Neuro 4 Seizures,Headache, Itis etc Leah Kelly Future Will use more agents to salvage cells and elim

oxygen derived free radicals So use scavengers and antioxidants glutamate antagonists Nerve gro!th factors and do neural trans"lants Kee"ing core #ody tem" under $% degrees for %4 hrs Neuroscience Futures &s noted "reviously less invasive, less time 'a" out #rain areas and use "ro#e &lso using laser and gamma (nife for radiosurgery )* shunts are im"regnated !ith anti#iotics to guard against infection valve "ressures can #e re"rogrammed Im"lanta#le devices No! many "rogramma#le devices to deliver analgesics or antis"asmodics to +SF , mor"hine- or .aclofen , s"asticity+an "lace a remote control over s(in to titrate dose &lso loo(ing at im"lanting neurotro"hic gro!th factors &lso doing visual / auditory im"lants in areas of #rain !here deaf or #lind Seizures Initially thot victims sacred then "ossessed No! as chronic disorder of recurrent electrical discharge Seizure is transient change in #ehavior r0t discharge of certain neurons 1enetic, develo"mental, trauma, +NS infection, &)', tumor, stro(e, degenerative disease 2%34 #illion cost in direct0indirect costs 256 of "o"ulation !ith one seizure in lifetime Seizures 26 of "o"ulation as a result "atients have emotional and social stressors and monetary #urden Family mem#ers !ith fears still in closet No! as many in over 75 as *edi &n ele"togenic focus activated #y tem"erature change, hy"oxia, decreased sodium, decrease sugar, light stimulus 8"ile"sy defined Syndrome of recurrent un"rovo(ed seizures Seizures are sudden e"isodes of neurological dysfunction caused #y a#normal #rain electrical activity %4 different (inds &lso are "sychogenic seizures Hysteria, rarely cry or laugh or thrust If you can sto" a lim# #y holding not neuro 8yes are o"en in real seizure if eyes shut !onder

Seizures are stereoty"ical Seizures $ grou"s Well controlled so 9ust !atch not too much meds !atch side effects 456 'oderately controlled $56 Not controlled no matter !hat com#ination So for some the issues are grave Ho! to chart a seizure *rodromal "hase oft a!ait it is coming headache, aura, tingly, irritated &ura smell, light, sound, automatism hel"s localize 8"ile"tic +ry from the air movt related to an a#dominal s"asm Ictal !hat ha""ens in seizure *ost Ictal !hat ha""ens after the seizure *atho"hysiology of seizures Some trigger causes #urst of electrical stimulation :isru"ts normal nerve conduction via a#normal de"olarization 'alfunction of hy"ersensitive neurons in cortex and oft lim#ic system !here more hy"ersensitive neurons *atho"hysiology of seizures 'alfunction of hy"ersensitive neurons in cortex and oft lim#ic system !here more hy"ersensitive neurons Stimulus is "hysiologic odor, music, noise, startle, ;), lights So medical management !ill eliminate focus either meds, surgery Seizure ;erms ;onic state of muscular contraction 0or rigidity voluntary muscles contracted< #ody stiff, rigid, !ould fall to floor cry cyanotic, 9a! fixed *u"ils are dilated, fixed and this lasts 2 minute +lonic s"asmic alternation of rigidity and relaxation "roducing rhythmic movements time !hen incontinent and #it tongue seem to fla" or move a#out Seizure ;erms 1eneralized all over #ody Focal 9ust in 2 localized area Ictal the seizure so then "re and "ost ictal =sed to tal( of aura, "sychomotor, convulse No! (no! aura is a sim"le "artial seizure that "rogresses into a different ty"e Seizures >ne seizure does not ma(e a diagnosis of e"ile"sy 8"ile"sy is a recurrent seizure "resentation 256 of "o"ulation !ill seize once and never again exam"le in 8;>H !ithdra!al, tumors, liver and (idney "ro#lems, hy"oxia, hy"oglycemia, lo! sodium, lo! calcium, lo! magnesium &lso sedative !ithdra!al

Severe slee" de"rivation ;he danger of seizures Increased need for &;* and oxygen !hich is ra"idly de"leted ;hen get #uild u" of lactic acid 'a9or hy"oxia !h leads to <<< .rain gets de"leted So in those areas ??33 :ifferent "resentations :e"ends on area of #rain motor, sensory, emotional, #ehavioral, "erce"tual 'ay0not lose consciousness ;em"oral< "sychic, hallucinations, motionless, oral automatism, laughing s"ells, #elching, a"hasia, confusion, unilateral t!itching Frontal (ic(0thrash, head0eye aversion, a"hasia, dizzy and staring, "osturing :ifferent "resentations *arietal severe vertigo, nausea, num#ness, tonic u""er lim#, tingling, loss of #ody a!areness >cci"ital #lurred vision, seeing colors, eye #lin(ing, nystagmus, visual hallucination ;!o ty"es Sim"le *artial occur in @46 focal, localized neuron discharges in only 2 "art of #rain No loss of consciousness often #rief, "t a!are of environment >ften seems li(e aura !eird ache, noise 'otor have 9ac(sonian march Somatosensory olfactory or auditory *sychic dA9B vu or fear Sim"le "artial *artial or 1eneraliized +om"lex "artial L>+ is im"aired may #egin a sim"le and "rogress 1eneralized a#normal discharge s"reads from 2 hemis"here to another involves entire cortex all #rain loss of consciousness Sim"le *artial Sim"le no loss consciousness one area #rain 'otor, sensory, mixed, autonomic oft is motor !ith turning, "osture change and sensory !eirdities a!a(e, arm moves "iloerect >ld Cac(sonian !as a focal motor seizure that marches thru a motor segment0dermatome *artial #ut motor, sensory or other changes that involve a larger area if "osterior frontal lo#e !ould seen motor involvt of o"" side??if anterior "arietal then in sensory cortex !ith no motor *resentation +om"lex *artial ;his is most common ty"e in adult

&lt consciousness !ith some memory loss Fum#le, "ic(, clinically manifest the site firing &utomatisms, motor activity Last 24 secs to $ minutes ;em"oral lo#e is one su#set of this of get a somatosensory "henom Secondarily generalized #egin as sim"le or com"lex "artial seizures then generalized to #oth sides of the #rain ;his is the aura !h then #ecomes something else :onDt !a(e u" so fast from this "ost ictal confusion 8x"ect some focal motor deficits often on the left side "ost seizure Last $5 secs to 2%5 secs *rimarily generalized Im"aired consciousness no mal or aura +ognitive confusion, &ffect strange #ehaviors *sychosensory automatisms or "sychomotor che!, smac(, stereoty"ical !eirds 1eneralized means !ides"read involvement of #oth hemis"heres &#sence, myoclonic , shoc(y 9er(s-, clonic, tonic clonic, atonic ,loss of tone*etit 'al or &#sence =sually seen in childhood rarely last longer than 25 secs .ut also seen in adults &#ru"t loss of consciousness during !hich ongoing activity is sto""ed Cust s"ace out some!here else 'ay thin( have learning disa#ilities ;onic +lonic 1rand 'al >nly 256 are this ty"e :uration usually a#out $ minutes in tonic are stiff0rigid then follo!ed #y clonic 9er(ing !hen are cyanotic and a"neic +an occur daily, monthly or yearly Lasts % 4 minutes and then are "ost ictal or unres"onsive +ould slee" for several hours &l!ays tired, de"ressed / confused after!ard 1rand 'al ;onic "hase shrill cry !ith rigidity, o"isthotonos, arms extended, "u"ils dilated and unreactive, decreased heart rate +lonic "hase #egins and ends suddenly Euic( #ilateral 9er(ing movements that last only a minute or so *ost Ictal 'uscles flaccid, consciousness returns gradually, amnesia a#out seizure 'yoclonic / &tonic 'yoclonic Short single a#ru"t muscle contractions &tonic loss of muscle tone and dro" to floor so ris( for in9ury *seudoseizures +linical "resentations of seizure li(e #ehavior not accom"anied #y a#normal 881s

>ft seen in "sych hx of !ith a#use, #ulimia >ft triggered #y stressful situations usually only !hen others "resent oft "elvic thrusting, crying, disoriented >ft hard to diagnose may occur !ith e"ile"sy :o not #ecome incontinent *seudo or *sychogenic seizures % not necessarily under voluntary control the secondary gain is not al!ays a""arent ;hese "ts need anxiolytics and antide"ressants High correlation to "hysical and sexual a#use 'ay also have real seizures &fter real seizures !ill have very high "rolactin levels if dra! #lood !ithin 24 minutes Status 8"ile"ticus '8:I+&L 8'8F18N+G +ere#ral meta# rate is $ 4Hnormal so get edema No recovery to #aseline so continual discharge and #uild u" of acidosis 1et a line ,NS- and air!ay stat did "t ta(e meds 1et lytes, .=N, glucose, &8: drug levels, tox screen Longer it lasts more use of glucose more danger of I+* Status &ctivity lasts $5 minutes could #e tonic clonic or even "artial, sensory, a#sence >ft ha""ens !ith sto""ing of anticonvulsants +lear air!ay turn to side "re"are to intu#ate 'eds for Status 8"ile"ticus &tivan ,loraze"am,- occasionally )alium or "heno#ar# also may#e muscle #loc(ade &tivan #etter than valium coz less li"id solu#le and longer half life drug of choice 4 mg I) :ilantin is not sedating #ut can irritate and give this after the #enzo hy"otension, Seizure meds +ere#yx fos"heytoin !hich #ecomes :ilantin in 24 min #ut can give faster than :ilantin #ut no local irritat #eyond "erineal "aresthesias %5 mg0(g at 245 mg0min Fe#rile +onvulsions Seizures that occur during e"isodes of high fever often in early childhood See in 46 of all (ids If localized and last longer than $5 minutes increased ris( of e"ile"sy +an "revent !ith anti"yretics 8;>H !ithdra!al In $$6 of heavy drin(ers @ $5 hrs " sto" 8;>H Will continue 4Ihrs :; $ 4 days J !ith agitation, hallucinations / autonomic insta#lity Will give )*& #ut not effective 8lderly Highest incidence of ne! onset

&fter stro(, head trauma, dementia, 8;>H 'onothera"y at lo! doses Ho! does med affect "t Seizure +ausation From +NS infections, oral a#cess, neurosurgery, ear infections .rain trauma contusions, lacerations, hematoma >ften first sign of #rain tumors cause irritation to cortex >ft occur in clusters from drug induction, concurrent illness So a seizure !or(u" &ll get same testing HH !hat are "reci"itants fever, in9ury, slee" de"rivation, drugs, hy"erventilation 1et +;, S(ull H ray, #lood glucose, lytes, calcium , 881 to locate focus and identify ty"e >ften !ill need to go to an e"ile"sy monitoring un it ;ime synched digital video !ith a digital 881 Seizure +are Never leave alone and "rotect from in9ury *rovide "rivacy If out of #ed ease to floor and "rotect head Loosen clothing roll to side to "revent as"iration :onDt force air!ay ;hen remain calm and reorient +harting in Seizure >nset !hen, !hat doing, !hat accom"anied, automatisms, cry etc :uration exact timings, !hen head turned, !hen "ost ictal, incontinent 'otor activity "rogression, rigidity, 9er(ing, eyes and tongue L>+ is arousa#leK +an tal(K :istracti#leK *u"ilsK ;eeth clenchedK Fes"irationsK +ontinenceK ;hen note changes for su#seLuent timeframe Seizure 'eds &8:s &ll sta#ilize cell mem#rane #y altering trans"ort of Na, K, +a Feduce res"onse to incoming stimuli, reduce s"read, etc Need holistic a""roach to find the #est ;hin( (inetics, side effects, serum levels, half lives Worry a#out Status 8"ile"ticus in "regnancy and times of stress &ll < dro!siness, sedation, allergy, 1I u"set Ne! meds oft so story !ill change .asic 'eds 1rand 'al :ilntina, ;egretol, :e"a(ene, *heno#ar# ,generics*heno#ar# is dulling &#sence 8thosuximide, :e"a(ote, Klono"in +om"lex0Sim"le *artialM ;egretol, :e"a(ote, :ilantin ;rile"tal, Ke""ra, Nonegran >ft large loading doses give til get side effects !atch serum levels Loo( at #lood level correlated !ith clinical res"onse &nticonvulsants

What has least side effects Ne! variants !ith less effects :ilantin< ne! Fos"hentoin :ilantin !ith #ig gums, hairy, thic( s(in ;egretol no! extended relief HL 'ysoline, :e"a(ene, :e"a(ote, Klono"in, Narontin, 1a#a"entin, Lamictal 'ysoline:e"a(ote is good for all of the seizures #ut hair loss and !eight gain Ne!er 'eds Lamictal augmenting, !orry Stevens Cohnson syndrome Sto" at first sign of rash 1a#a"entin Neurontin also for "ain, mood, fe! drug drug interaction ;o"iramate ,;o"amax- mess !ith cognition, s"eech ;rile"tal li(e ;egretol #ut not autoinduction so stay more clear, no "445 enzymes +an ta(e .iaxin *otiga Seeing more no! than older ones *otiga ,ezoga#ine- <"otassium channel agent3 &lso !or(s on amma amino #utyric acid ,1&.&- is an inhi#itory neurotransmitter that may hel" su""ress seizure activity3 *otiga is s"ecifically indicated as ad9unctive treatment of "artial onset seizures in adults3 Ke""ra =sing a lot does have a lot of side effects :e"ression is a #ig one No need for levels vim"at )im"at is an orally availa#le anticonvulsant3 It selectively enhances slo! inactivation of sodium and ,+F'* %-3 )im"at for "artial onset seizures in "atients !ith e"ile"sy aged 2@O3 )im"at oral and I) Seizure meds 'ost have levels and need to #e monitored closely :ilantin 25 %5 mg0ml ;egretol 7 25 :e"a(ote 45 255 'any hit at !#cs, chec( this in your med #oo( Interventions in seizures 'ay do surgery resect the area, cut the cor"us callosum or ma(e little cuts into cortex 46 !ill need a#lative surgery to destroy focus .ut for N=FSIN1 Femove o#9ects, loosen clothes, (ee" flat, "rotect head, maintain air!ay *rovide "rivacy, chart it all 'a(e sure suction availa#le, I) access, >% Seizure interventions

Stay calm and chec( for medi alert #racelet ;ime the seizure &#sence time and re"ort ;onic clonic turn on side and cushion head remove glasses and o#9ects :uring Seizure *lace on side to "revent as"iration Head tilt chin lift maneuver to facilitate air!ay "atency Nothing in mouth if arrive after seizure #egins ;onic clonic Note "osition *atient 8ducation *atients and family mem#ers Feduce exacer#ating factors 8;>H, stress, consti"ation, diarrhea, slee" de"rivation, flashing lights Non com"liance !ith meds canDt drive unless seizure free for 2 year ;each family !hat to do "rotections 1o to 8F if "rolonged seizure activity maintain seizure calendar >n admission &s( !hat seizure is li(e :id you ta(e your meds today ho! !ell are you controlled Let me (no! if feel aura, or "rodromal Ho! !ould you "ad rails &ir!ay at #edside Feduce stimulation 8"ile"sy 8valuation Loo( at medical Hx3, freLuency / character of seizures +ontinuous 881 monitoring, drug levels, scans and neuro"sych Slee" on #lue sheets !ith continuous monitoring >ft monitor tech to !atch 0family 'ay !ithdra! &8:s antie"ile"tic drugs "lace s"henoid electrodes, +;, 'FI, S*8+;, W&:& +ontinuous 881 >ver %$ scal" electrodes held on !ith colloidin no crPme rinse >cc im"lant su# s(in in s"henoid area ;hen :+ or ta"er seizure meds get to hy"erventilate or exercise Neuro"sych eval c hand eye memory, conc, attent, s"atial So also !ill need #aseline cognitive function in case of loss "ost o" Im"lications So you never leave then alone centers have cameras :riving restrictions must #e 2 $ years seizure free No s!imming alone, !atch #i(e, "o!er tools Sho!er vs3 tu# 'edic alert &void alcohol, avoid coffee, !atch fatigue, consti"ation Seizure Surgery % million &mericans are victims

2022 !ill have a seizure sometime Surgery is o"tion for 25 %46 of "artial seizure ty"es es"3 tem"oral lo#e Will locate seizure focus to see if can safely resect =su3 done at com"rehensive e"ile"sy ctr3 )agal Nerve Stimulator *acema(er li(e "ulse generator !hich gives intermittent stimulation %4 hrs day0 on $5 secs off 4 min .attery life of I 2% yrs Seems to sto" the seizure via retrograde stimulation ;hey can activate it on demand !hen ex"erience and aura Ketogenic diet Ketosis as formation of (etones so this diet maintains this as in &t(ins to alter use of car#s as #ody fuel Seems to "revent seizures in some (ids +oming 8arly !arning devices that monitor #rain for change leading to seizures 8"ile"sy +ontrol System 'edtronic closed loo" systems !ith microchi"s to analyze li(e "acer li(e I+:s tiny eeg !hen see a#norm activity send message to ant nucleus in thalamus so this !ill send counte!aves via electrodes In trials S&N;8 trial Infections .acterial, viral, fungal, "arasitic +lass #y !here occur or #y ty"e of organism &ll itises are diffuse #rain issues so have generalized sym"toms Watch for I+* from increased #lood volume increased tissue #ul( +an come on ra"idly or more slo!ly +are in itises Isolate the "ro#lem and give anti#iotic or antiviral on time &ssess / treat for I+* cool, hy"erventilate, oxygenate *rotect from in9ury Linen changes, fluid 0lyte status Isolation Watch com"lications #edrest !atch for "osturing :ar(, Luiet room , meningeal irritation 'eningitis Is inflammation of meninges !ith s!elling, change in neuro signs Inflammation of arachnoid, "ia, dura If hit #rain then also cord coz meninges Ho! does organism get in #lood, trauma, mouth, nose colonizes #y dro"let or contact .acterial or viral >nce form exudate inflames and changes arteries 'eningitis 'eningitis 2Q255,555 can #e ra"idly fatal des"ite anti#iotics college students high ris( *ro"hylax close contacts !ith rifam"in, ci"ro or ceftriaxone

Ne! meningitis vaccine tetravalent 'enactra 'eningitis medical emergency <can #e fatal es"3 if #acterial !ho""ing anti#iotics Loo( for signs of I+* < fluid lea(s from dilated vessels "ressure sho!s as headache, N/), res"iratory change, "u"il change, ocular movements &lso see confusion, hallucinations, delirium &ny ne! "legia, "aralysis, chec( muscle tone 'ore 'eningitis >ften a "etechial rash Signs of meningeal irritation Nuchal rigidity *hoto"ho#ia >"isthotonus Kernig KernigRs sign "t is flat flex thigh and get hamstring s"asm as leg cannot extend .rudzins(i .rudzin(i sign hold chest do!n, elevate head do cruncher and thighs flex at hi" &gain meningeal assess Loo( for meningeal signs *hoto"ho#ia >"isthotonos *etechial rash .rudzins(i Kernig .acterial 'eningitis 'ost commonly in childhood serious and lethal in 2st year Hard to "ic( u" &ny #acterium is causative #ut orgs are "articular to age S/S vary !ith age, organism, duration +ommunica#le til no cocci "resent in discharge .acterial meningitis SH vague irrita#le, vomit, lethargy, anorexia, fever headache, ; 252 25$, confusion may seize need anti#iosis immediately anti"yretic coz shiver increases #rain meta#olism 'a(ing :x of #acterial 'eningitis *neumococcus +SF "ressure is elevated / too cloudy +SF !ill have "rotein, increased W.+s, decreased sugar Need s"eed of treatment can die !ithin I 2% hrs &nti#iotics< hi doses and give on time Fifam"in or other that crosses #lood #rain #arrier )iral 'eningitis &lso called ase"tic usu $ days "rodromal >ft is +oc(sac(ie or oral0fecal s"read

See headache, fever, normal glucose in +SF No meds here although K Symmetrel, Noviraxes Intervention )iral 'eningitis or .acterial comfort for restless, irrita#ility, "hoto"ho#ia "rivate room if #acterial !hat is an isolation room limit visitors, little movt s"ace activities, sedate &deLuate nutrition and fluids ma(e sure I) is on time *o"sicleRs, !t, I/>, lytes su""ortive care rest and slee" SeLuelae meningitis if viral it is su""ortive care seLuelae otitis, hydroce"halus, deafness, retardation, seizures )accine 'eningitis )accines r ; cell inde" stim mature lym"hocytes Ne! vaccine is 'enactra and still is 'enomune hits most of grou"s #ut no good in (ids under % 2 su# E dose 534 ml can get "ain at site 8nce"halitis can #e viral, #acterial, fungal, "arasitic most viral fulminating fe#rile disease rare #ut fatal )iral as !estern eLuine, "olio, cytomegalo, +oc(sac(ie, her"es ence"halitis her"es as "rimary, re infection or activation of latent infection her"es in aids "atient 456 SH !orse if older or cold climate %46 of "o"ulation have HS) 2 as a cold sore attac(s "reci" #y stress, fever, sun, etc 8nce"halitis :N& from #ody fluids re"licates in cell nucleus can #e localized or travel ;a" #acterial is clouded viral is clear initial +; !ill #e negative 4 days !ill get mass effec :H of 8nce"halitis HS) virus no! v is "olymerase chain reaction test to +SF may see increase "rotein and increased +SF "ressure ;H of viral ence"halitis need to treat &S&* to "revent neuro damage I) acyclovir for @ 24 days early ;x !ill result in survival can still get com"lications and residual damage headache, fatigue, tremors, seizures ma9or nsg :x is altered cere#ral tissue "erfusion may :ilantin load to !hy Her"es ence"halitis HS) latent in trigeminal nerve

travels to middle / ant #rain in tem"oral and or#ital cortex lyses neuron 0 alters mitochondria, (ills cell get hemorrhage, cere#ral edema, I+*consciousness / "u"il change, delirium, coma < herniation signs de"end on area of #rain infected Her"es ence"halitis initially loo( li(e flu< headache, malaise, fever / vomiting memory im"airment / "ersonality change if get frontal lo#e dementia from degeneration of nerve cells !ith cognitive slo!ing tem"oral lo#e !ith terror, auditory, visual or olfactory hallucinations,ne! aggression seizures, hemi"aresis, a"hasia, visual field defects Headaches Gour does this !ell so read it text ;ension :ull achy, #ilateral tight head and nec( Start slo!ly, middle of day a stress headache 'ild mod to severe muscle contraction *'S, middle age, remove source of stim >;+ "re"s !or( !ell also heat, ice"ac(, sho!er, slee", exercise Headaches +luster headache Fare, more common in men, starts suddenly *ain #ehind eye, excruciating Nose and eye on side get red, s!ollen Last a#out 44 mins same time each day for 4 I !ee(s Fun in family in a cluster "eriod r0t smo(ing &lcohol can exacer#ated 8yes #ulge even !ith "tonsis &utonomic features ;reat !ith meds and a shot or inhalation med Infovin, Lithium, .eta#loc(ers Headache as Inflammation see 'igraine Lots of ne! stuff here and ne! meds #oo( is out of date changes in serotonin !hen hi vessels shrin( !hen lo!, vessels s!ell and cause "ain 'igraine oft under treated and underdiagnosed hard to ma(e :x 'igraineurs +hronic disease @56 have genetic association usu #egins in childhood or adolescence "ea(s in mid 45Ds 'a9or im"act on !or(ers 'igraine syndrome of "rolonged "ainful headache and disa#ling autonomic sym"toms !ith nausea / vomiting

;hro##ing, dull "ain on one or #oth sides ;ummy ache or vomit &nnoyed #y noise, light, smells, ;ired, confused, stuffy nose Stiff nec( :izzy +lassic !ith aura, of 24 or so minutes, common do not 'igraine 'nemonic Sultans Severe =nilateral ;hro##ing &ctivity !orsens With Nausea With light sensitivity &ura< reversi#le, gradual, 'igraine "ain Sym"toms of 'igraine *rolonged "ainful headache !ith eLually disa#ling autonomic Sx3 li(e N/) With or !ithout aura or "rodrome Without aura most common unilateral "ulsatile , "hoto"ho#ia, hy"er react to sound and smell *rodrome os de"ression, eu"horia, irrita#le, restless, still 'igraine !ith aura )isual distur#ance !ith scintillating lights or scotoma, hemi"aresis, hemisensory issues, a"hasia ;riggers are caffeine, stress, lac( of slee", exertion, menses, 8;>H 'igraine tt"Q00!!!3youtu#e3com0!atchKvMyNrSCoeI4!g htt"Q00!!!3youtu#e3com0!atchKvMl1C%HFC.H'I ;riggers of migraine &ged, cured meat hot dogs, lunch meat &ged cheese Fed !ine &s"artame &vocado .eans +affeine, chocolate Sour cream, #uttermil( Figs, 'S1, nuts, "eanut #utter >nions, "a"aya *assion fruit, "ea"ods >lives, "ic(les Faisins, red "lums Sauer(raut

Sno! "eas Soy sauce *athogenesis of 'igraine $ different theories "ro# a #it of all $ )ascular< !ith reactive "ainful vasodilation, "erivascular inflammation Neurogenic inflammation neuro"e"tide released to "erivascular inflammation =nsta#le serotogenic neurotransmission serotonin is an inhi#itor and stim rece"tors "ro#a#ly leads to release of inflammatory mediators 8ffect of drug over usage Narro! !indo! 9ust at headache onset that migraine meds !or( If miss this then !ill #e in futile catch u" mode ;hen get refractory headache !h is chronic re#ound, or daily headache &lso get tolerant to the sym"toms and the meds Non *harmaceuticals Fi#oflavin ,455mg-, chelated magnesium, Feverfe! Slee" and meals, #iofeed#ac(, massage, acu"uncture, hy"nosis 'gmt drugs *ro"hylactic agents M antagonists of 4H; serotonin sta#ilize ions, inflammation &#ortive agentsMagonists of the rece"tors Need early treatment / high enough dose So Narcotic analgesics, NS&I:3 8rgot get re#ound must ta(e immediately and can coz nausea :H8 dihydroergotamine < venoconstrictor T a long half life / no ris( of addiction or re#ound Will soon #e availa#le as a nasal s"ray &#ortive ;hera"y in 8F I) ;oradol I) ;horazine I) :H8 ergot S+ Imitrex *henergan or +om"azine ;ri"tans / .eta .loc(ers No! 4 of them 4H;2.02: agonists )asoconstriction su""ress nause, confusion Sumatri"tan, Imitrex-,Nolmitri"tan, ,Nomig-Fizatri"tan , 'axalt-, Naratri"tan ,&merge-, &lmotri"tan ,&xert-, Fravatri"tan ,FrovaFel"ax and &xert are long acting . #loc(ade Inderal LS &nticonvulsants ;o"amax may#e )*&, Neurontin ;ri"tans Li(e Imitrex this is a 4 H;2 agonist that is nonsedating oral, su#L, or in9ect :oesnDt modify cere#ral flo! Has intrinsic antiemetic effect Wor(s in minutes @56 recover in 2 hr I56 in % hrs

:onDt have to ta(e early and give after aura !hen "ain #egins Wor(s on "ain, N/), "hoto"ho#ia = stay alert, no re#ound headache ;ri"tans +anDt use these in +&:, H;N or those on SSFI coz !ill get serotonin syndrome Some are ta#s, others dissolve Naratri"tan has a long half life and fe! side effects >ther meds +odeine0fiorinal are out of date and dangerous Narcotics are only moderately effective and sedating &ctually increase nausea .eta .loc(ers Not good for "ro"hylaxis :e"a(ote No! a""roved for "ro"hylaxis coz is a 1&.& agonist reduces do"amine, ;o"amax ;etanus life threatening #ut com"letely "reventa#le usu "uncture !ounds and lacerations usu in elderly in non immunized incu#ates %O !ee(s clostridium tetanii gram "ositive, s"ore forming anaero#e soil0dust 0!ater "roduces neurotoxin that causes s(eletal muscle hy"ertonicity ;etanus % enters thru !oundM s"ores can lie dormant til activate to "roduce a tetanolysin !h affects the autonomic NS !ith cardiac dysrythmias, unsta#le .* and "ro#lems of "ulse and fever tetanos"as"asmin #loc(s neurotransmitter &+H / disinhi#iting the s"inal cord reflex arcs so that you get uncontrolled tetanos"asms ;etanus % o"isthotonus from s"asm of #ac( and nec( canRt ma(e enuf anti toxin so must have immunization loc(9a!, hy"er rigidity, hy"erreflexia, dys"hagia, 1I dysfunction, cardiac dysrythmias ;etanus $ air!ays < laryngos"asm com"romise in res" failure, thus lungs at issue may need intu#ation / #enzodiaze"ines to give neuromuscular #loc(ade also give ;acrium neuromusc #loc(ing agent and (ee" "aralyzed same idea of dar(, non simulating environment, analgesia and anxiolytics ;etanus $ since affects sym"athetic NS !ill get unsta#le rate, rhythm / fever !atch immo#ility, de#ride !ound tetanus immune glo#ulin $55 units I' at intervals to neutralize any toxin left in #ody

idea is #ooster E 25 years for life .rain a#cess residue or infection, meningitis, ence"halitis