Discover and read the best of Twitter Threads about #epilepsy

Commonest cause of recurrence of fits in a person with #epilepsy is stopping medicines

1. Epilepsy is common & is estimated to affect 5 people per 1000 population in India.
Many remain undiagnosed; many of those diagnosed remain untreated (treatment gap).
#MedTwitter

2. In persons with epilepsy (PwE), discontinuing or skipping anti-epileptic drugs (AEDs) is the commonest cause of recurrence of seizures (breakthrough seizures), closely followed by sleep deprivation and emotional stress.
#neurotwitter
dx.doi.org/10.4103/1110-1…

3. The reasons persons with epilepsy may skip anti-epileptic drugs could be varied: forgetting to take the medicines; fear of getting side effects; experiencing adverse effects due to AEDs; possibility of causing harm to foetus (in pregnant women); or cost (unaffordability).

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We need to talk about the role of GABA in mental illness and neurological disorders. And then I am going to explain to you why ketones can help regulate this neurotransmitter. 🧵 (1/21)

GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter in the brain, and it plays a critical role in regulating neuronal excitability and maintaining the balance between neuronal excitation and inhibition. (2/21)

GABAergic dysfunction has been implicated in a wide range of psychiatric and neurological disorders, including #anxiety disorders, #depression, #epilepsy, #schizophrenia, and #autism spectrum disorders. (3/21)

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Dr Sudhir Kumar MD DM

A teenager referred with "difficult to control" fits needed non-drug approach for controlling fits

1. 15-year old Rishi had been having fits for the past three months. He used to have jerky movements of hands and legs that lasted several hours and occurred 15-20 times per day.

1a. He was seen by local doctors. MRI brain & EEG were normal.
He was started on anti-epileptic drug (AED). As seizures did not get controlled with single AED, two more drugs were sequentially added. As seizures continued despite giving maximum doses of 3 AEDs, he was referred.

2. Rishi had no past history of fits or febrile seizures in early childhood. There was no family history of epilepsy. He was a bright kid, doing well in studies.
While in OPD, I witnessed one of the episodes of fits, which made me suspect the root cause of fits in Rishi.

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Depakote, Tegretol, Lamictal, Neurontin,
Gabapentin, Valium, Klonopin, Xanax, Topamax, and Topiramate are often used to treat seizures. Did you know that a ketogenic diet can be used to treat seizures? Without the dependency or side effects of these medications? (1/4)

Seizure #medications are used as "treatments" for mental illness and neurological disorders. (2/4) #neurology #epilepsy #psychiatry

Did you know that you can use a #ketogenic diet to help treat seizures, mental illness, and neurological issues and possibly not need to use these medications? Did you know that was an option you could pursue? (3/4)

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Gender equality is good, however, in this situation, it is better that women lag men

1. 45-year old Vani was admitted with complaints of epileptic fits followed by disorientation and confusion. A small brain infarct (clot) was seen, which was presumed to be the cause of seizure.

2. She had no obvious risk factors for stroke, and moreover, the clot was located in cerebellar vermis, which usually does not cause convulsions. So, we needed to look for other causes for her epileptic fits. Vani had become conscious the next day, and history was reviewed.

3. Vani admitted to consuming alcohol on daily basis for more than a year, and had abruptly stopped consuming alcohol one day prior (as she was fasting for a religious festival).
Now, the cause of seizure was obvious- alcohol withdrawal syndrome (ADS).

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Two ketogenic dieticians, @KaniaZupec
and @KetoPotterRDN were both recently interviewed on BipolarCast podcast by @IainCampbellPhD and Matt Baszucki. And I think you will be interested to hear what they had to say. 🧵(1/7)

@KaniaZupec @KetoPotterRDN @IainCampbellPhD Beth and Denise, ketogenic dieticians with experience in treating pediatric epilepsy populations, have long observed the significant improvement of other medical issues alongside epilepsy, such as cognitive delays, physical mobility issues, autism, and depression. (2/7)

@KaniaZupec @KetoPotterRDN @IainCampbellPhD They have seen that, even when epilepsy remains the same, other symptoms may improve with a #ketogenic diet. (3/7)

Did your doctor refer to the #ketogenic diet as a fad? Well, I'm sorry. But you're going to have to take a moment to educate them. 🤷‍♀️It's time for a thread. 🧵(1/7)

A common concern is that the ketogenic diet is just a fad weight loss diet & won't help with mental illness. This is far from the truth. (2/7)

The ketogenic diet has been used as a medical intervention for over 100 years to treat seizures in children with epilepsy. It's also used for adults with epilepsy. (3/7)

According to a 2018 Cochrane Review, most individuals affected with #epilepsy can eliminate seizures with medication, but about 30% cannot. 1/4

About 1/3 to ½ of people with drug-resistant #epilepsy can reduce seizure frequency by at least 50% with a #ketogenic diet 2/4 cochranelibrary.com/cdsr/doi/10.10…

Are people offered a ketogenic diet from the onset of diagnosis as an alternative to medication? Do they have the right to be offered a ketogenic intervention alongside medications as an option? 3/4

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Sue Fletcher-Watson

@SueReviews

OK here we go with the Day 2 run-down for @ITAKOM_CONF

We kick off with Prof Pierre Magistretti giving us a tour of the ever-changing brain. The hardware we all share despite our many different experiences of the world.

Later that morning @heasutherland and @maxdavie will...

...be talking about applying the neurodiversity paradigm in both clinical & social care settings.

@HariSri108 will be presenting on using assistive & augmented communication devices #AAC and the stigma that entails, drawing on his experience + research.

In the Inclusive...

...Learning session we'll hear the latest on the #LEANSProject from @a_m_alcorn0131 + inspiring work in outdoor learning & wellbeing from @WaveProject

Students from @EdinUniNeuro will lead a workshop exploring how medications can be neurodiversity-affirmative

And finally...

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A teenager who would intermittently rotate around himself for 1 minute

1. 15-year-old Raju was referred for evaluation of unusual behavior. For past one year, he would start rotating around his own body axis in full circles. This would go on for one minute and would stop on own.

2. He would remain fully conscious during these episodes, but was unable to control them. He was seen by a neurologist elsewhere. Brain scan and EEG were normal. He was empirically treated for possible #epilepsy, with no benefit.
#MedTwitter #neurotwitter

3. He was then thought to be suffering from conversion disorder (hysteria) and referred to psychiatrist. Psychiatrist ruled out any psychopathology and requested our opinion. While in the OPD, I witnessed an episode.

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jpbs.hapres.com/UpLoad/PdfFile…

"Many neurological diseases, such as Alzheimer’s disease, Parkinson’s disease, epilepsy, bipolar disorder, schizophrenia, and major depressive disorder are characterized by cerebral glucose hypometabolism, 🧵

insulin resistance, neurotransmitter imbalances, mitochondrial dysfunction, oxidative stress, and inflammation as potential causative factors."
#Alzheimers #Parkinsons #epilepsy #Bipolar #Schizophrenia #depression

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Arjun G. Shah

@neurogenicpoet

Resources to study #Neurology

Adams and Victor’s. By far my favourite textbook.
The book is more clinically oriented, coloured with anecdotes and mental models. Reading it feels like seeing a pt in the ward/OPD

#MedTwitter #neurotwitter

It has elements of philosophy, history and is written eloquently.
Whimsical, yet profound, it’s teachings stay with me. Added bonus, my Guru in Neurology finds mention in the text 🙃 I’d recommend this for #mbbs #md and #dm students

Bradley is the standard #textbook in #neurology. A great book, it’s more like #Harrison. Great for information, latest research and management. Essential for the DM #neurology candidate, but also useful for MD #internalmedicine

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A man who would become unconscious after singing romantic Kishore Kumar's Songs
1. 6 months ago, a 45-year-old man visited me for evaluation of a fainting episode that occurred while he was singing for a private gathering. He was a schoolteacher and singing was his passion.

2. On the fateful day, he had uneventfully sung a few songs of other singers.
On public demand, he sang “Pal pal dil ke paas”, a popular Kishore Kumar's song. A few minutes after completing the song, he collapsed on the stage and became unconscious.

3. His pulse rate was 110 beats per minute and BP was 160/100 mmHg. He was shifted to a hospital for evaluation.
He had regained consciousness while being taken to the hospital.
ECG, Echocardiogram and Cardiologist evaluation were normal.

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#Valproate (VPT) is still more efficacious and more cost-effective as compared to #levetiracetam (LEV) for treating generalized #Epilepsy (GE)

1. I see an increasing trend for prescribing LEV in emergency room, ICU & OPD for GE
#MedTwitter #neurotwitter

doi.org/10.1016%2FS014…

2. In a recent study, LEV was found to be inferior for times to treatment failure, 2-year remission from seizures, and first subsequent seizure. In addition, LEV was not found to be a cost-effective alternative.

3. This is despite the fact the LEV is associated with a higher incidence of #psychiatric and #behavioral adverse effects.
This is a major problem in #ICU patients, as it adds to the burden of patients with #psychosis in ICU.

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Maksim Parfyonov

@MParfyonov

I've seen two patients in my training with ring chromosome 20 associated epilepsy, which inspired my recent talk at #CleClinicNeuro Peds Epilepsy GR, so I decided to distill it to a #neurogenetics #epilepsy #tweetorial 🤓 🧬
1/🧵

what is a 💍 chromosome? Rather than having a full complement of rod-shaped chromosomes like this:

2/ 🧵

affected individuals have at least one chromosome with circular formation, due to fusion of distal chromosome regions:

3/ 🧵

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Ali Christy, MD, PhD

@OligoclonalBand

Meet the Luminaries from EndowedChairs.com, a card game created with @zach_london

#NeuroTwitter #gamedev #histmed @somedocs

****************************************
Luminary #4: Dorothy Russell (1895-1983)
1/🪑

Hands up if you used this textbook! The 7th edition of "R&R" was published in 2007.
You may have known that this was written by eminent neuropathologist Dorothy Russell, but did you know she had epilepsy? 2/🪑

Russell was born in Australia, but after both her parents died (her mother from measles), Dorothy and her sister Petronella went to live in England with an aunt. 3/🪑

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A teenager who continued enjoying the pleasurable #emotions induced by hot water bath until he became unconscious during one such bath

1. Here I am sharing the case of a 18-year old boy who used to experience extremely pleasurable emotions every time he poured water on his head

2. He loved taking #bath with #hot water. This was not just for the comfort of warm water sensation over his body, but also for the pleasurable sensations & emotions that used to start in his body & mind soon after he poured hot water on his head.
#MedTwitter #NeuroTwitter

3. He described the feeling as if he got transcended to another world, with feelings of extreme elation and happiness. These feelings increased as he continued pouring more hot water on his head. These had started about a year back. He hadn't shared this with his family members.

#diabetes and #Neurology
1. Peripheral #neuropathy can be the first manifestation of diabetes. 50-70% of diabetics suffer from neuropathy. Pain and burning sensation of feet are common symptoms. Numbness of feet can predispose to ulcer formation.
#WorldDiabetesDay #Medtwitter

2. Diabetes is a common risk factor of #stroke, seen in 30% of stroke cases. Diabetes leads to poorer outcome in stroke patients- longer length of hospital stay, higher risk of complications, higher risk of death due to stroke and greater disability in stroke survivors.

3. Diabetes is associated with higher risk of dementia including Alzheimer's disease. The risk of mild cognitive impairment (MCI) and conversion of MCI to dementia is higher in diabetics. Longer duration of diabetes and uncontrolled diabetes further increase the risk of dementia.

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How I (a #neurologist) helped a student pass in #Mathematics, which his Mathematics teacher couldn't manage

1. A 15-year old boy was brought to my clinic by his parents asking for some "pill" that would improve his interest and skill in mathematics, enabling him to pass exams

2. He was a bright class 10th kid doing well in all the subjects except in mathematics. His scores were 85-90% in other subjects, with <30% in mathematics. This appeared odd to me. On enquiry, the boy told "my mind switches off when solving complex mathematical problems".

3. The boy continued "my mind keeps on lapsing into absent-mindedness several times during exams" and "before I realize- the time is up". As per his teachers & parents, his answer sheet had many areas of ineligible scribbling. The initial part of answer would be correct though.