A. Simple partial seizures. Usually the aura of a complex seizure. Patient has no loss of consciousness. 1. Motor: tonic or clonic activity of one arm or leg 2. Sensory: such as an auditory, olfactory, visual hallucination 3. Autonomic: such as the epigastric rising sensation 4. Psychic: déjà vu, fear, indescribable feeling
B. Complex partial seizure. Consciousness is altered. Patient may exhibit complex behaviors. 1. Can begin with a simple partial onset 2. Can begin with immediate alteration of consciousness C. Partial seizure evolving to generalized. Patient starts with a simple or complex partial seizure that evolves into a generalized tonic-clonic seizure. II. Generalized. Epileptic focus is not lateralized to one hemisphere. Begins in both hemispheres of the brain simultaneously. A. Nonconvulsive. 1. Absence (petit mal) 2. Atonic: loss of muscle tone (drop attacks) B. Convulsive. Involves motor activity. 1. Myoclonic: abrupt muscle twitches or jerks 2. Tonic-clonic (grand mal): tonic, then clonic activity 3. Tonic: involving increased muscle tone, rigidity 4. Clonic: muscle contraction and relaxation movementsTreatment- goal of management in epilepsy is to control seizures with minimum adverse effects; control with a single drug should be goal.Generalized seizures--first line therapy- levetiracetam (Keppra)- can be used for gen or focal seizures-Valproate (Depakote)- addt’l first line drug for generalized forms of epilepsy-Other options include Lamotrigine (Lamictal)-favored for women r/t low risk of birth defects, For focal epilepsy and complex partial seizures -carbamazepine (Tegretol)- most effective drug & low costPhenytoin (Dilantin)- effective but has worse SE profile esp for womenTopiramate (Topamax)- not first line d/t cognitive SE: dysphagia and somnolence; effective for migraine prophylaxisGabapentin (Neurontin)- not very useful for seizure activity, can exacerbate seizures primary generalized epilepsies; useful as pain management drugThere is a question about seizures. I’m trying to remember it. Neuro – assessmentThalassemia vs deficiency anemiaThalassemia- remember genetic disorderThalassemia-rare group of inherited blood disorders, ranging from mild to severe, which is caused by a variant or missing gene which affects production of Hgb. 2 types alpha and beta. Diagnosis made within first few years of life. Management includes 2 things: regular transfusions to keep Hgb adequate for normal growth and development and iron chelating therapy to prevent iron overload. Deficiency anemia (Vit b12 and folate def)-primary cause of macrocytic anemia. Both nutrients required for DNA synthesis, and BM is highly sensitive to def. B12 found in meats and meat products, folate found in most foods, esp green leafy foods. Vit b12 def when severe has neuro s/s as well as anemia s/s. CBC with low Hgb and MCV greater than 100. Management includes determining if it is b12 def or folate def, or both, treating the cause-either supplementation with vit b12 or folic acid.
DM2– assessment, diagnosis, treatmentWhat test would help the provider assess DM?? CMP
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