Medsarticles. Medical Weblog

WHAT IS IT LIKE TO HAVE AN EPILEPTIC SEIZURE: EPILEPTIC AUTOMATISMS

admin — Thu, 03 Jun 2010 09:48:19 +0000

Daniel’s mother saw him off to school as usual one morning. He took his normal route, dawdling and stopping as he usually did, to look at the mountain bike he hoped to get for his birthday in the showroom window, so that he was overtaken, by his form master.

‘Morning Daniel. Are we going to see you on time this morning, do you think?’

‘I expect so, Mr Phelps. I’ll be along in a moment.’

But Daniel wasn’t along in a moment. When, by assembly time, he still hadn’t turned up, Mr Phelps was worried. After assembly he went to the headmaster, who phoned first Daniel’s parents, and then, when it was discovered that he hadn’t gone back home, the police.

In fact it was Daniel’s father, driving desperately around the town searching for his son, who spotted him some three quarters of an hour later. He was standing on a bridge, looking down into a river.

‘Daniel! What happened to you? Where’ve you been?’

Daniel looked bemused.

‘What time is it, Dad? Oh gosh, not 10 o ‘clock. I’ll be late for school again.’

Daniel remembered talking to Mr Phelps. But after that he had no memory of what had happened to him until he found himself looking down into the river. During that time he had walked about two miles and crossed several quite busy roads.

Daniel’s is a fairly unusual case of epileptic automatism after a complex partial seizure, but it is not that unusual. There are numerous examples of people performing complex acts in a state of confusion, during or immediately after a seizure, usually a generalized or complex partial seizure. Most of these automatisms are brief, lasting only a few seconds. They seldom last longer than a few minutes but can, rarely, continue for as much as an hour.

If someone had stopped Daniel and spoken to him while he was wandering through the town they would have noticed that he seemed out of touch with his surroundings, and looked dazed or vacant. Daniel would probably not have responded if he had been spoken to, or he might have given some incoherent or irrational reply.

However, an epileptic automatism is usually less dramatic than Daniel’s experience. The person is more likely to perform simple, repetitive, rather clumsy movements. They may pull at their clothes, repeatedly rub their face or fiddle with something. Sometimes they may perform more complex actions, such as walking about the room, searching for something in a drawer, dressing or undressing. But only occasionally is an automatism, like Daniel’s, so seemingly purposeful and coordinated that it is difficult to believe that it has been carried out entirely automatically, in a state of such deep confusion that the person does not realize what they are doing and afterwards has no memory at all of what they have done. My own favourite account of an automatism concerns an organist who had an attack while playing the organ in church for a carol concert. He suddenly stopped playing, gave the congregation three minutes of uninterrupted jazz, and then, the seizure over, continued with the carol he had been playing as though nothing had happened.

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Epilepsy

THE TREATMENT OF EPILEPSY: PRACTICAL ADVICE ABOUT ANTICONVULSANTS

admin — Thu, 03 Jun 2010 09:47:41 +0000

If you are taking anticonvulsants, do not take any other medications without asking your doctor or chemist. It is safe to take paracetamol for fever/headache and antibiotics (except erythromycin if you are on regular carbamazepine) for infections. If you are taking the contraceptive pill, let your doctor know which one it is; some anticonvulsants make the pill less effective and it may be necessary to recommend a different pill.

Most anticonvulsants can be taken twice a day, some once daily and occasionally it may be necessary to take them three times a day. For convenience take your medication with meals. If you are taking several different anticonvulsants, they can all be taken at the same time, once, twice or three times a day as directed.

Never stop taking anticonvulsants suddenly. This could produce a marked increase in the number of your fits.

Do not allow yourself to run out of medication. Always keep a spare prescription at home or with your chemist.

Always keep medications in a locked cupboard away from children.

Avoid alcohol in anything more than social amounts. It does not mix well with anticonvulsants and may trigger fits.

The dose that you take depends on your age, size, weight and the severity of your fits. Some people will need to take a lot more tablets than others.

If you miss one dose, it is safe, with the exception of phenytoin, to take double the dose on the next occasion.

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Epilepsy

YOUR CHILD’S HEALTH: HEART MURMURS

admin — Thu, 21 May 2009 07:17:04 +0000

A heart murmur is a noise heard in addition to the normal heartbeats.

Cause

The commonest cause of a murmur in children is an ‘innocent murmur’, which is the result of turbulence or vibration when the blood flows through the heart valves. This can occur, for example, when the child has a fever. The child’s heart is normal, and the murmur usually disappears with time.

Other heart murmurs can signify heart disease, which can either be present from birth (congenital) or acquired later in life. These murmurs are usually caused by aberrant blood flow through a hole in the wall between the heart chambers, or through faulty valves.

Clinical features

A child who has an innocent murmur will have absolutely no symptoms of heart disease. The child is perfectly normal. A child who has a significant murmur, will usually have characteristic symptoms related to heart disease. These may include breathlessness and blueness of the lips and of the fingers and toes. With some congenital abnormalities of the heart, these symptoms may appear immediately or soon after birth.

Investigations

If there is any uncertainty about the significance of your child’s murmur, your doctor may order an ECG and a chest X-ray. Referral to a paediatric cardiologist may be advised, and an echocardiogram, which is an ultrasound of the heart, may be performed.

Treatment

A child with an innocent murmur does not require any treatment. On the other hand, a child with heart- disease invariably requires some form of treatment, which can range from medication to surgery, depending on the nature and severity of the disorder.

The management of heart problems in children is a highly specialised field of medicine. Your family doctor can provide you with further information at your request.

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SEXUALITY, ILLNESS, AND HEALTH: JUGGLING SEX FOR HEALTH

admin — Tue, 19 May 2009 05:29:12 +0000

“We were sitting in your waiting room and got to talking with this older couple who said they were in your super marital sex program. They said they were your oldest couple.” The young wife was reviewing the first visit to the clinic and her husband was nodding.

“They told us about the tests and the recommendations. They said something about a posture of the future. You know us. We thought that maybe that would get us pregnant, but they just wouldn’t tell us. They laughed and said we would have to find out for ourselves. When your secretary came to get them, they turned to us and the husband said, ‘We love it. You’ll find it. But first, try these juggling bags. Dr. Pearsall gave them to us. They work like magic’ ”

“Well,” she continued, “we persons in fertility will try anything. We would stand on our heads if it would work. We took those things home and laughed like crazy. We got so daffy at home that we got carried away. We had sex on the wrong night. We had never—I mean never—done that. Some weeks later, we got pregnant. When we came to your office to see you, we met the same people. I gave him the bags back and told him that they worked. He laughed and took his wife’s hand. “Do you think we should juggle tonight? Two seventy-year-olds might just juggle themselves more than they could handle.”

Removing the burden of fear, pressure, and misunderstanding that can accompany health problems is the first step to protecting your sexual rights. To review this issue, try the next opportunity.

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YOUR MARITAL HEALTH/WHY HUSBANDS DON’T HAVE ORGASM: TESTOSTERONE POISONING – EVE’S RIB

admin — Mon, 18 May 2009 12:22:50 +0000

Starting at approximately three weeks of development in the uterus, if there is an X/broken-X (Y) chromosome pattern with one of the X chromosomes missing its lower right leg, a male will develop in relationship to the presence of testosterone. Overstating the case, we could say that the clitoris grows out to a penis, the ovaries become testicles and drop down into a sac created when the labia grow together. You have discovered the line where the scrotum grew together, the line called the penoscrotal raphe, the R area of sensitivity along the scrotom up the penis to the frenulum.

This theory of “male from female” is called “inductor” theory in that the male is induced by androgens and MIS, Mullerian Inhibiting Substance, which causes certain female formations to disappear in utero. Early female development is not dependent on hormones; it is autonomous. Mary Jane Sherfey proposed this idea in her book The Nature and Evolution of Female Sexuality. While not totally accurate and in many ways incomplete, the earlier Freudian notion of male superiority or “penis envy” is further from neurophysiological accuracy than inductor theory.

Of course, masculinity and femininity are not mutually exclusive developmental axes. You can be less feminine in terms of society’s criteria without being more masculine, and you can be more feminine without being less masculine. I had the husbands and wives point to areas on the following lines to show, how they felt about their own gender orientation and share these feelings with one another.

MALENESS a little very much

FEMALENESS a little very much

Throughout life, even throughout the day, people vary on both axes. It is a mistake to ascribe a natural superiority in sexual function to either gender’s sexual response.

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THE JOY OF PERFECT HEALTH/THE IMPORTANCE OF A PURE MIND: SOME USEFULL ADVICES

admin — Mon, 18 May 2009 09:21:24 +0000

Let go of fear. There is nothing in this world worth fearing about. This is not simply my belief. I know. To fear is one of the worst things you can do to your mind. All logical reasoning, not to mention the connection to your higher mind is completely blocked. People know about it, and some of them use fear techniques to take advantage of others. Look around. The field of medicine prospers by promoting the fear of disease. If they succeed, you fear disease, even if you don’t have any, and this feeling actually replaces the feeling of well being! Instead of enjoying your perfect health and being happy, you worry! Fear blocks your thinking, and in this state you are easy to control by others, who know it and want to take advantage of it. The technique of fear is frequently used by government and religious leaders as a tool to control people. Let go of fear. It blocks your mind. Never use the technique of fear to control children. Use explanation, examples and reasoning instead.

Eliminate feelings of anger, hate and anxiety. – they also block your mind at all levels, preventing the natural state of well being and spiritual development.

Forgive everyone and everything. Hate and resentment also clog your mind. By nourishing hatred and resentment you cannot gain anything except the same things from others. On the other hand, forgiveness and tolerance could give you a key to gaining respect and love.

Do not think of harming anyone or anything. Think of others the way you would like others to think about you.

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LEPROSY – GENERAL INFORMATION

admin — Fri, 15 May 2009 09:43:20 +0000

But it can cause deformity, disfigurement, paralysis and misery. A variety of drugs can control and cure the disease. Dapsone is widely used, and can eliminate the infectivity of an individual after a few months.

Treatment may need to be continued for many years.

Rifampicin, an antibiotic, also used to treat ÒÂ, has recently been shown to be effective in curing the disease and may render the person non-infective in a matter of weeks.

Those with the tuberculoid form of the disease do not need isolation.

And those with the lepromatous form can return to their community once the drugs have rendered them non-infectious.

A new vaccine has been developed in Britain and proved successful in the laboratory.

Field trials will soon take place, but it may take 10 years of use before accurate knowledge of its effectiveness is available.

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BOWEL CANCER – INTRODUCTION

admin — Fri, 15 May 2009 07:52:56 +0000

There are few pleasures left in life which have not at some time or another been accused of being dangerous for our health.

Cancer of the bowel is one of the most common forms of cancer in both men and women.

Most cancers of the bowel occur in the rectum or in the lowest portion of the large bowel just above the rectum.

It appears that these cancers are increasing.

As more people are surviving the infections of childhood and early life they are living to an age at which cancer has always been common.

What we eat also appears to be a significant cause of this disorder.

Research, so far, has concentrated on four items of our diet — meat, fat, fibre and alcohol.

There are several studies that show that a high meat diet is one of the causes of the increase in bowel cancer.

Yet, some other studies seem to conflict with this. How a high meat diet can cause cancer, if it does, is as yet unknown.

In the same way, the case against a high amount of fat in the diet as a cause of cancer is equivocal.

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ENDOMETRIOSIS: ALTERNATE THERAPIES

admin — Fri, 08 May 2009 15:00:38 +0000

Alternate therapies oiler many possible avenues for alleviating the many problems associated with endometriosis. Uppermost among the benefits of these therapies, such as acupuncture, herbal preparations, yoga and other relaxation techniques, may be temporary relief from chronic pain. These medically unorthodox therapies appeal to those women with endometriosis who do not like taking prescription drugs or for those who like to supplement medications with pain-control techniques.

In the last fifteen years or so, there has been greater interest in investigating pain control through behavior modification, self-hypnosis, biofeedback, imaging, arid stress management techniques, for the endometriosis sufferer, especially the woman who has severe and chronic pain, such a program can guide her toward feeling more in charge of her body and her life. A good pain-control program will address the psychological as well as physiological realities of the disease. A number of pain clinics across the country are affiliated with medical centers, such as the Pain Management Center at UCLA in California, which operates an outpatient Pelvic Pain Program. Other clinics may be privately run. Finding a pain-control program is a matter of asking your doctor or inquiring at a large hospital or medical association.

A good measure of satisfaction comes from having some success with these alternate techniques, since many of them depend on your commitment to them in time, energy, and a sense of purpose. Unlike conventional medical therapies, they can be something of a challenge in this regard, but they are fascinating nonetheless. When you learn how to control pain without painkilling drugs, you will understand more about who you arc, while having as well the adventure of mastering a new discipline, such as behavior modification, meditation, or yoga.

Many of what are now considered alternate therapies were once the only source of practical medical treatments. They coexist now with supersophisticated surgical techniques (such as laser) and the nearly perfected drugs for treating endometriosis (such as the gonadotropinreleasing hormones, or GnRH). They remain popular, if not without an aspect of controversy attached to whether or not they work.

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SKIN CARE: HAIR AND NAIL DISORDERS

admin — Fri, 08 May 2009 14:32:43 +0000

Both hair and nails are derived from the epidermis, and both consist of the same dead tissue—the protein, keratin. Because of their derivation from the epidermis it is not surprising that diseases affecting the skin may affect the hair and nails as well. In addition, there are a number of disorders which are peculiar to the hair (including the scalp) and nails.

Hirsutism, or increased growth of facial and body hair, is a common complaint amongst women attending endocrinology, gynaecology and dermatology clinics. The presence of fine vellus fuzz on the upper lip and chin is very common in women of all races. After the menopause this vellus hair is frequently accentuated by darker terminal hairs, which may appear interspersed among the finer hairs. There is considerable racial variation as regards hirsutism, with women of southern or eastern European extraction being more prone to excess hair, and women of Asian extraction —particularly the Japanese-being rarely affected. Often there is also a familial tendency to hirsutism.

When women are affected in those areas of the body which normally only develop hair in males, and particularly if this is associated with menstrual abnormalities, deepening of the voice, and frontal scalp recession, then there is most likely to be a correctable hormonal cause for this. Hormonal factors causing excessive hair growth include excessive male hormone production from either the adrenal glands, the pituitary gland, or certain rare ovarian tumours. Occasionally some drugs may be implicated—for example dilantin, streptomycin, penicillamine, diazoxide, psoralens, and corticosteroids. Most women however show no clinical evidence of an endocrine disease or hormone abnormality, and this finding can of course by confirmed with appropriate blood and urine tests. If there is any doubt, these tests should be performed after medical assessment has been sought. In those cases of hirsutism where no abnormalities are suggested or found, the cause is probably excessive sensitivity of the hair follicles to the normal quantities of circulating male hormones, or the manufacture of excessive quantities of male hormones within the skin itself. Stress is also thought to be able to cause excess hair production by stimulating the overproduction of male hormones via the pituitary gland, which has a close relationship with the brain.

Excess hair, particularly facial, has always been thought of as an undesirable characteristic in women; although in men, for some reason, it is thought to denote virility! Witches are frequently illustrated with hair on the nose or chin. Grafitti often shows girls with moustaches, and so forth. Consequently many women become psychologically upset by being hirsute. This commonly results in such feelings as irritability, frigidity, masculine trends, and impaired sexuality. As a result, treatment is frequently sought. Here again, we have a situation likely to be exploited: these unfortunate women are very susceptible to the promises of complete and permanent hair removal. From the number of establishments advertising the myth of permanent hair removal, one can get some idea of how many women must be seeking the hairless face. The actual incidence of hirsutism is impossible to assess. However a survey of women students in Wales, in which the women were actually examined and questioned, showed that over one quarter had terminal hair on the face, and that in about 5 per cent of cases it was considered disfiguring.

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