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Advances in epilepsy surgery

Stream Advances in epilepsy surgery by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 4 years ago
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Status Epilepticus

 
almostadoctor - free medical student revision notes
over 4 years ago
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Can someone help me with a question on epilepsy treatment?

Understanding the neurophysiology is important in treating epilepsy. In practice, how far often is it properly evaluated and how often is it simply treated by the drugs alone without any proper evaluation? Is the EEG a specific tool in epilepsy screening?  
sampath kumar
over 6 years ago
Foo20151013 2023 1crpsox?1444774314
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Neuropsychiatry's Fuzzy Borderlands

In NeuroPsychiatry it might be difficult to locate its territory, and find its niche. This might be an uneasy endeavour as its two parent branches neurology and psychiatry are still viable, also it siblings organic psychiatry, behavioural neurology and biological psychiatry are also present. This blogpost attempts to search for the definition and domains of neuropsychiatry. Neuropsychiatry can be defined as the 'biologic face' of mental health (Royal Melbourne Hospital, Neuropsychiatry unit). It is the neurological aspects of psychiatry and the psychiatric aspects of neurology (Pacific Neurpsychiatry Institute). It is not a new term. Many physicians used to brand themselves as neuropsychiatrists at the rise of the twentieth century. It has been looked upon with a sense of unease as a hybrid branch. Also, it was subject to pejorative connotations, as the provenance of amateurs in both parent disciplines (Lishman, 1987). The foundational claim is that 'all' mental disorders are disorders of the brain' (Berrios and Marková, 2002). The American NeuroPsychiatric Association (ANPA) defines it as 'the integrated study of psychiatric and neurologic disorders' (ANPA, 2013). The overlap between neuropsychiatry and biological psychiatry was observed (Trimble and George, 2010) as the domain of enquiry of the first and the approach of the second will meet at point. Berrios and Marková seemed to have focused on the degree of conversion among biological psychiatry, organic psychiatry, neuropsychiatry and behavioural neurology. They stated that they share the same foundational claims (FCcs): (1) mental disorder is a disorder of the brain; (2) reasons are not good enough as causes of mental disorder; and (3) biological psychiatry and its congeners have the patrimony of scientific truth. They further elaborated that the difference is primarily due to difference in historic origins. (D'haenen et al., 2002). The American Neuropsychiatric Association (ANPA) defines neuropsychiatry as the integrative study of neurological and psychiatric disorders on a clinical level, on a theoretical level; ANPA defines it as the bridge between neuroscience and clinical practice. The interrelation between both specialities is adopted by The Royal Australia and New Zealand College of Psychiatrists as it defines it as a psychiatric subspeciality. This seems to resonate the concept that 'biologisation' of psychiatry is inevitable (Sachdev and Mohan, 2013). The definition according to Gale Encyclopedia encompasses the interface between the two disciplines (Fundukian and Wilson, 2008). In order to acknowledge the wide use of the term 'neuropsychiatry'; the fourth edition of Lishman's Organic Psychiatry, appeared and it was renamed as 'textbook of neuropsychiatry'. The editor stated that the term is not used in its more restrictive sense (David, 2009). Ostow backtracked the origin of biological causes for illness to humoral view of temperament.In the nineteenth century, the differentiation between both did not seem to be apparent. The schism seems to have emerged in the twentieth century. The difficulties that arose with such early adoption of neuronal basis to psychiatric disorders are that they were based on on unsubstantiated beliefs and wild logic rather than scientific substance. (Panksepp, 2004). Folstein stated that Freud and Charcot postulated psychological and social roots for abnormal behaviours, thus differentiating neurology from psychiatry. (David, 2009). The separation may have lead to alienation of doctors on both camps and helped in creating an arbitary division in their scope of knowledge and skills. The re-emergence of interest in neurospsychiatry has been described to be due to the growing sense of discomfort in the lack of acknowledgment of brain disorders when considering psychiatric symptoms (Arciniegas and Beresford, 2001). There is considerable blurring regarding defining the territory and the boundaries of neuropsychiatry. The Royal College of Psychiatrists founded section of Neuropsychiatry in 2008. The major working groups include epilepsy, sleep disorders, brain injury and complex neurodisability. In 1987 the British NeuroPsychiatry Association was established, to address the professional need for distinction, without adopting the concept of formal affiliation with parent disciplinary bodies as the Royal College of Psychiatrists. The ANPA was founded in 1988. It issued training guide for residents. The guide included neurological and psychiatric assessments, interpretation of EEG and brain imaging techniques. With regards to the territory, it included delirium, dementia, psychosis, mood and anxiety disorders due to general medical condition. Neurpsychiatric aspects of psychopharmacologic treatments, epilepsy, neuropsychiatric aspects of traumatic brain injury and stroke. The diagnosis of movement disorders, neurobehavioural disorders, demyelinating disease, intellectual and developmental disorders, as well as sleep disorders was also included. The World Federation of Societies of Biological Psychiatry (WFSBP) was established in Buenos Aires in 1974 to address the rising significance of biological psychiatry and to join local national societies together. The National Institute of Mental Health (NIMH), is currently working on a biologically-based diagnosis, that incorporates neural circuits, cells, molecules to behavioural changes. The diagnostic system - named 'Research Domain Criteria (RDoC) - is agnostic to current classification systems DSM-5 & ICD-10. Especially that the current diagnostic classficiations are mostly based on descriptive rather than neurobiological aetiological basis. (Insel et al., 2010). For example, the ICD-10 F-Code designates the first block to Organic illness, however, it seems to stop short of localisation of the cause of illness apart from the common prefix organic. It also addresses adverse drug events as tardive dyskinesia but stops short of describing it neural correlates. Also, psychosocial roots of mental illness seem to be apparent in aetiologically-based diagnoses as Post-Traumatic Stress Disorder, acute stress reaction, and adjustment disorders, the diagnostic cluster emphasise the necessity of having 'stress'. Other diagnoses seem to draw from the psychodynamic literature, e.g. conversion[dissociative] disorder. The need for neuropsychiatry, has been increasing as the advances in diagnostic imaging and laboratory investigations became more clinically relevant. Nowadays, there are tests as DaT-Scan that can tell the difference between neurocognitive disorder with Lewy Bodies and Parkinson's Disease. Vascular neurocognitive disorders warrant imaging as the rule rather than the exception, vascular depression has been addressed is a separate entity. Frontal Lobe Syndromes have been subdivided into orbitofrontal and dorsolateral (Moore,2008) Much training is needed to address this subspeciality. The early cases that may have stirred up the neurological roots of psychiatric disorders can be backdated to the case of Phineas Gage, and later, the case H.M. The eearlier fruits of adopting a neuropsychiatric perspective can be shown in the writings of Eliot Slater, as he attempted to search for the scientific underpinnings of psychiatry, and helped via seminal articles to highlight the organic aspect of psychiatry. Articles like 'The diagnosis of "Hysteria", where Slater, challenged the common wisdom of concepts like hysteria and conversion, rejecting the social roots of mental illness, and presenting a very strong case for the possibility of organicity, and actual cases of for which 'hysteria' was a plain misdiagnosis was way ahead of its time prior to CT Brain. Slater even challenged the mere existence of the concept of 'hysteria. (Slater, 1965) Within the same decade Alwyn Lishman published his textbook 'Organic Psychiatry' addressing the organic aspects of psychiatric disorders. Around the same time, the pioneers of social/psychological roots of mental illness became under attack. Hans Eysenck, published his book 'Decline and Fall of the Freudian Empire'. Eysenck stated clearly that the case of Anna O. seems to have been mispresented and that she never had 'hysteria' and recovered she actually had 'tuberculous meningitis' and she died of its complications (Eysenck, 1986). To summarise, it seems difficult and may be futile to sharply delineate neurpsychiatry, biological psychiatry, organic psychiatry and behavioural neurology. However, it seems important to learn about the biological psychiatry as an approach and practice neuropsychiatry as a subspeciality. The territory is yet unclear from gross organic lesions as stroke to the potential of encompassing entire psychiatry as the arbitary distinction between 'functional' and 'organic' fades away. Perhaps practice will help to shape the domain of the speciality, and imaging will guide it. To date, the number of post-graduate studies are still low in comparison to the need for such speciality, much more board certification may be needed as well as the currently emerging masters and doctoral degrees. This post is previously posted on bmj doc2doc blogs Bibliography Eysenck, H.J., Decline and Fall of the Freudian Empire, Pelican Series, 1986 German E Berrios, I.S.M., The concept of neuropsychiatry: A historical overview, Journal of Psychosomatic Research, 2002, Vol. 53, pp. 629-638 Kieran O’Driscoll, J.P.L., “No longer Gage”: an iron bar through the head, British Medical Journal, 1998, Vol. 317, pp. 1637-1638 Perminder S. Sachdev, A.M., Neuropsychiatry: Where Are We And Where Do We Go From Here?, Mens Sana Monographs, 2013, Vol. 11(1), pp. 4-15 Slater, E., The Diagnosis of "Hysteria", British Medical Journal, 1965, Vol. 5447(1), pp. 1395–1399 Thomas Insel, Bruce Cuthbert, R.H.M.G.K.Q.C.S.P.W., Research Domain Criteria (RDoC): Toward a New Classification Framework for Research on Mental Disorders, American Journal of Psychiatry, 2010, Vol. 167:7, pp. 748-751 Organic Psychiatry, Anthony S. David, Simon Fleminger, M. D. K. S. L. J. D. M. (ed.), Wiley-Blackwell, 2009 Neuropsychiatry an introductory approach, Arciniegas & Beresford (ed.), Cambridge University Press, 2001 Biological Psychiatry, Hugo D’haenen, J.A. den Boer, P. W. (ed.), John Wiley and Sons, 2010 Gale Encyclopedia of Mental Health, Laurie J. Fundukian, J. W. (ed.), Thomson Gale, 2008 Biological Psychiatry, M. Trimble, M. G. (ed.), Wiley-Blackwell, 2010 Textbook of Neuropsychiatry, Moore, D. P. (ed.), Hodder Arnold, 2008 Textbook of Biological Psychiatry, Panksepp, J. (ed.), John Wiley and Sons, 2004 The American Neuropsychiatric Association Website www.anpaonline.org The Royal Melbourne Neuropsychiatry Unit Website http://www.neuropsychiatry.org.au/ The British Neuropsychiatry Association website www.bnpa.org.uk The Royal College of Psychiatrists website www.rcpsych.ac.uk The World Federation of Societies of Biological Psychiatry website www.wfsbp.org  
Dr Emad Sidhom
about 5 years ago
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Almost 1 in 5 adults with epilepsy may have symptoms of ADHD, study finds

A new study is the first to report that nearly 1 in 5 adults with epilepsy may also have ADHD, which may have implications for the treatment of epileptic patients.  
medicalnewstoday.com
over 4 years ago
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Study: Neurologists' focus on face-to-face time with patients undervalued by Medicare

Most neurologists provide face-to-face care of neurology patients, many of whom have complex diseases such as Alzheimer's disease, epilepsy and Parksinson's disease - conditions that require...  
medicalnewstoday.com
over 4 years ago
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Discovering the relationship between autism and epilepsy

Researchers at the University of Veracruz (UV), in the west coast of Mexico, study the neurobiological link between the Autism Spectrum Disorder (ASD) and epilepsy, in order to understand the...  
medicalnewstoday.com
over 4 years ago
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Link confirmed between missing DNA and birth defects

In 2010, scientists in Italy reported that a woman and her daughter showed a puzzling array of disabilities, including epilepsy and cleft palate.  
medicalnewstoday.com
over 4 years ago
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Marijuana extract shows promise as severe epilepsy treatment

A small study has trialled a marijuana extract in people with severe epilepsy. Seizures decreased among the participants, though 6% stopped taking the drug after side effects.  
medicalnewstoday.com
over 4 years ago
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GW Pharmaceuticals initiates first Phase 3 pivotal trial for epidiolex in Dravet syndrome

GW Pharmaceuticals plc, a biopharmaceutical company focused on discovering, developing and commercializing novel therapeutics from its proprietary cannabinoid product platform, announces it...  
medicalnewstoday.com
over 4 years ago
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New guideline on how to treat the one in 10 who experience a first seizure

In order to help doctors treat the millions of people who experience their first seizure each year, the American Academy of Neurology and the American Epilepsy Society have released a new...  
medicalnewstoday.com
over 4 years ago
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Epilepsy drug could protect eyesight of MS patients

An anticonvulsant drug used to prevent seizures could protect people with MS from some of the damage caused by acute optic neuritis.  
medicalnewstoday.com
over 4 years ago
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Study finds new genetic clues to pediatric seizure disorders

Researchers have identified a new genetic mutation at the heart of a severe and potentially deadly seizure disorder found in infants and young children.  
medicalnewstoday.com
over 4 years ago
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Researchers identify gene linked with early epilepsy

Certain types of early-onset epilepsy are caused by previously unknown mutations of a potassium channel gene, KCNA2. The mutations disrupt the electrical balance in the brain in two ways.  
medicalnewstoday.com
over 4 years ago
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Direct brain neurostimulation for partial onset seizures provides long-term benefit

Piotr Olejniczak, MD, PhD, LSU Health New Orleans Professor of Neurology and Director of the Epilepsy Center, contributed to a study of the long-term effectiveness of the first direct brain...  
medicalnewstoday.com
over 4 years ago
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Study: Medtronic deep brain stimulation therapy for treatment-resistant epilepsy shows significant and sustained seizure reduction at five year

Medtronic plc has announced five-year results from the pivotal SANTE (Stimulation of the Anterior Nucleus of the Thalamus in Epilepsy) trial, the largest clinical study of deep brain...  
medicalnewstoday.com
over 4 years ago
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Anavex confirms positive preclinical epilepsy data for ANAVEX 2-73

Anavex Life Sciences Corp. has confirmed positive preclinical data for its lead drug candidate ANAVEX 2-73 for the potential treatment of epilepsy, validating it also as a prospective platform...  
medicalnewstoday.com
over 4 years ago
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Epilepsy drug shows promise for reducing stroke-induced brain damage

A drug FDA-approved for treating epilepsy - retigabine - may also be effective for reducing brain damage following ischemic stroke, according to a new study.  
medicalnewstoday.com
over 4 years ago
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Coral snake venom reveals a unique route to lethality

Venom's toxins will be a powerful tool for studying epilepsy, schizophrenia and chronic painFast Facts: The reason for the lethality of venom from...  
medicalnewstoday.com
over 4 years ago
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LSU Health New Orleans research finds novel compound switches off epilepsy development

Researchers at the LSU Health New Orleans Neuroscience Center of Excellence have found that a novel compound they discovered helps curtail the onset and progression of temporal lobe epilepsy.  
medicalnewstoday.com
over 4 years ago