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February 8, 2007
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NeuroScience Insights for Health Care Professionals
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The physicians and staff of The Neuroscience Group are providing this physician and provider communication to help you stay abreast of issues and updates in the dynamic field of neurosciences, with the goal of helping you provide better overall healthcare services to your patients. | |
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Dear Fellow Physicians:
Thank you for your continued dedication and loyalty in serving the patient’s of North East Wisconsin. To assist in improving our patient care, we ask for three minutes of your time to complete a short assessment. The information you provide, will make a tremendous difference for The Neuroscience Group's opportunity to better serve you.
Please click on the link below to access your survey. Realizing your hectic schedules this will only take about three minutes to complete. We anticipate your responses and look forward to a productive future and lasting relationship.
Warmly, Dr. Steve Price
Link: http://www.caat21.com/survey/?id=446228027
Epilepsy and Fractures
Epilepsy patients are 2 to 7 time more likely to experience skeletal fractures than non-epileptics. Are the fractures due to falling during seizures or as a result of medication side effects, such as dizziness or imbalance? Long-term AED (anti-epileptic) medications have been implicated in bone disease, such as osteopenia and osteoporosis.
Optimal treating of seizures may be the best way to prevent fractures. Risk factors for the development of fractures include: 1) seizure types-generalize tonic-clonic, tonic and atonic. 2) increased frequency, 3) AED use-especially phenytoin or polytherapy, 4) intellectual disability. Mechanisms for fractures include, muscular contractions, falls, and bone loss. Some AEDs increase the risk of developing bone loss (osteopenia and osteoporosis). Phenytoin, phenobarbital and primidone were most often associated with bone loss. The relationship between the newer AEDs and bone loss has not been established. The mechanism for bone loss is not
clear-cut. Calcium, phosphate and Vitamin D levels have all been implicated in increasing fractures. Counsel patients to strive to control seizures. Weigh use of AEDs with true gains.
MCD’s and Epilepsy
A common cause of epilepsy is malformations of cortical development (MCDs). Brain formation continues beyond birth. Disruptions in the formation of cerebral cortex result in MCDs. This problem can present at many ages with CNS and extra-CNS manifestations. MCD’s are a common cause of epilepsy. However, seizures may not be the most noticable manifestation.
There are certain key features, which should alert the practitioner to suspect MCD as an underlying cause. These include developmental delays, static focal neurologic deficits, a family history of developmental delay or epilepsy, frequent seizures-right from onset and episodes of focal status epilepticus. Microcephaly (1-2 SD below the mean), mental retardation and neurocognitive deficits may be present. MCDs are classified based on cortical formation: 1) proliferation of neurons and glia in the ventricular and subventricular zones, 2) multidirectional migration of immature but post mitotic neurons to the developing cerebral cortex and 3) cortical
organization. The most common syndromes affecting patients with MCDs and epilepsy include focal cortical dysplasia, hemimegalencephaly, tuberous sclerosis, classical encephalopathy, perivetricular nodular heterotopic, focal sub cortical heterotopia, polymicrogyria and schinzencephaly. Some clinical features are related to specific syndromes and should help the provider in making a diagnosis. However, the majority of patients have nonspecific signs and symptoms with make it difficult to establish a diagnosis.
The neurologists at the Neuroscience Group of NE Wisconsin can serve as a resource in diagnosing and treating epilepsy. Please contact us with questions:
gizell.larson@neurosciencegroup.com susan.hibbs@neurosciencegroup.com
steven.price@neurosciencegroup.com lisa.kokontis@neurosciencegroup.com
thomas.mattio@neurosciencegroup.com
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Services Available:
Fox Cities
Green Bay
New London
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