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| Epilepsy-Seizures~PG |
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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 CARBATROL FOR SLEEP & ALERTNESS HARMONAL AFFECT ON SEIZURES?
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. |
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