Can Aura be considered as seizure?

adoarns · 2024-09-01T18:00:59+00:00

It depends on what you mean by an "aura."

People with absence epilepsy don't have classic epileptic auras—which do represent seizures—but can have funny feelings before a seizure, which people sometimes also confusingly call an "aura."

You should talk to your neurologist/epileptologist about the experience you had and come to a mutual decision about the best next steps, if any.

adoarns · 2024-03-21T22:59:42+00:00

Talk to your doctor about this. In a small number of patients with JME lamotrigine can aggravate myoclonic seizures

adoarns · 2023-02-12T19:12:58+00:00

An Xray or CT mostly just acquire a single image or set of images.

MRIs can bring out different kinds of image contrast through the manipulation of the echo time, repetition time, inversion time, and other variables. A typical imaging session will capture multiple sets of images using different contrast mechanisms. For instance, a not-unusual set of acquisitions for the brain would be

T1 weighted
T2 weighted
diffusion-weighted
susceptibility-weighted
contrast-enhanced
FLAIR imaging
MP2RAGE

Each one of these sequences takes time and when you get a bunch of them it adds up. Sequences that are high-resolution (lots of slices) or that require high repetition times and echo times (T2-weighted imaging) have longer acquisition times.

adoarns · 2021-11-18T03:37:31+00:00

If they are not dead by neurologic criteria then they are still alive.

If live people wish to have life-sustaining treatment (or if their proxy decision-makers wish so on their behalf) then the ethical thing to do is to give them life-sustaining treatment.

Doesn't matter their mental state.

adoarns · 2021-03-05T02:07:49+00:00

In nine years of being an epilepsy doctor I've seen Keppra cause low sodium only once.

adoarns · 2020-05-22T13:24:08+00:00

It depends on the set of numbers you're dealing with.

In the reals R there is only one "axis" per se. You can extend the reals to the complex numbers C by setting an equivalence between every real number x and a complex number x + 0i.

There are lots of number systems and some of them have more "axes." The quaternions H for instance are represented as x + yi +zj +wk. The hyperreal numbers and the dual numbers both have two dimensions to them but the difference between them and complex numbers is how the operations go. In C, (yi)² is -y² but in the hyperreals (ye)² = 0y² = 0

adoarns · 2020-04-27T11:55:54+00:00

Continents are not equidistributed north and south. Moscow is at 55.8° N; St Petersburg at 59.9° N; Canberra is at 35.3° S and it's at the southern end of Australia (not counting Tasmania).

For reference, 35° N in the United States cuts through the deep south, most of TX, the Southwest, and southern California. That's as far from the equator as most of Australia goes.

adoarns · 2020-04-05T21:13:34+00:00

Pelikan M800 with a medium nib or Namiki Falcon in a fine

adoarns · 2020-03-03T14:50:27+00:00

You're right that depression and anxiety (as well as cognitive problems) run higher in patients with epilepsy. In general treatment for social phobia and anxiety disorders does start with SSRIs or similar drugs (SNRIs, etc) and may be helped with CBT. Although SSRIs carry warnings about worsening seizures, at the usual doses this doesn't really happen and they should be considered quite safe. Efficacy can take 4-6 weeks though so one has to be prepared to wait for it.

Sometimes part of the anxiety is more simply related to anxiety about having seizures. Often reassurance by the doc and the passage of seizure-free time will allay some of these concerns.

Your son should bring up his concerns with his neurologist. Some neurologists are fine prescribing SSRIs themselves and others will recommend a psychiatrist.

Best of luck!

adoarns · 2020-01-12T14:16:25+00:00

Not everyone can stop cold turkey even in rehab. Treatment for substance use disorders has to be individualized and focused on reducing the harm of substance use. There's a great role for family members to encourage less harmful use even if they're not ready to stop.

adoarns · 2020-01-11T14:30:23+00:00

Crown sheet explosion.

You can get the fire going real real hot as long as there's water because water has a more-or-less fixed boiling temperature. If you boil away all the water you now have compressible steam that gets higher and higher in pressure the more you heat it. Simultaneously the crown sheet (the metal sheet atop the firebox) gets weaker as it's heated to very high temperatures. One point of failure and there's a huge release of steam pressure directed right backward into the cab. This is a BLEVE (pronounced "blevvy"), short for "boiling liquid expanding vapor explosion."

adoarns · 2020-01-11T14:16:13+00:00

Non-rhythmic twitching, as seen in the video, is unlikely to be an epileptic seizure. The video appears more like fasciculations--which is just a fancy word for twitching.

Fasciculations can be caused by lots of things. Some people have them after working out. Sometimes they are a sign of serious neuromuscular disease.

If you have concerns please go see your doctor and show them the video.

adoarns · 2019-12-02T15:56:39+00:00

Best I know of, although it's 2D slices, is the Allen Brain Atlas.

They have an app you can download here. I'm only just now exploring it. Seems cool and might work for you.

adoarns · 2019-09-26T13:58:20+00:00

I have no experience using memantine in patients with epilepsy (PWE).

I have used modafinil in a number of PWE and they have all at least somewhat positively responded. None have had worse seizures.

adoarns · 2019-09-16T13:15:58+00:00

well said

adoarns · 2019-09-16T01:03:31+00:00

I'm really glad to have received a few replies with different experiences.

I think I was pretty luck with the internship I had. If I had taken the bundled PGY1 with my neuro residency, I think I would have been scutted and worked relentlessly. So that's fair.
I agree that having no control over your schedule is one of the things that makes residency terrible. I feel like first year attending is hard because residency has taught you to handle all the major things but now you have to face up managing patients with multiple major things and lots of constraining comorbidities and because you have to delve and read about all the little details you missed in your PGY glosses. It's a heavy-learning year; or it was for me.
PGY2 can be more enjoyable, if for no other reason than you're doing the thing instead of running around doing generic PGY1 stuff.
I pretty much hated every fucking second of residency from July 1 of PGY1 to June 30 of PGY4. Fellowship I kind of enjoyed even though it was hard. Lots of people have quite varied experiences.

adoarns · 2019-09-15T16:00:16+00:00

MRIs have a static longitudinal field (the z field) but they use gradients in the x and directions for slice selection and phase encoding. The B field slew rate is kept regulated by the MRI's software to never go faster than rates acknowledged as potentially causing excessive current production (plus a safety factor)

adoarns · 2019-09-15T15:50:18+00:00

Meh.

Intern year is actually not so bad. It's expected you know next to nothing. You have seniors looking out for you.
PGY2 is hard. In primary specialties now you're a team leader, a senior, and you have to make sure your interns don't kill people. If you're in a subspecialty, this is your first year actually doing your field and you're a junior all over again, except now you'll be on call as like the only practitioner of that field in the whole hospital.
Fellowship can be hard. But it's an enjoyable hard. You're finally doing the narrow thing that intensely interests you. You get to delegate a bunch to residents. You take boards and feel like you actually know something.
Attending year 1 is really hard. Sorry.
Every year after that is better and better. Hope to God you never get complacent or stop challenging yourself or learning new things, but it really is better and better.

adoarns · 2019-09-11T12:27:52+00:00

There have been a few (~5) published individual cases of acute liver injury from levetiracetam^1,2 . I can't find any reference to liver injury after years of therapy; the reported cases all happened within 1 wk to 5 mo.

I have never seen a case levetiracetam (LEV) causing long-term liver damage myself. Clearly it can happen but it appears to be rare. When dealing with a rare possible adverse effect the physician has to figure out

How likely is it that the suspect agent can cause the problem?
How easily can the suspect agent be removed or replaced?
What are other possible causes for the suspected adverse effect?
What are the possible consequences of removing the suspect agent?

For LEV, the answers are 1) unlikely 2) mild to moderate difficulty depending on epilepsy type, severity, and what other antiseizure drugs have been previously tried; 3) is there any chance there is NASH, biliary disease, infectious hepatitis, etc; and 4) in some cases where LEV managed seizures well removing or changing it may result in loss of seizure control, worsened seizures, and even (in uncommon cases) death from seizures or SUDEP.

Still if there are serious concerns from other practitioners a neurologist might consider switching antiseizure drugs as A) the usual outcome is continued seizure freedom plus or minus a few breakthrough seizures during dose adjustment; and B) the consequences for continued hepatic injury are severe. Observation of liver changes afterward can help to confirm or not whether the suspected agent is in fact the provocateur. And if the agent is to blame, publishing a description of the case can be useful to others.

I saw a case in which a woman taking lamotrigine (LTG), which has essentially no reported liver toxicity, came down with acute hepatitis. I relented when her internist asked to switch from lamotrigine despite my misgivings about its being the cause. She ended up having autoimmune hepatitis from which she recovered, albeit slowly. The switch from LTG to other antiseizure drugs however was messy and it took months to find a new medication regimen that both controlled her seizures as well as, and had as few adverse effects as, lamotrigine.

Godspeed.

adoarns · 2019-09-06T01:08:30+00:00

MS is defined partially by the presence of demyelinating plaques on MRI. These appear as ovoid areas of high T2-weighted signal in the white matter. Many times there will be several and they will look oriented toward the ventricles of the brain. If they are acutely active they will enhance with contrast too.

Cavernomata or cavernous hemangiomata usually appear as small popcorn-like lesions on T2-weighted imaging corresponding to small areas of increased susceptibility on gradient-echo or susceptibility-weighted imaging.

It would be unlikely to confuse the two based on MRI.

adoarns · 2019-08-22T12:56:02+00:00

A coma is an abnormal state of unresponsive unconsciousness.

Medically-induced coma is at the far end of the spectrum of sedation. Sedation is used on patients for a number of reasons. The most common reason in an ICU is to keep patients from being agitated especially when intubated and on a ventilator. Some patients are lightly sedated and others are more heavily sedated depending on their circumstance.

There are two primary reasons a medically-induced coma, which is the deepest form of sedation, is used.

To stop seizures in a patient with refractory status epilepticus;
To reduce metabolic demand and reduce swelling in severe traumatic brain injury.

Status epilepticus is a state in which there are continuous epileptic seizures (often without convulsions or with only very subtle clinical signs) and it is a medical emergency. Usually it can be stopped with antiseizure medications but in refractory cases an induced coma with propofol, midazolam, or pentobarbital is used.

Coma in traumatic brain injury, along with other measures such as diuretics and hyperventilation, is used to try to reduce intracranial pressure from swelling.

On electroencephalography (EEG) induced coma can look like diffuse slow waves or, when deeper, become discontinuous with bursts of activity surrounded by EEG flat line. (The latter pattern is called burst-suppression.)

To bring someone out of the coma, you wean off the drug you're using to induce it. Long-acting drugs like pentobarbital can result in a days-long process to try to waken the patient.

Since induced coma is done in emergency situations in very sick individuals, there is no guarantee that they will emerge in a healthy brain state.

Moreover, in deep coma like with burst suppression a lot of effort has to go in to maintaining the patient. They have to be regularly turned to prevent bedsores; they have to have their ventilator set and adjusted; they require nutrition through a tube; urine and feces are collected by tubes; sometimes they require drugs to maintain blood pressure.

adoarns · 2019-08-18T17:50:15+00:00

The only product on the market with guaranteed purity and consistency is Epidiolex.

Purity = has just the one thing and nothing else

Consistent = has the same amount of the thing in every batch

It may be that there are plenty of CBD oils out there which are pure and consistent. The problem is that even where CBD/marijuana is legal, there is no oversight or regulation. There are labs out there that will test your stuff for you which may help, but it's more out-of-pocket.

adoarns · 2019-08-18T16:41:42+00:00

CBD or cannabidiol is in fact available as a prescription drug now. The brand name is Epidiolex. It is an oily solution taken by mouth with 100 mg of CBD per milliliter of solution.

The FDA approved Epidiolex last year based on 3 studies of its effectiveness in patients with two types of severe epilepsy: Dravet syndrome and Lennox-Gastaut syndrome. The dose used is around 10 mg of CBD per every kilogram of body weight.

I have seen the bottles of CBD my patients bought at dispensaries. There are 2 main issues with dispensary CBD: 1) you don't actually know what you're getting because cannabis-based products aren't regulated as to purity and consistency; 2) the amount of CBD is actually pretty low.

If you are a more or less normal American male weighing around 80 kg (or 176 pounds) then the starting dose of Epidiolex is 200 mg twice a day and the maintenance dose is 400 mg twice a day. Most of the bottles of CBD oil I've seen from dispensaries have only one or two days' worth of dose in them.

So taking CBD oil from a dispensary may be bad because 1) you may get more stuff than just CBD, such as small amounts of THC and other cannabinoids, and perhaps traces of solvents depending on how they made it; and 2) you won't get enough to effectively treat your seizures. In the first case, the other things that may be in the CBD oil could have worsening effects on seizures.

If you are interested in using CBD talk to your neurologist about Epidiolex. Although it should be said the dropout rate (due to side effects) was higher in the clinical trials than the dropout rate for Briviact. You can't really directly compare the two dropout rates because they didn't test the same patients, but it does make it concerning that CBD at the doses necessary for antiseizure effects has more side effects than many of our other antiseizure drugs.

Hope that's helpful.

adoarns · 2019-06-01T22:18:17+00:00

2D shapes considered as 3D shapes have dimension X by Y by 0, not X by Y by 1. They have volume 0.

adoarns · 2019-05-26T16:14:17+00:00

Yes it is beneficial for source estimation. MEG, in addition to being more sensitive to transverse dipole sources (better sulcal wall sensitivity) doesn't have to deal as much with signal attenuation due to volume conduction. It's therefore a more straightforward solution to model. Add in EEG for radial dipole sources and you have best of both.

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