Epilepsia
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Continuous EEG (CEEG) monitoring allows uninterrupted assessment of cerebral cortical activity with good spatial resolution and excellent temporal resolution. Thus, this procedure provides a means of constantly assessing brain function in critically ill obtunded and comatose patients. ⋯ Clinical examples of CEEG use, including monitoring of status epilepticus, assessment of ongoing therapy for treatment of seizures in critically ill patients, and monitoring for cerebral ischemia, are presented. Areas requiring further development of CEEG monitoring techniques and indications are discussed.
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Epilepsy and developmental disabilities (DD) often occur together but affect individuals differently and have a complex causal relationship. Most epilepsy in the population with DD is partial or symptomatic generalized. Seizures and antiepileptic drugs (AEDs) can further delay development, and the DD can complicate treatment and adjustment to epilepsy. ⋯ Studies have shown some success with oxcarbazepine (for partial and generalized epilepsy) and with adjunctive lamotrigine. For those on medication regimens, perhaps taking combinations of drugs for numerous years, queries about earlier attempts to reduce AEDs and gradual efforts to substitute less toxic mediations are worthwhile. Vagus nerve stimulation and epilepsy surgery for those with medically refractory epilepsy may be options after careful evaluation.
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A simple definition of the treatment gap is the number of people with a condition or disease who need treatment for it but who do not get it. It is an underutilised measure of health care. ⋯ The treatment gap in epilepsy is very high in the developing world. Possible causes of the treatment gap have been listed, but these have not been investigated.
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We briefly describe the Global Burden of Diseases (GBD) study, its goals, and some of its outcomes as related to neurologic and psychiatric disorders. The summary measure of population health DALYs (Disability Adjusted Life Years) are described, as well as the implications for neuropsychiatric disorders of changing health indicators and the move from mortality toward disability indicators. ⋯ The implications of a shift toward considering the disability of epilepsy, as outlined in the the WHO World Health Report 2001, are important. The burden of epilepsy is high and, for the year 2000, accounts for approximately 0.5% of the whole burden of diseases in the world.