Prognostic groups in Epilepsy.

1. Excellent Prognosis : 20-30% ; genetic etiology such as Benign childhood epilepsy with centrotemporal spikes, benign myoclonic epilepsy of childhood, benign neonatal seizures.Often remission occurs without AED treatment.

2. Good Prognosis : 30-40% ; epilepsy is easily controlled with AEDs. Remission is often permanent after discontinuation of medications. eg. Childhood absence epilepsy, epilepsy with generalized tonic-clonic seizures on awakening, and some focal seizures.

3. Uncertain prognosis : 10-20% ; AEDs are suppressive rather than curative.In this group medications must be continued for seizure control. eg. Juvenile myoclonic epilepsy (JME) and most of focal seizures.

4. Bad Prognosis : 20%; Most treatment including surgery reduce the incidence of seizures only partially. eg. Infantile spasms, Lennox- Gastaut syndrome, Tuberous sclerosis.

Ref : Bradley 2008

Causes of Daytime Sleepiness

1. Medications (sedatives, tranquilizers, anticonvulsants,antihistaminics, anti depressants, Beta blockers,dopamine agonists, L-dopa, alcohol abuse)

2. Acute medical illness of mononucleosis type, including mundane respiratory and gastrointestinal infections

3. Post-surgical, post-concussive and post-anesthetic states

4. Chronic neurologic diseases- MS, Dementias

5. Depression

6. Metabolic derangements - hypothyroidism, Addison`s disease, severe diabetes

7. Encephalitic disease - Post Viral encephalitis, Trypanosomiasis, Encephalitis lethargica (historical)

8. Lesions of hypothalamus - Kleine - Levin syndrome, Hypothalamic tumor or granuloma

9. Sleep apnea syndrome : Central and Obstructive

10. Narcolepsy - cataplexy

11. Idiopathic hypersomnia

(From : Adams and Victor)

Phenytoin metabolism

As serum concentration of phenytoin rises, particularly above 15mg/l, the metabolism slows substantially. This is called 'zero order kinetics'. At levels below 15 mg/l, doubling the dose will lead to doubling of serum concentration and the half life is 24 hrs. As metabolism slows at higher concentrations, even a 50 mg change in dose can double the serum concentration, and the half life increases to 48-70 hrs.Since the half life is so prolonged, a steady state after dose adjustments may not occur for weeks, with serum levels slowly rising over this time. This can easily lead to serious phenytoin toxicity.

Ref : Therapeutic Strategies in Epilepsy ( French and Delanty)

Understanding neuromuscular disorders.

coming soon.......

Primary Progressive Aphasia

Primary progressive aphasia (PPA) involves changes in the ability to communicate—to use language to speak, read, write, and understand what others are saying. Problems with memory, reasoning, and judgment are not apparent at first but can develop over time. In addition, some people with PPA may experience significant behavioral changes, similar to those seen in bvFTD, as the disease progresses. As symptoms get worse, people with PPA cannot live alone safely.

Currently, there are three types of PPA, categorized by the kind of language problems seen at first.

In semantic PPA, also called semantic dementia, a person slowly loses the ability to understand single words and sometimes to recognize the faces of familiar people and common objects.

In agrammatic PPA, also called progressive nonfluent aphasia, a person has trouble saying words that link nouns and verbs together—for example, "of," "from," and "for." Eventually, the person may no longer be able to speak at all. He or she may also have difficulty swallowing and develop movement symptoms similar to those seen in corticobasal syndrome.

In logopenic PPA, a person has trouble finding the right words during conversation but can understand words and sentences. The person does not have problems with grammar.

Behavioral Problems in Dementia.

This is a good paper which discusses behavioral problems related with dementia and their management.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181170/