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Seizures
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
Seizure treatment usually starts with medication. Dozens of medications for seizures exist, and finding one that works can be heavily based on trial and error (Thijs et al., 2019). However, some types of seizures don't seem to respond to medications, especially some focal seizures. After many medication failures, more elaborate treatments may be required (Schoenberg et al., 2011). One option is the implantation of neuromodulation devices that can stimulate parts of the brain in order to reduce seizures. Another option is the surgical removal of the seizure focus in the brain. The literal removal of part of the brain may sound extreme, and it does have many risks, but it is often a highly effective treatment. In fact, it has been argued that brain surgery may not be used often enough for people with drug-resistant focal seizures (Thijs et al., 2019). Hopefully, science will advance and eventually prevent the need to resort to partial brain removal. For now, careful observation of signs and symptoms is crucial for discovering how to restore control over a person's seizure-prone brain.
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Seizures are classified into either generalised or focal (also called partial) seizures. The whole brain (or at least the whole of the cerebral cortex) is involved in generalised seizures, whereas focal seizures only affect part of the brain, and often, only one part of one lobe of the brain. Generalised seizures are broadly classified into ‘absence’, ‘myoclonic’, ‘atonic’, ‘tonic’, ‘clonic’ and ‘tonic-clonic’. Focal or partial seizures are classified as ‘simple’, in which consciousness is retained, or ‘complex’, in which consciousness is impaired or lost; it is possible if not likely, that this division of ‘simple’ and ‘complex’ may be dropped from future classifications of the epilepsies. Simple partial seizures with sensory, autonomic or psychic symptoms may be easily overlooked in younger children unable to describe such symptoms. Focal or partial seizures may become secondarily generalised, resulting in a tonic-clonic convulsion. The symptoms of a simple partial seizure, prior to secondary generalisation, constitute the epileptic aura. A recent diagnostic scheme proposal has been submitted to the International League Against Epilepsy (ILAE). The scheme encompasses five levels or axes: seizure description, seizure type, epilepsy syndrome, aetiology and associated physical and/or learning impairments [3].
The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Focal seizure refers to onset of the seizure activity in one hemisphere of the brain, and the person experiencing this may be aware or have impaired awareness. There may not be motor involvement, such as jerking or stiffening of the limbs, but movement may be isolated to a muscle group such as the arm or face.
Fasting and post fasting effect of Ramadan on different seizure types in patients with active epilepsy
Published in Nutritional Neuroscience, 2022
Rehab Magdy, Nirmeen A. Kishk, Noha T. Abokrysha, Gihan M. Ramzy, Hoda Ibrahim Rizk, Mona Hussein
Fasting also has an additional and different role from the KD in reprograming metabolic and thus stress resistance pathways [10]. Ramadan is a difficult stressful period for several factors associated with fasting such as fatigue, emotional stress, disturbed sleep rhythm and duration, and alterations in the regimen of drug intake [6]. Ramadan fasting produces elevated levels of some neurotrophic factors like brain-derived neurotrophic factor (BDNF) as well as insulin-like growth factor (IGF-1) [11]. It was found that the serum levels of BDNF and IGF-1 were reduced particularly in patients with focal seizures with or without evolving to bilateral tonic-clonic seizures and were well correlated with higher seizure frequency [12]. This may explain the significant improvement particularly observed in our study with focal seizures.
A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism
Published in Expert Opinion on Pharmacotherapy, 2022
Lance V Watkins, Maire O’Dwyer, Rohit Shankar
The evidence base for the initial treatment of seizures, including focal seizures in childhood is detailed in the updated ILAE evidence review for anti-seizure medicines as initial monotherapy and the Cochrane Review and network meta-analysis of anti-seizure drug monotherapy (Table 2) [34,35]. It should be noted that this evidence applies to the treatment of the described seizure type for any individual and is not autism specific. Having an understating of the most appropriate anti-seizure drugs to consider by seizure type should inform treatment choice. However, as we have discussed, autistic people are a complex and heterogeneous population. Clinical response may not necessarily align with the evidence base for treatment of focal seizures arising from a different etiology. For a more detailed discussion on the approach to treatment in epilepsy, consider the Expert Opinion section of this review.
Management of epileptic disorders using nanotechnology-based strategies for nose-to-brain drug delivery
Published in Expert Opinion on Drug Delivery, 2021
Mihika Shringarpure, Sankalp Gharat, Munira Momin, Abdelwahab Omri
According to the International Classification of Epileptic Seizures, epileptic seizures can be classified into three major groups based on their onset- generalized onset, focal onset (may become secondarily generalized), and unclassified seizures [34]. Generalized seizures are a consequence of abnormal and rapid neuronal activity on both hemispheres of the brain simultaneously. The various kinds of generalized seizures include absence seizures, tonic seizures, clonic seizures, myoclonic seizures, atonic seizures, tonic-clonic seizures, and secondary generalized seizures. Focal seizures originate and affect a limited area of one hemisphere of the brain and occur in approximately 60% of cases. Focal seizures generally progress to secondary generalized tonic-clonic seizures. Partial seizures are split into two main categories, namely, simple partial seizures and complex partial seizures [28].