Epilepst Co-morbidities Flashcards
What may modulate depression in human TLE?
Chronic hippocampus hyperexcitability on the limbic network
What is the possible mechanism of TLE induced depression?
Persistent hyperexcitability of hippocample neurons activating prefrontal regions that influence depression symptoms.
What region of the prefrontal cortex is thought to have antidepressant effects?
Stimulation of the subgenual cingulate (Broadman area 25) has antidepressant effects.
What is the most common serious psychosocial issue facing a person with epilepsy?
33% have experienced depression, often with anxiety symptoms
The Americans with Disability Act of 1990 prohibits employers from discriminating based on disability. What are potential employers permitted to ask?
The ability to perform specific functions required for the job.
Under the ADA act, what are employers not permitted to ask about?
1- if the person has a disability
2- asking this parties regarding applicant’s disability status
Under the ADA, can the employer ask the person to describe or demonstrate how they would perform specific job duties.
1- Yes
2- can also ask if the employee can comply with an attendance policy
3- request to indicate any accommodations needed for pre-employment test
Under the ADA can an employer offer an applicant a job on the condition of a medical exam?
Yes
Under the ADA an employer can ask an employee once he has been offered a job any condition believed relevant to the ability to peer form the job.
Yes
Under the ADA who can the the employer discuss confidential information?
A supervisor, medical departments, safety personnel, government officials who investigate complaints
Under the ADA a conditional job offer be withdrawn due to:
Job related, employee safety, safety of others, or no reasonable accommodation available
Under Title 1 of the ADA is limited to businesses of what size?
> 15
What are the driving laws concerning driving non-commercial vehicles?
Varies from state to state.
What are the most liberal laws concerning driving?
Leaving the decision up to the physician.
Do most states require the physician to report seizures-?
No
What is the concern of adult neurologist taking over care of young adults with pediatric onset epilepsies?
Insufficient information about past medical history received from pediatric neurologist and patient does not know his past medical history.
In patients having SUDEP or near SUDEP experience had this common feature
A rapid pattern of breathing - over 15breaths per minute- occurring after a generalized convulsion. Often this is followed by cardiorespiratory dysfunction
What is the the seizure type at highest risk for SUDEP?
Generalized tonic clones seizures
What population of ethnic population has adverse effects to CBZ?
Han Chinese
What is the approximate incidence of SUDEP?
1.16 - 1.6 deaths per 1000 people with epilepsy per year
What is the most suggestive clinical finding atypical language dominance in patients with left hemispheric epilepsy?
Left-handed was
What is the atypical language dominance in patients with left hemisphere epilepsy?
17-38% who underwent WADA testing
What percentage of patients who are left-handed with left hemisphere epilepsy, who have atypical language dominance?
91% versus 31% of righted patients
Is there a difference in atypical language dominance in age of onset in left hemisphere epilepsy?
Yes, atypical language dominance is seen in 51% in patients with onset under 14 years and 28% with later onset.
In add on AED trials, the incidence of SUDEP in the placebo arm is altered compared to general epilepsy?
SUDEP was up to 7-fold higher in the placebo arm than those receiving drug.
What is hypothesized to cause SUDEP?
Sympathies hyperactivation, parasympathetic suppression and parasympathic overdrive, abnormal heart rate variability, and respiratory suppression.
What co-morbidity is associated with worse outcomes for both medical and surgical outcomes?
Depression
What psychiatric condition is most predictive of PNES in veterans?
Post traumatic stress disorder
