By Dieter Schmidt, Steven C. Schachter
From pediatric to the aged, from contractible to refractive, epilepsy is an disorder that manifests in lots of kinds and throughout various demographics. during this interesting quantity, the writer info a couple of hundred circumstances the place future health care practitioners confronted strange demanding situations in treating the disorder. All features of epilepsy are explored via those situations, from the occasionally complicated preliminary analysis to sufferer responses and therapy equipment. during this best-selling brief textual content, the writer additionally offers the teachings discovered from those amazing instances. a hundred and ten difficult circumstances in Epilepsy comes in handy for scientific scholars, citizens and all wellbeing and fitness care practitioners, because the practices used to appreciate those circumstances may be utilized to different diagnoses besides.
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Extra info for 110 Puzzling Cases of Epilepsy
Ozkara C, Dreifuss FE. Differential diagnosis in pseudoepileptic seizures. Epilepsia 1993;34:294–8. 6. Bazil CW, Kothari M, Luciano D, et al. Provocation of nonepileptic seizures by suggestion in a general seizure population. Epilepsia 1994;34:768–70. 7. Gulick TA, Spinks IP, King DW. Pseudoseizures: ictal phenomena. Neurology 1982;32:24–30. 8. Gumnit RJ, Gates JR. Psychogenic seizures. Epilepsia 1986;27:S124–S129. 9. Gates JR, Ramani V, Whalen S, et al. Ictal characteristics of pseudoseizures.
Nitrazepam was restarted but was ineffective despite an increase in the dose to clinical toxicity. Valproate was added 2 weeks later. The runs of spasms decreased but did not stop. About the same time she developed brief staring spells several times a day that were associated with speech interruption, odd facial expression, a small grunt and occasional eye deviation to the right with clonic arm movements. ACTH 60 units/day was given for 5 weeks with a major decrease in the frequency of the spasms.
Examination and investigations Neurological examination was normal except for moderate global mental retardation with predominant language dysfunction and hyperkinesia. A second MRI scan at age 2 years was said to be normal. Ictal single photon emission computed tomography (SPECT) scanning imaged a 20-second seizure with the semiology described above; this scan showed a focus of hyperperfusion in the right temporal pole, in contrast to right temporal hypoperfusion seen interictally (Fig. 1). Further review of the MRI and comparison with subtraction interictal–ictal SPECT scans co-registered with MRI (see Fig.