110 Puzzling Cases of Epilepsy (PDF)
(Sprache: Englisch)
In the field of epilepsy, original observations are often the key to diagnosis and successful treatment. Indeed, the acumen to recognize the unexpected or unusual case distinguishes astute physicians. Further, case observations may prompt and stimulate...
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In the field of epilepsy, original observations are often the key to diagnosis and successful treatment. Indeed, the acumen to recognize the unexpected or unusual case distinguishes astute physicians. Further, case observations may prompt and stimulate basic science experiments and well-controlled clinical research. Yet illustrative reports and vignettes seem to have lost their appeal and are increasingly viewed with disdain as evidence-free medicine.
Dieter Schmidt and Steven Schachter believe that original observations are fine examples of human curiosity and the quintessence of medical science, especially in epilepsy. For this reason, they have asked colleagues from around the world to contribute a case study, one that taught the clinician an important lesson and influenced the way they approached the care of their patients.
From pediatric to the elderly, from contractible to refractive, this bestselling short text contains 110 cases covering all aspects of epilepsy. Each case follows the same format.
Dieter Schmidt and Steven Schachter believe that original observations are fine examples of human curiosity and the quintessence of medical science, especially in epilepsy. For this reason, they have asked colleagues from around the world to contribute a case study, one that taught the clinician an important lesson and influenced the way they approached the care of their patients.
From pediatric to the elderly, from contractible to refractive, this bestselling short text contains 110 cases covering all aspects of epilepsy. Each case follows the same format.
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Case 43IF AT FIRST YOU DONT SUCCEED
Andrew N Wilner
History
F came to the office for his first visit when he was 40 years old. His mothers pregnancy was unremarkable, but he was premature by 6 weeks and blue at birth. He did not walk until 16 months of age or speak until 3 years of age. Fs first convulsion occurred at 15 months of age. He also had brief spells where he appeared afraid and ran to his mother. Despite phenobarbital and phenytoin, he continued to have seizures. After his physician switched him to primidone at the age of 12 years, F became violent and attacked a neighbor with a hatchet. He required institutionalization until he was aged 18.
While taking valproate 2 years ago he again became aggressive and was said to have a psychotic reaction. His behavior improved when he began phenytoin. However, he continues to have seizures three times a month, although they can occur as often as nine times a day. According to his parents, he has right hand jerks, which sometimes proceed to a generalized convulsion. He also has other spells where he smacks his lips and stares. His seizures have failed to improve with acetazolamide, carbamazepine, chlordiazepoxide, clorazepate, diazepam and ethosuximide. He had an episode of status epilepticus when an intercurrent illness resulted in protracted nausea and vomiting.
His past medical history includes hyperthyroidism and hypertension, which he treats with medications. As a result of his seizures, he has fractured both wrists and his right foot and has suffered numerous lacerations on his face and scalp. He has no allergies and does not abuse drugs; nor does he drink alcohol or smoke. F is the only one in his family with epilepsy. His social life is very limited because of his seizures and limited cognitive and social skills. His mother is overprotective. His stepfather mostly ignores him. A prior evaluation included a normal EEG and a normal
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magnetic resonance imaging (MRI) study. He takes phenytoin (100 mg four times daily) and primidone (250 mg four times daily).
Examination and investigations
F answers questions slowly, but appropriately. His Mini Mental State Examination score is 25/30. His physical examination is normal and his neurological examination is non-focal. VideoEEG monitoring of eight seizures failed to reveal lateralization or localization (because of muscle artifact produced by grimacing and chewing at the onset of each seizure). Depth electrode monitoring revealed that 12 of 13 seizures originated from his right temporal lobe. The origin of the remaining seizure was unclear. Fs repeat MRI scan demonstrated right hippocampal atrophy with increased T2-weighted signal consistent with mesial temporal sclerosis. Positron emission tomography was normal. Neuropsychological testing did not lateralize or localize. The IQ was 83. A Wada test determined that he was left hemisphere dominant for language. Using his left hemisphere, he was able to remember 11 of 12 items. Using his right hemisphere, F couldnt answer any questions correctly.
Diagnosis
Intractable epilepsy caused by partial complex seizures and partial seizures with secondary generalization from the right temporal lobe.
Treatment and outcome
F had a right anterior temporal lobectomy without complication. Postoperatively, primidone was discontinued and he had two breakthrough seizures. I restarted the medication and he remains seizure free on two antiepileptic drugs. He attended adult education classes and passed his high school equivalency exam. He has been to vocational rehabilitation and found some parttime work. He also volunteers at the local hospital. He has learned to drive and can do errands, but he continues to live at home. He has made some friends at the epilepsy support group and has a girlfriend. He has been .shing with his stepfather for the first time.
Examination and investigations
F answers questions slowly, but appropriately. His Mini Mental State Examination score is 25/30. His physical examination is normal and his neurological examination is non-focal. VideoEEG monitoring of eight seizures failed to reveal lateralization or localization (because of muscle artifact produced by grimacing and chewing at the onset of each seizure). Depth electrode monitoring revealed that 12 of 13 seizures originated from his right temporal lobe. The origin of the remaining seizure was unclear. Fs repeat MRI scan demonstrated right hippocampal atrophy with increased T2-weighted signal consistent with mesial temporal sclerosis. Positron emission tomography was normal. Neuropsychological testing did not lateralize or localize. The IQ was 83. A Wada test determined that he was left hemisphere dominant for language. Using his left hemisphere, he was able to remember 11 of 12 items. Using his right hemisphere, F couldnt answer any questions correctly.
Diagnosis
Intractable epilepsy caused by partial complex seizures and partial seizures with secondary generalization from the right temporal lobe.
Treatment and outcome
F had a right anterior temporal lobectomy without complication. Postoperatively, primidone was discontinued and he had two breakthrough seizures. I restarted the medication and he remains seizure free on two antiepileptic drugs. He attended adult education classes and passed his high school equivalency exam. He has been to vocational rehabilitation and found some parttime work. He also volunteers at the local hospital. He has learned to drive and can do errands, but he continues to live at home. He has made some friends at the epilepsy support group and has a girlfriend. He has been .shing with his stepfather for the first time.
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Bibliographische Angaben
- Autoren: Dieter Schmidt , Steven C Schachter
- 2002, Englisch
- Verlag: Taylor & Francis Group Plc
- ISBN-10: 0203270339
- ISBN-13: 9780203270332
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