RESUMO
Although sudden unexpected death in epilepsy (SUDEP) is the most feared epilepsy outcome, there is a dearth of SUDEP counseling provided by neurologists. This may reflect limited time, as well as the lack of guidance on the timing and structure for counseling. We evaluated records from SUDEP cases to examine frequency of inpatient and outpatient SUDEP counseling, and whether counseling practices were influenced by risk factors and biomarkers, such as post-ictal generalized EEG suppression (PGES). We found a striking lack of SUDEP counseling despite modifiable SUDEP risk factors; counseling was limited to outpatients despite many patients having inpatient visits within a year of SUDEP. PGES was inconsistently documented and was never included in counseling. There is an opportunity to greatly improve SUDEP counseling by utilizing inpatient settings and prompting algorithms incorporating risk factors and biomarkers.
Assuntos
Biomarcadores , Aconselhamento , Eletroencefalografia , Epilepsia , Morte Súbita Inesperada na Epilepsia , Humanos , Fatores de Risco , Masculino , Feminino , Adulto , Epilepsia/epidemiologia , Epilepsia/terapia , Biomarcadores/sangue , Pessoa de Meia-Idade , Morte Súbita Inesperada na Epilepsia/epidemiologia , Morte Súbita Inesperada na Epilepsia/prevenção & controle , Adulto Jovem , Adolescente , Criança , IdosoRESUMO
For more than 20 years, the American College of Physicians (ACP) has advocated for the need to address firearm-related injuries and deaths in the United States. Yet, firearm violence continues to be a public health crisis that requires the nation's immediate attention. The policy recommendations in this paper build on, strengthen, and expand current ACP policies approved by the Board of Regents in April 2014, based on analysis of approaches that the evidence suggests will be effective in reducing deaths and injuries from firearm-related violence.
Assuntos
Política de Saúde , Violência/prevenção & controle , Ferimentos por Arma de Fogo/prevenção & controle , Armas de Fogo/legislação & jurisprudência , Homicídio/prevenção & controle , Humanos , Papel do Médico , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade , Prevenção do SuicídioRESUMO
The evaluation of new seizures is a common clinical query for neurologists. It can be challenging to delineate between the numerous etiologies of new focal or generalized seizures and, if focal, to localize their onset. In this case report, we present a 26-year-old patient with a new onset of stereotyped events concerning for seizures featuring facial grimacing, dystonic left-hand posturing, and convulsions with immediate return to baseline. Throughout the case, we highlight a stepwise diagnostic approach to the evaluation of new-onset seizures, discuss clues that seizure semiology can provide for localization of ictal onset, and review a novel and atypical presentation of a disease entity frequently encountered by neurologists.