Neurologic clinics
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The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy.
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Factitious disorders including Munchausen's syndrome are likely encountered by all clinicians during their career. Neurologic presentations are common, especially with Munchausen's syndrome by proxy. ⋯ Underlying psychiatric syndromes need to be assiduously evaluated and steadfastly treated. Prognosis is best for patients who do not meet criteria for Munchausen's syndrome or who have psychosocial supports and less severe personality pathology.
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Women with epilepsy who are of childbearing age need to understand what the risks of pregnancy are. These women have a 33% risk of increased seizures, a twofold increase in risk of hemorrhage, eclampsia, premature labor, and an increased need for cesarean sections. ⋯ Seizure control should be obtained without clinical toxicity. Monotherapy reduces the risk of adverse outcomes.
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This article concentrates primarily on infections of viral origin, although numerous microorganisms can infect the fetal and newborn brain (see Tables 1 and 2). Intrauterine infections occur most often for HIV, CMV and rubella, whereas HSV is preferentially transmitted intrapartum. ⋯ Surprisingly, the AIDS epidemic appears to have had minimum impact on infections with other organisms such as Toxoplasma and CMV that commonly infect the brain of adults with AIDS. The recent availability of improved viral diagnostic methods and anti-viral drugs has aided in the identification and treatment of infected newborns.
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The evaluation, diagnosis, and treatment of childhood epilepsy or isolated seizures deserve special consideration. Whenever possible, a working diagnosis of an epilepsy syndrome should be implemented early in the course of evaluation to help plan the necessary investigations and acute and chronic treatment. ⋯ Treatment proceeds after balancing antiepileptic drug efficacy versus adverse drug effects. The length of treatment, discussion of prognosis, and likelihood for genetic transmission are all related to the proper diagnosis of epilepsy syndromes.