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The characteristic massive myoclonic seizures structural generic 400mg skelaxin spasms hands fingers, genetic discount skelaxin 400mg amex back spasms 34 weeks pregnant, or inborn errors of metabolism present (39) buy skelaxin 400mg line muscle relaxant names. This syndrome appears to order 400mg skelaxin with visa muscle relaxant headache be at the malignant end of the spec Characterization of the discharges shows that they tend to trum for children who manifest partial epilepsy in childhood. Atypical than the mean callosal transmission time and may further benign partial epilepsy with continuous spike-and-waves in decrease in duration as the discharge continues (9). Central spikes are usually prominent with this syn with this phenomenon may imitate absence seizures further drome similar to other forms of more benign focal epilepsy. Seizure types that may be observed include atypical absence, myoclonic, clonic, and complex partial seizures. Three or more epileptic foci are present with at least Rett syndrome is encountered between 6 months and 3 years one in each hemisphere. Rett syndrome is characterized by than 50% of patients had more than one type of seizure and cognitive regression, autistic features, microcephaly, ataxia, and 50% were having daily seizures (8). This is especially true when hand-wringing movements in addition to multiple seizure types the spikes occurred at least every 10 seconds (8). It is helpful to have specific neuroimaging protocols that are designed to detect neuronal migrational disorders that might further implicate a potentially surgically remediable local ization remediable epilepsy (53). Many other medications have purported benefit includ the diagnosis of patients with epileptic encephalopathies (20) ing levetiracetam, clonazepam, and clobazam. In particular, benzodiazepines Metabolic and genetic evaluations without a clinical direc use may evoke sedation and may provoke atypical absence tion suspected from the history, physical, and neuroimaging is and tonic status epilepticus (30,31). Valproate is efficacious for myoclonic, Early in the course of the epilepsy when this evaluation is absence, and atonic seizures. The effect was most marked in tion for aminoacidopathies, organic acidopathies, urea cycle tonic–clonic and atonic seizures and was less helpful for atypi defects, chromosomal abnormalities should be performed cal absence (63). Lumbar puncture should be used in cases compared to placebo except for an increase in respiratory of suspected infectious and metabolic etiologies (especially infections. From a practical standpoint, it is difficult to use it mitochondrial and neurotransmitter deficiencies). Parental reports of increased alertness and with generalized tonic and atonic seizures that require transcal improved verbal output were noted very early in its use (67). Now, it has more limited use due to the risk of liver failure in In severely mentally retarded patients, a complete callosotomy children (approximately 1 in 30,000). There is also a risk of may offer improved efficacy when compared with partial cor about 127 per million exposures for aplastic anemia but no pus callosotomy (76). Disconnection syndrome is the most seri cases were seen under the age of 13 (59). In a study of six patients, leve encephalopathies is rarely performed though it has been used tiracetam showed significant reductions in myoclonic, atonic, in patients with Landau–Kleffner syndrome that are capable and atypical absence, but not tonic seizures (68). Ethosuximide occasionally demonstrates benefit in although it does not appear to have the same efficacy as it patients with atypical absence but also myoclonic and atonic does in partial seizures (80). Substantiation of efficacy in randomized controlled clin ical trials remains to be elucidated. Few seizures and should be considered an option when medical patients lead independent lives as an adult as a result of daily therapy is ineffective (see Chapter 69) (73). There is some evidence that adults with refrac established function especially when seizures are frequent tory epilepsy may benefit from the diet even when less restric (52). Long term prognosis for symptomatic (secondar non-convulsive status epilepticus usually have the same ily) generalized epilepsies: a population based study. Prevalence and Descriptive atypical absence or myoclonic seizures carry a more hopeful Epidemiology of Lennox-Gastaut Syndrome among Atlanta Children. Occurrence, outcome, and prognostic factors on infantile spasms and Lennox-Gastaut Syndrome. Childhood epileptic encephalopathy with slow spike wave: a statistical study of 80 cases. The Lennox-Gastaut syndrome: historical aspects from Similarly, identifying refractory epilepsies with a genetic foun 1966 to 1987 in the Lennox-Gastaut Syndrome. Lennox-Gastaut syndrome: a the goal of seizure reduction must be realistically balanced consensus approach on diagnosis, assessment, management, and trial with the risks of overmedication. The Axial spasm-the predominant type of drop seizure in patients with secondary generalized epilepsy. While protective helmets may help prevent plexes-associated clinical features and long term follow up. Different neurophysiologic patterns of myoclonus characterize Lennox-Gastaut syndrome and myoclonic asta balance safety with psychosocial development. Anticonvulsant-induced status epilepticus in their success as human beings need to be measured using a dif Lennox-Gastaut syndrome. Paradoxical precipitation of tonic seizures by ferent scale than those patients with normal cognitive function lorazepam in a child with atypical absence seizures. Clinical and electroencephalographic correlates of the multiple suppression burst. Chapter 22: Encephalopathic Generalized Epilepsy and Lennox–Gastaut Syndrome 293 42. A double-blind, randomized trial of of myoclonic-astatic epilepsy of early childhood. Delineation of cryptogenic syndrome: open-label treatment of patients completing a randomized con Lennox-Gastaut syndrome and myoclonic astatic epilepsy using multiple trolled trial. The myoclonic epilepsies in the children, adolescents and young adults with Lennox-Gastaut syndrome: an treatment of epilepsy: Principles and Practices. Severe myoclonic epilepsy of infants Felbamate in Childhood Epileptic Encephalopathy (Lennox-Gastaut (Dravet Syndrome): Natural history and neuropsychological findings. Magnetoencephalographic analyis epilepsy after long term treatment: a postmarketing, multi-institutional of secondary bilateral synchrony.
Electroencephalography A technique that is used to trusted skelaxin 400 mg skeletal muscle relaxant quizlet measure gross electrical activity of the brain by placing electrodes on the scalp order skelaxin 400mg mastercard muscle relaxant tv 4096. Event-related potentials A physiological measure of large electrical change in the brain produced by sensory stimulation or motor responses buy skelaxin 400mg mastercard spasms hamstring. Forebrain A part of the nervous system that contains the cerebral hemispheres skelaxin 400 mg amex muscle relaxant patch, thalamus, and hypothalamus. Fornix (plural form, fornices) A nerve fiber tract that connects the hippocampus to mammillary bodies. Frontal lobe the most forward region (close to forehead) of the cerebral hemispheres. Gray matter Composes the bark or the cortex of the cerebrum and consists of the cell bodies of the neurons (see also white matter). Gyrus (plural form, gyri) A bulge that is raised between or among fissures of the convoluted brain. The Nervous System 126 Hippocampus (plural form, hippocampi) A nucleus inside (medial) the temporal lobe implicated in learning and memory. Immunocytochemistry A method of staining tissue including the brain, using antibodies. Lateral sulcus the major fissure that delineates the temporal lobe below the frontal and the parietal lobes. Lesion studies A surgical method in which a part of the animal brain is removed to study its effects on behavior or function. Limbic system A loosely defined network of nuclei in the brain involved with learning and emotion. Medulla oblongata the Nervous System 127 An area just above the spinal cord that processes breathing, digestion, heart and blood vessel function, swallowing, and sneezing. Motor strip A strip of cortex just in front of the central sulcus that is involved with motor control. Neural crest A set of primordial neurons that migrate outside the neural tube and give rise to sensory and autonomic neurons in the peripheral nervous system. Neuroblasts Brain progenitor cells that asymmetrically divide into other neuroblasts or nerve cells. Parasympathetic nervous system A division of the autonomic nervous system that is slower than its counterpart—that is, the sympathetic nervous system—and works in opposition to it. Parietal lobe An area of the cerebrum just behind the central sulcus that is engaged with somatosensory and gustatory sensation. Pons A bridge that connects the cerebral cortex with the medulla, and reciprocally transfers information back and forth between the brain and the spinal cord. The Nervous System 128 Rostrocaudal A front-back plane used to identify anatomical structures in the body and the brain. Somatic nervous system A part of the peripheral nervous system that uses cranial and spinal nerves in volitional actions. Somatosensory strip A strip of cerebral tissue just behind the central sulcus engaged in sensory reception of bodily sensations. Spina bifida A developmental disease of the spinal cord, where the neural tube does not close caudally. Sulcus (plural form, sulci) the crevices or fissures formed by convolutions in the brain. Sympathetic nervous system A division of the autonomic nervous system, that is faster than its counterpart that is the parasympathetic nervous system and works in opposition to it. Temporal lobe An area of the cerebrum that lies below the lateral sulcus; it contains auditory and olfactory (smell) projection regions. Thalamus A part of the diencephalon that works as a gateway for incoming and outgoing information. Wernicke’s area A language area in the temporal lobe where linguistic information is comprehended (Also see Broca’s area). White matter Regions of the nervous system that represent the axons of the nerve cells; whitish in color because of myelination of the nerve cells. The Nervous System 129 Working memory Short transitory memory processed in the hippocampus. On the origins of species by means of natural selection, or, the preservation of favoured races in the struggle for life. Topography of the retina and striate cortex and its relationship to visual acuity in rhesus monkeys and squirrel monkeys. Information processing in the primate visual system: An integrated systems perspective. This module provides an introductory overview of the brain, including some basic neuroanatomy, and brief descriptions of the neuroscience methods used to study it. Learning Objectives • Name and describe the basic function of the brain stem, cerebellum, and cerebral hemispheres. Introduction Any textbook on psychology would be incomplete without reference to the brain. Every the Brain 133 behavior, thought, or experience described in the other modules must be implemented in the brain. A detailed understanding of the human brain can help us make sense of human experience and behavior.
This effect has also been noted in a recent systematic review and for a major congenital malformation has been shown by all the major registry studies order skelaxin 400mg online spasms in your back. There is also meta-analysis which identifed increased risk of preterm birth (37 weeks gestation) O 400 mg skelaxin with mastercard spasms meaning in hindi. Data from all three of the main epilepsy and pregnancy registries has shown a dose-related increase in rates of major congenital malformations with higher valproate doses77 skelaxin 400mg without a prescription muscle relaxant for sciatica, 129 order 400mg skelaxin amex muscle relaxant comparison, 132. There is evidence of a pharmacogenetic susceptibility to the teratogenic effects of valproate It has also been consistently reported that women who take polytherapy are more at risk than those who both, from human reports139,140 and preclinical studies141. Again this could be argued as simply being a refection of the severity of the studies that for valproate, at least, high peak plasma concentrations are associated with an increased epilepsy. This fnding was replicated in the Australian study were the mean daily dose of valproate was higher in those with a major malformation143. This approach, however, failed to show any beneft in a retrospective analysis by compared to background of 2–3% for each pregnancy)119, 120, 124, 125. This has resulted in less valproate being prescribed in at subsequent reviews, especially when a girl reaches puberty and when pregnancy is being planned145. Of the withdrawal group 20% had to restart valproate later in pregnancy or else an alternative agent147. The International Lamotrigine Pregnancy Registry has recently reported the outcomes of 1558 frst trimester lamotrigine Lamotrigine 49/2098 Dose 17/836 (2. The percentage of outcomes exposed to lamotrigine monotherapy with major birth (2. In contrast to earlier results, only a small dose include: hypertelorism, epicanthic response was seen with 3. A positive dose-response has not been reported by some other registers spina bifda and hypospadia 126 including the International Lamotrigine Registry. The North American Pregnancy Register reported Carbamazepine 43/1657 Dose 5/148 (3. Another report of 55 exposures to oxcarbazepine (35 monotherapy and 20 polytherapy) Topiramate 3/70 (4. Six malformations from the outcomes of the 248 monotherapy 3 hypospadias, 0 neural tube defects exposures to oxcarbazepine (2. In a post-marketing surveillance study of gabapentin as add-on therapy for 3100 patients in England Phenobarbital Not 16/217 (7. Urogenital defects, and dysmorphic facial and other features such as Preliminary data for topiramate appears concerning. Doses of valproate above 800 mg/day For zonisamide data for exposed pregnancies is limited. There was also a signifcant negative correlation raised concerns regarding use of zonisamide during pregnancy. Study of much larger numbers of pregnancies prenatally to carbamazepine of between 8% and 20%164,169,170. Vigabatrin was also In a study from Finland the authors reported similar fndings among a small number of exposed infants shown to be teratogenic in rabbits, inducing cleft defects158. Of importance however, the mothers of the valproate exposed fusion of skull bones and sternabrae in rats. The types of abnormalities found have included minor craniofacial and digital anomalies language functions in children of mothers with epilepsy174. It is unclear what the infuence of other variables is, such as maternal epilepsy infuence on cognitive functioning and other aspects of development. In any case such abnormalities, although undesirable, have usually been felt to date suggests less of an deleterious effect on neurocognitive development than for valproate. Tonic-clonic seizures may result in foetal hypoxia and it is therefore generally recommended 178. A Cochrane review published in 2014 included 22 prospective cohort studies and 6 registry based that delivery takes place in a unit equipped with facilities for maternal and neonatal resuscitation93, 94 studies. Hence the amount transferred to the infant in disorders were more frequently seen in the children of women with epilepsy (15 of 201, 7. Lamotrigine was also protein binding and immature elimination mechanisms can also result in drug accumulation. This can associated with a higher incidence of neurodevelopmental disorders than the control group (6. In this study, indicate that lamotrigine passes into breast milk at 40–45% of the level in plasma, with levels comparable from all children born alive in Denmark from 1996 to 2006 (total 665,615) 5437 children were identifed to those seen in patients having been noted189. Exposure to carbamazepine, lamotrigine, is therefore reassuring, albeit the numbers studied were small. At age 6 years, breastfed children had oxcarbazepine or clonazepam was not associated with a signifcantly higher risk for these disorders181. Longer term follow up of these cohorts is required as the during the delivery hospitalisation when pregnant, fnding a >10 fold increased risk of death. Key areas highlighted for improvement were the During Labour need for robust pre-conceptual counselling, involvement of an epilepsy specialist, and ideally to obtain improved control prior to undertaking pregnancy. There is some case-control evidence that drug choice Most women with epilepsy will have a normal uncomplicated vaginal delivery81. Ann Neurol Despite the fact there is experimental evidence that oestrogen is a potent proconvulsant and progesterone 53, 390–391. Neurology 22, 345–8 oestrogen to progesterone ratio, the menopause appears to have a limited impact on seizure frequency, 22. J Neurol Neurosurg Psychiatr unless the woman has a history of catamenial epilepsy where this appears more relevant and they may 47, 1279–1282. It is not yet clear if other types in women with partial seizures of temporal lobe origin.
The Diagnostic stability in very young children with genetic landscapes of autism spectrum disorders cheap skelaxin 400 mg visa spasms heat or ice. Ketogenic diet-induced peroxi analysis exposes mitochondrial abnormalities in a some proliferator-activated receptor-gamma acti mouse model of Rett syndrome purchase skelaxin 400mg with mastercard spasms while peeing. Altered the heterogeneity of autism spectrum disor metabolites in the plasma of autism spectrum dis der through genetic fndings generic skelaxin 400mg overnight delivery spasms 2012. International J Clin Chem 229 purchase skelaxin 400 mg without prescription zerodol muscle relaxant, 205–207 Mitochondria in neuroplasticity and neurological Legido, A. The behavioral tasks relevant to autism: phenotypes of neuroprotective properties of calorie restriction, 10 inbred strains. Potential tion products of the gut microbiome: implications therapeutic use of the ketogenic diet in autism in autism spectrum disorders. The ketogenic diet for the treat Purines and the Anti-Epileptic Actions of ment of childhood epilepsy: a randomised con Ketogenic Diets. In utero stasis in autism-spectrum disorders: evidence exposure to valproic acid and autism—a current from biochemical and genetic studies of the mito review of clinical and animal studies. Developmental regression and mito of association between autism and the mitochon chondrial dysfunction in a child with autism. Evidence for treatable inborn errors Gene x environment interactions in autism spec of metabolism in a cohort of 187 Greek patients trum disorders: role of epigenetic mechanisms. Dev Med Child of essential fatty acids on voltage-regulated ionic Neurol 36, 351–356. Mitochondria: major regulators of neural develop Mitochondrial dynamics and apoptosis. Neuronal glucose transporter isoform Mitochondrial abnormalities in temporal lobe 3 defcient mice demonstrate features of autism of autistic brain. While other organs use free fatty acids function in older age, is debilitating and dehu directly to replace insufcient availability of glu manizing, and is expensive to manage. To make cose, ketones (also known as ketone bodies) are matters worse, there is currently no efective treat the only signifcant alternative fuel to glucose for ment. The two ketones that replace glucose the development of antiamyloid medications, for the brain are beta-hydroxybutyrate and aceto there is no clear sign that this treatment strat acetate. As the decarboxylation product of aceto egy will be efective in the near future (Jack et al. An emerg one feature in common—that of improving brain ing literature is discussed here that provides sev energy metabolism in older people. Given that brain function is whereas the adult brain represents about 2% of acutely dependent on a constant supply of glucose adult body weight, it consumes about 20%–23% and oxygen, it is crucial to know whether latent of whole body energy requirements. We quan the brain, that is, that ketones played a physi tify the magnitude of glucose and ketone uptake ologically important role in the adult brain regionally throughout the brain. Clinical studies rather than simply being a pathological marker are underway to test the potential therapeutic of severe insulin deficiency in decompensated utility of ketogenic supplements based primarily type 1 diabetes. Here, we review the rationale not describe brain ketone uptake under less for these studies with the objective of highlighting extreme conditions, but shortly after their paper the main points supporting a strategy that impli was published, Gottstein et al. This method produced several ground showed that brain glucose uptake was impaired breaking reports comparing brain ketone and by 26% but that brain ketone uptake was still nor glucose uptake that laid the foundation for our mal (Table 15. In presymptomatic individuals with impaired oxygen uptake and lower blood fow to these aforementioned conditions in whom the the brain. Incidentally, in older people with cose, and further cognitive decline (Figure 15. Polycystic hypometabolism: ovary syndrome is a multifactorial endocrine v glycolysis v brain glucose uptake disease involving infertility, hyperandrogenism, and mild-to-moderate insulin resistance. Tese women with polycystic ovary syndrome were of nor Cognitive symptoms: mal weight and body-mass index, so this condi v memory v executive function tion represents a possible model of the impact of processing speed v mild insulin resistance on brain glucose metabo lism that is independent of age and obesity. Tese dysfunction that increases the risk of developing Alzh women also had borderline low-normal scores on eimer’s disease (from Cunnane et al. The increased supply of fatty acids enter problem is with brain glucose uptake, that is, its ing the liver leads to ketogenesis by condensation transport into the brain, or with glycolysis, that is, of two acetyl-CoAs, which are present in excess glucose metabolism within the brain, or both. Postprandial lism via glycolysis; either way, if uncorrected, the hyperinsulinemia inhibits fatty acid release from brain’s main energy source is compromised and it adipose tissue and ketogenesis, which is appro is at increased risk of chronic energy defcit and priate as long as insulin sensitivity and tissue eventual exhaustion. In fact, the energy supply glucose uptake are normal, that is, when and insu problem seems to be at the level of both brain lin returns to normal 3–4 hours postprandially. The essentially matches synthesis in normal weight human liver can produce ketones at a rate of 100– adults fasted overnight (Avogaro et al. The rapid is more than sufcient to account for the brain’s utilization of ketones as they are produced during ketone utilization even during prolonged star short-term fasting generally keeps plasma ketones vation. Exercise for 30 minutes has ketones is mostly supplied by gluconeogenesis, the little or no efect on ketone synthesis, utilization or rate of which parallels and may eventually actu clearance. Afer 3–5 days fasting, plasma ketones ally limit ketone production (Flatt, 1972; Garber rise about 10-fold due mainly to increased synthe et al. However, during extended fasting, free kinetic parameters, but synthesis may exceed uti fatty acids compete with ketones and become the lization, thereby raising plasma ketones a bit more main fuel for some tissues such as skeletal mus than in normal weight adults. In type 1 diabetes, cle, leaving most if not all of ketone production 12 hours of fasting increases plasma ketones about available to complement the available glucose in 10-fold more than in nondiabetic adults, but it is meeting the energy needs of the brain (Drenick not clear why, as utilization appears to keep pace et al. Ketone with synthesis, both of which are similar to values transport into tissues occurs via monocarboxylic seen in nondiabetic adults afer 12 hours of fasting acid transporters, of which there are at least six (Table 15.
The difference in relapse rates between the two groups was maximal at nine months generic 400mg skelaxin overnight delivery spasms rib cage, with the rate of relapse higher in the discontinuation group up to quality skelaxin 400 mg spasms medicine two years’ follow-up discount 400mg skelaxin fast delivery spasms lower stomach, but by 2 4 years the risk of relapse was higher in those continuing 36 treatment 400 mg skelaxin for sale muscle relaxant lorzone. Patients who experienced a relapse were followed up, and by three years 95% had a further one-year remission and by five years 90% had had a further two-year remission 37 period, indicating that the long-term prognosis was similar in both groups. A second remission may, however, take many years to achieve, while in an average of 19% the reintroduction of the medication did not control the seizures as before. Risk factors for subsequent poor treatment outcome were symptomatic partial epilepsy and 39 cognitive deficits. Despite the risk of seizure recurrence, patients may choose to discontinue treatment because 40 of the impact of continuing antiepileptic medication on quality of life. At one year seizure recurrence had occurred in 15% of the withdrawal group compared with 7% in the non-withdrawal group. The proportion of patients having completely normal neuropsychological findings increased from 11% to 28% in the withdrawal group while decreasing from 11% to 9% in the non withdrawal group. At 41 months’ follow-up, predictors of continued seizure freedom following treatment withdrawal were prior use of carbamazepine (approximately three-fold increase in likelihood of remaining seizure free compared with patients on any other drug) and a normal 40 neurological examination. Prognosis following epilepsy surgery Only two randomised controlled trials have compared the outcomes of patients with temporal 41,42 lobe epilepsy randomised to either surgery or continued medical treatment, the latter study being of somewhat limited value due to difficulty recruiting suitable patients for inclusion in 42 the study. In the earlier study, 80 patients with temporal lobe epilepsy were randomised to have either epilepsy surgery or continued medical treatment for one year. A total of 90% of patients in the surgery group underwent surgery with 64% free from seizures impairing consciousness (42% completely seizure free) compared to 8% (3% completely seizure free overall) in the medical group at one year. Quality of life was also improved in patients after 41 surgery compared to patients in the medical group (P < 0. In a recent review of controlled studies (total 2734 patients, all but one study non-randomised) 44% of patients in the surgical group (mainly temporal lobe surgery) were seizure free compared to 12% with medical treatment only. Moreover surgical patients were four times 43 more likely to be able to discontinue medication compared to non-surgical patients. The longer a person remains seizure free the less likely they would relapse, while conversely the longer seizures persisted post-operatively the 44 less likely seizure remission would be achieved. In summary, in appropriately selected patients, surgery is four times more likely to render patients seizure-free than medical treatment alone. A recent series of papers suggests, however, that such a view is overly pessimistic. In a retrospective analysis of the effect of 265 medication changes in 155 patients with uncontrolled epilepsy of at least five years’ duration, 16% of all patients were rendered seizure free (12 months or more) following a drug introduction while a further 21% had a significant reduction of seizure frequency. In another study a group of 246 patients with refractory epilepsy was followed for three years. Patients with mental retardation were statistically less likely to achieve a remission. The probability of seizure relapse following remission was retrospectively studied in a cohort of 186 patients with intractable epilepsy who were followed for a median of 3. Overall 20 patients achieved a remission of 12 months with a 4% probability of remission per year. Of these, five subsequently suffered a relapse with the estimated cumulative probability of relapse 33% at two years and 44% at three years. In summary, approximately 4 5% a year of those with refractory epilepsy will achieve a remission of 12 months on medication, although more long-term follow-up demonstrates that 48 approximately one-half will subsequently relapse. Conclusions the overall prognosis for people with newly diagnosed epilepsy is good, with 60 70% becoming seizure-free, many of whom doing so in the early course of the condition. The probability of obtaining seizure freedom is particularly high in those with idiopathic generalised epilepsy and normal neurological examination. Despite this, medical changes will achieve a remission of 12 months in 4 5% a year of those with seemingly intractable epilepsy. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence. Seizure recurrence in adults after a newly diagnosed unprovoked epileptic seizure. Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study. Remission of seizures in a population-based adult cohort with a newly diagnosed unprovoked epileptic seizure. Long-term medical, educational, and social prognoses of childhood-onset epilepsy: a population-based study in a rural district of Japan. Natural history of treated childhood-onset epilepsy: prospective, long-term population-based study. Course and outcome of childhood epilepsy: a 15-year follow-up of the Dutch Study of Epilepsy in Childhood. Early seizure frequency and aetiology predict long-term medical outcome in childhood-onset epilepsy. Seizure clustering during drug treatment affects seizure outcome and mortality of childhood-onset epilepsy. Does the cause of localisation-related epilepsy influence the response to antiepileptic drug treatment
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