epilepsy [read-only] - columbia university · pdf file– neonatal convulsions ... the...
TRANSCRIPT
![Page 1: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/1.jpg)
1
![Page 2: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/2.jpg)
2
![Page 3: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/3.jpg)
3
![Page 4: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/4.jpg)
4
![Page 5: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/5.jpg)
5
![Page 6: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/6.jpg)
6
Classification of Epilepsy
• GeneralizedConvulsive (grand mal)Nonconvulsive (petit mal)MyoclonicFebrile
• Partial (focal)P. seizures with elementary symptomsP. seizures with complex symptomsP. seizures with secondary generalization
![Page 7: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/7.jpg)
7
Complex partial seizures -localization• Orbital frontal
Olfactory hallucinations, autonomic phenomena.• Anterior temporal, amygdalar
Lip smaking, forced searching, blank staring, epigastric distress, respiratory irregularity.
• Posterior temporalAuditory, vestibular, and visual phenomena.
• Temporal, limbicDysmnestic states (déjà vu, j’amais vu), dream states,
mind-body dissociation, fear, panic, and anxiety.
Hippocampus
Fornix
Amygdala
Hippocampus
![Page 8: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/8.jpg)
8
![Page 9: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/9.jpg)
9
Insights from genetics
• Mendelian inheritance– Neonatal convulsions– Nocturnal frontal lobe epilepsy– Progressive myoclonic epilepsy– Cortical malformation syndromes
• Complex inheritance (alters synaptic function, ion channels, neuronal structure
Most epilepsies
![Page 10: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/10.jpg)
10
Molecular genetics of idiopathic epilepsies
Disease Mode ofInheritance
Gene
Generalized epilepsywith seizures plus
AD Na+ channel (β1subunit)
Na+ channel (α1subunit)
Benign familialneonatal convulsions
AD K+ channel (KCNQ2)
K+ channel (KCNQ3)Autosomal dominantnocturnal frontal lobeepilepsy
ADnACh receptorsubunit
Lord, have mercy on my son, for he is an epileptic and he suffers terribly; for often he falls into the fire, and often into the water,
And I brought him to your disciples, And they could not heal him.
– Matthew 17:15-16
![Page 11: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/11.jpg)
11
Both Pat and Shirley believe that exorcism is a much-too-neglected therapy for the epileptic,
“What we call fits - seizures and epilepsy today” he explained, “Jesus recognized as possession by demons. Jesus saw epilepsy for what it is - the work of Satan.”
– Pat Boone Believes in MiraclesMcCalls Magazine, February 1973, p. 122
![Page 12: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/12.jpg)
12
Pharmacotherapy
• ↓Burst firing (Na+ channel blockade)Phenytoin, Carbamezapine, Felbamate,
Topiramate
• ↑Inhibition (GABA potentiation)Barbituates, Benzodiazepines, Valproate,
Gabapentin, Tiagabine, Topiramate
• ↓Coupling (Glutamate receptor antagonist)Topiramate, Felbamate
![Page 13: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/13.jpg)
13
Trephination was practiced in the Old and New world 7,000 - 3,000 B.C.
Neuroimaging
![Page 14: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/14.jpg)
14
Neuroimaging: mesial temporal lobe sclerosis (Flair)
Neuroimaging: MTS (T2)
Gamma Knife Surgery
![Page 15: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/15.jpg)
15
Texas.
Cyberonics, Webster, Texas
Figure 1: The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). Reprinted with permission of Cyberonics, Webster, Texas.
Tacuinum sanitatis, 15th century, Rx for insomnia
![Page 16: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/16.jpg)
16
![Page 17: Epilepsy [Read-Only] - Columbia University · PDF file– Neonatal convulsions ... The Vagus Nerve Stimulator: NCP 101 generator (with leads attached). ... Epilepsy [Read-Only]](https://reader031.vdocuments.net/reader031/viewer/2022022706/5a7e65207f8b9a72118e68e0/html5/thumbnails/17.jpg)
17