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Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The distinction between epileptic and non-epileptic seizures is of practical significance for therapy and prognosis. However, clinical differentiation of these two types of seizure may be extremely difficult. EEG seizure discharges without detectable clinical manifestations are common in neonates. This is especially common in infants receiving antiepileptic drugs, particularly phenobarbital, which often produces “uncoupling” of clinical and EEG seizure manifestations [12,32]. An undefined proportion of newborns may have such discharges without having seizures. Conversely, clinical seizures deemed to be epileptic but without typical EEG abnormality are also encountered [15,26].
100 MCQs from Dr. Brenda Wright and Colleagues
Published in David Browne, Selena Morgan Pillay, Guy Molyneaux, Brenda Wright, Bangaru Raju, Ijaz Hussein, Mohamed Ali Ahmed, Michael Reilly, MCQs for the New MRCPsych Paper A, 2017
Dr Olivia Gibbons, Dr Marie Naughton, Dr Selena Morgan Pillay
Non-epileptic seizures occur very commonly in patients who also experience epileptic seizures. The movements in non-epileptic seizures often involve generalised rigidity with arching of the back and random thrashing of the limbs, contrasting with the stereotypical tonic-clonic movements in grand mal seizures. Reflexes are unaltered in non-epileptic attacks. Incontinence is common in epileptic seizures but rare in non-epileptic episodes. (8, p 31)
Deception, dissociation and malingering
Published in John C. Gunn, Pamela J. Taylor, Forensic Psychiatry, 2014
John Gunn, John Gunn, David Mawson, Paul Mullen, Peter Noble, Paul Mullen
The features of non-epileptic seizure includeattempted restraint of the convulsive movements leads to struggling, even combativeness;absence of cyanosis;normal pupil responses and corneal reflexes present;pressure on the supraorbital arch causes head withdrawal;the level of consciousness fluctuates during the seizure;marked emotionality after the episode.
Epilepsy: expert opinion on emerging drugs in phase 2/3 clinical trials
Published in Expert Opinion on Emerging Drugs, 2022
Amanda W Pong, Jonathan Ross, Ivana Tyrlikova, Alexander J Giermek, Maya P Kohli, Yousef A Khan, Roger D Salgado, Pavel Klein
Human data have shown a 25% median seizure reduction with ganaxolone up to 1800 mg/day or 63 mg/kg/day in an initial open label phase 2 study of PCDH19 (NCT02358538). Response was highest in subjects with low baseline allo-S levels [75]. A double-blind, randomized, placebo-controlled, phase 2 trial of adjunctive ganaxolone up to 1800 mg/day or 63 mg/kg/day has been conducted in 21 PCDH19-positive females between 1 and 17 years of age (Violet, NCT03865732), with an open-label extension ongoing. The primary endpoint showed median seizure frequency reduction in 61.5% with ganaxolone versus 24% with placebo (p = 0.17), and 50% responders 50% seizure reduction) with ganaxolone versus 36% with placebo. Discontinuation occurred in 10% of patients due to psychogenic non-epileptic seizures, deemed as treatment related. Because there is a spontaneous trend in seizure reduction, due to the natural history in PCDH19 of clustering seizures with long intervals between clusters, novel clinical trial designs may be needed [76].
Laughter yoga reduces the cortisol response to acute stress in healthy individuals
Published in Stress, 2021
Maria Meier, Lisa Wirz, Philip Dickinson, Jens C. Pruessner
Laughter is a universal phenomenon characterized by strong exhalations and inhalations, with resulting increases in respiratory rate and breathing volume (Ruch & Ekman, 2001). Gelotology – the research field investigating physiological, and psychological effects of laughter (Miller & Fry, 2009) – is still in its infancy. An overarching idea is that laughter has positive effects on health (Martin, 2001; Savage et al., 2017; Yim, 2016), perhaps mediated by the capacity of laughter to modulate the relationship between stressful events and negative affect (Kuiper & Martin, 1998). In an extreme example, individuals suffering from non-epileptic seizures often experience major stressors before, and feelings of calmness after seizures (Dickinson et al., 2011), showing the notable similarity in paroxysmal nature of pathological seizures and laughter.
Gut microbiota and psychogenic non-epileptic seizures; are they related?
Published in Expert Review of Neurotherapeutics, 2019
Ali A. Asadi-Pooya, Kamyar Asadipooya, Raidah S. AlBaradie
We read with interest the article by Dr. Iannone et al. entitled: ‘Microbiota-gut brain axis involvement in neuropsychiatric disorders.’ [1] We enjoyed this article and would like to add to it by hypothesizing that there is an association between abnormal emotional processing in patients with psychogenic non-epileptic seizures (PNES) and gut microbiota; patients with PNES may have unhealthy gut microbial composition. Psychogenic non-epileptic seizures are a relatively common reason why patients attend epilepsy clinics [2]. It has been speculated that patients with PNES may process their emotional and cognitive information inconsistently and within a limited range of options [3]. On the other hand, alterations in bidirectional gut–brain interactions are implicated in brain disorders [1]. Alterations in gut microbiota have also been associated with marked changes in behaviors relevant to mood and cognition, suggesting the critical importance of the bidirectional pathway of communication between gut microbiota and brain in health and disease [4]. Findings from a study suggest that the microbial colonization process initiates signaling mechanisms that affect neuronal circuits involved in anxiety behavior [5]. Moreover, a functional MRI study in healthy women demonstrated that a four-week intake of a fermented milk product with probiotics affected activity of the brain regions that control central processing of emotion and sensation [6].