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HD~Seizure/Convulsion/Epilepsy/Tics
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Why Certain Symptoms Occur In HD
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Speech & Swallowing Difficulties~Lynn Rhodes
Swallowing Problem Warning Signs
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HD & Diet~HSA Fact Sheet 7
HD~Swallowing & Nutrition
Weight Gain
Taste
5 Levels Difficulty In Swallowing
Feeding Tube~Advanced Stages of HD
Feeding Tube~Jean Miller
One more word on feeding tubes
PEG Tubes and baby foods
Feeding Tubes-More Info
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Depression - Treatment Resistant Patient
HD~Anxiety/Apathy/Irritability
HD~Mania, Obsessive Disorders
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HD~Rigidity, Spasticity, and Dystonia
HD~Seizure/Convulsion/Epilepsy/Tics
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Out-of-Home Care Options FAQ
Preparing for Emergencies

Chapter 3-The Physicians Guide To The Management of HD

Movemement Disorder

Myodonus, Tics and Epilepsy

Myoclonus, sudden brief jerks involving groups of muscles, is more common in juvenile-onset HD, where it may be mistaken for a seizure. Like chorea, myoclonus may not be disabling or particularly distressing, but may respond to treatment with clonazepam or divalproex sodium if treatment is necessary.

Tics are brief, intermittent stereotyped movements such as blinking, nose twitching, head jerking, or transient abnormal postures. Ties which involve the respiratory and vocal apparatus may result in sounds including sniffs, snorts, grunts, coughs, and sucking sounds.

Patients may be unaware of vocal tics, but family members may find the incessant noises grating. They should be helped to understand that the tics are not under voluntary control. Tics generally do not by themselves require treatment, but may respond to neuroleptics, benzodiazepines, or SSRIs.

Epilepsy is uncommon, though not unheard of, in adults with HD, but is said to be present in 30% of individuals with juvenile-onset HD.

A first seizure in an HD patient should not be attributed to HD without further evaluation as it may be indicative of  an additional neurologic problem, such as a subdural hematoma sustained in a fall.

The workup of a first seizure should include a complete exam, laboratory studies to rule out an infection or metabolic disturbance, an EEG, and a brain imaging study. The treatment of a seizure disorder in a person with HD depends on the nature of the seizures.

In the juvenile HD patient, myoclonic epilepsy or other generalized seizures may suggest divalproex sodium as a first treatment choice.

Although seizure management in HD is not usually difficult, for the occasional patient seizure control is quite difficult to achieve, requiring multiple medications or specialized referral. ======================================================

In the following it is interesting to see the types of seizures from dehydration/electrolytes which is critical in someone not consuming sufficient amounts of clear liquids each day!

Seizure- Convulsion. Epilepsy
http://www.fpnotebook.com/NEU183.htm
(See links for causes, signs & symtpoms and treatments)

See Also
    Single Seizure Evaluation
http://www.fpnotebook.com/NEU184.htm
    Status Epilepticus http://www.fpnotebook.com/NEU185.htm
    Febrile Seizure http://www.fpnotebook.com/NEU188.htm
    Newborn Seizure  http://www.fpnotebook.com/NEU143.htm

Primary Seizure Types
    Absence Seizure (Petit Mal Seizure)
http://www.fpnotebook.com/NEU187.htm
    Generalized Tonic Clonic Seizure
         (Grand Mal Seizure) http://www.fpnotebook.com/NEU189.htm
    Simple Partial Seizure http://www.fpnotebook.com/NEU190.htm
    Complex Partial Seizure http://www.fpnotebook.com/NEU191.htm
    Rolandic Epilepsy http://www.fpnotebook.com/NEU192.htm

New Onset Secondary Seizure Causes by age
    Age under 10 years
        Idiopathic
        Congenital
        Birth Injury
        Metabolic disorder
    Age 10 to 40 years
        Idiopathic
        Head Trauma
http://www.fpnotebook.com/ER40.htm
        Pre-existing focal brain disease
        Drug Withdrawal
http://www.fpnotebook.com/PSY29.htm
    Age over 40 years
        Brain tumor
        Old Cerebrovascular Accident
http://www.fpnotebook.com/NEU25.htm
        Head Trauma

Non-Epileptic Causes of Seizure
    Cardiogenic
        Syncope
http://www.fpnotebook.com/CV209.htm
        Transient Ischemic Attack http://www.fpnotebook.com/NEU26.htm
        Arrythmia
        Sick Sinus Syndrome
    Electrolyte
        Hypocalcemia/Low Serum Calcium/
http://www.fpnotebook.com/REN10.htm
        Hyponatremia (Water intoxication)
            Low Serum Sodium http://www.fpnotebook.com/REN116.htm
        Hypomagnesemia Low Serum
                Magnesium http://www.fpnotebook.com/REN87.htm

    Metabolic disorders
        Abnormal Glucose (especially Hypoglycemia)
        Hyperthyroidism
http://www.fpnotebook.com/END147.htm
        Thyroid Storm http://www.fpnotebook.com/END150.htm
        Vitamin B6 deficiency http://www.fpnotebook.com/PHA84.htm

    Drug Withdrawal http://www.fpnotebook.com/PSY29.htm
        Alcohol Withdrawal http://www.fpnotebook.com/PSY31.htm
        Benzodiazepine Withdrawal http://www.fpnotebook.com/PSY43.htm
        Cocaine withdrawal http://www.fpnotebook.com/PSY42.htm
        Barbiturate withdrawal http://www.fpnotebook.com/PSY42.htm
        Meperidine withdrawal Demerol http://www.fpnotebook.com/PHA29.htm
    Drug intoxication or overdose
        Cocaine
        D-Amphetamine
        Theophylline
        Isoniazid (INH)
        Lithium
        Nitrous Oxide
        Acethylcholinesterase inhibitor
    Metal toxicity
        Mercury poisoning
        Lead Poisoning
http://www.fpnotebook.com/HEM135.htm
    Infectious disease
        Gram Negative Sepsis
http://www.fpnotebook.com/ID46.htm
        Viral Meningitis http://www.fpnotebook.com/NEU117.htm
        Bacterial Meningitis http://www.fpnotebook.com/NEU115.htm
    Miscellaneous
        Hyperthermia
        PseudoSeizure
        Malignancy
        Idiopathic
        Isolated unprovoked, non-epileptic Seizure
=================================================
Seizure studies to watch   October 16, 2001

Cleveland Clinics Clinical Trials
http://www.clevelandclinic.org/health/research/
CAPS my input/Jean Miller

TOPIRAMATE FOR COGNITION?
New Topiramate Study The Cleveland Clinic Foundation is beginning a study investigating the effects of the antiepileptic drug topiramate on cognition and vigilance using self-administered computer neuropsychological batteries, polysomnography and the multiple sleep latency test. Patients with epilepsy who have incompletely controlled seizures may qualify for treatment with the new antiepileptic drug. The study requires five visits to The Cleveland Clinic Foundation.

CARBATROL FOR SLEEP & ALERTNESS
Opportunity for Patients with Newly Diagnosed/Untreated Epilepsy The Cleveland Clinic Foundation is beginning a study investigating the effects of the antiepileptic drug Carbatrol (carbamazepine) on nighttime sleep and daytime alertness. Carbamazepine is a commonly used, FDA-approved medication used in the treatment of partial (focal) seizures. Untreated
patients interested in participating would undergo sleep evaluation including sleep questionnaires and a baseline overnight sleep study followed by a "daytime nap" test at no charge. Subjects would be treated with carbamazepine for several weeks and then undergo a second sleep
evaluation.

HARMONAL AFFECT ON SEIZURES?
For Women Only Women and adolescent girls recently diagnosed with a seizure disorder who are not yet taking anti-epileptic medications may be eligible to participate in a new study being conducted at the Cleveland Clinic. Hormonal, metabolic and ovarian functions will be evaluated in females using either lamotrigine or valproic acid.


NEW DRUG HARKOSERIDE
For Refractory Patients Adults who continue to have difficulty controlling their partial seizures may be eligible to participate in a study to begin soon at the Cleveland Clinic. This five month study will investigate the efficacy of harkoseride as an add-on treatment in the control of partial seizures with or without generalization.

NOTE: Kelly's seizures were typically only during her menstrual cycle when her choretic movements were accelerated.  Earlier discussions with doctors on the relationship to her mentstrual cycle and chorea were dismissed as a whacko mother trying to the determine NON HD causes when of course they all knew everything was HD related (era late 1980's).  In the early 90's I heard there was a study on female HD patients to determine relationship between menstrual cycles and chorea.  I haven't been able to find the outcome of that study.