Of all muscles of body overextension of body only

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of all muscles of body, overextension of body only head and feet touch the floor 3. Clonic seizures- loss of consciousness and shaking of body- chaotic motor activity 4. Tonic- clonic seizures- Grand Mal seizures- loss of consciousness, development of opisthotonus which lasts up to 1min> transformation into chaotic motor activity- shaking 5. Atonic seizures- loss of consciousness, drastic and rapid loss of muscle tone>patient falls down 6. Myoclonic seizures- consciousness may be preserved; associated with involvement of subcortical structures- nuclei in neostriatum; may be provoked by external stimulation f.e clapping of hands; short-lasting episodes of myoclonal contractions; 19. Grand Mal Stages and clinical presentation: 1 st stage- stage of aura 1. Lasts approximately 15min
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2. Symptoms correspond to partial seizures 3. Euphoria, hallucinations 4. Patient knows that he will have seizure 2 nd stage- tonic stage 1. Lasts no more than 1min 2. Yelling, crying> loss of consciousness> patient falls down> development of opistohonus 3. Due to increased muscle tone patient is unable to breath> cyanosis 4. Involuntary defecation and urination 3 rd stage- clonic stage 1. Lasts approximately 15min 2. Consciousness is still lost 3. Development of chaotic motor activities of lower extremities, lower jaw (patient may bite tongue) 4. Foam in the mouth 4 th stage- stage of epileptic sleep (epileptic coma, postictal) 1. Lasts several hours to 1day 2. Patient sleeps 3. After waking up does not remember what happen (amnesia) Emergency treatment: Inside hospital: 1. IV injection of benzodiazepine- diazepam to stop attack 2. After stoping of seizure: IV infusion of diuretics, corticosteroids Outside hospital: 1. Do not put anything into patients mouth, it may break teeth and cause aspiration 2. Put patient in supine position, keep head in lateral position to avoid aspiration of vomit 20. Epilepsy- diagnostic, preventive therapy (pharma and nonpharma) Diagnostic: 1. Suspect epilepsy if: patient had at list two episodes of consciousness loss or chaotic motor activities in his life 2. EEG- confirms that patient is epileptic: 1. peak- sharp waves 2. may localize epileptic focus 3. may confirm specific epileptic seizure 4. patient should spend sleepless night before EEG 5. perform EEG with stimulation- hypoventilation, photic, auditory stimuli 6. EEG monitoring for 24h (cause) 3. MRI 1. May confirm cause 2. Shows specific changes in brain which are consequences of epilepsy (f. e sclerosis of hyppocampus) 4. If nothing is seen on MRI> we perform complex assessment for somatic causes metabolic monitoring, lab investigations, ECG Preventive therapy: 1. Use one or two drugs maximally
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2. Dosing- start with minimal dose and then slowly increase. Minimal therapeutic dose is preferred because drugs have to be administred for a long period 3. Can stop therapy if patient does not have epilepsy for at list two years and normal EEG, but most often there is recurrence of epilepsy in a few months so drugs should be used life-long Drugs: 1.
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  • Winter '18
  • Jane doe

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