KRIJRANO G.

CABAÑEZ BSNURSING III

RESOURCE: PUBMED JOURNALS

Cognition and dementia in older patients with epilepsy.

Sen A, Capelli V, Husain M (February, 2018)

Abstract
With advances in healthcare and an ageing population, the number of older
adults with epilepsy is set to rise substantially across the world. In developed countries
the highest incidence of epilepsy is already in people over 65 and, as life expectancy
increases, individuals who developed epilepsy at a young age are also living longer.
Recent findings show that older persons with epilepsy are more likely to suffer from
cognitive dysfunction and that there might be an important bidirectional relationship
between epilepsy and dementia. Thus some people with epilepsy may be at a higher
risk of developing dementia, while individuals with some forms of dementia, particularly
Alzheimer's disease and vascular dementia, are at significantly higher risk of
developing epilepsy. Consistent with this emerging view, epidemiological findings reveal
that people with epilepsy and individuals with Alzheimer's disease share common risk
factors.

Recent studies in Alzheimer's disease and late-onset epilepsy also suggest

common pathological links mediated by underlying vascular changes and/or tau
pathology. Meanwhile electrophysiological and neuroimaging investigations in epilepsy,
Alzheimer's disease, and vascular dementia have focused interest on network level
dysfunction, which might be important in mediating cognitive dysfunction across all
three of these conditions. In this review we consider whether seizures promote
dementia, whether dementia causes seizures, or if common underlying
pathophysiological mechanisms cause both.

We examine the evidence that cognitive impairment is associated

with epilepsy in older people (aged over 65) and the prognosis for patients
with epilepsy developing dementia, with a specific emphasis on common mechanisms
that might underlie the cognitive deficits observed in epilepsy and Alzheimer's disease.
Our analyses suggest that there is considerable intersection between epilepsy,
Alzheimer's disease and cerebrovascular disease raising the possibility that better
understanding of shared mechanisms in these conditions might help to ameliorate not
just seizures, but also epileptogenesis and cognitive dysfunction.

Insights/Reaction:

In care for the older patients as a nursing subject, it is very important in

identifying other manifestations that are experienced by our older patients because this
puts them in more risks. Moreover, since it was proven that cognitive dysfunction is
common for patients with Epilepsy, it is our job as nurses to guide them carry on with
their daily lives and promote independence when it comes to hygiene, common chores
and other activities of daily living.
Consensus research priorities for paediatric status epilepticus: A Delphi study of
health consumers, researchers and clinicians.
Furyk J, Ray R, Watt K, Dalziel SR, Oakely E, Mackay M, Dabscheck G, Riney K, Babl FE (February, 2018)

Abstract
Status epilepticus (SE) is a paediatric emergency with significant morbidity and
mortality. Recommendations beyond first line care are not based on high quality
evidence. Emergency physicians and neurologists are key stakeholders in managing
this condition. A collaborative, widely consulted approach to identifying priorities can
help direct limited research funds appropriately. The objectives of this study are to
identify consensus research priorities in paediatric SE among experts and health
consumers.

A three-stage Delphi process was conducted. Paediatric Neurologists and

Emergency Physicians in Australia and New Zealand participated. Round one asked
participants to generate three research questions important for further research in
paediatric status epilepticus. Responses were refined into unique individual questions.
Rounds two and three required participants to rate questions on a seven point ordinal
scale. Health consumers were invited to participate by providing up to three problem
areas that could be addressed by research.

54 experts and 76 health consumers participated in the process. Nine questions

reached our definition of consensus "high priority", 21 questions achieved consensus
"low priority" and seven questions did not achieve consensus. High priority areas
included second line management including levetiracetam (efficacy, dose and timing),
use of third line agents, induction of anaesthesia (timing and best agent), management
of focal SE, and indicators of "subtle SE". Consumer priority areas included themes of
treatment efficacy, aetiology, and community education.

We identified nine priority research questions in paediatric SE, congruent with the
health consumer theme of treatment efficacy. Future research efforts should be directed
towards these priority areas.

INSIGHTS/REACTIONS:

Status Epilepticus is a dangerous condition in which epileptic seizures follow one

another without recovery of consciousness between them. As future health care
professionals, it is very important to educate and share the knowledge about Status
epilepticus and its sudden onset and the interventions while the attack is ongoing
especially when it comes to the medications that are highly needed for the dangerous
condition. Aside from that, health care professionals should also understand and be
knowlegable about its prevention because prevention of status epilepticus depends on
the underlying cause of the disorder. Since most cases have no known cause and
patients have no history of seizure, preventing SE may not be possible. However,
lifestyle management steps may help in the prevention status epilepticus. Patients who
take anti-epileptic medications should rigorously follow prescribed use as withdrawal
from these drugs can lead to SE. Proper management of metabolic disorders, such as
diabetes and hypoglycemia can reduce risk. Excessive drinking should be avoided, too,
as alcohol intoxication and withdrawal also are known to cause some SE events.
 Headache Diagnosis in Children and Adolescents.
Dao JM, Qubty W. (February, 2018)

Abstract
Headache phenotypes can differ between adults and children. While most
headaches are due to primary headachedisorders, in a small population, they can be an
indication of a potentially life-threatening neurologic condition. The challenge lies in
identifying warning signs that warrant further workup. This article reviews
different types of pediatric headaches and headache evaluation in children and teens,
and focuses on the approach for diagnosis of secondary headaches.

Common thought is that increased frequency and severity of headache may

reflect secondary pathology; however, headache phenotype may not be fully developed
and can evolve in adolescence or adulthood. Headache location, particularly
occipital headache alone, does not necessarily signify secondary intracranial pathology.
Certain warning signs warrant neuroimaging, but others only warrant imaging in certain
clinical contexts.

Brain MRI is the neuroimaging modality of choice, though there is a high rate of
incidental findings and often does not change headache management. A stepwise
approach is essential to avoid missing secondary headaches. There are several
differences between adults and children in clinical manifestations of headache.
Evaluation and diagnosis of pediatric headache starts with a thorough headache and
medical history, family and social history, and identification of risk factors. A thorough
physical and neurologic exam is important, with close attention to features that could
suggest secondary headache pathology. Neuroimaging and other testing should only be
performed if there is concern for secondary headache.

INSIGHTS/REACTIONS:

Headaches are one of the most common medical complaints; most people
experience them at some point in their life. They can affect anyone regardless of age,
race, and gender. A headache can occur in any part of the head, on both sides of the
head, or in just one location. It is very important to properly assess a patient who have
complaints of headache. Its location, severity of the pain, and its possible causes.

Aside from that, there are two types of headache, Primary headaches are stand-
alone illnesses caused directly by the overactivity of, or problems with, structures in the
head that are pain-sensitive.This includes the blood vessels, muscles, and nerves of the
head and neck. They may also result from changes in chemical activity in the brain.
Common primary headaches include migraines, cluster headaches, and tension
headaches.

Lastly, Secondary headaches are symptoms that happen when another condition
stimulates the pain-sensitive nerves of the head. In other words, the headache
symptoms can be attributed to another cause.