Duodecim; lääketieteellinen aikakauskirja
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Suspicion of epilepsy is an indication for an urgent referral to a pediatric or child neurology care unit. Diagnosis of epilepsy is based on medical history and clinical examination, supplemented with EEG, brain imaging and laboratory tests. Antiepileptic medication is usually initiated after the second epileptic seizure. ⋯ Some children with epilepsy may benefit from ketogenic diet. Surgical treatment options should be considered in children with drug-resistant epilepsy. Acute treatment for febrile seizures follows the same principles as treatment of epileptic seizures, but long-term preventive anticonvulsants are not recommended.
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Advanced Parkinson's disease, essential tremor and dystonia are the most common indications for deep brain stimulation (DBS). The patients having this disease should be referred to DBS assessment at a stage where a satisfactory response to motor symptoms is no longer obtained with conventional medication. DBS therapy is acceptable also in epilepsy, when standard epilepsy surgery is out of question. To date, about 500 patients have had a deep brain stimulator implanted in Finland.
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Respiratory symptoms cause much of suffering in palliative care. Opioids are the first-line drugs in symptomatic treatment, and a therapeutic intervention with benzodiazepines may also be justified. ⋯ Physical therapy and methods of respiratory management are profitable in the treatment of respiratory symptoms. Radiation therapy relieves cancer-induced hemoptysis, cough, chest pain and dyspnea.
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The health-promoting effects of physical exercise are scientifically proven, but the health risks of sitting still remain rather poorly known. Technological development of the society will by no means cut down sitting. Should too much sitting be considered as one of the independent factors increasing the risk of metabolic diseases and its reduction as a health-promoting measure? Innovative solutions made possible by the new technology to cut down on sitting and to increase physical activity may prove to be important future tools for promoting health.
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Palliative pain management is usually successful, if the medication is strengthened in a stepwise manner in accordance with pain intensity, and initiation of a strong opioid is not delayed. Finding of a sufficiently effective dose of the opioid drug with simultaneous management of adverse effects requires continuous pain assessment and patient monitoring. In many cases it is possible to enhance analgesia by supplementing the medication with an antidepressant or an antiepileptic along with the opioid and paracetamol or the analgesic. Palliative radiotherapy will relieve tissue injury pain caused by bone metastases and soft tissue tumors as well as pain due to the possible nerve entrapments caused by them.