Epilepsy term paper

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“Epileptic convulsions may occur in the anatomical absence of the cerebrum (Taylor, 1932). Convulsions may occur in the newborn (Dreyfus-Brisac & Monod, 1964), where the cerebral cortex is thought to be essentially non-functional. Moreover, a number of studies have indicated that, beyond age 4 years, there is a fairly dramatic fall in the percentage of the population classified as epileptic (Robb, 1975) -- this is the age beyond which the cerebrum may fully exert an inhibitory influence upon the neo-cerebellum via the cerebro-corticopontine tract. It has been suggested that epileptic activity is not necessarily, or normally, of cerebral origin (Dreyfus-Brisac & Monod, 1964; Kreindler, 1965; Penfield, 1975b). However, data indicates that the hippocampus may be critically involved with the emergence within the cerebrum of impulses from sub-cerebral regions (Laidlaw & Richens, 1976; Penfield, 1975a; Smythies, 1970). Normal epileptic seizures may be enhanced during sleep, and some epileptic seizures may occur exclusively during sleep. Convulsive seizures such as grand mal are facilitated during S/NREM sleep (Angeleri, 1974; Passouant, 1976; Passouant et al., 1974; Vein et al., 1980; Wyler, 1974), but supressed during D/REM sleep (Angeleri, 1974; Passouant, 1976; Passouant et al., 1974) especially during the REM bursts themselves (Pompeiano, 1969; Stevens et al., 1971). Conversely, local seizures (those manifest within the cerebral EEG), especially those of temporal lobe "origin," appear to be facilitated by D/REM sleep (Passouant, 1976; Passouant et al., 1974; Pompeiano, 1969). There is evidence that during the daytime awake state, epileptic characteristics within the EEG, especially temporal lobe and typical petit mal absence discharges, increase cyclically approximately every 90 minutes; that is, with the same periodicity as the sleep cycle (Broughton, 1978; Stevens et al., 1971; Wyler, 1974).”
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“The strategies geared to symptom alleviation in the somatizing disorders must deal with the secondary gain features of the symptoms. (In the case of malingering, these are equivalent to the primary gain features.) Especially with children, adolescents, and retarded patients, the long-range benefits of a therapeutic endeavour may be difficult for the patient to appreciate if the immediate benefits of the symptom constitute a substantial deterrent to symptom relinquishment. Therefore, it is essential that any ongoing secondary gain features of a symptom be diminished or eliminated. Indeed, this is crucial if removal of the symptom is to be sustained.
Mostofsky & Balaschak ( 1977) illustrated a number of ways in which behaviour-modification strategies can be formulated with seizure patients, taking into account the existing contingencies of reinforcement that impinge on the patient. Many of the cases cited in this paper do not distinguish clearly between patients with documented epilepsy, those with exclusive psychogenic seizures, or those with some combination of the two. A number of recent cases updated the status of the behavioural treatments of epilepsy. Because these cases are detailed and comprehensive, they will not be reoutlined here. Suffice it to say that a growing number of behavioural studies with improved methodologies provide abundant evidence of the close relationship between epileptic seizure activity and the psychological state of the patient. It follows that seizure control in many patients can be significantly influenced by altering the outlook and behaviour of the patient. A variety of behavioural strategies are addressed by these reviews, with no clear delineation yet feasible of the specific correlation between the optimal behavioural interventions for specific seizure type.”
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“The lack of findings concerning decreased memory skills may reflect the heterogeneous nature of children with epilepsy. For example, children with symptomatic complex partial seizures resulting from lesions in the left temporal lobe may experience decreased verbal memory skills that are not apparent in group findings based predominantly on children who have idiopathic epilepsy or complex partial seizures that originate in other areas of the brain. Further refinement of subgroups might also include whether the children had experienced secondary generalization or status epilepticus, as the hippocampus is highly sensitive to the effects of prolonged seizures. A notable finding was the reduced performance on verbal and visual memory skills when polytherapy was present. Although children are often prescribed more than two medications to reduce seizure occurrence, all patients studied on polytherapy were receiving only two antiepileptic drugs. Findings concerning decreased memory skills in children treated with polytherapy support an earlier study in which reduction of polytherapy to monotherapy resulted in improvement in alertness, concentration, drive, mood, and sociability .Modern studies support the recommendation of using monotherapy whenever possible with children.”
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