History of Epilepsy or Seizures - Essay Example

?Case Study 1. The most likely diagnosis for this patient is he has epilepsy associated with complex partial seizures developing into secondary generalized tonic-clonic seizures. In complex partial seizures, there is a loss of consciousness but the symptoms of the seizure are fairly mild, as seen in this patient. These can then become generalized to the brain and cause tonic-clonic seizures (Engel et al, 2008). These present as a stiffening of the body and then a jerking movement (or myoclonus), which is exhibited in the patient described here. 2. Epilepsy is the most common cause of seizure, and can be genetic or sporadic. Seizures can also be caused by fever, in which case they are known as a febrile seizure. There are also infectious causes, such as meningitis or tapeworm. In the case of this patient, it appears that the DPT vaccine caused a fever, which led to a febrile seizure. This is rare, but can occur (Griffin et al, 1990). In many cases, patients will only have one or a limited number of febrile seizures. However, this patient has first- and second-degree relatives with related conditions, and this increases the chances of developing epilepsy (Griffin et al, 1990), which means that it could have been triggered by this initial event. 3. The information from the family history is useful because epilepsy does not normally develop from febrile seizures unless there is a family history of epilepsy or seizures (Brodie et al, 2009). In this case, there is, and therefore it is evident that there is some genetic component playing a part in the seizures discussed in this case study. 4. The most reliable way of diagnosing any form of epilepsy and categorizing seizures is to use an EEG. EEGs pick up electrical signals from the brain and represent brainwave patterns, and if these are different from normal values then this can indicate epilepsy. It is helpful to do this during a seizure to identify what type of seizure is occurring, so a seizure may need to be provoked to correctly identify whether this is a tonic-clonic or other form (Engel et al, 2008). In this patient, we would expect to see focal activity during the initial stages of the seizure, followed by extreme brain activity during the tonic-clonic stages. 5. The parents of the patient should be advised to lie the patient down away from any objects that may cause harm during a seizure. If the floor is hard, it may be worthwhile putting the patient or a blanket. Turning the patient on his side may help to prevent him biting his tongue or swallowing any vomit. 6. There are a wide variety of treatments for epilepsy. If it occurs during a fever, as in the case of the first seizure of the patient, it may help to reduce the fever. There are also a number of anti-epileptic drugs which are useful in about 70% of patients and can help keep them under control completely. Surgery is a last-resort option and can be done in extreme cases. A ketogenic diet can also be advised and can be helpful in many cases of childhood epilepsy. This type of diet is high in fats and low in carbohydrates and protein and may make seizures less likely by altering the chemical composition of the brain (Theodore & Porter, 1995). As stress is sometimes associated with epilepsy, it may be worthwhile to ensure that the child is kept away from stressors and perhaps when older meditation or relaxation therapies may help to prevent further seizures (Brodie et al, 2009). Case Study 2 1. There are a number of disorders associated with the symptoms that Katherine is presenting with. However, systemic lupus erythematosus (SLE) is associated with fatigue, migraine, and has been associated with some skin conditions (Buyon, 2008). It is also associated with pain which occurs mainly in the joins (Buyon, 2008), as seen in Katherine’s case. It would also account for the slightly elevated blood pressure that Katherine exhibits. Some studies have shown that it can be triggered by the Epstein-Barr virus, which may explain why the symptoms began after an infection described as ‘flu’ in the case study. 2. There is some possibility that Katherine’s symptoms may be psychological, although it would be difficult to tell without a psychological consult. Chronic fatigue syndrome (CFS) often follows an infection, as in the case of Katherine, and can cause fatigue and mood changes, and some physicians believe this to be a partly psychological condition (Goldenburg, 2009). However, considering the elevated blood pressure, SLE is more likely and therefore the symptoms are probably not psychological. 3. SLE would not necessarily cause structural abnormalities in any organs, as seen in the patient here, especially as the symptoms vary from person to person. As previously mentioned, it is possible that it is CFS which would also not cause any structural abnormalities. CFS is often diagnosed by elimination, however, and it is not possible to test for the disorder (Goldenburg, 2009). Cushing’s syndrome also causes high blood pressure and fatigue, and can easily be eliminated by testing for cortisol in the blood, urine and saliva. Fibromyalgia is also a possible disorder associated with pain and fatigue, although the pain is usually associated with the muscles and ligaments (Goldenburg, 2009) and Katherine appears to be suffering in her joins, more typical of lupus. It may be worth completing a psychological evaluation on Katherine as some types of pain, fatigue and cognitive changes are associated with depression, which may require some work to diagnose. There are a number of ways of testing for SLE with blood tests, including an anti-nuclear antibody test and an anti-DNA antibody test (Buyon, 2009). These are good, reliable tools that can be used without the presence of structural abnormalities. 4. As lupus is associated with elevated blood pressure, it has been linked to cardiovascular disease. Katherine needs to understand that there are risks of further increases in blood pressure, artherosclerosis and coronary heart disease, which can be combatted partly by changes in lifestyle, such as exercising more and diet improvements (Bruce et al, 2011). Lupus can also cause a kidney disease known as lupus nephritis which is associated with swelling of the feet, headaches and dizziness, which needs to be controlled using immunosuppressants. SLE can also affect the reproductive organs in some cases, although given her age Katherine may not be worried about the possible loss of fertility associated with many cases. 5. There is no cure for lupus, although many patients live for a long time after diagnosis fairly healthily. As Katherine’s blood pressure is elevated, she should be advised to quit smoking, take up some form of exercise and adjust her diet to prevent problems associated with this. For SLE, it is advised that you should protect yourself from the sun, as this can cause the rashes sometimes associated with SLE. She can also take non-steroidal anti-inflammatory drugs such as ibuprofen to help combat her joint pain. Hydroxychloroquine, an anti-malarial drug, has been shown to combat the joint pain and fatigue associated with SLE and therefore Katherine can take this if the other treatments are not working (Bruce et al, 2011). Corticosteroids and immunosuppressants can be used in extreme cases, but Katherine should be advised to try the other treatments first to see if they improve her symptoms. References Brodie, M.J., Schachter, S.C., Kwan, P.K.L., 2009. Fast facts: epilepsy. Health Press. Bruce, I.N., Isenberg, D., Lightstone, E., Lear, J., 2011. Systemic lupus erythematosus: a pragmatic guide to current managementIP64. When to Consider a Biologic: Evidence Based and Pragmatic GuidanceIP65. Management of Lupus Nephritis: The Rheumatologist’s RoleIP66. Cutaneous Lupus: Diagnosis, Management and Common Pitfalls IP63. Assessment and Management of Systemic Lupus Erythematosus in the Routine Clinic Setting. Rheumatology 50, iii16–iii16. Buyon, J.P., 2008. Systemic lupus erythematosus. Primer on the Rheumatic Diseases 303–338. Engel, J., Pedley, T.A., Aicardi, J., 2008. Epilepsy: a comprehensive textbook. Lippincott Williams & Wilkins. Goldenberg, D.L., 2009. Diagnosis and differential diagnosis of fibromyalgia. The American journal of medicine 122, S14–S21. Griffin, M.R., Ray, W.A., Mortimer, E.A., Fenichel, G.M., Schaffner, W., 1990. Risk of seizures and encephalopathy after immunization with the diphtheria-tetanus-pertussis vaccine. JAMA: the journal of the American Medical Association 263, 1641–1645. Theodore, W.H., Porter, R.J., 1995. Epilepsy: 100 elementary principles. WB Saunders Company. Read More