Epilepsy - Diagnosis and treatment. Diagnosis. To diagnose your condition, your doctor will review your symptoms and medical history.
Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include: A neurological exam. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have. Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures. Your doctor may also suggest tests to detect brain abnormalities, such as: Electroencephalogram (EEG).
This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste- like substance. The electrodes record the electrical activity of your brain.
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Your doctor may also suggest tests to detect brain abnormalities, such as: Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. Concerta ® is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children 6 years of age and older, adolescents, and adults up to the.
If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may monitor you on video while conducting an EEG while you're awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you're having or rule out other conditions. Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test. High- density EEG. In a variation of an EEG test, your doctor may recommend high- density EEG, which spaces electrodes more closely than conventional EEG — about a half a centimeter apart. High- density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures.
Computerized tomography (CT) scan. A CT scan uses X- rays to obtain cross- sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts. Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.
Functional MRI (f. MRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an f.
MRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating. Positron emission tomography (PET). PET scans use a small amount of low- dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities. Single- photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating. A SPECT test uses a small amount of low- dose radioactive material that's injected into a vein to create a detailed, 3- D map of the blood flow activity in your brain during seizures.
Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more- detailed results. Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected. Fun Large Group Ice Breakers For Adults.
Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start: Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin. Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring. Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset. Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment. Treatment. Doctors generally begin by treating epilepsy with medication.
If medications don't treat the condition, doctors may propose surgery or another type of treatment. Medication. Most people with epilepsy can become seizure- free by taking one anti- seizure medication, which is also called anti- epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure- free life. Many adults can discontinue medications after two or more years without seizures.
Your doctor will advise you about the appropriate time to stop taking medications. Finding the right medication and dosage can be complex.
Acute Hyperammonemic Encephalopathy in Adults: Imaging Findings. Abstract. BACKGROUND AND PURPOSE: Acute hyperammonemic encephalopathy has significant morbidity and mortality unless promptly treated. Dating A Modern Orthodox Jew.
We describe the MR imaging findings of acute hyperammonemic encephalopathy, which are not well- recognized in adult patients. MATERIALS AND METHODS: We retrospectively reviewed the clinical and imaging data and outcome of consecutive patients with documented hyperammonemic encephalopathy seen at our institution.
All patients underwent cranial MR imaging at 1. T. RESULTS: Four patients (2 women; mean age, 4. Causes included acute fulminant hepatic failure, and sepsis with a background of chronic hepatic failure and post–heart- lung transplantation with various systemic complications.
Plasma ammonia levels ranged from 5. L. Bilateral symmetric signal- intensity abnormalities, often with associated restricted diffusion involving the insular cortex and cingulate gyrus, were seen in all cases, with additional cortical involvement commonly seen elsewhere but much more variable and asymmetric. Involvement of the subcortical white matter was seen in 1 patient only. Another patient showed involvement of the basal ganglia, thalami, and midbrain. Two patients died (1 with fulminant cerebral edema), and 2 patients survived (1 neurologically intact and the other with significant intellectual impairment). CONCLUSIONS: The striking common imaging finding was symmetric involvement of the cingulate gyrus and insular cortex in all patients, with more variable and asymmetric additional cortical involvement.
These specific imaging features should alert the radiologist to the possibility of acute hyperammonemic encephalopathy. Abbreviations. ALTalanine transaminase.
APalkaline phosphatase. ASTaspartate transaminase. DWIdiffusion- weighted imaging. EEGelectroencephalography.
FLAIRfluid- attenuated inversion recovery. GCSGlasgow Coma Scale. ICUintensive care unit. IVintravenous. N/Anot applicable. PTprothrombin time. TPNtotal parenteral nutrition.
Patients with acute hyperammonemic encephalopathy present with progressive drowsiness, seizures, and coma due to primary toxic effects of ammonia on the brain parenchyma. Prolonged hyperammonemia can lead to significant brain injury and long- term sequelae, such as intellectual impairment.
Prompt recognition and treatment of hyperammonemia is, therefore, essential to avoid complications such as cerebral edema and brain herniation, which can prove fatal. In the pediatric population, acute hyperammonemic encephalopathy and its imaging findings have been well described as a result of inborn errors of metabolism (eg, urea cycle disorders or organic acidemias). In adults, this condition is more commonly encountered in very ill patients being treated in the ICU.
Acute hepatic dysfunction is most frequently implicated, but other etiologies include portosystemic shunt surgery, drugs (eg, sodium valproate, asparaginase therapy, or chemotherapy), infections, hypothyroidism, multiple myeloma, and post- lung or bone marrow transplantation. The radiologic findings of acute hyperammonemic encephalopathy are less well recognized in the adult literature, yet imaging may yield clues to the underlying diagnosis. The purpose of this study was to describe the MR imaging features of adult hyperammonemic encephalopathy. Materials and Methods.
The institutional review board of our hospital approved this retrospective study and waived informed consent. Our study included consecutive patients treated between 2.
Clinical records, biochemical laboratory indices, and EEG reports were reviewed for each patient. All patients underwent cranial MR imaging at 1. T (Signa HDXT, GE Healthcare, Milwaukee, Wisconsin; or Magnetom Avanto, Siemens Medical Systems, Iselin, New Jersey). Routine spin- echo sagittal T1- weighted, T2- weighted, FLAIR, ultrafast spoiled gradient- echo, and DWI sequences were performed in all 4 cases. Routine postcontrast T1- weighted imaging in the axial and coronal planes was performed in 2 patients after IV injection of 0.
Gadovist; Bayer Schering Pharma, Berlin, Germany). The MR imaging features were analyzed by 1 neuroradiologist (J. M. U.- K.- I), who recorded the extent of signal- intensity abnormalities on FLAIR, T2- weighted sequences, and DWI. The pattern of involvement, including cortical and subcortical white matter; distribution; symmetry; enhancement; and involvement of other sites, such as the basal ganglia, thalami, and posterior fossa structures, were recorded.
Results. The salient demographics, clinical data, and MR imaging features of the 4 patients with hyperammonemic encephalopathy are summarized in the On- line Table. Patients. Four patients (2 women; mean, age 4. ICU, were included in this study. All patients presented with seizures and reduced level of consciousness (GCS scores ranging from 3 to 8). Additionally, 1 patient had abnormal posturing. Plasma ammonium levels ranged from 5. L (normal range, 0–3.
Seizures in adults. WHAT IS A SEIZURE? The brain contains billions of neurons (nerve cells) that create and receive electrical impulses.
Electrical impulses allow neurons to communicate with one another. During a seizure, there is abnormal and excessive electrical activity in the brain.
This can cause changes in awareness, behavior, and/or abnormal movements. This activity usually lasts only a few seconds to minutes. Epilepsy refers to a condition in which a person has a risk of recurring epileptic seizures.
Not everyone who has had a seizure has epilepsy. Nonepileptic seizures can be caused by other conditions such as low blood sugar, a fainting spell, or an anxiety attack. SEIZURE SYMPTOMSSeizure types — One of the most common seizure types is a convulsion. This may be called a "tonic clonic" or "grand mal" seizure. In this type of seizure, a person may stiffen and have jerking muscle movements; during the muscle- jerking, the person may bite their tongue, causing bleeding or frothing at the mouth. Other seizure types are less dramatic.
Shaking movements may be isolated to one arm or part of the face. Alternatively, the person may suddenly stop responding and stare for a few seconds, sometimes with chewing motions or smacking the lips. Seizures may also cause "sensations" that only the patient feels. As an example, one type of seizure can cause stomach discomfort, fear, or an unpleasant smell. Such subjective feelings are commonly referred to as auras. A person usually experiences the same symptoms with each seizure aura. Sometimes, a seizure aura can occur before a convulsive seizure.
Seizure triggers — A minority of people have seizure triggers, such as strong emotions, intense exercise, loud music, or flashing lights. When these triggers are at play, they usually immediately precede the seizure.
Although they are more difficult to link to a seizure, other factors can also increase the likelihood that a seizure will happen. As an example, fever, menstrual periods, a lack of sleep, and stress can all increase the risk of seizures in some people. After a seizure (postictal state) — For many seizure types, you may be unaware during the seizure. When you are told about your behavior during the seizure, you may not believe it because you have no memory of the event. The period following a seizure is called the postictal state.
During this time, you may be confused and tired, and you may develop a throbbing headache. This period usually lasts several minutes, although it can last for hours or even days. In some people, the postictal period comes with certain symptoms.
For example, you may experience mild to severe weakness in a hand, arm, or leg. Other people have difficulty speaking or experience temporary (partial) vision loss or other types of sensory loss. These can be important clues about the type of seizure and the part of the brain that was affected during the seizure. SEIZURE CAUSESAs noted earlier, all seizures are not caused by epilepsy. There are three broad categories of seizure causes: ●Epileptic seizures – People with epilepsy have a type of brain dysfunction that intermittently causes episodes of abnormal electrical activity. This can be caused by any type of brain injury, such as trauma, stroke, brain infection, or a brain tumor. In some individuals, epilepsy is an inherited condition.
In many cases, the cause of epileptic seizures is not clear.●Provoked seizures – A similar type of abnormal electrical activity in the brain can be caused by certain drugs, alcohol withdrawal, and other imbalances, such as a low blood sugar. Seizures that are caused by problems like these are called "provoked" seizures, and they do not usually occur again once the problem is remedied. People with provoked seizures are not said to have epilepsy.●Nonepileptic seizures – Nonepileptic seizures look like seizures, but are not caused by abnormal brain activity. These seizures may be due to fainting spell, a muscle disorder, or a psychological condition.
SEIZURE DIAGNOSISIf you have a seizure and have never had one before, your healthcare provider will want to get as much information about the seizure as possible. Dating Chat Line Phone Numbers on this page. He or she will want to know a detailed description of the episode, if you lost consciousness, stared blankly, or twitched and jerked violently. The more information your healthcare provider has about your seizure, the better able he or she will be to make the right diagnosis. If a witness to the seizure is available and can come to the appointment or be contacted later, this can be very helpful to the physician.
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