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Oliver Kent Glass, PhD

• Assistant Professor in Medicine
• Assistant Professor in Pathology

https://medicine.duke.edu/faculty/oliver-kent-glass-phd

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Except in rare cases, the brain has its own way of bringing the seizure safely to an end after a minute or two. In an emergency, doctors may use drugs to bring a lengthy, non-stop seizure to an end. However, the average person should wait for the seizure to run its course and try to protect the person from harm while consciousness is clouded. Seizures that are prolonged, or occur as a series (repeated seizures in the same day) are called status epilepticus. Diagnosis and Treatment Options Diagnosis Doctors take a medical history, do blood tests and use a variety of medical tests to determine if a person is at risk for recurrent seizures. If a person is at risk for recurrent seizures (epilepsy), they will often be referred to a neurologist for evaluation and treatment. A neurologist is a doctor that specializes in diseases of the brain, spine, and nerves. This test records the electrical activity in the brain in the form of brain waves. In many patients the doctor can determine if the brain has abnormal electrical activity. During the painless and non-invasive test, electrodes are placed on the scalp and brain waves are recorded. A brain scan may also 4 be done to see if there are any abnormalities within the brain which may cause seizures. Treatment For those at risk for seizure in the future, the doctor usually prescribes a drug that will lower the risk of recurrent seizures. More than 70 percent of patients with epilepsy can have their seizures controlled with medications. Effectiveness of the medication depends on the type of seizure, age, and other medical conditions. Patients with seizures or serious side effects on seizure medication should discuss the various treatment options with their neurologist. For most people, medication will prevent seizures as long as they are taken regularly.

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Increase the accurate diagnosis of primary headaches in patients age 12 years and older. Percentage of patients diagnosed with primary headache using the appropriate diagnostic criteria. Increase the percentage of patients with primary headache diagnosis who receive educational materials about headache. Percentage of patients with primary headache who received educational materials on headache. Increase the percentage of patients with primary headache syndrome who receive prophylactic treatment when appropriate. Percentage of patients with primary headache syndrome who are prescribed prophylactic treatment when appropriate. Increase the percentage of patients with migraine headache who have improvement in their functional status. Percentage of patients with migraine headache who are showing improvement in functional status shown by using one of the following disease-specific tools or questionnaires. Percentage of patients with migraine headache seen for migraine in the emergency department/ urgent care. Increase the percentage of patients with migraine headache who have a treatment plan or report adherence to a treatment plan for mild, moderate and severe migraine headaches. Percentage of patients with migraine headache with treatment plan who report adherence to their treatment plan. Decrease the percentage of patients with migraine headache who are prescribed opiates and barbiturates for the treatment of migraines to less than 5%. Percentage of patients with migraine headache with a prescription for opiates or barbiturates for the treatment of migraine. Increase the percentage of patients with migraine headache who have appropriate acute treatment. Percentage of patients with migraine headache prescribed appropriate acute treatment. Population Definition Data of Interest Patients age 12 years and older diagnosed with a primary headache. Method/Source of Data Collection Review electronic medical records for patients age 12 years and older with one of headache diagnoses: migraine, tension-type, cluster, sinus or chronic daily headache.

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Learn about your federally mandated protections and explore assistance offered by advocacy groups in your state. Maintaining a notebook of ordered tests and their results can help you keep track of costs, as well as the scheduling of repeat or follow-up tests. Keep track of all expenses related to medical care, including costs of transportation to appointments and costs of food for prescribed diets, as some may be tax deductible. Among patients with refractory epilepsy, temporal lobectomy is also associated with a decline in the unemployment rate,13 and with significantly improved quality of life within six months of surgery. While all surgery entails risk, and the thought of brain surgery may be particularly frightening, there is evidence that the risks associated with uncontrolled seizures "outweigh the risks of aggressive medical or ajn@wolterskluwer. While a cortical resection may provide freedom from seizures for a person with temporal lobe epilepsy, a palliative surgery, such as a corpus callosotomy, would be expected to halt disabling and dangerous atonic seizures in a person having several per day but would not stop other types of seizures. With epilepsy surgery, potential postoperative neurologic deficits depend on the area of the brain that is operated on. A recent analysis of epilepsy surgery outcomes identified complications by surgical approach. For hemispherectomy, possible complications included aseptic meningitis (3% to 26%), dysphasia (13%), infection (8% to 11%), behavioral problems (9%), shunt insertion (4% to 5%), subdural hematoma (4%), hydrocephalus (1%), and death (1%). The ideal candidate for curative epilepsy surgery will have concordant findings (agreement) on both structural and functional presurgical evaluations. The findings will identify the onset area of seizure activity and the area in need of ablation or resection to stop the activity. Epilepsy surgery, though regarded as the most important intervention for pharmacologically refractory epilepsy, is underutilized,17 often owing to difficulty in obtaining an accurate diagnosis, the cost of surgery, and limited access to an epilepsy center. If, however, epilepsy surgery is not an option for a person with pharmacologically refractory epilepsy, there are other treatment considerations, including neurostimulation and epilepsy diets.

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Optimal clinical effect may be achieved with a nontrough N-desmethyl-methsuximide plasma concentration of 20 to 24 g/mL (15), near the middle of the therapeutic range of 10 to 40 g/mL, reported by Strong and colleagues (14). Browne and associates (16) reported a therapeutic range of 10 to 30 g/mL for fasting N-desmethyl-methsuximide plasma concentrations. The usual dosage increase of 150 or 300 mg/day can be made at biweekly intervals to avoid toxicity. Methsuximide is no longer available in 150-mg tablets; biweekly dosage increments of one tablet (300 mg) every other day may be used (16). Chemistry and Mechanism of Action the chemical structure of methsuximide (N-2-dimethyl-2phenyl-succinimide) is shown in Figure 68. Phenyl group substitution at the 2C position counteracts experimentally induced maximal electroshock seizures, whereas alkyl group substitution at the 2C position counteracts experimentally induced pentylenetetrazol seizures. Methyl group substitution at the 5N position adds to the antipentylenetetrazol effect and the sedative activity. Methsuximide is a nonpolar chemical compound that is water soluble and slightly lipophilic. Because of its effectiveness against absence and partial seizures, the agent probably has more than one mechanism of action, including effects on transmitter release, calcium uptake into presynaptic endings, and conductance of sodium, potassium, and chloride. Wilder, Buchanan, and Uthman (15,22) found methsuximide to be an effective adjunctive agent in the management of refractory complex partial seizures. Twentyone patients taking phenytoin, phenobarbital, primidone, or carbamazepine as monotherapy or in combination were studied. Optimal plasma levels and control of complex partial seizures were associated with daily methsuximide dosages of 9. Browne and colleagues (16) described the use of adjunctive methsuximide in 26 patients with medically refractory complex partial seizures.

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The only possible evidence identified was one early pharmacokinetic paper, which reported a modest 43% increase in the peak level of digoxin after administration of acetyldigoxin with carob seed flour,4 which is also a rich source of quercetin (about 39 mg/100 g). Modulation of Pglycoprotein-mediated resistance by kaempferol derivatives isolated from Zingiber zerumbet. F Flavonoids + Etoposide the interaction between flavonoids and etoposide is based on experimental evidence only. Experimental evidence In an in vitro study using rat gut sacs, pre-treatment with quercetin or a natural diet (assumed to contain flavonoids) for 30 minutes increased etoposide absorption when compared with a flavonoid-free diet. However, there was no difference in etoposide absorption when rats were pretreated for one week with a natural diet (assumed to contain flavonoids) compared with a flavonoid-free diet. However, these are animal data, and therefore some caution is required in extrapolating their findings. Also, the data suggest that the effect of continued use over one week 192 Flavonoids might have little effect. Comparison of effects of natural or artificial rodent diet on etoposide absorption in rats. Flavonoids + Irinotecan or Topotecan Limited evidence suggests that high doses of chrysin are unlikely to cause an adverse interaction with irinotecan and possibly topotecan. Clinical evidence In a pilot study in patients with colorectal cancer receiving intravenous irinotecan 350 mg/m2 every 3 weeks, chrysin 250 mg twice daily for one week before, and one week after, irinotecan appeared to be associated with a low incidence of irinotecan-induced diarrhoea. There was no difference in the pharmacokinetics of irinotecan and its metabolites when compared with historical data for irinotecan. Survival data did not differ from historical data suggesting that chrysin did not reduce the efficacy of irinotecan. Importance and management the available data suggest that high doses of chrysin are unlikely to cause an adverse interaction if given with irinotecan, and might possibly be beneficial, but more study is needed to establish this. It is too early to say whether chrysin might affect topotecan pharmacokinetics, but the study does highlight a problem with extrapolating animal data to humans when studying this potential interaction. Flavonoids chrysin and benzoflavone, potent breast cancer resistance protein inhibitors, have no significant effect on topotecan pharmacokinetics in rats or mdr1a/1b (-/-) mice.

Lactobacillus paracasei (Lactobacillus). Lamotrigine.

• Preventing diarrhea in children caused by antibiotics or hospitalization.
• Reducing symptoms of too much bacteria in the intestines. Yeast infections after taking antibiotics.
• Lung infections in children.
• How does Lactobacillus work?
• Preventing diarrhea due to traveling.
• Helping prescription medications treat Helicobacter pylori (H pylori) infection.
• Urinary tract infections (UTIs), general digestion problems, yeast infections, high cholesterol, Lyme disease, hives, fever blisters, canker sores, acne, cancer, stimulating the immune system, and other conditions.
• Diarrhea in children caused by certain viruses.
• Are there safety concerns?

Source: http://www.rxlist.com/script/main/art.asp?articlekey=96769

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For the best overall result, it is strongly recommended that you adjust the morning jump start dose prior to adjusting the hourly doses. Accuracy of the dose and exact hourly timing between doses is critical for optimal benefit. Publicly traded companies have to report their study results as soon as they are available and before they are presented at scientific meetings. While headlines may make it sound like new drugs are available, a closer look often reveals that the new drug is only in the early stages of research and years away from becoming an available treatment. Taking some time to evaluate the research behind the headlines can help determine the best way to use the new information. Has the information been published or presented at a trustworthy scientific meeting Check with a member of your healthcare team to determine if the source is reliable. The higher the number of participants, the more likely the results will achieve statistical significance and be more accurate. The gold standard for the most valid clinical trial is one that includes all of three of these elements. This lack of understanding can seriously affect your quality of life, both in the hospital and after you are discharged. Nurses are accustomed to dispensing medications on certain schedules and likely have an hour window to distribute medications within that schedule. They may not realize that even a 15-minute delay can make the difference between independent function and poor mobility. It is important for you or your advocate to double check the drugs and schedules in your medical chart.

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While the bottle is upright, put the syringe into the bottle through the opening in the bottle adapter. If you see air bubbles in the syringe, fully push in the plunger so the medicine flows back into the bottle. If using 1 syringe, draw the first 20 mL into the syringe and slowly squirt into the corner of the mouth (Steps 8 to 9). Do n y after e cap tightl Replace th opening Rinse the syringe(s) with tap water after each use. If you have suicidal thoughts or actions, your healthcare provider may check for other causes. Stopping suddenly can cause serious problems and can cause you to have seizures more often. These medicines include: birth control, carbamazepine, phenytoin, oxcarbazepine, rifampin, and St. Do not drink alcohol or take other medicines that make you sleepy or dizzy until you talk to your healthcare provider. You may have problems walking normally if you are unsteady because you feel dizzy. Your risk of feeling dizzy and having problems walking normally may be higher if you are elderly. Eligible commercially insured patients may pay as little as $10 per month with a maximum savings of $1,300 per year. Eligible cash patients can receive up to $60 per prescription for a maximum savings of $720 per year. Ask your doctor or pharmacist if you are not sure whether the offer applies to you. Please see Important Safety Information on pages 22 to 23 and enclosed Prescribing Information and Medication Guide. Community outreach Eisai is actively involved in the community and supporting foundations that help spread awareness about epilepsy.

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Patients, friends, and family are welcome to join group discussion to help better understand and cope with epilepsy. The Hoag Epilepsy Center is also available to answer general questions about epilepsy and referral resources. The Epilepsy Alliance of Orange County offers classes every month for education on seizures and seizure safety. People who have recently had a seizure or are having active seizures should not drive. However, people with epilepsy whose seizures are fully controlled with medication can qualify to drive. With close follow-up with a neurologist, you can often drive after being seizure-free for a period of time. The physician will work with you to help you drive as soon as your seizures are controlled and there is no risk of loosing consciousness from seizures. If driving is not an option, alternatives such as using public transportation, signing-up with local services for the elderly or disabled, or even moving to an apartment complex or community that has its own transportation may be among the alternatives. Clinical studies conducted with clobazam in the pediatric population Author, Year Retrospective studies Buchanan, 199316 Montenegro et al. The most common adverse effect in patients on clobazam was sleepiness in 27%, which is slightly greater than the 14. Clobazam may be associated with fewer adverse events because of its partial agonist activity. We found a relationship between the development of adverse events and the titration schedule of clobazam, as well as greater doses at first follow-up. Some postulate that the disinhibitory action of the medication could be caused by a loss of cortical restraint. Side effects most commonly observed in our study include tiredness, mood/ behavioral changes, sleep problems, appetite changes, and slurred speech. Side effects may be sufficiently severe to require treatment discontinuation in only a minority of patients, as seen in 6% of our series and a comparable percentage in other trials. Challenges retrospective nature of our study, it was not possible to report data on seizure frequency by seizure type because this information was not available in the clinical charts.

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Ressel, 34 years: Acute hemorrhagic myocardial necrosis and sudden death of rats exposed to a combination of ephedrine and caffeine. Unfortunately, drug trials in rats with spontaneous seizures take on another level of complexity.

Goran, 61 years: The role of early left-brain injury in determining lateralization of cerebral speech functions. The inducing properties of oxcarbazepine were less (29%) compared to carbamazepine (54%).

Merdarion, 27 years: When treatment guidelines are followed, the incidence of serious rash may be reduced (42,44,45). Some patients may respond similarly to different stimulant classes, whereas other patients may respond preferentially to only 1 of the classes of stimulants.

Ford, 63 years: Some treatments cause seizure aggravation in idiopathic epilepsies (especially absence epilepsy). No case of incomplete disconnection toward the midline was detected, but too anteriorly placed disconnections were seen.

References

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