Seizures
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A Modern Epidemiologic View of Status Epilepticus in the United States
In this retrospective review of mortality and hospitalization related to status epilepticus from 1999 to 2010, the authors found that overall mortality remained relatively stable, whereas the rate of related hospitalizations significantly increased, particularly in patients who were intubated and in whom status epilepticus was not the primary diagnosis.
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Neurological Emergencies in Children and Adolescents
Neurological issues in children can take a very dramatic but relatively benign form, or can be subtle but representative of serious underlying illness. Differentiating between high- and low-risk presentations can be challenging, but a thorough understanding of pediatric practice guidelines can help emergency department physicians determine the most appropriate ED interventions and eliminate potential injury to a child from either excessive intervention or the sequelae of a missed diagnosis. This monograph will help ED physicians recognize and appropriately treat seizures in children, and provide advice to worried parents about their child’s potential for seizure recurrence. In addition, physicians will learn how to determine which patients require lumbar puncture and understand the risks of brain CT imaging in the pediatric population. It also covers how to know when to emergently or urgently refer children to pediatric neurology.
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Predictors of Refractory Status Epilepticus
In a combined derivation and validation study, three independent risk factors for refractory status epilepticus were identified — acute symptomatic cause for seizures, stupor or coma, and a low serum albumin < 35 g/L. -
When Is it Best to Evaluate the Results of a CSF Tap Test?
The tap test has variable results as a tool to assess patients with a presumed diagnosis of normal pressure hydrocephalus. -
Rituximab May Be Effective for Refractory Myasthenia Gravis
In a restrospective review, rituximab appeared beneficial for patients with medication-resistant myasthenia gravis. -
Pharmacology Watch
New recommendations for HPV vaccine; guidelines for treatment of essential tremor; updates on smoking cessation drugs; and FDA actions. -
Stroke Alert: A Review of Current Clinical Stroke Literature
Forty-nine clinical centers and 18 positron emission tomography (PET) centers in the United States and Canada participated in a randomized, blinded-adjudication clinical treatment trial of 195 patients with symptomatic atherosclerotic internal carotid artery occlusion (AICAO) who also had hemodynamic cerebral ischemia identified by ipsilateral increased oxygen extraction fraction measured by PET. -
Clinical Briefs in Primary Care Supplement
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Teriflunomide: A New Oral Agent for the Treatment of Multiple Sclerosis
Teriflunomide, an orally administered inhibitor of dihydro-orotate dehydrogenase, was found to be superior to placebo in reducing relapses in a 2-year, Phase 3 clinical trial in patients with multiple sclerosis. -
Women with Migraine: Options for Decreasing Disability
Menstrually related migraine is difficult to treat and options are limited. Hormonal manipulation is controversial and unproven.