant woman, can prevent her fetus from developing neural tube
defects; food sources for folic acid include nuts, fortified breads, leafy
green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become
toxic if consumed in excess (e.g. vitamin A, D, E and K).
Like vitamins, minerals are chemicals that are required by the body to
remain in good health. Because the human body does not manufacture these
chemicals internally, we obtain them from food and other dietary sources.
The more important minerals include:
·
Calcium is needed for healthy bones, teeth, and muscles, but also helps
the nervous system function; food sources for calcium include dry beans,
peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for
chromium include egg yolks, raw sugar, cheese, nuts, beets, whole
grains, and meat.
·
Fluoride is used by the body to help prevent tooth decay and to reinforce
bone strength; sources of fluoride include drinking water and certain
brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the
hormone thyroxine; food sources include leafy green vegetables, nuts,
egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and
certain proteins; food sources for iron include meat, dairy products, eggs,
and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for
healthy teeth, bones, muscles, and nerves; food sources for magnesium
include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones
and teeth; food sources for phosphorous include eggs, meat, cereals, and
dairy products.
·
Selenium primarily helps maintain normal heart and liver functions;
food sources for selenium include wholegrain cereals, fish, meat, and
dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid
growth and energy; food sources include dried beans, shellfish, eggs, and
nuts.
The United States government periodically publishes recommended diets
and consumption levels of the various elements of food. Again, your doctor
may encourage deviations from the average official recommendation based
on your specific condition. To learn more about basic dietary guidelines, visit
the Web site: http://www.health.gov/dietaryguidelines/. Based on these
guidelines, many foods are required to list the nutrition levels on the food’s
packaging. Labeling Requirements are listed at the following site maintained
by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government
recommends that consumers become familiar with the following
abbreviations before reading FDA literature:46
·
DVs (Daily Values): A new dietary reference term that will appear on
the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies
to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and
potassium.
·
RDIs (Reference Daily Intakes): A set of dietary references based on the
Recommended Dietary Allowances for essential vitamins and minerals
and, in selected groups, protein. The name “RDI” replaces the term “U.S.
RDA.”
46
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient
allowances established by the National Academy of Sciences. It is
updated periodically to reflect current scientific knowledge.
What Are Dietary Supplements?47
Dietary supplements are widely available through many commercial
sources, including health food stores, grocery stores, pharmacies, and by
mail. Dietary supplements are provided in many forms including tablets,
capsules, powders, gel-tabs, extracts, and liquids. Historically in the United
States, the most prevalent type of dietary supplement was a
multivitamin/mineral tablet or capsule that was available in pharmacies,
either by prescription or “over the counter.” Supplements containing strictly
herbal preparations were less widely available. Currently in the United
States, a wide array of supplement products are available, including vitamin,
mineral, other nutrients, and botanical supplements as well as ingredients
and extracts of animal and plant origin.
The Office of Dietary Supplements (ODS) of the National Institutes of Health
is the official agency of the United States which has the expressed goal of
acquiring “new knowledge to help prevent, detect, diagnose, and treat
disease and disability, from the rarest genetic disorder to the common
cold.”48 According to the ODS, dietary supplements can have an important
impact on the prevention and management of disease and on the
maintenance of health.49 The ODS notes that considerable research on the
effects of dietary supplements has been conducted in Asia and Europe where
the use of plant products, in particular, has a long tradition. However, the
overwhelming majority of supplements have not been studied scientifically.
To explore the role of dietary supplements in the improvement of health
care, the ODS plans, organizes, and supports conferences, workshops, and
symposia on scientific topics related to dietary supplements. The ODS often
works in conjunction with other NIH Institutes and Centers, other
This discussion has been adapted from the NIH:
http://ods.od.nih.gov/whatare/whatare.html.
48 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31,
Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920,
Fax: (301) 480-1845, E-mail: ods@nih.gov.
49 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health
and Education Act defines dietary supplements as “a product (other than tobacco) intended
to supplement the diet that bears or contains one or more of the following dietary
ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance
for use to supplement the diet by increasing the total dietary intake; or a concentrate,
metabolite, constituent, extract, or combination of any ingredient described above; and
intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not
represented as a conventional food or as a sole item of a meal or the diet.”
47
government agencies, professional organizations, and public advocacy
groups.
To learn more about official information on dietary supplements, visit the
ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact:
The Office of Dietary Supplements
National Institutes of Health
Building 31, Room 1B29
31 Center Drive, MSC 2086
Bethesda, Maryland 20892-2086
Tel: (301) 435-2920
Fax: (301) 480-1845
E-mail: ods@nih.gov
Finding Studies on Seizures and Epilepsy
The NIH maintains an office dedicated to patient nutrition and diet. The
National Institutes of Health’s Office of Dietary Supplements (ODS) offers a
searchable bibliographic database called the IBIDS (International
Bibliographic Information on Dietary Supplements). The IBIDS contains over
460,000 scientific citations and summaries about dietary supplements and
nutrition as well as references to published international, scientific literature
on dietary supplements such as vitamins, minerals, and botanicals.50 IBIDS is
available to the public free of charge through the ODS Internet page:
http://ods.od.nih.gov/databases/ibids.html.
After entering the search area, you have three choices: (1) IBIDS Consumer
Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We
recommend that you start with the Consumer Database. While you may not
find references for the topics that are of most interest to you, check back
periodically as this database is frequently updated. More studies can be
found by searching the Full IBIDS Database. Healthcare professionals and
researchers generally use the third option, which lists peer-reviewed
citations. In all cases, we suggest that you take advantage of the “Advanced
Search” option that allows you to retrieve up to 100 fully explained
references in a comprehensive format. Type “seizures and epilepsy” (or
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary
Supplements (ODS) at the National Institutes of Health to assist the public, healthcare
providers, educators, and researchers in locating credible, scientific information on dietary
supplements. IBIDS was developed and will be maintained through an interagency
partnership with the Food and Nutrition Information Center of the National Agricultural
Library, U.S. Department of Agriculture.
50
synonyms) into the search box. To narrow the search, you can also select the
“Title” field.
The following information is typical of that found when using the “Full
IBIDS Database” when searching using “seizures and epilepsy” (or a
synonym):
·
Effects of tetrahydroaminoacridine (tacrine) derivatives and
physostigmine in convulsions induced by pentylenetetrazol.
Author(s): J.H., Purkyne Medical Research Institute, Hradec Kralove,
CSSR.
Source: Herink, J Koupilova, M Hrdina, V Act-Nerv-Super-(Praha). 1989
December; 31(4): 303-5 0001-7604
·
Effects of the diterpene sclareol glycol on convulsive seizures.
Author(s): Institute of Pharmacology and Pharmacy, Medical Academy,
Sofia, Bulgaria.
Source: Georgieva, J Methods-Find-Exp-Clin-Pharmacol. 1989 May; 11(5):
335-40 0379-0355
·
Ketogenic diet reduces spontaneous seizures and mossy fiber
sprouting in the kainic acid model.
Author(s): Department of Neurology, Children's Hospital and Medical
Center, Boston, MA, USA.
Source: Muller Schwarze, A B Tandon, P Liu, Z Yang, Y Holmes, G L
Stafstrom, C E Neuroreport. 1999 May 14; 10(7): 1517-22 0959-4965
Federal Resources on Nutrition
In addition to the IBIDS, the United States Department of Health and Human
Services (HHS) and the United States Department of Agriculture (USDA)
provide many sources of information on general nutrition and health.
Recommended resources include:
·
healthfinder®, HHS’s gateway to health information, including diet and
nutrition:
http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag
e=0
·
The United States Department of Agriculture’s Web site dedicated to
nutrition information: www.nutrition.gov
·
The Food and Drug Administration’s Web site for federal food safety
information: www.foodsafety.gov
·
The National Action Plan on Overweight and Obesity sponsored by the
United States Surgeon General:
http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site
sponsored by the Food and Drug Administration and the Department of
Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United
States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library
sponsored by the United States Department of Agriculture:
http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department
of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources
A number of additional Web sites offer encyclopedic information covering
food and nutrition. The following is a representative sample:
·
·
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
·
WebMDÒHealth: http://my.webmd.com/nutrition
·
WholeHealthMD.com:
http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to Seizures and Epilepsy; please
note that any particular subject below may indicate either a therapeutic use,
or a contraindication (potential danger), and does not reflect an official
recommendation:
·
Vitamins
Folic Acid
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi
taminB9FolicAcidcs.html
Folic acid
Hyperlink:
887,00.html
Riboflavin
www.onemedicine.com
Hyperlink:
taminB2Riboflavincs.html
Riboflavin
Alternative names: Vitamin B2 (Riboflavin)
www.onemedicine.com
Hyperlink:
teractions/VitaminB2Riboflavincs.html
Vitamin B
Hyperlink:
10067,00.html
Vitamin B2 (Riboflavin)
www.onemedicine.com
Hyperlink:
taminB2Riboflavincs.html
Vitamin B2 (Riboflavin)
Alternative names: Riboflavin
www.onemedicine.com
Hyperlink:
teractions/VitaminB2Riboflavincs.html
Vitamin B9 (Folic Acid)
Alternative names: Folate, Folic Acid
www.onemedicine.com
Hyperlink:
Vitamin D
Vitamin K
·
Minerals
Aluminum, Calcium, and Magnesium-Containing Preparations
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsDepletions/Ant
acidsAluminumCalciumandMagnesiumContainingPreparationscl.ht
ml
Boron
Hyperlink:
http://www.thedacare.org/healthnotes/Supp/Boron.htm
Cisplatin
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Cisplatin.htm
Clorazepate Dipotassium
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Clorazepate_Dipotass
ium.htm
Folate
www.onemedicine.com
Hyperlink:
Folate
Gabapentin
Hyperlink:
http://www.thedacare.org/healthnotes/Drug/Gabapentin.htm
Iron
Hyperlink: http://www.thedacare.org/healthnotes/Supp/Iron.htm
Manganese
www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsSupplements/M
anganesecs.html
Vocabulary Builder
The following vocabulary builder defines words used in the references in
this chapter that have not been defined in previous chapters:
Aluminum: A metallic element that has the atomic number 13, atomic
symbol Al, and atomic weight 26.98. [NIH]
Bacteria: Unicellular prokaryotic microorganisms which generally possess
rigid cell walls, multiply by cell division, and exhibit three principal forms:
round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH]
Boron: Boron. A trace element with the atomic symbol B, atomic number 5,
and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron
absorber in BORON NEUTRON CAPTURE THERAPY. [NIH]
Capsules: Hard or soft soluble containers used for the oral administration of
medicine. [NIH]
Catalase: An oxidoreductase that catalyzes the conversion of hydrogen
peroxide to water and oxygen. It is present in many animal cells. A
deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH]
Cholesterol: The principal sterol of all higher animals, distributed in body
tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]
Iloprost: An eicosanoid, derived from the cyclooxygenase pathway of
arachidonic acid metabolism. It is a stable and synthetic analog of
epoprostenol, but with a longer half-life than the parent compound. Its
actions are similar to prostacyclin. Iloprost produces vasodilation and
inhibits platelet aggregation. [NIH]
Iodine: A nonmetallic element of the halogen group that is represented by
the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a
nutritionally essential element, especially important in thyroid hormone
synthesis. In solution, it has anti-infective properties and is used topically.
[NIH]
Nadir: The lowest point; point of greatest adversity or despair. [EU]
Neuropeptides: Peptides released by neurons as intercellular messengers.
Many neuropeptides are also hormones released by non-neuronal cells. [NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal
and plant tissues. Required by the body for the formation of coenzymes
NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic
properties. [NIH]
Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through
membranes. It can be applied topically to the conjunctiva. It also can cross
the blood-brain barrier and is used when central nervous system effects are
desired, as in the treatment of severe anticholinergic toxicity. [NIH]
Potassium: An element that is in the alkali group of metals. It has an atomic
symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation
in the intracellular fluid of muscle and other cells. Potassium ion is a strong
electrolyte and it plays a significant role in the regulation of fluid volume
and maintenance of the water-electrolyte balance. [NIH]
Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver,
kidney, heart, and leafy vegetables. The richest natural source is yeast. It
occurs in the free form only in the retina of the eye, in whey, and in urine; its
principal forms in tissues and cells are as FMN and FAD. [NIH]
Selenium: An element with the atomic symbol Se, atomic number 34, and
atomic weight 78.96. It is an essential micronutrient for mammals and other
animals but is toxic in large amounts. Selenium protects intracellular
structures against oxidative damage. It is an essential component of
glutathione peroxidase. [NIH]
Somatostatin: A polypeptide hormone produced in the hypothalamus, and
other tissues and organs. It inhibits the release of human growth hormone,
and also modulates important physiological functions of the kidney,
pancreas, and gastrointestinal tract. Somatostatin receptors are widely
expressed throughout the body. Somatostatin also acts as a neurotransmitter
in the central and peripheral nervous systems. [NIH]
Tacrine: A cholinesterase inhibitor that crosses the blood-brain barrier.
Tacrine has been used to counter the effects of muscle relaxants, as a
respiratory stimulant, and in the treatment of Alzheimer's disease and other
central nervous system disorders. [NIH]
Thermoregulation: Heat regulation. [EU]
Thyroxine: An amino acid of the thyroid gland which exerts a stimulating
effect on thyroid metabolism. [NIH]
Finding Medical Libraries 307
APPENDIX D. FINDING MEDICAL LIBRARIES
Overview
At a medical library you can find medical texts and reference books,
consumer health publications, specialty newspapers and magazines, as well
as medical journals. In this Appendix, we show you how to quickly find a
medical library in your area.
Preparation
Before going to the library, highlight the references mentioned in this
sourcebook that you find interesting. Focus on those items that are not
available via the Internet, and ask the reference librarian for help with your
search. He or she may know of additional resources that could be helpful to
you. Most importantly, your local public library and medical libraries have
Interlibrary Loan programs with the National Library of Medicine (NLM),
one of the largest medical collections in the world. According to the NLM,
most of the literature in the general and historical collections of the National
Library of Medicine is available on interlibrary loan to any library. NLM’s
interlibrary loan services are only available to libraries. If you would like to
access NLM medical literature, then visit a library in your area that can
request the publications for you.51
51
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
Finding a Local Medical Library
The quickest method to locate medical libraries is to use the Internet-based
directory published by the National Network of Libraries of Medicine
(NN/LM). This network includes 4626 members and affiliates that provide
many services to librarians, health professionals, and the public. To find a
library in your area, simply visit http://nnlm.gov/members/adv.html or call
1-800-338-7657.
Medical Libraries Open to the Public
In addition to the NN/LM, the National Library of Medicine (NLM) lists a
number of libraries that are generally open to the public and have reference
facilities. The following is the NLM’s list plus hyperlinks to each library Web
site. These Web pages can provide information on hours of operation and
other restrictions. The list below is a small sample of libraries recommended
by the National Library of Medicine (sorted alphabetically by name of the
U.S. state or Canadian province where the library is located):52
·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library
Cooperative, Lister Hill Library of the Health Sciences),
http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine
Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center
(Samaritan Health System, Phoenix, Arizona),
http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health
System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health
Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of
Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical
Center Library) - Carson, CA,
http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center),
http://www-med.stanford.edu/healthlibrary/
52
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
·
California: Patient Education Resource Center - Health Information and
Resources (University of California, San Francisco),
http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District),
http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library,
http://planetreesanjose.org/
·
California: Sutter Resource Library (Sutter Hospitals Foundation),
http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource
Center (ValleyCare Health System),
http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library
(Washington Community Health Resource Library),
http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare),
http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford
Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information
Center (University of Connecticut Health Center, Lyman Maynard Stowe
Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury
Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System,
Eugene du Pont Preventive Medicine & Rehabilitation Institute),
http://www.christianacare.org/health_guide/health_guide_pmri_health
_info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine),
http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia),
http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
·
Georgia: Health Resource Center (Medical Center of Central Georgia),
http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service
(Hawaii Medical Library), http://hml.org/CHIS/
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center),
http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital
(Northwestern Memorial Hospital, Health Learning Center),
http://www.nmh.org/health_info/hlc.html
·
Illinois: Medical Library (OSF Saint Francis Medical Center),
http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students &
the Public (Central Baptist Hospital),
http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library
(University of Kentucky, Chandler Medical Center, Health Information
Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner
Medical Foundation), http://www.ochsner.org/library/
·
Louisiana: Louisiana State University Health Sciences Center Medical
Library-Shreveport, http://lib-sh.lsuhsc.edu/
·
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial
Hospital), http://www.fchn.org/fmh/lib.htm
·
Maine: Gerrish-True Health Sciences Library (Central Maine Medical
Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine
Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center),
http://www.mmc.org/library/
·
Maine: Parkview Hospital,
http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library
(Southern Maine Medical Center),
http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library
(Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service
(University of Manitoba Libraries),
http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre),
http://www.deerlodge.mb.ca/library/libraryservices.shtml
·
Maryland: Health Information Center at the Wheaton Regional Library
(Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional
Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health
System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical
Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell
General Hospital),
http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
·
Massachusetts: Paul E. Woodard Health Sciences Library (New England
Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s
Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center
(Massachusetts General Hospital),
http://www.mgh.harvard.edu/library/chrcindex.html
·
Massachusetts: UMass HealthNet (University of Massachusetts Medical
School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health
(Botsford General Hospital, Library & Internet Services),
http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and
Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library
(Marquette General Hospital, Health Information Center),
http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan
Cancer Center (University of Michigan Comprehensive Cancer Center),
http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information,
http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health
Sciences Center),
http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
·
National: Consumer Health Library Directory (Medical Library
Association, Consumer and Patient Health Information Section),
http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of
Medicine) - provides library services for health professionals in the
United States who do not have access to a medical library,
http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network
of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas
Clark County Library District),
http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College
Library),
http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld
/
·
New Jersey: Consumer Health Library (Rahway Hospital),
http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood
Hospital and Medical Center),
http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical
Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant,
http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State
University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center),
http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital),
http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical
& Consumer Health Library),
http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center
(Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical
Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S.
Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical
Center), http://www.geisinger.edu/education/commlib.shtml
·
Pennsylvania: HealthInfo Library (Moses Taylor Hospital),
http://www.mth.org/healthwellness.html
·
Pennsylvania: Hopwood Library (University of Pittsburgh, Health
Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of
Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library
(Susquehanna Health System),
http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System),
http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital),
http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center
(Rapid City Regional Hospital, Health Information Center),
http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas
Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care
System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community
Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest
Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 315
APPENDIX E. YOUR RIGHTS AND INSURANCE
Overview
Any patient with seizures and epilepsy faces a series of issues related more
to the healthcare industry than to the medical condition itself. This appendix
covers two important topics in this regard: your rights and responsibilities as
a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient
The President’s Advisory Commission on Consumer Protection and Quality
in the Healthcare Industry has created the following summary of your rights
as a patient.53
Information Disclosure
Consumers have the right to receive accurate, easily understood information.
Some consumers require assistance in making informed decisions about
health plans, health professionals, and healthcare facilities. Such information
includes:
·
Health plans. Covered benefits, cost-sharing, and procedures for
resolving complaints, licensure, certification, and accreditation status,
comparable measures of quality and consumer satisfaction, provider
network composition, the procedures that govern access to specialists
and emergency services, and care management information.
53Adapted
from Consumer Bill of Rights and Responsibilities:
http://www.hcqualitycommission.gov/press/cbor.html#head1.
·
Health professionals. Education, board certification, and recertification,
years of practice, experience performing certain procedures, and
comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and
services, accreditation status, comparable measures of quality, worker,
and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to
promote consumer confidence and to work cooperatively with health
plans, providers, payers, and regulators. Desirable characteristics of such
programs are sponsorship that ensures accountability to the interests of
consumers and stable, adequate funding.
Choice of Providers and Plans
Consumers have the right to a choice of healthcare providers that is
sufficient to ensure access to appropriate high-quality healthcare. To ensure
such choice, the Commission recommends the following:
·
Provider network adequacy. All health plan networks should provide
access to sufficient numbers and types of providers to assure that all
covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week.
If a health plan has an insufficient number or type of providers to
provide a covered benefit with the appropriate degree of specialization,
the plan should ensure that the consumer obtains the benefit outside the
network at no greater cost than if the benefit were obtained from
participating providers.
·
Women’s health services. Women should be able to choose a qualified
provider offered by a plan -- such as gynecologists, certified nurse
midwives, and other qualified healthcare providers -- for the provision of
covered care necessary to provide routine and preventative women’s
healthcare services.
·
Access to specialists. Consumers with complex or serious medical
conditions who require frequent specialty care should have direct access
to a qualified specialist of their choice within a plan’s network of
providers. Authorizations, when required, should be for an adequate
number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment
for a chronic or disabling condition (or who are in the second or third
trimester of a pregnancy) at the time they involuntarily change health
plans or at a time when a provider is terminated by a plan for other than
cause should be able to continue seeing their current specialty providers
for up to 90 days (or through completion of postpartum care) to allow for
transition of care.
·
Choice of health plans. Public and private group purchasers should,
wherever feasible, offer consumers a choice of high-quality health
insurance plans.
Access to Emergency Services
Consumers have the right to access emergency healthcare services when and
where the need arises. Health plans should provide payment when a
consumer presents to an emergency department with acute symptoms of
sufficient severity--including severe pain--such that a “prudent layperson”
could reasonably expect the absence of medical attention to result in placing
that consumer’s health in serious jeopardy, serious impairment to bodily
functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions
Consumers have the right and responsibility to fully participate in all
decisions related to their healthcare. Consumers who are unable to fully
participate in treatment decisions have the right to be represented by
parents, guardians, family members, or other conservators. Physicians and
other health professionals should:
·
Provide patients with sufficient information and opportunity to decide
among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent
manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with
members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks,
nontreatment.
·
Give patients the opportunity to refuse treatment and to express
preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
·
Discuss the use of advance directives -- both living wills and durable
powers of attorney for healthcare -- with patients and their designated
family members.
·
Abide by the decisions made by their patients and/or their designated
representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should:
·
Disclose to consumers factors -- such as methods of compensation,
ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses”
or other contractual mechanisms that restrict healthcare providers’ ability
to communicate with and advise patients about medically necessary
treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare
professionals or other health workers for advocating on behalf of their
patients.
Respect and Nondiscrimination
Consumers have the right to considerate, respectful care from all members of
the healthcare industry at all times and under all circumstances. An
environment of mutual respect is essential to maintain a quality healthcare
system. To assure that right, the Commission recommends the following:
·
Consumers must not be discriminated against in the delivery of
healthcare services consistent with the benefits covered in their policy, or
as required by law, based on race, ethnicity, national origin, religion, sex,
age, mental or physical disability, sexual orientation, genetic information,
or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a
health plan or program, or as required by law, must not be discriminated
against in marketing and enrollment practices based on race, ethnicity,
national origin, religion, sex, age, mental or physical disability, sexual
orientation, genetic information, or source of payment.
Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in
confidence and to have the confidentiality of their individually identifiable
healthcare information protected. Consumers also have the right to review
and copy their own medical records and request amendments to their
records.
Complaints and Appeals
Consumers have the right to a fair and efficient process for resolving
differences with their health plans, healthcare providers, and the institutions
that serve them, including a rigorous system of internal review and an
independent system of external review. A free copy of the Patient’s Bill of
Rights is available from the American Hospital Association.54
Patient Responsibilities
Treatment is a two-way street between you and your healthcare providers.
To underscore the importance of finance in modern healthcare as well as
your responsibility for the financial aspects of your care, the President’s
Advisory Commission on Consumer Protection and Quality in the
Healthcare Industry has proposed that patients understand the following
“Consumer Responsibilities.”55 In a healthcare system that protects
consumers’ rights, it is reasonable to expect and encourage consumers to
assume certain responsibilities. Greater individual involvement by the
consumer in his or her care increases the likelihood of achieving the best
outcome and helps support a quality-oriented, cost-conscious environment.
Such responsibilities include:
·
Take responsibility for maximizing healthy habits such as exercising, not
smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and
carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes
to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the
American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,”
go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s
Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number
471124.
55 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.
54
·
Recognize the reality of risks, the limits of the medical science, and the
human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient
and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options
(when available) including all covered benefits, limitations, and
exclusions, rules regarding use of network providers, coverage and
referral rules, appropriate processes to secure additional information, and
the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans,
healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan
There are a number of official government agencies that help consumers
understand their healthcare insurance choices.56 The U.S. Department of
Labor, in particular, recommends ten ways to make your health benefits
choices work best for you.57
1. Your options are important. There are many different types of health
benefit plans. Find out which one your employer offers, then check out the
plan, or plans, offered. Your employer’s human resource office, the health
plan administrator, or your union can provide information to help you
match your needs and preferences with the available plans. The more
information you have, the better your healthcare decisions will be.
2. Reviewing the benefits available. Do the plans offered cover preventive
care, well-baby care, vision or dental care? Are there deductibles? Answers
to these questions can help determine the out-of-pocket expenses you may
face. Matching your needs and those of your family members will result in
the best possible benefits. Cheapest may not always be best. Your goal is
high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web
site:
http://www.ahrq.gov/consumer/qntascii/qnthplan.htm.
57 Adapted from the Department of Labor:
http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html.
56
3. Look for quality. The quality of healthcare services varies, but quality can
be measured. You should consider the quality of healthcare in deciding
among the healthcare plans or options available to you. Not all health plans,
doctors, hospitals and other providers give the highest quality care.
Fortunately, there is quality information you can use right now to help you
compare your healthcare choices. Find out how you can measure quality.
Consult the U.S. Department of Health and Human Services publication
“Your Guide to Choosing Quality Health Care” on the Internet at
www.ahcpr.gov/consumer.
4. Your plan’s summary plan description (SPD) provides a wealth of
information. Your health plan administrator can provide you with a copy of
your plan’s SPD. It outlines your benefits and your legal rights under the
Employee Retirement Income Security Act (ERISA), the federal law that
protects your health benefits. It should contain information about the
coverage of dependents, what services will require a co-pay, and the
circumstances under which your employer can change or terminate a health
benefits plan. Save the SPD and all other health plan brochures and
documents, along with memos or correspondence from your employer
relating to health benefits.
5. Assess your benefit coverage as your family status changes. Marriage,
divorce, childbirth or adoption, and the death of a spouse are all life events
that may signal a need to change your health benefits. You, your spouse and
dependent children may be eligible for a special enrollment period under
provisions of the Health Insurance Portability and Accountability Act
(HIPAA). Even without life-changing events, the information provided by
your employer should tell you how you can change benefits or switch plans,
if more than one plan is offered. If your spouse’s employer also offers a
health benefits package, consider coordinating both plans for maximum
coverage.
6. Changing jobs and other life events can affect your health benefits.
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you,
your covered spouse, and your dependent children may be eligible to
purchase extended health coverage under your employer’s plan if you lose
your job, change employers, get divorced, or upon occurrence of certain
other events. Coverage can range from 18 to 36 months depending on your
situation. COBRA applies to most employers with 20 or more workers and
requires your plan to notify you of your rights. Most plans require eligible
individuals to make their COBRA election within 60 days of the plan’s
notice. Be sure to follow up with your plan sponsor if you don’t receive
notice, and make sure you respond within the allotted time.
7. HIPAA can also help if you are changing jobs, particularly if you have a
medical condition. HIPAA generally limits pre-existing condition exclusions
to a maximum of 12 months (18 months for late enrollees). HIPAA also
requires this maximum period to be reduced by the length of time you had
prior “creditable coverage.” You should receive a certificate documenting
your prior creditable coverage from your old plan when coverage ends.
8. Plan for retirement. Before you retire, find out what health benefits, if any,
extend to you and your spouse during your retirement years. Consult with
your employer’s human resources office, your union, the plan administrator,
and check your SPD. Make sure there is no conflicting information among
these sources about the benefits you will receive or the circumstances under
which they can change or be eliminated. With this information in hand, you
can make other important choices, like finding out if you are eligible for
Medicare and Medigap insurance coverage.
9. Know how to file an appeal if your health benefits claim is denied.
Understand how your plan handles grievances and where to make appeals
of the plan’s decisions. Keep records and copies of correspondence. Check
your health benefits package and your SPD to determine who is responsible
for handling problems with benefit claims. Contact PWBA for customer
service assistance if you are unable to obtain a response to your complaint.
10. You can take steps to improve the quality of the healthcare and the
health benefits you receive. Look for and use things like Quality Reports
and Accreditation Reports whenever you can. Quality reports may contain
consumer ratings -- how satisfied consumers are with the doctors in their
plan, for instance-- and clinical performance measures -- how well a
healthcare organization prevents and treats illness. Accreditation reports
provide information on how accredited organizations meet national
standards, and often include clinical performance measures. Look for these
quality measures whenever possible. Consult “Your Guide to Choosing
Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid
Illness strikes both rich and poor families. For low-income families, Medicaid
is available to defer the costs of treatment. The Health Care Financing
Administration (HCFA) administers Medicare, the nation’s largest health
insurance program, which covers 39 million Americans. In the following
pages, you will learn the basics about Medicare insurance as well as useful
contact information on how to find more in-depth information about
Medicaid.58
Who Is Eligible for Medicare?
Generally, you are eligible for Medicare if you or your spouse worked for at
least 10 years in Medicare-covered employment and you are 65 years old
and a citizen or permanent resident of the United States. You might also
qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or
transplant). Here are some simple guidelines:
You can get Part A at age 65 without having to pay premiums if:
·
You are already receiving retirement benefits from Social Security or the
Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have
not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay
premiums if:
·
You have received Social Security or Railroad Retirement Board disability
benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts:
·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B.
Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small
facilities that give limited outpatient and inpatient services to people in rural
areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information:
http://www.medicare.gov/Basics/Overview.asp.
58
Cost: Most people get Part A automatically when they turn age 65. You do
not have to pay a monthly payment called a premium for Part A because you
or a spouse paid Medicare taxes while you were working.
If you (or your spouse) did not pay Medicare taxes while you were working
and you are age 65 or older, you still may be able to buy Part A. If you are
not sure you have Part A, look on your red, white, and blue Medicare card. It
will show “Hospital Part A” on the lower left corner of the card. You can
also call the Social Security Administration toll free at 1-800-772-1213 or call
your local Social Security office for more information about buying Part A. If
you get benefits from the Railroad Retirement Board, call your local RRB
office or 1-800-808-0772. For more information, call your Fiscal Intermediary
about Part A bills and services. The phone number for the Fiscal
Intermediary office in your area can be obtained from the following Web
site: http://www.medicare.gov/Contacts/home.asp.
Part B (Medical Insurance)
Helps Pay For: Doctors, services, outpatient hospital care, and some other
medical services that Part A does not cover, such as the services of physical
and occupational therapists, and some home healthcare. Part B helps pay for
covered services and supplies when they are medically necessary.
Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month.
In some cases this amount may be higher if you did not choose Part B when
you first became eligible at age 65. The cost of Part B may go up 10% for each
12-month period that you were eligible for Part B but declined coverage,
except in special cases. You will have to pay the extra 10% cost for the rest of
your life.
Enrolling in Part B is your choice. You can sign up for Part B anytime during
a 7-month period that begins 3 months before you turn 65. Visit your local
Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually
taken out of your monthly Social Security, Railroad Retirement, or Civil
Service Retirement payment. If you do not receive any of the above
payments, Medicare sends you a bill for your part B premium every 3
months. You should receive your Medicare premium bill in the mail by the
10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the
Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For
more information, call your Medicare carrier about bills and services. The
phone number for the Medicare carrier in your area can be found at the
following Web site: http://www.medicare.gov/Contacts/home.asp. You may
have choices in how you get your healthcare including the Original
Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare
Private Fee-for-Service Plans.
Medicaid
Medicaid is a joint federal and state program that helps pay medical costs for
some people with low incomes and limited resources. Medicaid programs
vary from state to state. People on Medicaid may also get coverage for
nursing home care and outpatient prescription drugs which are not covered
by Medicare. You can find more information about Medicaid on the
HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm.
States also have programs that pay some or all of Medicare’s premiums and
may also pay Medicare deductibles and coinsurance for certain people who
have Medicare and a low income. To qualify, you must have:
·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than
$4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information, look at the Medicare Savings Programs brochure,
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua
ge=English&Type=Pub&PubID=10126. There are also Prescription Drug
Assistance Programs available. Find information on these programs which
offer discounts or free medications to individuals in need at
http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs
Finally, the National Organization for Rare Disorders, Inc. (NORD)
administers medication programs sponsored by humanitarian-minded
pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.59 NORD
programs ensure that certain vital drugs are available “to those individuals
whose income is too high to qualify for Medicaid but too low to pay for their
59
Adapted from NORD: http://www.rarediseases.org/.
prescribed medications.” The program has standards for fairness, equity,
and unbiased eligibility. It currently covers some 14 programs for nine
pharmaceutical companies. NORD also offers early access programs for
investigational new drugs (IND) under the approved “Treatment INDs”
programs of the Food and Drug Administration (FDA). In these programs, a
limited number of individuals can receive investigational drugs that have yet
to be approved by the FDA. These programs are generally designed for rare
diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources
In addition to the references already listed in this chapter, you may need
more information on health insurance, hospitals, or the healthcare system in
general. The NIH has set up an excellent guidance Web site that addresses
these and other issues. Topics include:60
·
Health Insurance:
http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics:
http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care:
http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care:
http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman
Programs, Privacy and Patient Issues:
http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange:
http://www.nlm.nih.gov/medlineplus/veteranshealth.html
60
Access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
NIH Consensus Statement on Surgery for Epilepsy 327
APPENDIX F. NIH CONSENSUS STATEMENT ON SURGERY
FOR EPILEPSY
Overview
NIH Consensus Development Conferences are convened to evaluate
available scientific information and resolve safety and efficacy issues related
to biomedical technology. The resultant NIH Consensus Statements are
intended to advance understanding of the technology or issue in question
and to be useful to health professionals and the public.61 Each NIH consensus
statement is the product of an independent, non-Federal panel of experts
and is based on the panel’s assessment of medical knowledge available at the
time the statement was written. Therefore, a consensus statement provides a
“snapshot in time” of the state of knowledge of the conference topic.
The NIH makes the following caveat: “When reading or downloading NIH
consensus statements, keep in mind that new knowledge is inevitably
accumulating through medical research. Nevertheless, each NIH consensus
statement is retained on this website in its original form as a record of the
NIH Consensus Development Program.”62 The following concensus
statement was posted on the NIH site and not indicated as “out of date” in
March 2002. It was originally published, however, in March 1990.63
61 This paragraph is adapted from the NIH:
http://odp.od.nih.gov/consensus/cons/cons.htm.
62 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm.
63 Surgery for Epilepsy. NIH Consens Statement Online 1990 Mar 19-21 [cited 2002 February
21];8(2):1-20. http://consensus.nih.gov/cons/077/077_statement.htm.
Abstract
The National Institutes of Health Consensus Development Conference on
Surgery for Epilepsy brought together neurologists, neurosurgeons,
psychologists, other health care providers, and the public to address issues
regarding epilepsy surgery including patient selection and management,
localization of seizure site onset, appropriate diagnostic techniques, and
postoperative outcome assessment.
The panel concluded that brain surgery is an alternative treatment when
medication fails. Seizure frequency, severity type, possible brain damage or
injury from frequent seizures, and effect on quality of life all must be
considered in deciding to evaluate for surgery. An appropriate medication
trial must have been conducted, using the correct drugs for the patient’s
seizure type at adequate doses and blood levels. Nonepileptic attacks must
be ruled out, and diagnostic tests to detect any underlying cause should be
performed.
If surgery is considered, patients should be evaluated by a team including
neurologists, neurosurgeons, neuropsychologists, social workers, and, if
needed, psychiatrists. Assessment of outcome should include standardized
methods of information collection. Measures assessing quality of life and
overall health status can compare epilepsy to other chronic conditions.
Assessment of economic and social impact on the patient’s family should be
included.
The full text of the panel’s statement follows.
What Is Epilepsy?
Epilepsy is common. About 10 percent of all Americans will have at least one
seizure at some time. Many people have one or a few attacks and then never
have another one. For those with recurrent seizures, about 70 percent are
satisfactorily controlled with antiepileptic drugs. Of the 150,000 people who
develop epilepsy each year, 10 to 20 percent prove to have “medically
intractable epilepsy.” Many of these patients and their families have to deal
with a chronic disorder that impairs the quality of life for all concerned.
Brain surgery may be an alternative treatment if antiepileptic drugs fail, and
it is being used more often. Several centers have reported success, and
increasing numbers of patients are being referred for surgery, including
many children. Improved technology has made it possible to identify more
accurately where seizures originate in the brain (epileptic regions), and
advances in surgery have made operative management safer. As a result,
investigators have estimated that 2,000 to 5,000 new patients in the United
States might be suitable for operations each year, compared with the present
annual rate of about 500.
Nevertheless, controlled trials have not been done, and there is disagreement
among investigators about the choices and application of methods to
evaluate patients for surgery, which procedures should be done, and how
best to assess outcome. For these reasons, this consensus conference was
organized.
There is no precise definition of intractable epilepsy. Among the
considerations are seizure frequency, seizure type, severity of attacks, and
impact on quality of life. Before seizures are deemed intractable it is
necessary to be certain that the correct drugs have been used in the correct
amounts. Complex partial seizures are more likely to be intractable than
tonic-clonic or other common forms of epilepsy. In uncontrolled complex
partial seizures, the frequency of seizures varies from fewer than one a week
to five or more each day. The clinical manifestations also vary in different
patients. Some are not apparent to anyone but the patient; others disrupt
daily activities and are socially embarrassing. If a patient falls during
seizures that occur only a few times a year, repeated injuries and trips to
emergency rooms can make life miserable. Even one seizure a year may
disqualify a person from having a driver’s license. Disability is also
influenced by the reaction of the patient’s family, friends, teachers, or
employers. All of these factors have an impact on what is judged severe
enough to warrant consideration of surgical therapy.
There are other reasons to consider surgical therapy. For instance, repeated
seizures may have adverse effects on the brain, leading to progressive
cerebral degeneration and more severe clinical handicaps. Chronic use of
antiepileptic drugs may cause toxic syndromes and may also have adverse
effects on learning, scholastic achievement, development, and job
performance.
On the other hand, surgery has risks and costs that have to be considered.
Before a patient is accepted for surgery, it is necessary to be certain of the
diagnosis and the adequacy of previous drug therapy. Evaluation for
surgery includes several methods: video-monitoring, brain imaging,
different kinds of electroencephalography, and neuropsychological tests. The
best combination of these studies has yet to be defined. Investigators do not
agree about the preoperative need to identify areas of the brain that control
speech. Similarly, there are differences of opinion about the specific surgical
procedures that produce the best outcomes for different kinds of attacks.
Anterior temporal lobe operations and other cortical resections involve the
removal of epileptic regions from the temporal lobe and other areas of the
brain and are done for complex partial seizures. Corpus callosotomy
involves the severing of connections between the right and left sides of the
brain and is used for some types of generalized attacks; corpus callosotomy
and hemispherectomy can be used for seizures with childhood hemiplegia.
This consensus conference was designed to address the following questions:
·
How should patients be selected?
·
What evaluation is necessary to localize epileptic regions?
·
What procedures are appropriate for specific epilepsies?
·
How should outcome be assessed?
·
Directions for future research--should a controlled trial be done? If so, for
what seizure types?
To address these questions, the National Institute of Neurological Disorders
and Stroke and the Office of Medical Applications of Research of the
National Institutes of Health convened a Consensus Development
Conference on Surgery for Epilepsy on March 19-21, 1990. After a day and a
half of presentations by experts and discussion by the audience, a consensus
panel drawn from specialists and generalists from the medical profession
and related scientific disciplines, clinical investigators, and public
representatives considered the evidence and came to the following
conclusions.
How Should Patients Be Selected?
Patients with unsatisfactory seizure control often seek alternative care. The
number or severity of the seizures may be unacceptable to the patient,
family, or treating physician. Other reasons for referral include the results of
diagnostic tests that may show a structural focal brain lesion, unsatisfactory
psychosocial adaptation due to poor seizure control, unacceptable sedation,
or other drug side effects. Such patients, especially those with persistent
complex partial seizures and some types of generalized seizures, may be
candidates for surgical treatment. First, however, these patients should be
referred to an adult or pediatric neurologist for further evaluation of
diagnosis and treatment.
Evaluation and medical treatment of these patients may take place under the
supervision of a neurologist or in an epilepsy center that provides
comprehensive diagnostic and treatment services designed for patients with
intractable epilepsy. By “intractable” we mean that seizures have not been
brought under acceptable control with the resources available to the primary
care physician or neurologist.
To be effective and comprehensive, the staff of a center should include the
following: neurologists with special training and experience in epilepsy;
neurosurgeons with experience in epilepsy surgery; neuropsychologists; and
personnel trained to deal with social, psychological, and psychiatric
problems and rehabilitation for school and work. Personnel to perform
ancillary neurodiagnostic assessment must also be available, including
closed-circuit TV and electroencephalography (EEG) monitoring telemetry;
modern neurophysiological and EEG equipment; neuroimaging capabilities,
including magnetic resonance imaging (MRI); and neuropsychological
testing. Some centers also have positron emission tomography (PET), single
photon emission computed tomography (SPECT), or other methods of
evaluating cerebral blood flow and metabolism.
Before a patient is considered for surgery, evaluation should be sufficient to
ensure the following:
·
Nonepileptic attacks have been excluded and epilepsy is, in fact, present.
Cardiogenic syncope, psychogenic seizures, and other nonepileptic states
can closely mimic epileptic attacks.
·
The epileptic seizure type and syndrome have been clarified. Primary
and secondary epilepsies, partial seizures, and tonic-clonic seizures
respond to different antiepileptic drugs and different surgical
procedures.
·
Diagnostic tests have been performed to define a metabolic or structural
cause of the epileptic attacks.
·
The patient has had a reasonable trial of the appropriate antiepileptic
drugs, with adequate monitoring of compliance and the effects of the
treatment.
·
The patient and family have received detailed information about the
specific seizure disorder, available drug treatments and side effects, and
alternative treatments such as surgery. If, after this evaluation, seizures
prove to be intractable or drug treatment is unsatisfactory, appropriate
patients should be referred to an epilepsy center to be evaluated for
surgery. Referrals should be made as soon as it is clear that medical
treatment is unlikely to result in further benefit. Early referrals may
prevent the development of chronic psychosocial and physical problems
that result from uncontrolled seizures.
Coexisting disorders may affect the decision to operate; they may include
severe psychiatric disorders, profound developmental retardation, or
progressive neurodegenerative diseases. After the initial evaluation and a
full unsuccessful trial of medical therapy, surgery may be considered.
Patients with partial seizures and secondarily generalized seizures (attacks
that begin locally and spread to both sides of the brain) are potential
candidates. Secondarily generalized seizures may take the form of atonic,
tonic, or tonic-clonic attacks. Patients with seizures and childhood
hemiplegia may also benefit from surgery. Patients with the following
seizure types are potential candidates: complex partial seizures of temporal
lobe origin or other focal seizures; generalized, atonic, akinetic, or myoclonic
seizures; and partial seizures with childhood hemiplegia.
What Evaluation Is Necessary to Localize Epileptic Foci?
Precise clinical, electrophysiologic, and imaging data are necessary to carry
out surgical therapy. Neurological assessment is necessary to identify and
exclude other forms of neurological disease. In all cases, EEG and MRI are
used. Additional tests are often necessary for precise localization.
The following electrophysiological techniques are used in establishing the
diagnosis and focality of an epileptic disorder:
·
EEG is essential, sometimes with sleep deprivation or other activation
techniques.
·
EEG monitoring with video (video-EEG) is used widely in the evaluation
of potential surgical candidates to exclude nonepileptic seizures and to
define the electroclinical characteristics of the seizures. It is often used to
establish and localize consistency and validity of the epileptogenic
region.
·
For precise cerebral localization, other more or less invasive techniques
are used in some cases to establish a high degree of confidence in the
electrical localization. These methods include sphenoidal leads, subdural
and epidural electrodes and grids, and depth electrodes placed
stereotaxically. Decisions about the need for these procedures must be
individualized.
Brain Imaging Techniques
Imaging techniques include x-ray computed tomography (CT), MRI, PET,
and SPECT.
CT has a limited role in the investigation of partial epilepsy because MRI is
superior to CT in demonstrating brain tumors, vascular malformations, and
focal brain atrophy. The diagnostic value of MRI in visualizing mesial
temporal sclerosis and atrophy is under study. MRI is useful postoperatively
to assess the extent of surgical resection.
PET measures regional cerebral metabolism and blood flow. PET imaging
has been quite successful in identifying the focus as an area of
hypometabolism between attacks. This observation may be used in selecting
patients with partial and secondarily generalized seizures for resective
surgery. Because of the high costs and complexities of PET, this technology
has been confined to a limited number of centers.
SPECT can also be used for functional imaging of the brain because it
demonstrates regional cerebral blood flow, which is linked to cerebral
metabolism and can therefore be used to identify the epileptic focus. SPECT
uses
conventional
and
readily
available
equipment
and
radiopharmaceuticals. These compounds can be used to study both ictal and
interictal states. In the past decade, this relatively affordable technology has
become widely available. More work is needed to determine whether SPECT
is as sensitive as PET in localizing the epileptic regions.
Psychological tests are essential for the evaluation of varied cerebral
functions, including memory and language. The intra-arterial amobarbital
test is used to localize language function and to assess memory
preoperatively.
These diagnostic methods should be available at specialized epileptic
centers. However, the data are insufficient to determine which particular
patients require the more invasive and detailed techniques.
Combining data from the major epilepsy centers would allow the
development of a data bank or registry that should clarify many unanswered
questions about the use of these diagnostic techniques.
What Procedures Are Appropriate for Specific Epilepsies?
For 60 years, there has been continuous development of the surgical
management of epilepsy. There have been many advances in the scientific
understanding of epilepsy, in new technologies for localizing epileptic foci,
and in methods for reducing operative risk. Neither randomized controlled
trials nor large community-based clinical trials have been undertaken;
nevertheless, several surgical approaches have been reported to be
successful and rational in managing some types of intractable epilepsy. The
data are not definitive and are primarily derived from single-institution
studies. Surgery for epilepsy in patients with preoperatively detected
neoplasms or vascular malformations depends as much on the nature and
site of the lesion as on the seizure disorder.
The following discussion relates specifically to surgical procedures
performed with the primary goal of alleviating a seizure disorder rather than
removing a specific brain lesion. Data collected to date suggest that patients
in three general categories are suitable candidates for epilepsy surgery:
partial seizures of temporal or extratemporal origin, secondarily generalized
seizures, or unilateral, multifocal epilepsy associated with infantile
hemiplegia.
Patients with Partial Seizures
The largest group of surgical candidates comprises patients with complex
partial seizures of temporal lobe origin. Preoperative evaluation identifies
those patients with tumors or vascular malformations and can determine
whether the epileptic focus is deep (in the amygdala or hippocampus) or
superficial (cortical).
Appropriately directed, surgical resection of epileptogenic tissue has
resulted in success rates of 55 to 70 percent of patients, when success was
defined as no seizures (some auras may be present) for 5 years after surgery
sometimes with some patients still taking anticonvulsant medication. In
some patients, surgery also results in an improved psychosocial outcome,
but this has not been studied adequately. Combined morbidity and mortality
rates for surgery are below 5 percent. The charges for diagnostic evaluation
and surgery vary from $25,000 in uncomplicated cases to over $100,000 in
those who require extensive preoperative testing, with a median charge of
$40-60,000.
Partial seizures of frontal origin and from other extratemporal sites may also
be treated surgically when the clinical manifestations and diagnostic studies
indicate an epileptic region in a resectable area. Appropriately directed
surgical resection of epileptogenic tissue may result in improvement (as
defined above) in 30-50 percent of cases. The mortality rates are less than 2
percent, and the charges are slightly more than the cost of temporal lobe
resection.
Patients with Secondarily Generalized Seizures
Some patients with generalized seizures may be candidates for surgical
management. Specifically, patients with the Lennox-Gastaut syndrome or
drop-attacks may be helped by section of the corpus callosum, a procedure
designed to prevent rapid bilateral generalization of epileptic discharges.
The procedure is most frequently recommended in patients who are prone to
violent falls that often result in head injury. The seizure disorder usually
persists postoperatively but seizures may become less frequent, less
disabling, and less violent. Evaluation and selection of candidates have not
been standardized. There is also variability of surgical technique,
particularly how completely the corpus callosum is sectioned. Postoperative
mortality is low, but significant complications may occur in as many as 20
percent. The charge for the surgery is often higher than for lobectomy
because the procedure as done in some centers requires two operations, but
the charge for the preoperative evaluation is often less.
Seizures Associated with Infantile Hemiplegia
In patients with intractable unilateral, multifocal epilepsy associated with
infantile hemiplegia, hemispherectomy or callosotomy may be beneficial.
These cases are rare, accounting for about 2 percent of all patients treated
surgically for epilepsy. Success is measured not only by improvement in
seizure frequency and type but also by improvement in behavior. Avoidance
of complications (superficial cortical hemosiderosis and hydrocephalus) is a
major consideration in the selection of surgical technique and has led to a
current consensus for a “functional” hemispherectomy rather than one that
is “anatomically complete.” Success rates of 50 to 70 percent are balanced by
combined mortality and morbidity rates that, in the past, reached 50 percent
with anatomical hemispherectomy. Initial charges are similar to those for
callosotomy but are increased by subsequent charges of dealing with late
complications.
How Should Outcome Be Assessed?
Most studies that have assessed the outcome of either medical or surgical
treatment of epilepsy have emphasized a single measure: seizure elimination
or reduction in frequency. This measurement of seizure frequency needs to
be clarified. For example, is a 50-percent reduction in a person who has two
complex partial seizures a week equivalent to a 50-percent reduction in a
person who has two seizures a year? We recommend the use of standardized
methods to collect information about the frequency and kinds of seizures the
patients are having.
Although we recognize the importance of seizure frequency, we recommend
that future studies should use “general measures” of outcome that would
take advantage of validated and quantitative methods to assess the quality of
life and health status of individuals. This could be achieved by a
standardized survey to assess the following: short-term surgical mortality
and morbidity or complications (e.g., death, paralysis, or infection in the
postoperative period); physical health (symptoms, functioning, role
activities, sleep-wake cycle, and mobility); mental health (psychiatric
diagnoses as well as symptoms such as anxiety or depression);
neuropsychological assessment, including cognitive functioning and
memory, both verbal and nonverbal; social health (personal interactions,
employment, sexuality, driver’s license, and community interactions); and
general health (health perceptions, including fear of death and pain, life
satisfactions, and energy). Evaluation of children should include assessment
of developmental progress and school performance.
To evaluate each of the above, we recommend using general measures of
health status and quality of life so that patients with epilepsy can be
compared to patients with other chronic conditions. Epilepsy is a unique
condition and we also recommend that, in addition to the general measures,
supplemental information should be collected about the specific aspects of
the quality of life of patients with seizures, as discussed above. This
information should be gathered from family members in addition to the
patients themselves. Because epilepsy affects the whole family, the family’s
well-being should be part of the assessment.
The assessment of any treatment of epilepsy must include analysis of the
economic impact on patients, families, and society. Economic impact
includes expenditures on medical care directly (surgical and hospitalization
costs, medication costs, costs of allied health personnel) as well as indirect
costs such as contributed care by family members and whether a patient’s
income and productivity are affected positively or negatively in the future.
Assessment must be done repeatedly for several years. Data from treatment
centers should be pooled to achieve statistical power sufficient to test the
efficacy of treatment, as assessed by the multiple outcome measures.
We recognize that individuals will emphasize different outcomes. Some may
be more concerned with the reduction in seizure frequency; others may be
more concerned with the effect of treatment on memory or social function.
Evaluation of any therapy for intractable epilepsy must explicitly consider
these patient preferences.
For all of these considerations, there is a need for a standardized method of
data collection so that results from different treatment centers can be
combined and compared.
Directions for Future Research
Should a controlled trial be done? If so, for what seizure types?
·
The panel is impressed that surgery is beneficial for selected patients, but
the optimal timing of surgery is not known. Because of current referral
patterns, patients considered for temporal lobe resection tend to have had
uncontrolled (intractable) epilepsy for 10 to 20 years. We therefore
recommend a controlled trial of early versus late surgery to determine
whether early surgery or optimal medical treatment followed by later
surgery of patients with complex partial seizures will result in better
health status and quality of life and may prevent additional brain
damage or chronic social disability.
·
Investigators differ in the selection of tests for preoperative evaluation. In
particular, it is not known when more extensive diagnostic tests are
needed, including ictal surface EEG recording, invasive intracranial
electrode recording, PET, or SPECT. A program should be developed to
assess the value of these tests, and should include the development and
evaluation of algorithms. This would require standardization of
definitions, data collection, and central analysis of the data.
·
We recommend development of an outcome assessment method that
combines validated measures already used to assess general health status
and function in a population of patients with other chronic conditions,
with special items that are sensitive to the unique characteristics of
people with epilepsy and those close to them, as described in the answer
to question 4.
·
We recommend that psychiatric and behavioral functions be
systematically assessed before surgery and during followup to determine
whether there are specific contraindications to any particular surgical
procedure and whether these procedures subsequently affect behavior.
·
In temporal lobe surgery for partial seizures, standard and “tailored”
resections are used by different groups but the results are apparently
similar. The circumstances in which each technique is maximally effective
should be clarified by standardized data collection including
documentation of extent of surgical resection and multivariate analysis so
that an appropriate trial may ultimately be planned, if needed.
·
Because epilepsy surgery now may be used more often in children than
in the past, we recommend additional studies to determine the effects of
uncontrolled seizures and antiepileptic drug therapy on the developing
brain. These studies might include, but not be limited to, evaluation of
sequential neurodevelopmental assessment, anatomic and metabolic
imaging procedures, cognitive-linguistic-academic achievement in
school, and psychosocial adaptation of the child and family.
·
Surgical treatment of epilepsy might not be needed if we knew more
about ways to prevent brain injury or if we had more effective and less
toxic anticonvulsant drugs. It is therefore necessary to support
fundamental research in the basic sciences of epilepsy: developmental
neurobiology, neural science, cellular pathology, neuropharmacology,
and preventive epidemiology.
Conclusions and Recommendations
·
Most epilepsy surgery is performed by teams of committed physicians at
sophisticated medical centers. The number of operations is increasing
rapidly.
·
As currently used, surgery for intractable epilepsy is capable of stopping
seizures or reducing their frequency. Effects on overall health status and
quality of life have not been adequately studied.
·
Several different diagnostic studies and surgical techniques have been
used but do not clearly differ in effectiveness.
·
Before surgery is performed, there are three absolute requirements. First,
the diagnosis of epilepsy must be ascertained. Second, there must have
been an adequate trial of drug therapy; that is, the correct drugs used in
the correct dosage, carefully monitored for an appropriate time. Finally,
the electroclinical syndrome must be defined.
·
As demand for surgery grows and it becomes available at more hospitals,
quality of care must be maintained. Surgery should be performed at
hospitals equipped with modern technology and staffed by
multidisciplinary teams capable of preoperative diagnosis, selection of
medical and surgical treatments, comprehensive postoperative
evaluation, and ambulatory rehabilitative care. Rehabilitation should
include the transition of patients to a seizure-free or almost seizure-free
lifestyle with respect to psychological and social adjustment, education,
and vocational training.
·
Physicians in any center or independent hospital that offers surgery for
epilepsy should agree to use standardized data collection for all patients.
The data should be maintained in a central registry, with respect for
confidentiality. The data should include demographic information,
diagnosis, clinical history, results of preoperative evaluation, and
outcome assessment of quality of life and health status for at least 5 years.
Outcome information should be provided to patients considering surgery
so that expectations about the benefits and risks can be discussed and
assessed.
Online Glossaries 341
ONLINE GLOSSARIES
The Internet provides access to a number of free-to-use medical dictionaries
and glossaries. The National Library of Medicine has compiled the following
list of online dictionaries:
·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical
reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.):
http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.):
http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight
European Languages (European Commission) - Danish, Dutch, English,
French, German, Italian, Portuguese, and Spanish:
http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB):
http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care
Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases):
http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia
covering every aspect of medicine (licensed from A.D.A.M., Inc.). The
ADAM
Medical
Encyclopedia
Web
site
address
is
http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also
available
on
commercial
Web
sites
such
as
Web
MD
(http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a)
and
drkoop.com (http://www.drkoop.com/). Topics of interest can be researched
by using keywords before continuing elsewhere, as these basic definitions
and concepts will be useful in more advanced areas of research. You may
choose to print various pages specifically relating to seizures and epilepsy
and keep them on file. The NIH, in particular, suggests that patients with
seizures and epilepsy visit the following Web sites in the ADAM Medical
Encyclopedia:
·
Basic Guidelines for Seizures and Epilepsy
Seizures
Web site:
·
Signs & Symptoms for Seizures and Epilepsy
Amnesia
Web site:
Anosmia
Web site:
Drooling
Web site:
Dysgeusia
Web site:
Fever
Web site:
Hyperventilation
Web site:
Impairment of taste
Web site:
Loss of bladder or bowel control
Web site:
Loss of smell
Web site:
Memory loss
Web site:
Muscle
Web site:
Muscle contraction
Web site:
Muscle contractions
Web site:
Nausea
Web site:
Rapid breathing
Web site:
Vomiting
Web site:
·
Diagnostics and Tests for Seizures and Epilepsy
Blood pressure
Web site:
Blood sugar level
Web site:
CT scan of the head
Web site:
EEG
Web site:
Pulse
Web site:
·
Background Topics for Seizures and Epilepsy
Chronic
Web site:
Head injury
Web site:
Heatstroke
Web site:
Injury or trauma to the head
Web site:
Physical examination
Web site:
Seizure-first aid
Web site:
Unconscious
Web site:
Vital signs
Web site:
Online Dictionary Directories
The following are additional online directories compiled by the National
Library of Medicine, including a number of specialized medical dictionaries
and glossaries:
·
Medical Dictionaries: Medical & Biological (World Health Organization):
http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical
Dictionaries (Michigan Electronic Library):
http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project):
http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University):
http://www.yourdictionary.com/diction5.html#medicine
Glossary 347
SEIZURES AND EPILEPSY GLOSSARY
The following is a complete glossary of terms used in this sourcebook. The
definitions are derived from official public sources including the National
Institutes of Health [NIH] and the European Union [EU]. After this glossary, we
list a number of additional hardbound and electronic glossaries and
dictionaries that you may wish to consult.
Abdomen: That portion of the body that lies between the thorax and the
pelvis. [NIH]
Accommodation:
distances. [EU]
Adjustment, especially that of the eye for various
Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major
transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic
effector junctions, a subset of sympathetic effector junctions, and at many
sites in the central nervous system. It is generally not used as an
administered drug because it is broken down very rapidly by
cholinesterases, but it is useful in some ophthalmological applications. [NIH]
Acidosis: A pathologic condition resulting from accumulation of acid or
depletion of the alkaline reserve (bicarbonate content) in the blood and body
tissues, and characterized by an increase in hydrogen ion concentration. [EU]
ACTH: Adrenocorticotropic hormone. [EU]
Adenosine: A nucleoside that is composed of adenine and d-ribose.
Adenosine or adenosine derivatives play many important biological roles in
addition to being components of DNA and RNA. Adenosine itself is a
neurotransmitter. [NIH]
Adolescence: The period of life beginning with the appearance of secondary
sex characteristics and terminating with the cessation of somatic growth. The
years usually referred to as adolescence lie between 13 and 18 years of age.
[NIH]
Alendronate:
A nonhormonal medication for the treatment of
postmenopausal osteoporosis in women. This drug builds healthy bone,
restoring some of the bone loss as a result of osteoporosis. [NIH]
Algorithms: A procedure consisting of a sequence of algebraic formulas
and/or logical steps to calculate or determine a given task. [NIH]
Alopecia: Baldness; absence of the hair from skin areas where it normally is
present. [EU]
Aluminum: A metallic element that has the atomic number 13, atomic
symbol Al, and atomic weight 26.98. [NIH]
Amnesia: Lack or loss of memory; inability to remember past experiences.
[EU]
Amniocentesis: Percutaneous transabdominal puncture of the uterus
during pregnancy to obtain amniotic fluid. It is commonly used for fetal
karyotype determination in order to diagnose abnormal fetal conditions. [NIH]
Amphetamine:
A powerful central nervous system stimulant and
sympathomimetic. Amphetamine has multiple mechanisms of action
including blocking uptake of adrenergics and dopamine, stimulation of
release of monamines, and inhibiting monoamine oxidase. Amphetamine is
also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are
included here. The l-form has less central nervous system activity but
stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH]
Amygdala: Almond-shaped group of basal nuclei anterior to the inferior
horn of the lateral ventricle of the brain, within the temporal lobe. The
amygdala is part of the limbic system. [NIH]
Anaesthesia: Loss of feeling or sensation. Although the term is used for loss
of tactile sensibility, or of any of the other senses, it is applied especially to
loss of the sensation of pain, as it is induced to permit performance of
surgery or other painful procedures. [EU]
Anaphylaxis: An acute hypersensitivity reaction due to exposure to a
previously encountered antigen. The reaction may include rapidly
progressing urticaria, respiratory distress, vascular collapse, systemic shock,
and death. [NIH]
Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU]
Anemia: A reduction in the number of circulating erythrocytes or in the
quantity of hemoglobin. [NIH]
Anesthesia: A state characterized by loss of feeling or sensation. This
depression of nerve function is usually the result of pharmacologic action
and is induced to allow performance of surgery or other painful procedures.
[NIH]
Anesthesiology: A specialty concerned with the study of anesthetics and
anesthesia. [NIH]
Anorexia: Lack or loss of the appetite for food. [EU]
Anosmia: Absence of the sense of smell; called also anosphrasia and
olfactory anaesthesia. [EU]
Antibiotic: A chemical substance produced by a microorganism which has
the capacity, in dilute solutions, to inhibit the growth of or to kill other
microorganisms. Antibiotics that are sufficiently nontoxic to the host are
used as chemotherapeutic agents in the treatment of infectious diseases of
man, animals and plants. [EU]
Glossary 349
Anticonvulsant: An agent that prevents or relieves convulsions. [EU]
Antidepressant: An agent that stimulates the mood of a depressed patient,
including tricyclic antidepressants and monoamine oxidase inhibitors. [EU]
Antiepileptic: An agent that combats epilepsy. [EU]
Anxiety: The unpleasant emotional state consisting of psychophysiological
responses to anticipation of unreal or imagined danger, ostensibly resulting
from unrecognized intrapsychic conflict. Physiological concomitants include
increased heart rate, altered respiration rate, sweating, trembling, weakness,
and fatigue; psychological concomitants include feelings of impending
danger, powerlessness, apprehension, and tension. [EU]
Aphasia: Defect or loss of the power of expression by speech, writing, or
signs, or of comprehending spoken or written language, due to injury or
disease of the brain centres. [EU]
Apnea: A transient absence of spontaneous respiration. [NIH]
Arrhythmia: Any variation from the normal rhythm of the heart beat,
including sinus arrhythmia, premature beat, heart block, atrial fibrillation,
atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU]
Arterial: Pertaining to an artery or to the arteries. [EU]
Asphyxia: A pathological condition caused by lack of oxygen, manifested in
impending or actual cessation of life. [NIH]
Auditory: Pertaining to the sense of hearing. [EU]
Aura: A subjective sensation or motor phenomenon that precedes and
marks the of a paroxysmal attack, such as an epileptic attack on set. [EU]
Autoimmunity: Process whereby the immune system reacts against the
body's own tissues. Autoimmunity may produce or be caused by
autoimmune diseases. [NIH]
Automatism: Aimless and apparently undirected behaviour that is not
under conscious control and is performed without conscious knowledge;
seen in psychomotor epilepsy, catatonic schizophrenia, psychogenic fugue,
and other conditions. Called also automatic behaviour. [EU]
Autonomic: Self-controlling; functionally independent. [EU]
Bacteria: Unicellular prokaryotic microorganisms which generally possess
rigid cell walls, multiply by cell division, and exhibit three principal forms:
round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH]
Benign: Not malignant; not recurrent; favourable for recovery. [EU]
Benzodiazepines: A two-ring heterocyclic compound consisting of a
benzene ring fused to a diazepine ring. Permitted is any degree of
hydrogenation, any substituents and any H-isomer. [NIH]
Bilateral: Having two sides, or pertaining to both sides. [EU]
Biochemical: Relating to biochemistry; characterized by, produced by, or
involving chemical reactions in living organisms. [EU]
Biopsy: The removal and examination, usually microscopic, of tissue from
the living body, performed to establish precise diagnosis. [EU]
Blinking: Brief closing of the eyelids by involuntary normal periodic
closing, as a protective measure, or by voluntary action. [NIH]
Boron: Boron. A trace element with the atomic symbol B, atomic number 5,
and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron
absorber in boron neutron capture therapy. [NIH]
Calmodulin: A heat-stable, low-molecular-weight activator protein found
mainly in the brain and heart. The binding of calcium ions to this protein
allows this protein to bind to cyclic nucleotide phosphodiesterases and to
adenyl cyclase with subsequent activation. Thereby this protein modulates
cyclic AMP and cyclic GMP levels. [NIH]
Camping: Living outdoors as a recreational activity. [NIH]
Cannabinoids:
Compounds extracted from Cannabis sativa L. and
metabolites having the cannabinoid structure. The most active constituents
are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH]
Capsules: Hard or soft soluble containers used for the oral administration of
medicine. [NIH]
Carbamazepine: An anticonvulsant used to control grand mal and
psychomotor or focal seizures. Its mode of action is not fully understood, but
some of its actions resemble those of phenytoin; although there is little
chemical resemblance between the two compounds, their three-dimensional
structure is similar. [NIH]
Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
particularly of the pentahydric and hexahydric alcohols. They are so named
because the hydrogen and oxygen are usually in the proportion to form
water, (CH2O)n. The most important carbohydrates are the starches, sugars,
celluloses, and gums. They are classified into mono-, di-, tri-, poly- and
heterosaccharides. [EU]
Cardiac: Pertaining to the heart. [EU]
Cardiogenic: Originating in the heart; caused by abnormal function of the
heart. [EU]
Cardiovascular: Pertaining to the heart and blood vessels. [EU]
Caspases: A family of intracellular cysteine endopeptidases. They play a key
role in inflammation and mammalian APOPTOSIS. They are specific for
aspartic acid at the P1 position. They are divided into two classes based on
Glossary 351
the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10
have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-.
[NIH]
Catalase: An oxidoreductase that catalyzes the conversion of hydrogen
peroxide to water and oxygen. It is present in many animal cells. A
deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH]
Catheter: A tubular, flexible, surgical instrument for withdrawing fluids
from (or introducing fluids into) a cavity of the body, especially one for
introduction into the bladder through the urethra for the withdraw of urine.
[EU]
Caudal: Denoting a position more toward the cauda, or tail, than some
specified point of reference; same as inferior, in human anatomy. [EU]
Cerebellar: Pertaining to the cerebellum. [EU]
Cerebellum: Part of the metencephalon that lies in the posterior cranial
fossa behind the brain stem. It is concerned with the coordination of
movement. [NIH]
Cerebral: Of or pertaining of the cerebrum or the brain. [EU]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU]
Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain.
[EU]
Ceroid:
A naturally occurring lipid pigment with histochemical
characteristics similar to lipofuscin. It accumulates in various tissues in
certain experimental and pathological conditions. [NIH]
Chemotherapy: The treatment of disease by means of chemicals that have a
specific toxic effect upon the disease - producing microorganisms or that
selectively destroy cancerous tissue. [EU]
Cholesterol: The principal sterol of all higher animals, distributed in body
tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]
Chronic: Persisting over a long period of time. [EU]
Chronobiology: The study of biological systems as affected by time. Aging,
biological rhythms, and cyclic phenomena are included. Statistical,
computer-aided mathematical procedures are used to describe, in
mathematical terminology, various biological functions over time. [NIH]
Cisplatin: An inorganic and water-soluble platinum complex. After
undergoing hydrolysis, it reacts with DNA to produce both intra and
interstrand crosslinks. These crosslinks appear to impair replication and
transcription of DNA. The cytotoxicity of cisplatin correlates with cellular
arrest in the G2 phase of the cell cycle. [NIH]
Citrus: Any tree or shrub of the rue family or the fruit of these plants. [NIH]
Clonazepam:
An anticonvulsant used for several types of seizures,
including myotonic or atonic seizures, photosensitive epilepsy, and absence
seizures, although tolerance may develop. It is seldom effective in
generalized tonic-clonic or partial seizures. The mechanism of action appears
to involve the enhancement of GABA receptor responses. [NIH]
Clonic: Pertaining to or of the nature of clonus. [EU]
Cocaine: An alkaloid ester extracted from the leaves of plants including
coca. It is a local anesthetic and vasoconstrictor and is clinically used for that
purpose, particularly in the eye, ear, nose, and throat. It also has powerful
central nervous system effects similar to the amphetamines and is a drug of
abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain
catecholaminergic neurons; the mechanism of its reinforcing effects is
thought to involve inhibition of dopamine uptake. [NIH]
Comorbidity: The presence of co-existing or additional diseases with
reference to an initial diagnosis or with reference to the index condition that
is the subject of study. Comorbidity may affect the ability of affected
individuals to function and also their survival; it may be used as a
prognostic indicator for length of hospital stay, cost factors, and outcome or
survival. [NIH]
Conception: The onset of pregnancy, marked by implantation of the
blastocyst; the formation of a viable zygote. [EU]
Conduction: The transfer of sound waves, heat, nervous impulses, or
electricity. [EU]
Confusion: Disturbed orientation in regard to time, place, or person,
sometimes accompanied by disordered consciousness. [EU]
Consciousness: Sense of awareness of self and of the environment. [NIH]
Contraceptive:
conception. [EU]
An agent that diminishes the likelihood of or prevents
Convulsion: A violent involuntary contraction or series of contractions of
the voluntary muscles. [EU]
Cortex: The outer layer of an organ or other body structure, as distinguished
from the internal substance. [EU]
Curative: Tending to overcome disease and promote recovery. [EU]
Cutaneous: Pertaining to the skin; dermal; dermic. [EU]
Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to
chemical compounds that contain a ring of atoms in the nucleus. [EU]
Cysteine: A thiol-containing non-essential amino acid that is oxidized to
form cystine. [NIH]
Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and
some non-leukocytic cells, that act as intercellular mediators. They differ
Glossary 353
from classical hormones in that they are produced by a number of tissue or
cell types rather than by specialized glands. They generally act locally in a
paracrine or autocrine rather than endocrine manner. [NIH]
Dehydration: The condition that results from excessive loss of body water.
Called also anhydration, deaquation and hypohydration. [EU]
Dementia: An acquired organic mental disorder with loss of intellectual
abilities of sufficient severity to interfere with social or occupational
functioning. The dysfunction is multifaceted and involves memory,
behavior, personality, judgment, attention, spatial relations, language,
abstract thought, and other executive functions. The intellectual decline is
usually progressive, and initially spares the level of consciousness. [NIH]
Dendrites: Extensions of the nerve cell body. They are short and branched
and receive stimuli from other neurons. [NIH]
Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites.
[EU]
Deprivation: Loss or absence of parts, organs, powers, or things that are
needed. [EU]
Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]
Disorientation: The loss of proper bearings, or a state of mental confusion
as to time, place, or identity. [EU]
Dizziness: An imprecise term which may refer to a sense of spatial
disorientation, motion of the environment, or lightheadedness. [NIH]
Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position
more toward the back surface than some other object of reference; same as
posterior in human anatomy; superior in the anatomy of quadrupeds. [EU]
Dysgeusia: Distortion of the sense of taste. [EU]
Dyskinesia: Impairment of the power of voluntary movement, resulting in
fragmentary or incomplete movements. [EU]
Dysphagia: Difficulty in swallowing. [EU]
Dysplasia: Abnormality of development; in pathology, alteration in size,
shape, and organization of adult cells. [EU]
Dystrophy: Any disorder arising from defective or faulty nutrition,
especially the muscular dystrophies. [EU]
Eclampsia: Convulsions and coma occurring in a pregnant or puerperal
woman, associated with preeclampsia, i.e., with hypertension, edema,
and/or proteinuria. [EU]
Edema: Excessive amount of watery fluid accumulated in the intercellular
spaces, most commonly present in subcutaneous tissue. [NIH]
Electroacupuncture: A form of acupuncture using low frequency electrically
stimulated needles to produce analgesia and anesthesia and to treat disease.
[NIH]
Electroencephalography: The recording of the electric currents developed in
the brain, by means of electrodes applied to the scalp, to the surface of the
brain (intracranial e.) or placed within the substance of the brain (depth e.).
[EU]
Electrophysiological: Pertaining to electrophysiology, that is a branch of
physiology that is concerned with the electric phenomena associated with
living bodies and involved in their functional activity. [EU]
Electroshock: Induction of a stress reaction in experimental subjects by
means of an electrical shock; applies to either convulsive or non-convulsive
states. [NIH]
Encephalitis: Inflammation of the brain. [EU]
Encephalopathy: Any degenerative disease of the brain. [EU]
Endocarditis: Exudative and proliferative inflammatory alterations of the
endocardium, characterized by the presence of vegetations on the surface of
the endocardium or in the endocardium itself, and most commonly
involving a heart valve, but sometimes affecting the inner lining of the
cardiac chambers or the endocardium elsewhere. It may occur as a primary
disorder or as a complication of or in association with another disease. [EU]
Endogenous: Developing or originating within the organisms or arising
from causes within the organism. [EU]
Enzyme: A protein molecule that catalyses chemical reactions of other
substances without itself being destroyed or altered upon completion of the
reactions. Enzymes are classified according to the recommendations of the
Nomenclature Committee of the International Union of Biochemistry. Each
enzyme is assigned a recommended name and an Enzyme Commission (EC)
number. They are divided into six main groups; oxidoreductases,
transferases, hydrolases, lyases, isomerases, and ligases. [EU]
Epidemiological: Relating to, or involving epidemiology. [EU]
Epidural: Situated upon or outside the dura mater. [EU]
Estradiol: The most potent mammalian estrogenic hormone. It is produced
in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH]
Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal
tract and distributed throughout the body. It has bactericidal activity and is
used often as a topical disinfectant. It is widely used as a solvent and
preservative in pharmaceutical preparations as well as serving as the
primary ingredient in alcoholic beverages. [NIH]
Ethosuximide: An anticonvulsant especially useful in the treatment of
absence seizures unaccompanied by other types of seizures. [NIH]
Glossary 355
Exanthema: Exanthem; an eruptive disease or its symptomatic eruption. [EU]
Excitation: An act of irritation or stimulation or of responding to a stimulus;
the addition of energy, as the excitation of a molecule by absorption of
photons. [EU]
Fatigue: The state of weariness following a period of exertion, mental or
physical, characterized by a decreased capacity for work and reduced
efficiency to respond to stimuli. [NIH]
Febrile: Pertaining to or characterized by fever. [EU]
Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU]
Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as
an antidepressant and often has a more acceptable side-effects profile than
traditional antidepressants. [NIH]
Flurothyl: A convulsant primarily used in experimental animals. It was
formerly used to induce convulsions as a alternative to electroshock therapy.
[NIH]
GABA: The most common inhibitory neurotransmitter in the central
Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely
organized connective tissue located outside the central nervous system. [NIH]
Gastroenteritis: An acute inflammation of the lining of the stomach and
intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain,
and weakness, which has various causes, including food poisoning due to
infection with such organisms as Escherichia coli, Staphylococcus aureus,
and Salmonella species; consumption of irritating food or drink; or
psychological factors such as anger, stress, and fear. Called also
enterogastritis. [EU]
Gestation: The period of development of the young in viviparous animals,
from the time of fertilization of the ovum until birth. [EU]
Gestures:
Movement of a part of the body for the purpose of
communication. [NIH]
Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as
dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the
normal blood of all animals. It is the end product of carbohydrate
metabolism and is the chief source of energy for living organisms, its
utilization being controlled by insulin. Excess glucose is converted to
glycogen and stored in the liver and muscles for use as needed and, beyond
that, is converted to fat and stored as adipose tissue. Glucose appears in the
urine in diabetes mellitus. [EU]
Gluten: The protein of wheat and other grains which gives to the dough its
tough elastic character. [EU]
Gonadal: Pertaining to a gonad. [EU]
Gout: Hereditary metabolic disorder characterized by recurrent acute
arthritis, hyperuricemia and deposition of sodium urate in and around the
joints, sometimes with formation of uric acid calculi. [NIH]
Gynecology: A medical-surgical specialty concerned with the physiology
and disorders primarily of the female genital tract, as well as female
endocrinology and reproductive physiology. [NIH]
Hemiplegia: Paralysis of one side of the body. [EU]
Hemorrhage: Bleeding or escape of blood from a vessel. [NIH]
Hemosiderosis: Conditions in which there is a generalized increase in the
iron stores of body tissues, particularly of liver and the reticuloendothelial
system, without demonstrable tissue damage. The name refers to the
presence of stainable iron in the tissue in the form of hemosiderin. [NIH]
Heredity: 1. The genetic transmission of a particular quality or trait from
parent to offspring. 2. The genetic constitution of an individual. [EU]
Hormonal: Pertaining to or of the nature of a hormone. [EU]
Hormones: Chemical substances having a specific regulatory effect on the
activity of a certain organ or organs. The term was originally applied to
substances secreted by various endocrine glands and transported in the
bloodstream to the target organs. It is sometimes extended to include those
substances that are not produced by the endocrine glands but that have
similar effects. [NIH]
Hydrocephalus: A condition marked by dilatation of the cerebral ventricles,
most often occurring secondarily to obstruction of the cerebrospinal fluid
pathways, and accompanied by an accumulation of cerebrospinal fluid
within the skull; the fluid is usually under increased pressure, but
occasionally may be normal or nearly so. It is typically characterized by
enlargement of the head, prominence of the forehead, brain atrophy, mental
deterioration, and convulsions; may be congenital or acquired; and may be
of sudden onset (acute h.) or be slowly progressive (chronic or primary b.).
[EU]
Hyperbaric: Characterized by greater than normal pressure or weight;
applied to gases under greater than atmospheric pressure, as hyperbaric
oxygen, or to a solution of greater specific gravity than another taken as a
standard of reference. [EU]
Hypnotic: A drug that acts to induce sleep. [EU]
Hypogonadism: A condition resulting from or characterized by abnormally
decreased functional activity of the gonads, with retardation of growth and
sexual development. [EU]
Hypothalamus: Ventral part of the diencephalon extending from the region
Glossary 357
of the optic chiasm to the caudal border of the mammillary bodies and
forming the inferior and lateral walls of the third ventricle. [NIH]
Hysteria: Historical term for a chronic, but fluctuating, disorder beginning
in early life and characterized by recurrent and multiple somatic complaints
not apparently due to physical illness. This diagnosis is not used in
contemporary practice. [NIH]
Idiopathic: Of the nature of an idiopathy; self-originated; of unknown
causation. [EU]
Iloprost: An eicosanoid, derived from the cyclooxygenase pathway of
arachidonic acid metabolism. It is a stable and synthetic analog of
EPOPROSTENOL, but with a longer half-life than the parent compound. Its
actions are similar to prostacyclin. Iloprost produces vasodilation and
inhibits platelet aggregation. [NIH]
Immunization: The induction of immunity. [EU]
Indicative: That indicates; that points out more or less exactly; that reveals
fairly clearly. [EU]
Induction: The act or process of inducing or causing to occur, especially the
production of a specific morphogenetic effect in the developing embryo
through the influence of evocators or organizers, or the production of
anaesthesia or unconsciousness by use of appropriate agents. [EU]
Infantile: Pertaining to an infant or to infancy. [EU]
Inflammation: A pathological process characterized by injury or destruction
of tissues caused by a variety of cytologic and chemical reactions. It is
usually manifested by typical signs of pain, heat, redness, swelling, and loss
of function. [NIH]
Infusion: The therapeutic introduction of a fluid other than blood, as saline
solution, solution, into a vein. [EU]
Ingestion: The act of taking food, medicines, etc., into the body, by mouth.
[EU]
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin
plays a major role in the regulation of glucose metabolism, generally
promoting the cellular utilization of glucose. It is also an important regulator
of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH]
Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU]
Intubation: The insertion of a tube into a body canal or hollow organ, as
into the trachea or stomach. [EU]
Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or
incision of the skin or insertion of an instrument or foreign material into the
body; said of diagnostic techniques. [EU]
Iodine: A nonmetallic element of the halogen group that is represented by
the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a
nutritionally essential element, especially important in thyroid hormone
synthesis. In solution, it has anti-infective properties and is used topically.
[NIH]
Lesion: Any pathological or traumatic discontinuity of tissue or loss of
function of a part. [EU]
Libido: Sexual desire. [EU]
Limbic: Pertaining to a limbus, or margin; forming a border around. [EU]
Lithium: Lithium. An element in the alkali metals family. It has the atomic
symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are
used in treating manic-depressive disorders. [NIH]
Lobe: A more or less well-defined portion of any organ, especially of the
brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective
tissue, and by their shape. [EU]
Localization: 1. the determination of the site or place of any process or
lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU]
Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic,
anticonvulsant, and considerable sedative properties and has been proposed
as a preanesthetic agent. [NIH]
Lumbar: Pertaining to the loins, the part of the back between the thorax and
the pelvis. [EU]
Lupus: A form of cutaneous tuberculosis. It is seen predominantly in
women and typically involves the nasal, buccal, and conjunctival mucosa.
[NIH]
Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term
lymphoma often is used alone to denote malignant lymphoma. [EU]
Magnetoencephalography: The measurement of magnetic fields over the
head generated by electric currents in the brain. As in any electrical
conductor, electric fields in the brain are accompanied by orthogonal
magnetic fields. The measurement of these fields provides information about
the localization of brain activity which is complementary to that provided by
electroencephalography. Magnetoencephalography may be used alone or
together with electroencephalography, for measurement of spontaneous or
evoked activity, and for research or clinical purposes. [NIH]
Malabsorption: Impaired intestinal absorption of nutrients. [EU]
Malformation: A morphologic defect resulting from an intrinsically
abnormal developmental process. [EU]
Mastocytosis: A group of diseases resulting from proliferation of mast cells.
[NIH]
Glossary 359
Mediator: An object or substance by which something is mediated, such as
(1) a structure of the nervous system that transmits impulses eliciting a
specific response; (2) a chemical substance (transmitter substance) that
induces activity in an excitable tissue, such as nerve or muscle; or (3) a
substance released from cells as the result of the interaction of antigen with
antibody or by the action of antigen with a sensitized lymphocyte. [EU]
Membrane: A thin layer of tissue which covers a surface, lines a cavity or
divides a space or organ. [EU]
Meningitis: Inflammation of the meninges. When it affects the dura mater,
the disease is termed pachymeningitis; when the arachnoid and pia mater
are involved, it is called leptomeningitis, or meningitis proper. [EU]
Menopause: Cessation of menstruation in the human female, occurring
usually around the age of 50. [EU]
Menstruation: The cyclic, physiologic discharge through the vagina of
blood and mucosal tissues from the nonpregnant uterus; it is under
hormonal control and normally recurs, usually at approximately four-week
intervals, in the absence of pregnancy during the reproductive period
(puberty through menopause) of the female of the human and a few species
of primates. It is the culmination of the menstrual cycle. [EU]
Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to
the chin. [EU]
Methylphenidate:
A central nervous system stimulant used most
commonly in the treatment of attention-deficit disorders in children and for
narcolepsy. Its mechanisms appear to be similar to those of
dextroamphetamine. [NIH]
Microdialysis: A technique for measuring extracellular concentrations of
substances in tissues, usually in vivo, by means of a small probe equipped
with a semipermeable membrane. Substances may also be introduced into
the extracellular space through the membrane. [NIH]
Mobility: Capability of movement, of being moved, or of flowing freely. [EU]
Monotherapy: A therapy which uses only one drug. [EU]
Muscimol: Neurotoxic isoxazole isolated from Amanita muscaria and A.
phalloides and also obtained by decarboxylation of ibotenic acid. It is a
potent agonist at GABA-A receptors and is used mainly as an experimental
tool in animal and tissue studies. [NIH]
Muscle Contraction: A process leading to shortening and/or development
of tension in muscle tissue. Muscle contraction occurs by a sliding filament
mechanism whereby actin filaments slide inward among the myosin
filaments. [NIH]
Nadir: The lowest point; point of greatest adversity or despair. [EU]
Nausea: An unpleasant sensation, vaguely referred to the epigastrium and
abdomen, and often culminating in vomiting. [EU]
Neocortex: The largest portion of the cerebral cortex. It is composed of
neurons arranged in six layers. [NIH]
Neonatal: Pertaining to the first four weeks after birth. [EU]
Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a
greater degree of anaplasia and have the properties of invasion and
metastasis, compared to benign neoplasms. [NIH]
Nervousness: Excessive excitability and irritability, with mental and
physical unrest. [EU]
Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of
the spinal axis, as the neutral arch. [EU]
Neuroanatomy: Study of the anatomy of the nervous system as a specialty
or discipline. [NIH]
Neurology: A medical specialty concerned with the study of the structures,
functions, and diseases of the nervous system. [NIH]
Neuronal: Pertaining to a neuron or neurons (= conducting cells of the
nervous system). [EU]
Neurons: The basic cellular units of nervous tissue. Each neuron consists of
a body, an axon, and dendrites. Their purpose is to receive, conduct, and
transmit impulses in the NERVOUS SYSTEM. [NIH]
Neuropeptides: Peptides released by neurons as intercellular messengers.
Many neuropeptides are also hormones released by non-neuronal cells. [NIH]
Neuropharmacology: The branch of pharmacology dealing especially with
the action of drugs upon various parts of the nervous system. [NIH]
Neurophysiology: The scientific discipline concerned with the physiology
of the nervous system. [NIH]
Neuropsychology:
A branch of psychology which investigates the
correlation between experience or behavior and the basic neurophysiological
processes. The term neuropsychology stresses the dominant role of the
nervous system. It is a more narrowly defined field than physiological
psychology or psychophysiology. [NIH]
Neurosciences: The scientific disciplines concerned with the embryology,
anatomy, physiology, biochemistry, pharmacology, etc., of the nervous
sytem. [NIH]
Neurosurgery: A surgical specialty concerned with the treatment of diseases
and disorders of the brain, spinal cord, and peripheral and sympathetic
Neurotransmitter:
Any of a group of substances that are released on
Glossary 361
excitation from the axon terminal of a presynaptic neuron of the central or
peripheral nervous system and travel across the synaptic cleft to either excite
or inhibit the target cell. Among the many substances that have the
properties of a neurotransmitter are acetylcholine, norepinephrine,
epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance
P, enkephalins, endorphins, and serotonin. [EU]
Niacin: Water-soluble vitamin of the B complex occurring in various animal
and plant tissues. Required by the body for the formation of coenzymes
NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic
properties. [NIH]
Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at
nicotinic cholinergic receptors where it dramatically stimulates neurons and
ultimately blocks synaptic transmission. Nicotine is also important medically
because of its presence in tobacco smoke. [NIH]
Nimodipine:
A calcium channel blockader with preferential
cerebrovascular activity. It has marked cerebrovascular dilating effects and
lowers blood pressure. [NIH]
Obstetrics: A medical-surgical specialty concerned with management and
care of women during pregnancy, parturition, and the puerperium. [NIH]
Octreotide: A potent, long-acting somatostatin octapeptide analog which
has a wide range of physiological actions. It inhibits growth hormone
secretion, is effective in the treatment of hormone-secreting tumors from
various organs, and has beneficial effects in the management of many
pathological states including diabetes mellitus, orthostatic hypertension,
hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH]
Ophthalmology: A surgical specialty concerned with the structure and
function of the eye and the medical and surgical treatment of its defects and
diseases. [NIH]
Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball).
[EU]
Overdose: 1. To administer an excessive dose. 2. An excessive dose. [EU]
Pacemaker: An object or substance that influences the rate at which a certain
phenomenon occurs; often used alone to indicate the natural cardiac
pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance
whose rate of reaction sets the pace for a series of interrelated reactions. [EU]
Paediatric: Of or relating to the care and medical treatment of children;
belonging to or concerned with paediatrics. [EU]
Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU]
Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or
located near the parietal bone, as the parietal lobe. [EU]
Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU]
Pediatrics: A medical specialty concerned with maintaining health and
providing medical care to children from birth to adolescence. [NIH]
Pentylenetetrazole: A pharmaceutical agent that displays activity as a
central nervous system and respiratory stimulant. It is considered a noncompetitive GABA antagonist. Pentylenetetrazole has been used
experimentally to study seizure phenomenon and to identify
pharmaceuticals that may control seizure susceptibility. [NIH]
Perinatal: Pertaining to or occurring in the period shortly before and after
birth; variously defined as beginning with completion of the twentieth to
twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU]
Perphenazine: An antipsychotic phenothiazine derivative with actions and
uses similar to those of chlorpromazine. [NIH]
Perspiration: Sweating; the functional secretion of sweat. [EU]
Phenobarbital: A barbituric acid derivative that acts as a nonselective
central nervous system depressant. It promotes binding to inhibitory GABA
subtype receptors, and modulates chloride currents through receptor
channels. It also inhibits glutamate induced depolarizations. [NIH]
Phenotype: The outward appearance of the individual. It is the product of
interactions between genes and between the genotype and the environment.
This includes the killer phenotype, characteristic of yeasts. [NIH]
Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is
also an anti-arrhythmic and a muscle relaxant. The mechanism of
therapeutic action is not clear, although several cellular actions have been
described including effects on ion channels, active transport, and general
membrane stabilization. The mechanism of its muscle relaxant effect appears
to involve a reduction in the sensitivity of muscle spindles to stretch.
Phenytoin has been proposed for several other therapeutic uses, but its use
has been limited by its many adverse effects and interactions with other
drugs. [NIH]
Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through
membranes. It can be applied topically to the conjunctiva. It also can cross
the blood-brain barrier and is used when central nervous system effects are
desired, as in the treatment of severe anticholinergic toxicity. [NIH]
Picrotoxin: A noncompetitive antagonist at GABA-A receptors and thus a
convulsant. Picrotoxin blocks the GABA-activated chloride ionophore.
Although it is most often used as a research tool, it has been used as a CNS
stimulant and an antidote in poisoning by CNS depressants, especially the
barbiturates. [NIH]
Pilocarpine:
A slowly hydrolyzed muscarinic agonist with no nicotinic
Glossary 363
effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH]
Plantago: Three different species of Plantago or plantain, P. psyllium, P.
ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH]
Poisoning: A condition or physical state produced by the ingestion,
injection or inhalation of, or exposure to a deleterious agent. [NIH]
Polytherapy: A therapy which uses more than one drug. [EU]
Posterior: Situated in back of, or in the back part of, or affecting the back or
dorsal surface of the body. In lower animals, it refers to the caudal end of the
body. [EU]
Postnatal: Occurring after birth, with reference to the newborn. [EU]
Postoperative: Occurring after a surgical operation. [EU]
Postural: Pertaining to posture or position. [EU]
Potassium: An element that is in the alkali group of metals. It has an atomic
symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation
in the intracellular fluid of muscle and other cells. Potassium ion is a strong
electrolyte and it plays a significant role in the regulation of fluid volume
and maintenance of the water-electrolyte balance. [NIH]
Predisposition: A latent susceptibility to disease which may be activated
under certain conditions, as by stress. [EU]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from
cortisone. It is biologically inert and converted to prednisolone in the liver.
[NIH]
Preeclampsia: A toxaemia of late pregnancy characterized by hypertension,
edema, and proteinuria, when convulsions and coma are associated, it is
called eclampsia. [EU]
Prejudice: A preconceived judgment made without adequate evidence and
not easily alterable by presentation of contrary evidence. [NIH]
Prenatal: Existing or occurring before birth, with reference to the fetus. [EU]
Preoperative: Preceding an operation. [EU]
Presynaptic: Situated proximal to a synapse, or occurring before the
synapse is crossed. [EU]
Prevalence: The total number of cases of a given disease in a specified
population at a designated time. It is differentiated from incidence, which
refers to the number of new cases in the population at a given time. [NIH]
Progesterone:
Pregn-4-ene-3,20-dione. The principal progestational
hormone of the body, secreted by the corpus luteum, adrenal cortex, and
placenta. Its chief function is to prepare the uterus for the reception and
development of the fertilized ovum. It acts as an antiovulatory agent when
administered on days 5-25 of the menstrual cycle. [NIH]
Progressive:
Advancing; going forward; going from bad to worse;
increasing in scope or severity. [EU]
Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a
molecular weight of about 23,000. It is essential in the induction of lactation
in mammals at parturition and is synergistic with estrogen. The hormone
also brings about the release of progesterone from lutein cells, which renders
the uterine mucosa suited for the embedding of the ovum should
fertilization occur. [NIH]
Prophylaxis: The prevention of disease; preventive treatment. [EU]
Proteins: Polymers of amino acids linked by peptide bonds. The specific
sequence of amino acids determines the shape and function of the protein.
[NIH]
Psychiatric: Pertaining to or within the purview of psychiatry. [EU]
Psychiatry: The medical science that deals with the origin, diagnosis,
prevention, and treatment of mental disorders. [NIH]
Psychic: Pertaining to the psyche or to the mind; mental. [EU]
Psychogenic: Produced or caused by psychic or mental factors rather than
organic factors. [EU]
Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU]
Psychopharmacology: The study of the effects of drugs on mental and
behavioral activity. [NIH]
Psychosomatic: Pertaining to the mind-body relationship; having bodily
symptoms of psychic, emotional, or mental origin; called also
psychophysiologic. [EU]
Psychotropic: Exerting an effect upon the mind; capable of modifying
mental activity; usually applied to drugs that effect the mental state. [EU]
Puberty: The period during which the secondary sex characteristics begin to
develop and the capability of sexual reproduction is attained. [EU]
Pulmonary: Pertaining to the lungs. [EU]
Radiology: A specialty concerned with the use of x-ray and other forms of
radiant energy in the diagnosis and treatment of disease. [NIH]
Receptor: 1. A molecular structure within a cell or on the surface
characterized by (1) selective binding of a specific substance and (2) a
specific physiologic effect that accompanies the binding, e.g., cell-surface
receptors for peptide hormones, neurotransmitters, antigens, complement
fragments, and immunoglobulins and cytoplasmic receptors for steroid
hormones. 2. A sensory nerve terminal that responds to stimuli of various
kinds. [EU]
Recuperation: The recovery of health and strength. [EU]
Glossary 365
Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]
Refractory: Not readily yielding to treatment. [EU]
Remission: A diminution or abatement of the symptoms of a disease; also
the period during which such diminution occurs. [EU]
Resection: Excision of a portion or all of an organ or other structure. [EU]
Retina: The ten-layered nervous tissue membrane of the eye. It is
continuous with the optic nerve and receives images of external objects and
transmits visual impulses to the brain. Its outer surface is in contact with the
choroid and the inner surface with the vitreous body. The outer-most layer is
pigmented, whereas the inner nine layers are transparent. [NIH]
Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver,
kidney, heart, and leafy vegetables. The richest natural source is yeast. It
occurs in the free form only in the retina of the eye, in whey, and in urine; its
principal forms in tissues and cells are as FMN and FAD. [NIH]
Rickets: A condition caused by deficiency of vitamin D, especially in
infancy and childhood, with disturbance of normal ossification. The disease
is marked by bending and distortion of the bones under muscular action, by
the formation of nodular enlargements on the ends and sides of the bones,
by delayed closure of the fontanelles, pain in the muscles, and sweating of
the head. Vitamin D and sunlight together with an adequate diet are
curative, provided that the parathyroid glands are functioning properly. [EU]
Rubella: An acute, usually benign, infectious disease caused by a togavirus
and most often affecting children and nonimmune young adults, in which
the virus enters the respiratory tract via droplet nuclei and spreads to the
lymphatic system. It is characterized by a slight cold, sore throat, and fever,
followed by enlargement of the postauricular, suboccipital, and cervical
lymph nodes, and the appearances of a fine pink rash that begins on the
head and spreads to become generalized. Called also German measles,
roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU]
Saline: Salty; of the nature of a salt; containing a salt or salts. [EU]
Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva).
[EU]
Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder
comprised of epithelioid and multinucleated giant cells with little necrosis. It
usually invades the lungs with fibrosis and may also involve lymph nodes,
skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH]
Schizophrenia:
A severe emotional disorder of psychotic depth
characteristically marked by a retreat from reality with delusion formation,
hallucinations, emotional disharmony, and regressive behavior. [NIH]
Sclerosis: A induration, or hardening; especially hardening of a part from
inflammation and in diseases of the interstitial substance. The term is used
chiefly for such a hardening of the nervous system due to hyperplasia of the
connective tissue or to designate hardening of the blood vessels. [EU]
Secretion: 1. The process of elaborating a specific product as a result of the
activity of a gland; this activity may range from separating a specific
substance of the blood to the elaboration of a new chemical substance. 2. Any
substance produced by secretion. [EU]
Sedative: 1. Allaying activity and excitement. 2. An agent that allays
excitement. [EU]
Seizures: Clinical or subclinical disturbances of cortical function due to a
sudden, abnormal, excessive, and disorganized discharge of brain cells.
Clinical manifestations include abnormal motor, sensory and psychic
phenomena. Recurrent seizures are usually referred to as epilepsy or
"seizure disorder." [NIH]
Selenium: An element with the atomic symbol Se, atomic number 34, and
atomic weight 78.96. It is an essential micronutrient for mammals and other
animals but is toxic in large amounts. Selenium protects intracellular
structures against oxidative damage. It is an essential component of
glutathione peroxidase. [NIH]
Serum: 1. The clear portion of any body fluid; the clear fluid moistening
serous membranes. 2. Blood serum; the clear liquid that separates from
blood on clotting. 3. Immune serum; blood serum from an immunized
animal used for passive immunization; an antiserum; antitoxin, or antivenin.
[EU]
Skull: The skeleton of the head including the bones of the face and the
bones enclosing the brain. [NIH]
Somatostatin: A polypeptide hormone produced in the hypothalamus, and
other tissues and organs. It inhibits the release of human growth hormone,
and also modulates important physiological functions of the kidney,
pancreas, and gastrointestinal tract. Somatostatin receptors are widely
expressed throughout the body. Somatostatin also acts as a neurotransmitter
in the central and peripheral nervous systems. [NIH]
Spasticity: A state of hypertonicity, or increase over the normal tone of a
muscle, with heightened deep tendon reflexes. [EU]
Species: A taxonomic category subordinate to a genus (or subgenus) and
superior to a subspecies or variety, composed of individuals possessing
common characters distinguishing them from other categories of individuals
of the same taxonomic level. In taxonomic nomenclature, species are
designated by the genus name followed by a Latin or Latinized adjective or
noun. [EU]
Spectrum: A charted band of wavelengths of electromagnetic vibrations
Glossary 367
obtained by refraction and diffraction. By extension, a measurable range of
activity, such as the range of bacteria affected by an antibiotic (antibacterial
s.) or the complete range of manifestations of a disease. [EU]
Sporadic: Neither endemic nor epidemic; occurring occasionally in a
random or isolated manner. [EU]
Steroid:
A group name for lipids that contain a hydrogenated
cyclopentanoperhydrophenanthrene ring system. Some of the substances
included in this group are progesterone, adrenocortical hormones, the
gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol),
toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]
Stomach: An organ of digestion situated in the left upper quadrant of the
abdomen between the termination of the esophagus and the beginning of the
duodenum. [NIH]
Subarachnoid: Situated or occurring between the arachnoid and the pia
mater. [EU]
Substrate: A substance upon which an enzyme acts. [EU]
Superstitions: A belief or practice which lacks adequate basis for proof; an
embodiment of fear of the unknown, magic, and ignorance. [NIH]
Symptomatic: 1. Pertaining to or of the nature of a symptom. 2. Indicative
(of a particular disease or disorder). 3. Exhibiting the symptoms of a
particular disease but having a different cause. 4. Directed at the allying of
symptoms, as symptomatic treatment. [EU]
Syncope: A temporary suspension of consciousness due to generalized
cerebral schemia, a faint or swoon. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU]
Tacrine: A cholinesterase inhibitor that crosses the blood-brain barrier.
Tacrine has been used to counter the effects of muscle relaxants, as a
respiratory stimulant, and in the treatment of Alzheimer's disease and other
central nervous system disorders. [NIH]
Taenia: A genus of large tapeworms. [NIH]
Telecommunications:
electronic means. [NIH]
Transmission of information over distances via
Temperament: Predisposition to react to one's environment in a certain
way; usually refers to mood changes. [NIH]
Testicular: Pertaining to a testis. [EU]
Tetanus: A disease caused by tetanospasmin, a powerful protein toxin
produced by clostridium tetani. Tetanus usually occurs after an acute injury,
such as a puncture wound or laceration. Generalized tetanus, the most
common form, is characterized by tetanic muscular contractions and
hyperreflexia. Localized tetanus presents itself as a mild condition with
manifestations restricted to muscles near the wound. It may progress to the
generalized form. [NIH]
Thermoregulation: Heat regulation. [EU]
Thyroxine: An amino acid of the thyroid gland which exerts a stimulating
effect on thyroid metabolism. [NIH]
Tick Paralysis: Paralysis caused by a neurotropic toxin secreted by the
salivary glands of ticks. [NIH]
Tomography: The recording of internal body images at a predetermined
plane by means of the tomograph; called also body section roentgenography.
[EU]
Tone: 1. The normal degree of vigour and tension; in muscle, the resistance
to passive elongation or stretch; tonus. 2. A particular quality of sound or of
voice. 3. To make permanent, or to change, the colour of silver stain by
chemical treatment, usually with a heavy metal. [EU]
Tonic: 1. Producing and restoring the normal tone. 2. Characterized by
continuous tension. 3. A term formerly used for a class of medicinal
preparations believed to have the power of restoring normal tone to tissue.
[EU]
Toxicity: The quality of being poisonous, especially the degree of virulence
of a toxic microbe or of a poison. [EU]
Toxin: A poison; frequently used to refer specifically to a protein produced
by some higher plants, certain animals, and pathogenic bacteria, which is
highly toxic for other living organisms. Such substances are differentiated
from the simple chemical poisons and the vegetable alkaloids by their high
molecular weight and antigenicity. [EU]
Toxoids: Preparations of pathogenic organisms or their derivatives made
nontoxic and intended for active immunologic prophylaxis. They include
deactivated toxins. [NIH]
Uricosuric: 1. Pertaining to, characterized by, or promoting uricosuria (= the
excretion of uric acid in the urine). 2. An agent that promotes uricosuria. [EU]
Urinalysis: Examination of urine by chemical, physical, or microscopic
means. Routine urinalysis usually includes performing chemical screening
tests, determining specific gravity, observing any unusual color or odor,
screening for bacteriuria, and examining the sediment microscopically. [NIH]
Valerian: Valeriana officinale, an ancient, sedative herb of the large family
Valerianaceae. The roots were formerly used to treat hysterias and other
neurotic states and are presently used to treat sleep disorders. [NIH]
Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning
involuntarily or unconsciously, as the vegetative nervous system. 3. Resting;
Glossary 369
denoting the portion of a cell cycle during which the cell is not involved in
replication. 4. Of, pertaining to, or characteristic of plants. [EU]
Veins: The vessels carrying blood toward the heart. [NIH]
Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position
more toward the belly surface than some other object of reference; same as
anterior in human anatomy. [EU]
Viral: Pertaining to, caused by, or of the nature of virus. [EU]
Withdrawal: 1. A pathological retreat from interpersonal contact and social
involvement, as may occur in schizophrenia, depression, or schizoid
avoidant and schizotypal personality disorders. 2. (DSM III-R) A substancespecific organic brain syndrome that follows the cessation of use or
reduction in intake of a psychoactive substance that had been regularly used
to induce a state of intoxication. [EU]
General Dictionaries and Glossaries
While the above glossary is essentially complete, the dictionaries listed here
cover virtually all aspects of medicine, from basic words and phrases to
more advanced terms (sorted alphabetically by title; hyperlinks provide
rankings, information and reviews at Amazon.com):
·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski
(Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins
Publishers, ISBN: 1560534605,
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of
Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg,
M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational
Series, ISBN: 0764112015,
·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition
(2001), CRC Press-Parthenon Publishers, ISBN: 185070368X,
a
·
Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland,
et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN:
0721662544,
·
Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th
Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN:
0721694934,
·
Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical
Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B
Saunders Co, ISBN: 0721682812,
/103-4193558-7304618
·
Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical
Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X,
http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for
Windows and Macintosh, Individual) by Stedmans, CD-ROM edition
(2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328,
·
Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN:
068340007X,
a
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes
(Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co,
ISBN: 0803606540,
Index 371
INDEX
A
Acetylcholine ...........................15, 63, 361
Acidosis ...............................................154
Adenosine....................119, 139, 155, 347
Adolescence ....... 18, 19, 55, 58, 63, 173,
347, 362
Alendronate .........................................152
Algorithms....................................124, 337
Amphetamine ......................................119
Amygdala.............134, 147, 156, 334, 348
Anaesthesia.................152, 158, 348, 357
Anatomical...........................128, 133, 335
Anemia ..................................................24
Anesthesia.............20, 156, 290, 348, 354
Anorexia ......................................158, 355
Antibiotic ........................................65, 367
Antidepressant.............................158, 355
Anxiety.........................185, 253, 336, 358
Aphasia................................116, 189, 192
Apnea ..................................................130
Arrhythmia .................21, 23, 59, 206, 349
Arterial .................................................333
Asphyxia ......................................119, 186
Autoimmunity.......................................120
Autonomic......................58, 121, 201, 347
B
Bacteria .................65, 161, 294, 367, 368
Benign ......19, 72, 73, 116, 144, 153, 290,
360, 365
Bilateral................................132, 190, 335
Biochemical .............................23, 91, 146
Blinking ............................................18, 19
Boron ...........................................304, 350
C
Camping ................................................70
Cannabinoids.......................................119
Capsules..............................................297
Carbamazepine .............................87, 206
Carbohydrate.................90, 110, 296, 355
Cardiac .....21, 23, 63, 112, 206, 290, 354,
361, 367
Cardiovascular.......................24, 156, 348
Caspases.............................................125
Catheter ...........................................85, 99
Caudal .........................158, 160, 357, 363
Cerebellar ............................................145
Cerebellum ..................................157, 351
Cerebral......14, 15, 61, 64, 104, 173, 176,
201, 212, 329, 331, 332, 333, 356, 364,
367
Cerebrospinal ................................61, 356
Cerebrovascular ........... 14, 111, 227, 361
Cholesterol.................. 112, 294, 296, 367
Cisplatin ...................................... 289, 351
Citrus..................................................... 26
Clonazepam.................................. 25, 206
Cocaine............................... 119, 150, 204
Comorbidity......................................... 176
Conception.............................. 36, 60, 352
Confusion................ 37, 52, 198, 221, 353
Cortex .... 30, 97, 100, 104, 110, 111, 134,
175, 187, 189, 191, 354, 363
Curative............... 121, 160, 304, 361, 365
Cutaneous................................... 221, 358
Cyclic .... 62, 136, 157, 289, 350, 351, 359
D
Dehydration........................................... 33
Dendrites............... 62, 128, 157, 353, 360
Dendritic.............................................. 128
Deprivation...................... 15, 35, 130, 332
Diarrhea .............................................. 294
Disorientation ................................ 60, 353
Dizziness............................................... 26
Dorsal.................................. 145, 160, 363
Dyskinesia........................................... 261
Dysphagia ........................................... 116
Dysplasia ........................................ 14, 15
Dystrophy.................................... 226, 233
E
Eclampsia ....................... 20, 35, 111, 363
Edema................... 60, 111, 189, 353, 363
Electroacupuncture............................. 262
Electrophysiological .... 125, 128, 138, 332
Electroshock ....................... 158, 261, 355
Encephalitis........... 14, 19, 28, 30, 71, 142
Endogenous........................................ 127
Enzyme ......... 61, 196, 304, 351, 354, 367
Epidemiological................................... 137
Epidural....................................... 192, 332
Estradiol ................................................ 93
Ethosuximide ................................ 25, 206
Exanthema.......................................... 146
Excitation ..... 62, 129, 132, 133, 157, 355,
361
F
Fatigue .................................... 26, 59, 349
Febrile ...... 4, 20, 21, 24, 42, 49, 56, 141,
142, 144, 146, 148, 150, 175, 176, 228
Fibrosis ............................... 149, 291, 365
Fluoxetine ........................................... 146
Flurothyl .............................................. 145
G
Ganglia ..........................58, 152, 154, 347
Gastroenteritis .....................................144
Gestation ...............................63, 187, 362
Gestures ................................................42
Glucose ...95, 98, 101, 110, 237, 355, 357
Gluten ....................................................14
Gonadal .................................93, 112, 367
H
Hemiplegia.............28, 330, 332, 334, 335
Hemorrhage...................................35, 187
Hemosiderosis.....................................335
Heredity .................................................55
Hormonal .........................15, 62, 137, 359
Hormones .......64, 93, 112, 221, 304, 353,
360, 364, 367
Hydrocephalus.........................14, 29, 335
Hyperbaric ...........................262, 290, 356
Hypnotic.......................................253, 358
I
Idiopathic ......12, 121, 122, 135, 150, 151,
291, 365
Immunization .................................64, 366
Indicative .............................123, 161, 367
Induction ................61, 132, 160, 357, 364
Infantile .......4, 19, 20, 28, 102, 143, 145,
153, 206, 334, 335
Inflammation .......19, 64, 71, 86, 156, 158,
350, 355, 366
Infusion ..........................................84, 125
Ingestion ................................63, 297, 363
Insulin ..........................110, 237, 355, 357
Intestinal ..............................290, 294, 358
Intrinsic ........................................125, 189
Intubation.............................................186
Invasive .......104, 187, 190, 332, 333, 337
L
Lesion ...28, 158, 187, 188, 190, 206, 330,
334, 358
Libido .....................................................55
Limbic .......126, 127, 134, 140, 149, 156,
174, 188, 348
Lithium .........................................158, 358
Localization....... 120, 136, 148, 159, 190,
192, 193, 328, 332, 358
Lumbar ..................................................86
Lymphoma...................................290, 358
M
Magnetoencephalography...................148
Meningitis ..............................62, 150, 359
Menopause......................55, 62, 173, 359
Methylphenidate ..................................143
Mobility ................................................336
Molecular ......64, 124, 126, 160, 161, 224,
230, 232, 289, 350, 364, 368
Monotherapy....................................26, 92
Muscimol....................................... 84, 145
N
Nausea............................ 16, 31, 158, 355
Neocortex.................... 188, 189, 190, 193
Neonatal.................. 19, 35, 118, 153, 186
Neoplasms .................................. 334, 360
Neural ............. 30, 55, 138, 177, 295, 338
Neurology...................................... 25, 176
Neurons .... 11, 12, 14, 23, 27, 38, 62, 63,
85, 138, 155, 157, 158, 189, 304, 352,
355, 360, 361
Neuropeptides ............................ 304, 360
Neuropharmacology ................... 124, 338
Neurophysiology ......................... 124, 179
Neuropsychology ................ 176, 195, 360
Neurosciences .................................... 179
Neurosurgery .............................. 173, 176
Neurotransmitter .. 12, 15, 58, 61, 63, 120,
132, 156, 305, 347, 355, 361, 366
Niacin .................................................. 294
Nicotine ................................................. 15
Nimodipine .......................................... 103
O
Orbital ................................................. 192
Overdose ............................................ 295
P
Pacemaker.............................. 30, 63, 361
Parasitic ................................................ 14
Parietal............................ 19, 63, 190, 361
Paroxysmal ........................... 59, 184, 349
Pentylenetetrazole .............................. 261
Perinatal................................................ 36
Phenobarbital.......... 25, 26, 137, 187, 206
Phenotype................... 133, 138, 159, 362
Phenytoin .......... 25, 26, 35, 137, 142, 206
Physostigmine .................................... 299
Pilocarpine .......................... 145, 146, 154
Poisoning .............. 24, 158, 160, 355, 362
Polytherapy ......................................... 116
Posterior.............. 154, 157, 237, 351, 353
Postnatal ............................................. 129
Postoperative .............. 178, 328, 336, 339
Postural............................................... 175
Potassium ........................................... 296
Predisposition ..................................... 133
Prednisone............................................ 20
Preeclampsia ........................ 60, 103, 353
Prenatal..................................... 24, 34, 35
Preoperative ....... 330, 334, 335, 337, 339
Presynaptic ........................... 62, 129, 361
Prevalence .................. 119, 121, 135, 228
Progesterone …..93, 112, 136, 160, 364,
367
Progressive ...... 13, 19, 61, 122, 128, 133,
137, 176, 290, 329, 332, 353, 356
Prophylaxis ................................. 253, 368
Index 373
Proteins ..13, 94, 125, 138, 220, 294, 296,
352
Psychiatry ..............................64, 176, 364
Psychic ....62, 64, 195, 201, 359, 364, 366
Psychogenic ............21, 59, 263, 331, 349
Psychomotor............18, 59, 110, 349, 350
Psychosomatic ....................................178
Puberty ..............................18, 55, 62, 359
Pulmonary ...........................................135
R
Receptor ...60, 63, 95, 119, 125, 129, 132,
140, 144, 352, 362
Recuperation .......................................202
Recurrence ..................128, 153, 206, 227
Refractory ...102, 116, 120, 122, 124, 130,
137, 145, 193
Remission................19, 27, 122, 160, 365
Resection......29, 102, 130, 188, 189, 333,
334, 335, 337, 338
Retina ..............................72, 73, 305, 365
Riboflavin.............................................294
Rickets.................................................154
S
Saline.....................................85, 111, 357
Salivation .............................................192
Schizophrenia..................59, 65, 349, 369
Sclerosis ...... 14, 72, 148, 174, 193, 233,
333
Secretion ....159, 161, 195, 238, 361, 362,
365, 366
Sedative.................25, 253, 291, 358, 368
Selenium..............................................296
Serum ......................................34, 64, 366
Skull .......................... 61, 85, 97, 100, 356
Somatostatin ............................... 159, 361
Spasticity............................................. 182
Spectrum............................................... 40
Steroid........................................... 64, 364
Stomach.............. 158, 195, 208, 355, 357
Subarachnoid...................................... 189
Substrate............................................. 194
Superstitions ......................................... 11
Symptomatic ...... 135, 137, 144, 151, 157,
161, 201, 355, 367
Syncope ...................................... 206, 331
Systemic ..................... 289, 291, 348, 365
T
Tacrine ................................................ 299
Telecommunications............................. 53
Temperament ..................................... 126
Tetanus ............................... 128, 161, 367
Thermoregulation................................ 294
Thyroxine ............................................ 295
Tomography....... 23, 85, 86, 89, 98, 193,
207, 208, 331, 333
Tone........................ 17, 65, 195, 366, 368
Toxicity.......................... 90, 206, 305, 362
Toxin ........................... 128, 161, 367, 368
U
Urinalysis .................................... 112, 368
V
Vegetative ........................... 174, 196, 368
Ventral................................................. 145
Viral................................................. 14, 71
W
Withdrawal ...................... 35, 93, 137, 153

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