Neuromuscular diseases

Neuromuscular diseases
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  • Clinical Neurophysiology FAQ

What is epilepsy? A seizure is caused by a sudden discharge of electric current in the brain. When this recurs, the patient is said to suffer from epilepsy.

What are partial seizures? Partial seizures are seizures that are focal or unilateral, indicating that the epileptic discharges is confined to an area of the brain. It may consist for example, of a twitching of an arm or leg, or involve one side of the body, or may present as hallucinations. Partial seizures may remain localised or become widespread to involve the entire brain.

What are generalized seizures? In generalized seizures, the entire brain in involved in the electrical storm. Usually there is loss of consciousness with generalized convulsion of all limbs.

What are the causes? Many different brain diseases may present as seizures. It is important to exclude the underlying causes such as infection, head injury, tumours, metabolic derangement, and strokes. Often however no cause is found. Each case of epilepsy is investigated carefully, especially seizures that begin in adult life. A careful history is taken, with a good description of the attack, from the patient and any witnesses. A thorough neurological examination follows, and then other testes as indicated, such as brain scan, electroencephalogram (EEG) and blood tests.

Is it inherited? Some genetic disorders manifest as epilepsy. These are however rare. In general, the risk of epilepsy is several times higher in relatives of patients with idiopathic epilepsy.

Does epilepsy develop only in childhood? No. Epilepsy can develop at any age.

How is epilepsy treated? Treatment of an underlying condition, such as infection or tumour often cures the epilepsy. However many patients require medications for control, and majority can be seizure free with only one drug. It is important to follow the doctor’s instructions on dosage and time of medications closely, as missing medications may lead to continuous seizures called status epilepticus, which is life threatening. Recently epileptic surgery and vagal nerve stimulation have been shown to be effective in selected patients.

What complications can result from epilepsy? There is a risk of injury during as seizure. It is wise to avoid potentially dangerous physical activities such as swimming, climbing heights, working with heavy machinery unless the neurologist feels it is safe. As for driving, it is necessary to check with the local government authority particularly driving heavy vehicles. Majority of patients lives a normal life, with few restrictions.

Is it permanent? There is a 75% chance of remaining seizure free after treatment for four years, if there have been no seizures during this period. Certain seizures in childhood, such as benign rolandic epilepsy or petit mal often cease with maturity.

What precautions should a person with epilepsy take? Epileptics should ensure that they have adequate sleep, avoid stimulant drugs and alcohol. Flickering lights may trigger some seizures. In such cases, avoid sitting too close to the television or spend too much time in front of the computer. It is most important to take your medications regularly.

Should a woman with epilepsy consider bearing a child? Although in most instances pregnancy is not a problem, one should consult one’s physician. Closer monitoring of drug dosages is usually necessary. Most anti-epileptic drugs are reported to affect the foetus, so it is important to discuss with the neurologist.

What should a person do if someone has a seizure? Lie the person down in a safe place, turned on his side to prevent obstruction of the airway. Do not force anything in the mouth.

Driving and epilepsy? Most countries in the West allow epileptics to drive if there has been no attacks for a certain period. However, in Singapore, no exceptions are made to the rule that epileptics cannot drive. Discuss this issue with your neurologist.

EEG FAQ:

How is an EEG obtained? Electrical signals generated by the brain cells are recorded through electrodes placed on the scalp and produced in a paper recording that can be interpreted by the neurologist. The procedure is entirely painless and harmless.

What is the purpose of an EEG? Its main purpose is to detect functional abnormalities of the brain as shown by abnormalities in the electrical signals. It is extremely useful, for instance, in the diagnosis of epilepsy.

What is a stroke? A stroke is a sudden impairment of brain function caused by disruption of blood flow to the brain. The resulting disability may be temporary or permanent and may even result in death. The two major types of stroke are 1)Ischaemic strokes, due to blockage of blood supply to the brain, and 2)Haemorrhagic strokes, due to a ruptured blood vessel.

What are the symptoms of a stroke? The main features of a stroke are sudden onset, and localised. Thus, sudden onset of a body function that can be localised to an area of a brain should always raise the suspicion of a stroke. Typical presentations include: weakness and/or numbness of one side of the body or both sides, slurred speech or loss of speech or speech that is difficult to comprehend, double vision or loss of vision in one or both eyes, unsteadiness of gait, severe sudden headache. The symptoms may last only minutes when it is probably a transient ischaemic attack (TIA). As this often is a warning of a major stroke, it should never be ignored.

What can be done to help someone who has a stroke? Remember that stroke is an emergency. Getting skilled medical attention, preferably in a specialized stroke unit, is the step that makes the most difference to the patient’s outcome. Do not give food or drink as the patient may vomit, and also surgery may have to be done urgently. Take along all medications that the patient is taking.

What is the hospital treatment for stroke patients? A detailed history is taken from the patient and/or the family and a detailed examination conducted. Blood samples are usually taken to determine whether there are other associated conditions. Then usually a CT scan is done as soon as possible to differentiate an ischaemic stroke from a haemorrhage and to rule out other causes. Subsequent treatment then depends on the nature of the stroke. This may include "clot busters" such as TPA, carotid artery angioplasty and stenting.

What are the chances of making a full recovery from a stroke? In cases of mild stroke, full or nearly full recovery is possible. Most often, however, some residual disability persists. Even then, many patients are able to return to an independent life style.

Can strokes be prevented? One can only minimize risk factors that predispose to stroke. Such risk factors include a high cholesterol level, hypertension, diabetes, smoking, and heart disease.

How much sleep is normal? An average person sleeps 6 to 8 hours. Children and teenagers need longer hours and the elderly usually sleep less. Normal sleep should leave one waking up feeling refreshed.

Is too much sleep harmful? Excessive sleep may be an indication of underlying medical conditions or due to a sleep disorder such as sleep apnoea. Narcolepsy may also present with excessive daytime somnolence.

Is it normal to snore during sleep? Snoring that is excessively loud, especially when associated with cessation of breathing, may be due to sleep apnoea. The patient may also fall asleep during the day whilst working or driving. This sleep disorder is known to be associated with complications such as hypertension, stroke, irregularities of heart rhythm and even cardiac arrest.

How is insomnia treated? Insomnia which has a clear cause, such as a stress situation, and is of recent onset, can often be treated with counseling, exercise, and a short course of a hypnotic. Insomnia that is longer than 6 months should be investigated and medical conditions such as thyrotoxicosis ruled out. An overnight polysomnography sleep study in a sleep centre may assist in ruling out causes such as restless leg syndrome.

How are sleep disorders studied and treated? First a thorough history and clinical examination is carried out. Particular attention is paid to how the sleep disorder has affected daytime activities. The patient’s sleeping partner is asked to observe the patient’s sleep pattern for a few nights. When indicated, an overnight sleep study is carried out in a sleep centre. Physiological parameters such as EEG, eye movements, air flow, respiratory movements, oxygen saturation, heart rhythm, limb movements, body position and snore are recorded. This is referred to as polysomnography. A time-linked video recording is also done. The sleep medicine specialist then analyses the study and recommends appropriate treatment. The multiple sleep latency test (MSLT) measures the speed of falling asleep, and is useful to measure the degree of daytime sleepiness.

How is sleep apnoea treated? The most common and effective treatment is nasal continuous positive airway pressure (CPAP). A small light portable machine is used to deliver air under pressure through a mask which is fitted over the nose. The air pressure is adjusted so that it is just enough to stop snoring and apnoea. This is used during sleep. Other methods of treatment include uvulopalatopharyngoplasty (UPPP) to cut away excessive parts of the uvula, soft palate and tonsils. Tracheostomy may be required in severe life-threatening sleep apnoea. In mild cases of sleep apnoea, loosing weight, abstaining from alcohol and sleeping pills and sleeping in a side position may be at least partially effective.

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