Epilepsy in dementia. Case 1. Dr. Yotin Chinvarun M..D. Ph.D. 5/25/16. CEP, PMK hospital
|
|
- Myles Wilkinson
- 6 years ago
- Views:
Transcription
1 Epilepsy in dementia Dr. Yotin Chinvarun M..D. Ph.D. CEP, PMK hospital Case 1 M 90 years old Had a history of tonic of both limbs (Lt > Rt) at the age of 88 years old, eye rolled up, no grunting, lasting < minutes, usually had blurred consciousness after that for three minutes, had frequently attack nearly everyday Seen by doctor, had CT brain shows generalized cortical atrophy, then had been Rx PHT 300 mg hs, but patient did not take the medication 1
2 Case 2 The patient had been treated with Levitiracetam 3ml bid and had a remarkably reduced of the attack Then, became seizure-free, when on Levitiracetam 4 ml bid for two years now 2
3 Case 2 M 61 years old, university lecturer Hx of cognitive impairment for a few months, witnessed by colleague and students that patient had several episodes of blank staring, poor short term memory, frequently repeated same question, missed the appointment and forgot recent memory, patient had apathy and not active as before Weight loss 10 Kg recently, underwent fully checked up did not found anything abnormal PE: well neat dressing, thinner, good cooperated, memory testing - pending 3
4 4
5 Case 2 He had been treated with Valproate chrono 500 mg 0.5 tab bid and Rivastigmine Follow up two weeks later, the patient was remarkably improved His blank staring was remarkably decreased Memory particularly, short term memory and recall improved, the repetitive question was also reduced, he had more interactive during conversation Introduction Epilepsy and AD are common neurologic disorders for which increasing age common and well-established risk factor From clinical aspect, patients with AD have an increased risk of developing seizures and epilepsy; thus AD may be an important cause of epilepsy in the elderly AD and other neurodegenerative conditions represent etiology for 10% of new onset epilepsy in patients older than 65 5
6 Risk of Seizures in AD Diagnosis of seizures in patients with AD not always easy because manifestation of partial seizures might be hard to recognize and distinguish from other behaviors common in these patients Lead to underestimation of the real frequency of seizures in AD. Possibility funny or unusual behaviors of demented patients considered seizures particularly by nonepileptologists, may lead to overestimation of seizure rates Risk of Seizures in AD Patients with sporadic AD have a 6-10 fold increased risk of developing clinical seizures during the course of their illness Prospective and retrospective studies reporting great variability in the lifetime prevalence of seizures in patients with AD, ranging 1.5 to 64 percent However, it is difficult to accurately assess the real prevalence of seizures in AD 6
7 Risk of Seizures in AD Studies in elderly reporting recurrence risk after the 1 st seizure as high as 80%, probably because epilepsy in elderly mainly associated with underlying structural lesion In terms of seizure types, Generalized convulsive seizures identified in 90% of cases Other data suggest 70% of seizures are complex partial seizures Partial seizures without convulsive character underestimated Risk of Seizures in AD Characterization of clinical manifestations of seizures usually based on information derived from patient or caregiver; Limitations both sources of information. Even in nondemented patients, fewer than 25% (19, 20) are able to report their true seizure frequency for the simple reason that they don t remember the event. In demented patients, percentage could be even lower. it is difficult for caregivers to report seizure frequency accurately, because Unaware of how partial seizures manifest It may be challenging to separate seizures from certain behaviors that demented patients often manifest (e.g., fluctuations in alertness and attention, hallucinations, confusion). 7
8 Risk of Seizures in AD Seizures in AD should be of focal origin because neurodegenerative pathology is multifocal Beyond complex partial seizures, other seizure subtypes such as transient epileptic amnesia (where the patients experience memory problems reminiscent of dementia for repeated short time periods) may also be underestimated Therefore, it remains doubtful whether convulsive seizures represent majority of seizure types in AD Risk of Seizures in AD In early-onset familial AD (EOFAD), seizures and epilepsy occur more often than in sporadic AD, for example Seizures have been described in 37 to 58 percent of patients with the PSEN1 E280A mutation 30 percent with presenilin 2 mutations 57 percent of patients with amyloid precursor protein (APP) duplications Alzheimer-type neuropathologic abnormalities demonstrated also in patients with Down syndrome (DS), and DS patients develop dementia at young ages Up to 84 percent of demented individuals with DS develop seizures 8
9 Pathogenesis of Epilepsy in AD Substantial body of evidence spontaneous recurrent seizures occur in a subset of patients with Alzheimer disease (AD), especially familial forms that have an early onset In transgenic mice AD, seizures or reduced seizure threshold reported Mechanisms underlying seizures or reduced seizure threshold in these mice not yet clear, and likely to be complex, because synthesis of amyloid b (Ab) involves many peptides and proteases that infuence excitability Pathogenesis of Epilepsy in AD Based on transgenic mouse models of AD Ab and its precursor elevated suggesting seizures caused by downregulation of the Nav1.1 sodium channel in a subset of GABAergicinterneurons, leading to a reduction in GABAergicinhibition Another mechanism of hyperexcitability appears to involve tau Deletion of tau reduces seizures in some of same transgenic mouse models of AD, Therefore, altered excitability may be as much a characteristic of AD as plaques and tangles 9
10 Pathogenesis of Epilepsy in AD Increasing evidence that mechanisms of AD and epilepsy overlap AD and epilepsy are related beneficial to both fields, because potential therapeutic advances in one may help translational efforts in other Complexities of clinical disorders and the limitations of mouse models need to be carefully considered It is opportunity i.e. remarkable anticonvulsant effects of tau suggest that it could be a new target for AED development Factors Modifying Risk for Seizures in AD Seizure prevalence seems to increase with AD duration Most of the studies support onset of seizures at later stages, ~6.8 years after onset This might be because of the increasing accuracy of AD diagnosis, increasing age or increasing severity of neurodegenerative process According to diagnostic criteria for AD, seizures in advanced stage consistent with a diagnosis of probable AD, while seizures earlier in the course or at onset of dementia suggest uncertain or unlikely diagnosis No reports suggesting increased rates of seizures in mild cognitive impairment 10
11 Factors Modifying Risk for Seizures in AD Report patients with a younger age of AD onset more susceptible to seizures compared with age-matched populations. Seizure incidence increases 3-fold around the age of 70 and nearly 87-fold around the age of 50 Could be explained by higher prevalence of familial AD in younger patients, associated with higher seizure rates, or more aggressive AD course in younger AD patients. However, there contrasts with other studies Reporting neither disease duration nor age of onset were significant risks for seizures in AD patients Factors Modifying Risk for Seizures in AD AD severity seems to constitute another risk factor for seizures In prospective studies of patients with probable AD of mild severity, seizures occurred in 1.5 to 16 percent over 1 to 8.5 years of follow-up Whereas studies of institutionalized AD patients, most had more severe dementia, seizure frequencies ranging 9-64 percent 11
12 Factors Modifying Risk for Seizures in AD Dementia severity or worse performance on tests of orientation and information reported associated with an increased risk of seizures in AD patients. African-American ethnicity suggested as a risk factor for developing seizures in AD Infrequent, inconsistent reports of other possible risk factors i.e. diabetes, hypertension, and antipsychotic-cholinesterase inhibitor drugs Potential risk factors for developing seizures in AD A number of risk factors have been identified, including Antipsychotic drug use African-American race Epileptiform findings on EEG Greater cognitive impairment at baseline However, most robust association has been with young age at dementia onset While seizures can appear at any stage of the disease, the odds of developing epilepsy in AD highest in Young patients with AD and early in the disease course 12
13 Role of EEG If seizures in AD related to hyperexcitability in the hippocampus, a higher frequency of epileptiform activity in scalp EEG should be seen similar in human mesial temporal lobe epilepsy Some observational studies reporting epileptiform discharges in minority of AD patients with seizures, but also in some AD patients without seizures In a study of 1,674 patients with dementia, routine EEGs showed epileptiform discharges 3% Focal and mainly located in the temporal lobe Sixty percent did not have clinical seizures at or before the time of EEG 10% of these AD patients, with epileptiform discharges and no clinical seizures at or before the time of EEG, developed seizures later on However, EEGs performed in only a subset of patients with AD, limiting our ability to adequately derive safe conclusions Role of EEG Even if a larger number of AD patients to be studied with scalp EEG Significant limitations still remain as detection of epileptiform activity is low even in patients with temporal lobe epilepsy The yield would probably increase if video-eeg monitoring performed Also, video- EEG monitoring may be limited by poor cooperation of AD patients and confusional episodes associated with hospitalization and changes of environment 13
14 Seizure Treatment in AD No randomized controlled trials exploring usefulness and efficacy of specific antiepileptic drugs (AEDs) for seizure treatment in AD patients Some observational studies suggest small differences in the efficacy of AEDs in elderly Efficacy of AEDs in elderly people seems to be either comparable or even better than in younger individuals, with seizure freedom rates as high as 62% Seizure Treatment in AD Adverse drug reactions of AEDs, could be either from Dose-dependent (i.e., dizziness, unsteadiness, lethargy) Specific drug- related (i.e., tremor, hyponatremia, osteopenia) Although, it less frequent at lower doses. To use of AEDs in AD patients should be based on their pharmacokinetic and side effects profile Using AED with the fewest possible interactions with other medications commonly taken by older patients, and titrating AEDs slowly, employing lowest possible doses 14
15 Seizure Treatment in AD In studies of the general population, newer AEDs seem to be better tolerated than the 1 st generation AEDs in elderly Avoid to use AEDs with deleterious cognitive sequelae such as Valproic acid (VPA) and benzodiazepines (BZDs) Long term use of BZDs associated with increased risk for cognitive deterioration and falls Seizures and AD Course The higher rates of seizures in more advanced dementia could suggest either Seizures lead to higher rates of cognitive decline Seizures are an epiphenomenon or a marker of more severe dementia stages Some small series reported cognitive deterioration after seizure onset, limited in terms of sample size Overall, relatively limited studies on question of impact of seizures in further AD course and severity 15
16 In conclusion AD is a clear risk factor for seizures Risk of seizures and epilepsy in AD seems to increase 3 to 87 times compared with the age-matched general population Increased risk is age dependent, with higher risk at younger ages Increasing dementia severity is other reliable risk factor for seizures in AD. Variability reports regarding seizure frequency in patients with AD; overall incidence of newonset nonprovoked seizures in AD ~ 1 per 200 person-years In conclusion Role of EEG and its prognostic value in predicting seizures has not been adequately explored, video-eeg monitoring might be useful but difficult to do When seizures in AD occur, they seem to be infrequent In the absence of specific studies, choice of AEDs of treatment is mostly empirical and based primarily on side effect profiles 16
Objectives. Amanda Diamond, MD
Amanda Diamond, MD Objectives Recognize symptoms suggestive of seizure and what those clinical symptoms represent Understand classification of epilepsy and why this is important Identify the appropriate
More informationEpilepsy DOJ Lecture Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis
Epilepsy DOJ Lecture - 2005 Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis Epilepsy SEIZURE: A temporary dysfunction of the brain resulting from a self-limited abnormal
More informationDementia Update. October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada
Dementia Update October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada Outline New concepts in Alzheimer disease Biomarkers and in vivo diagnosis Future trends
More information*Pathophysiology of. Epilepsy
*Pathophysiology of Epilepsy *Objectives * At the end of this lecture the students should be able to:- 1.Define Epilepsy 2.Etio-pathology of Epilepsy 3.Types of Epilepsy 4.Role of Genetic in Epilepsy 5.Clinical
More informationMedicine Review Course Approach to Transient Amnesia
Medicine Review Course Approach to Transient Amnesia 9 Sept 2012 Dr See Siew Ju Neurology NNI@SGH A Few Questions.. What did you have for breakfast on Friday? How many red lights did you stop at on your
More informationCognitive disorders. Dr S. Mashaphu Department of Psychiatry
Cognitive disorders Dr S. Mashaphu Department of Psychiatry Delirium Syndrome characterised by: Disturbance of consciousness Impaired attention Change in cognition Develops over hours-days Fluctuates during
More informationElectroencephalography. Role of EEG in NCSE. Continuous EEG in ICU 25/05/59. EEG pattern in status epilepticus
EEG: ICU monitoring & 2 interesting cases Electroencephalography Techniques Paper EEG digital video electroencephalography Dr. Pasiri Sithinamsuwan PMK Hospital Routine EEG long term monitoring Continuous
More informationCommon Forms of Dementia Handout Package
Common Forms of Dementia Handout Package Common Forms of Dementia 1 Learning Objectives As a result of working through this module, you should be better able to: 1. Describe clinical features of 4 major
More informationCase 2: Epilepsy A 19-year-old college student comes to student health services complaining of sporadic loss of memory. The periods of amnesia occur
Case 2: Epilepsy A 19-year-old college student comes to student health services complaining of sporadic loss of memory. The periods of amnesia occur while the student is awake and occasionally in class.
More informationDementia. Stephen S. Flitman, MD Medical Director 21st Century Neurology
Dementia Stephen S. Flitman, MD Medical Director 21st Century Neurology www.neurozone.org Dementia is a syndrome Progressive memory loss, plus Progressive loss of one or more cognitive functions: Language
More informationThe ABCs of Dementia Diagnosis
The ABCs of Dementia Diagnosis Dr. Robin Heinrichs, Ph.D., ABPP Board Certified Clinical Neuropsychologist Associate Professor, Psychiatry & Behavioral Sciences Director of Neuropsychology Training What
More informationP20.2. Characteristics of different types of dementia and challenges for the clinician
P20.2. Characteristics of different types of dementia and challenges for the clinician, professor Danish Dementia Research Center Rigshospitalet, University of Copenhagen (Denmark) This project has received
More informationChallenges In Treatment of NCSE NCSE. Definition 22/07/56
Challenges In Treatment of NCSE Anannit Visudtibhan, MD. Division of Neurology, Department of Pediatrics, Faculty of Medicine-Ramathibodi Hospital NCSE Definition & Classification Diagnosis Issues in specific
More informationOld Age and Stress. Disorders of Aging and Cognition. Disorders of Aging and Cognition. Chapter 18
Disorders of Aging and Cognition Chapter 18 Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Comer, Abnormal Psychology, 8e Disorders of Aging and Cognition Dementia deterioration
More informationIdiopathic Photosensitive Occipital Lobe Epilepsy
Idiopathic Photosensitive Occipital Lobe Epilepsy 2 Idiopathic photosensitive occipital lobe epilepsy (IPOE) 5, 12, 73, 75, 109, 110 manifests with focal seizures of occipital lobe origin, which are elicited
More informationEpilepsy. Presented By: Stan Andrisse
Epilepsy Presented By: Stan Andrisse What Is Epilepsy Chronic Neurological Disorder Characterized by seizures Young children or elderly Developing countries Famous Cases Socrates Muhammad Aristotle Joan
More informationEvaluation and management of drug-resistant epilepsy
Evaluation and management of drug-resistant epilepsy Fateme Jahanshahifar Supervised by: Professor Najafi INTRODUCTION 20 to 40 % of patients with epilepsy are likely to have refractory epilepsy. a substantive
More informationChild Neurology. The Plural. of anecdote. is not evidence. University of Texas Health Science Center at San Antonio
Child Neurology Management of Seizure Disorders The stated goal of advocacy groups for patients with seizures, is to have the patient seizure free. S W Atkinson, MD Management of When to pharmacologically
More informationPediatrics. Convulsive Disorders in Childhood
Pediatrics Convulsive Disorders in Childhood Definition Convulsion o A sudden, violent, irregular movement of a limb or of the body o Caused by involuntary contraction of muscles and associated especially
More informationClinical Diagnosis. Step 1: Dementia or not? Diagnostic criteria for dementia (DSM-IV)
Step 1: Dementia or not? Diagnostic criteria for dementia (DSM-IV) A. The development of multiple cognitive deficits manifested by both 1 and 2 1 1. Memory impairment 2. One (or more) of the following
More informationKristin s Head Trauma Board Questions 11/07/14
Kristin s Head Trauma Board Questions { 11/07/14 A healthy 15 y/o boy was playing football at a park near his home with a group of friends when he tripped over a friend s leg while trying to catch a pass.
More informationErnie Somerville Prince of Wales Hospital EPILEPSY
Ernie Somerville Prince of Wales Hospital EPILEPSY Overview Classification New and old anti-epileptic drugs (AEDs) Neuropsychiatric side-effects Limbic encephalitis Non-drug therapies Therapeutic wishlist
More informationEpilepsy: problems of diagnosis and recommended treatment Nicola Cooper MRCP and Morgan Feely MD, FRCP, FRCP(I)
Epilepsy: problems of diagnosis and recommended treatment Nicola Cooper MRCP and Morgan Feely MD, FRCP, FRCP(I) VM Our series Prescribing in gives practical advice for successful management of the special
More information7/3/2013 ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER FOURTEEN CHAPTER OUTLINE. Dementia, Delirium, and Amnestic Disorders. Oltmanns and Emery
ABNORMAL PSYCHOLOGY SEVENTH EDITION Oltmanns and Emery PowerPoint Presentations Prepared by: Ashlea R. Smith, Ph.D. This multimedia and its contents are protected under copyright law. The following are
More informationIntracranial Studies Of Human Epilepsy In A Surgical Setting
Intracranial Studies Of Human Epilepsy In A Surgical Setting Department of Neurology David Geffen School of Medicine at UCLA Presentation Goals Epilepsy and seizures Basics of the electroencephalogram
More informationNeuromuscular Disease(2) Epilepsy. Department of Pediatrics Soochow University Affiliated Children s Hospital
Neuromuscular Disease(2) Epilepsy Department of Pediatrics Soochow University Affiliated Children s Hospital Seizures (p130) Main contents: 1) Emphasize the clinical features of epileptic seizure and epilepsy.
More informationDravet syndrome : Clinical presentation, genetic investigation and anti-seizure medication. Bradley Osterman MD, FRCPC, CSCN
Dravet syndrome : Clinical presentation, genetic investigation and anti-seizure medication Bradley Osterman MD, FRCPC, CSCN Objectives Learn about the typical early clinical presentation of Dravet syndrome
More informationIntroduction. 1 person in 20 will have an epileptic seizure at some time in their life
Introduction 1 person in 20 will have an epileptic seizure at some time in their life Epilepsy is diagnosed on the basis of two or more epileptic seizures. Around 450,000 people in the UK have epilepsy
More informationTau Mechanism in Dementia
ADC Directors Meeting Saturday, April 12, 2008 Sheraton V Tau Mechanism in Dementia Lennart Mucke, M.D. Director, Gladstone Institute of Neurological Disease Joseph B. Martin Distinguished Professor Department
More informationThe EEG and Epilepsy in Kelantan --- A Hospital/laboratory... Based Study
The EEG and Epilepsy in Kelantan --- A Hospital/laboratory... Based Study M.N. Wm, FRCP Department of Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, 75990 Kelantan Darul Nairn Introduction
More informationCase report. Epileptic Disord 2005; 7 (1): 37-41
Case report Epileptic Disord 2005; 7 (1): 37-41 Periodic lateralized epileptiform discharges (PLEDs) as the sole electrographic correlate of a complex partial seizure Gagandeep Singh, Mary-Anne Wright,
More informationDavid Dredge, MD MGH Child Neurology CME Course September 9, 2017
David Dredge, MD MGH Child Neurology CME Course September 9, 2017 } 25-40,000 children experience their first nonfebrile seizure each year } AAN/CNS guidelines developed in early 2000s and subsequently
More informationWHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient
DEMENTIA WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient Progressive and disabling Not an inherent aspect of
More informationClinical Genetics & Dementia
Clinical Genetics & Dementia Dr Nayana Lahiri Consultant in Clinical Genetics & Honorary Senior Lecturer Nayana.lahiri@nhs.net Aims of the Session To appreciate the potential utility of family history
More informationClinical severity of seizures Hot Topics Symposium December 10, 2013
Clinical severity of seizures Hot Topics Symposium December 10, 2013 R. Edward Hogan, M.D. Associate Professor Washington University in St. Louis Director, Comprehensive Epilepsy Center at Barnes-Jewish
More informationIntroduction to seizure and epilepsy
Introduction to seizure and epilepsy 1 Epilepsy : disorder of brain function characterized by a periodic and unpredictable occurrence of seizures. Seizure : abnormal increased electrical activity in the
More informationCase reports functional imaging in epilepsy
Seizure 2001; 10: 157 161 doi:10.1053/seiz.2001.0552, available online at http://www.idealibrary.com on Case reports functional imaging in epilepsy MARK P. RICHARDSON Medical Research Council Fellow, Institute
More informationA Neurologist s Approach to Altered Mental Status
A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old
More informationDefinition พ.ญ.ส ธ ดา เย นจ นทร. Epidemiology. Definition 5/25/2016. Seizures after stroke Can we predict? Poststroke seizure
Seizures after stroke Can we predict? พ.ญ.ส ธ ดา เย นจ นทร PMK Epilepsy Annual Meeting 2016 Definition Poststroke seizure : single or multiple convulsive episode(s) after stroke and thought to be related
More informationEpilepsy: diagnosis and treatment. Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM
Epilepsy: diagnosis and treatment Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM Definition: the clinical manifestation of an excessive excitation of a population of cortical neurons Neurotransmitters:
More informationCHILDHOOD OCCIPITAL EPILEPSY OF GASTAUT: A LONG-TERM PROSPECTIVE STUDY
Acta Medica Mediterranea, 2017, 33: 1175 CHILDHOOD OCCIPITAL EPILEPSY OF GASTAUT: A LONG-TERM PROSPECTIVE STUDY MURAT GÖNEN ¹, EMRAH AYTAǹ, BÜLENT MÜNGEN¹ University of Fırat, Faculty of medicine, Neurology
More informationElderly and Epilepsy. Information for Elderly people with Epilepsy
Elderly and Epilepsy Information for Elderly people with Epilepsy Other booklets and information available from What is Epilepsy? Living Well with Epilepsy Children, Adolescents and Epilepsy Women and
More informationResources: Types of dementia
1/5 Dementia is an umbrella term for a number of progressive conditions affecting the functioning of the brain. Different types of dementia have different causes. There are a great number of rare forms.
More informationTypes of epilepsy. 1)Generalized type: seizure activity involve the whole brain, it is divided into:
Types of epilepsy We have different types of epilepsy, so it is not one type of seizures that the patient can suffer from; we can find some patients with generalized or partial seizure. So, there are two
More informationMOVEMENT DISORDERS AND DEMENTIA
MOVEMENT DISORDERS AND DEMENTIA FOCUS ON DEMENTIA WITH LEWY BODIES MADHAVI THOMAS MD NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC DEMENTIA de men tia dəˈmen(t)sh(ē)ə/ nounmedicine noun: dementia a chronic
More informationMemory Disorders. 1. Episodic: memory for time and places. 2. Semantic: memory for facts and knowledge (language, numbers, etc).
I. Types of memory: A. Declarative memory: Memory Disorders 1. Episodic: memory for time and places. 2. Semantic: memory for facts and knowledge (language, numbers, etc). B. Procedural memory: - examples:
More informationDementia: Diagnosis and Treatment
Dementia: Diagnosis and Treatment Outline 1. Risk factors and definition of dementia 2. Types of Dementias 3. MMSE and testing 4. Treatment options Cognitive decline with aging Mild changes in memory and
More informationThere are several types of epilepsy. Each of them have different causes, symptoms and treatment.
1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic
More informationSession outline. Introduction to dementia Assessment of dementia Management of dementia Follow-up Review
Dementia 1 Session outline Introduction to dementia Assessment of dementia Management of dementia Follow-up Review 2 Activity 1: Person s story Present a person s story of what it feels like to live with
More informationALZHEIMER S DISEASE. Mary-Letitia Timiras M.D. Overlook Hospital Summit, New Jersey
ALZHEIMER S DISEASE Mary-Letitia Timiras M.D. Overlook Hospital Summit, New Jersey Topics Covered Demography Clinical manifestations Pathophysiology Diagnosis Treatment Future trends Prevalence and Impact
More informationIntroduction, use of imaging and current guidelines. John O Brien Professor of Old Age Psychiatry University of Cambridge
Introduction, use of imaging and current guidelines John O Brien Professor of Old Age Psychiatry University of Cambridge Why do we undertake brain imaging in AD and other dementias? Exclude other causes
More informationFRONTOTEMPORAL DEGENERATION: OVERVIEW, TRENDS AND DEVELOPMENTS
FRONTOTEMPORAL DEGENERATION: OVERVIEW, TRENDS AND DEVELOPMENTS Norman L. Foster, M.D. Director, Center for Alzheimer s Care, Imaging and Research Chief, Division of Cognitive Neurology, Department of Neurology
More informationWhat if it s not Alzheimer s? Update on Lewy body dementia and frontotemporal dementia
What if it s not Alzheimer s? Update on Lewy body dementia and frontotemporal dementia Dementia: broad term for any acquired brain condition impairing mental function such that ADLs are impaired. Includes:
More informationUnderstanding Dementia
Dementia Handbook for Carers Essex Understanding Dementia What is dementia? 1 Summary of dementia symptoms 4 Medication and treatment 5 1 Dementia is the name for several conditions that lead to the progressive
More informationThe Person: Dementia Basics
The Person: Dementia Basics Objectives 1. Discuss how expected age related changes in the brain might affect an individual's cognition and functioning 2. Discuss how changes in the brain due to Alzheimer
More informationEpilepsy T.I.A. Cataplexy. Nonepileptic seizure. syncope. Dystonia. Epilepsy & other attack disorders Overview
: Clinical presentation and management Markus Reuber Professor of Clinical Neurology Academic Neurology Unit University of Sheffield, Royal Hallamshire Hospital. Is it epilepsy? Overview Common attack
More informationChild-Youth Epilepsy Overview, epidemiology, terminology. Glen Fenton, MD Professor, Child Neurology and Epilepsy University of New Mexico
Child-Youth Epilepsy Overview, epidemiology, terminology Glen Fenton, MD Professor, Child Neurology and Epilepsy University of New Mexico New onset seizure case An 8-year-old girl has a witnessed seizure
More informationIt s Always a Stroke; Except For When It s Not..
It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when
More informationInfiltrative Brain Mass Due To Progressive Alzheimer's Disease
Article ID: WMC00505 2046-1690 Infiltrative Brain Mass Due To Progressive Alzheimer's Disease Corresponding Author: Dr. Mark Lyons, Associate Professor, Mayo Clinic Arizona, 85054 - United States of America
More informationEpilepsy 7/28/09! Definitions. Classification of epilepsy. Epidemiology of Seizures and Epilepsy. International classification of epilepsies
Definitions Epilepsy Dr.Yotin Chinvarun M.D., Ph.D. Seizure: the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons Epilepsy: a tendency toward recurrent
More informationDementia and Delirium: A Neurologist s Approach to Altered Mental Status. Case 1 4/7/11. Which of the following evaluations is your next step?
Dementia and Delirium: A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Director, Neurohospitalist Program Medical Director, Inpatient Neurology University of California San Francisco
More informationEpilepsy and EEG in Clinical Practice
Mayo School of Professional Development Epilepsy and EEG in Clinical Practice November 10-12, 2016 Hard Rock Hotel at Universal Orlando Orlando, FL Course Directors Jeffrey Britton, MD and William Tatum,
More informationPsychogenic Disturbances
Psychogenic Disturbances Psychogenic seizures Episodic dyscontrol Dissociative states (dissociative hysterical neuroses) - Psychogenic fugue - Multiple personality disorder - Psychogenic amnesia - Depersonalization
More informationEpilepsy in the Primary School Aged Child
Epilepsy in Primary School Aged Child Deepak Gill Department of Neurology and Neurosurgery The Children s Hospital at Westmead CHERI Research Forum 15 July 2005 Overview The School Age Child and Epilepsy
More informationNew antiepileptic drugs
Chapter 29 New antiepileptic drugs J.W. SANDER UCL Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen Square, London, and Epilepsy Society, Chalfont
More informationACTH therapy for generalized seizures other than spasms
Seizure (2006) 15, 469 475 www.elsevier.com/locate/yseiz ACTH therapy for generalized seizures other than spasms Akihisa Okumura a,b, *, Takeshi Tsuji b, Toru Kato b, Jun Natsume b, Tamiko Negoro b, Kazuyoshi
More informationDEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.
DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that
More informationNew life Collage of nursing Karachi
New life Collage of nursing Karachi Presenter: Zafar ali shah Faculty: Raja khatri Subject: Pathophysiology Topic :Alzheimer s Disease Post RN BScN semester 2 nd Objective Define Alzheimer s Describe pathophysiology
More informationDatabase of paroxysmal iceeg signals
POSTER 2017, PRAGUE MAY 23 1 Database of paroxysmal iceeg signals Ing. Nikol Kopecká 1 1 Dept. of Circuit Theory, Czech Technical University, Technická 2, 166 27 Praha, Czech Republic kopecnik@fel.cvut.cz
More informationDementia and cognitive decline
Dementia and cognitive decline Expert Briefing Su Ray and Dr Susan Davidson Research Department Together, we can help everyone to love later life 01 Brain basics Normal ageing, cognitive impairment and
More informationAlan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination P 80/min reg, BP 160/95, normal
More informationRecommendations. for Care of Adults with Epilepsy. Seeking the best treatment from the right doctor at the right time!
Recommendations for Care of Adults with Epilepsy Seeking the best treatment from the right doctor at the right time! Contents This booklet is to help adults and their caregivers know when it is appropriate
More informationContemporary Developments in Childhood Epilepsy Management. Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital
Contemporary Developments in Childhood Epilepsy Management Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital Developments in Epilepsy Care Standardised epilepsy care using
More informationDEMENTIA AND MEDICATION
DEMENTIA AND MEDICATION Dr. Siobhan Ni Bhriain, MRCP, MRCPsych. Clinical Director, Tallaght and SJH MHS, Consultant Old Age Psychiatrist, Chair, DSIDC Steering Committee. SUMMARY OF TODAY S TALK Dementia-definition,
More informationINTRODUCTION TO NEUROLOGICAL DISEASE. Learning in Retirement: Epilepsy
INTRODUCTION TO NEUROLOGICAL DISEASE Learning in Retirement: Epilepsy Lesson Overview Seizures VS Epilepsy What Causes Seizures? Types of Seizures Epilepsy Pathology General Cellular Molecular Diagnosis
More informationEpilepsy. Seizures and Epilepsy. Buccal Midazolam vs. Rectal Diazepam for Serial Seizures. Epilepsy and Seizures 6/18/2008
Seizures and Epilepsy Paul Garcia, M.D. UCSF Epilepsy Epileptic seizure: the physical manifestation of aberrant firing of brain cells Epilepsy: the tendency to recurrent, unprovoked epileptic seizures
More informationInterictal High Frequency Oscillations as Neurophysiologic Biomarkers of Epileptogenicity
Interictal High Frequency Oscillations as Neurophysiologic Biomarkers of Epileptogenicity December 10, 2013 Joyce Y. Wu, MD Associate Professor Division of Pediatric Neurology David Geffen School of Medicine
More informationThe Blackouts Checklist i
The Blackouts Checklist i The Blackouts Checklist key aim is to help you and your doctor reach the correct diagnosis for any unexplained loss of consciousness (blackout). The Checklist gives you information
More informationepilepticus (SE) or trauma. Between this injury and the emergence of recurrent
Introduction Epilepsy is one of the oldest medical disorders known. The word epilepsy derived from the Greek word epilamhanein, meaning to be seized or to be overwhelmed by surprise. Epilepsy is one of
More informationEEG IN FOCAL ENCEPHALOPATHIES: CEREBROVASCULAR DISEASE, NEOPLASMS, AND INFECTIONS
246 Figure 8.7: FIRDA. The patient has a history of nonspecific cognitive decline and multiple small WM changes on imaging. oligodendrocytic tumors of the cerebral hemispheres (11,12). Electroencephalogram
More informationFirst clinical attack of inflammatory or demyelinating disease in the CNS. Alteration in consciousness ranging from somnolence or coma
ADEM Clinical features First clinical attack of inflammatory or demyelinating disease in the CNS Acute or subacute onset Affects multifocal areas of the CNS Polysymptomatic presentation Must include encephalopathy:
More informationNon Alzheimer Dementias
Non Alzheimer Dementias Randolph B Schiffer Department of Neuropsychiatry and Behavioral Science Texas Tech University Health Sciences Center 9/11/2007 Statement of Financial Disclosure Randolph B Schiffer,,
More informationDementia and Delirium
Dementia and Delirium LPT Gondar Mental Health Group www.le.ac.uk Dementia and Delirium WTINP Chapter 4.6 Introduction - areas to be covered Delirium Definition and causes Clinical features Management
More informationGreg Jicha, M.D., Ph.D. Associate Professor of Neurology The Robert T. & Nyles Y. McCowan Chair in Alzheimer s Research University of Kentucky
Greg Jicha, M.D., Ph.D. Associate Professor of Neurology The Robert T. & Nyles Y. McCowan Chair in Alzheimer s Research University of Kentucky Alzheimer s Disease Center and the Sanders-Brown Center on
More informationDisclosures 2/10/2017. RAIN 2017 Difficult Cases Session. Patient MC, Original Diagnosis, 9/2006. MRI 9/5/06, pre-op
Disclosures RAIN 2017 Difficult Cases Session Clinical trials research funding support from: Novartis Genentech/Roche Merck NEUROLOGY AND NEUROLOGICAL SURGERY Jennifer L. Clarke, MD, MPH Associate Professor
More informationWe Will Discuss. Dementia and Alzheimer s Disease Basics. Dementia. Developmental Disabilities and Dementia: A Behavior Management Guide
10/18/2013 1 Dayna Thompson M.S., LMHC Alzheimer s Educator Developmental Disabilities and Dementia: A Behavior Management Guide Alzheimer s Resource Service IU Health Bloomington-Community Health 812-353-9299
More informationWhen to start, which drugs and when to stop
When to start, which drugs and when to stop Dr. Suthida Yenjun, MD. PMK Epilepsy Annual Meeting 2016 The main factors to consider in making the decision The risk for recurrent seizures, which varies based
More informationEpilepsy after stroke
Call the Stroke Helpline: 0303 3033 100 or email: info@stroke.org.uk Epilepsy after stroke In the first few days and weeks after a stroke some people have a seizure, and a small number go on to develop
More informationAntiepileptic agents
Antiepileptic agents Excessive excitability of neurons in the CNS Abnormal function of ion channels Spread through neural networks Abnormal neural activity leads to abnormal motor activity Suppression
More informationAlzheimer s Disease. Pathophysiology: Alzheimer s disease (AD) is a progressive dementia affecting cognition, behavior,
2 Alzheimer s Disease Alzheimer s disease (AD) is a progressive dementia affecting cognition, behavior, and functional status with no known cause or cure. Patients eventually lose cognitive, analytical,
More informationMoving Targets: An Update on Diagnosing Dementia in the Clinic
Moving Targets: An Update on Diagnosing Dementia in the Clinic Eric McDade DO Department of Neurology School of Medicine Alzheimer Disease Research Center Disclosures No relevant financial disclosures
More informationFirst seizure. Information for patients
First seizure Information for patients What happened to me? You have been given this leaflet because you have had a suspected seizure. A seizure may be triggered by stress, exhaustion, a bang to the head,
More informationMichael A. Lobatz MD The Neurology Center Scripps Rehabilitation Center
Michael A. Lobatz MD The Neurology Center Scripps Rehabilitation Center Dementia an acquired syndrome consisting of a decline in memory and other cognitive functions Alzheimer s Disease Fronto temporal
More informationDementia. Aetiology, pathophysiology and the role of neuropsychological testing. Dr Sheng Ling Low Geriatrician
Dementia Aetiology, pathophysiology and the role of neuropsychological testing Dr Sheng Ling Low Geriatrician Topics to cover Why is dementia important What is dementia Differentiate between dementia,
More informationChapter 15: Late Life and Psychological Disorders
\ Chapter 15: Late Life and Psychological Disorders 1. Ageism refers to a. the physical deterioration that accompanies old age. b. the intellectual deterioration that frequently occurs as a person ages.
More informationDelirium & Dementia. Nicholas J. Silvestri, MD
Delirium & Dementia Nicholas J. Silvestri, MD Outline Delirium vs. Dementia Neural pathways relating to consciousness Encephalopathy Stupor Coma Dementia Delirium vs. Dementia Delirium Abrupt onset Lasts
More informationPsychotropic Strategies Handout Package
Psychotropic Strategies Handout Package Psychotropic Strategies Learning Objectives Utilize all clinical information available Assess the patient s overall condition this is essential Basic Principles
More informationOverview of neurological changes in Alzheimer s disease. Eric Karran
Overview of neurological changes in Alzheimer s disease Eric Karran Alzheimer s disease Alois Alzheimer 1864-1915 Auguste D. 1850-1906 Case presented November 26 th 1906 Guildford Talk.ppt 20 th March,
More informationAlzheimer's Disease. Dementia
Alzheimer's Disease Victor W. Henderson, MD, MS Departments of Health Research & Policy (Epidemiology) and of Neurology & Neurological Sciences Stanford University Director, Stanford Alzheimer s Disease
More informationBrainwave The Irish Epilepsy Association
249 Crumlin Road Dublin 12 Tel: 01-4557500 Email: info@epilepsy.ie Web: www.epilepsy.ie AUTISTIC SPECTRUM DISORDER (ASD) AND EPILEPSY Rates of epilepsy among children and adults with autism may be higher
More information