Neurological disorders episodic

Clozapine also has been shown to benefit schizoaffective and bipolar patients with treatment-refractory mania ( 54) patients with Parkinson s disease and those with other neurological disorders with psychoses, such as Huntington s disease. Although clozapine has been shown to be an effective agent in the elderly, its usefulness in this population is limited because of its anticholinergic, sedative, cardiovascular, and potentially toxic effects on the bone marrow ( 55). In a study of 12 elderly female psychotic patients on clozapine (maximal daily dose, 300 mg), for example, five were taken off clozapine because of postural hypotension, one had a nonfatal episode of agranulocytosis, and one had leukopenia ( 56). 

Epilepsy is a chronic neurologic disorder characterized by recurrent seizures.33 Seizures are episodes of sudden, transient disturbances in cerebral excitation that occur when a sufficient number of cerebral neurons begin to fire rapidly and in synchronized bursts.42 Depending on the type of seizure, neuronal activity may remain localized in a specific area of the brain, or it may spread to other areas of the brain. In some seizures, neurons in the motor cortex are activated, leading to skeletal muscle contraction via descending neuronal pathways. These involuntary, paroxysmal skeletal muscle contractions seen during certain seizures are referred to as convulsions. However, convulsions are not associated with all types of epilepsy, and other types of seizures are characterized by a wide variety of sensory or behavioral symptoms. 

Neurological adverse effects of ciclosporin have been reported in up to 39% of all transplant patients. Most are mild. The most frequent is a fine tremor, the mechanism of which is not known. From many case reports or studies in transplant patients, the pattern of ciclosporin neurotoxicity ranges from common and mild to moderate symptoms, such as headaches, tremors, paresthesia, restlessness, mood changes, sleep disturbances, confusion, agitation, and visual hallucinations, to rare but severe or hfe-threatening disorders, including acute psychotic episodes, cerebellar disorders, cortical blindness (permanent in one report), spasticity or paralysis of the limbs, catatonia, speech disorders or mutism, chorea, seizures, leukoencephalopathy, and coma (SED-13,1124) (SEDA-16, 516) (SEDA-17, 520) (SEDA-20, 343) (SEDA-21, 383) (17-19). 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

Epilepsy (or epilepsies, since markedly different clinical entities exist) is a common neurological abnormality affecting about 1% of the human population. Epilepsy is a chronic, usually life-long disorder characterized by recurrent seizures or convulsions and usually, episodes of unconsciousness and/or amnesia. Table 32.1 illustrates the major types of epileptic seizures. Patients often exhibit more than one type. In most instances, the cause of the seizure disorder is not known (idiopathic epilepsy), although trauma during birth is suspected of being one cause. 

The acute or acute recurrent form can be equated with the manifestation of portosystemic encephalopathy in chronic liver disease. It is also known as acute episodic form . Discrete psychometric disorders usually precede the manifest picture as a latent stage. Manifestation includes stages I-IV and hence covers a wide spectrum of clinical, neurological and psychopathological symptoms. Once the liver function is stabilized and the trigger factors are eliminated, all the symptoms of this form are as a rule reversible. 

Wilson s disease often involves low plasma levels of ceruloplasmin, increased plasma nonceruloplasmin copper, and increased urinary copper. The disease can involve a tenfold increase in liver copper lev els. The normal value for hepatic copper is 20 to 50 pg/g of liver dry weight). Outward signs of the disease include episodes of jaundice, vomidng, and tiredness. Bone disorders such as osteoporosis can also occur. The neurological damage includes a loss in coordination. V ilson s disease does not result in mental retardation. The rate of incorporation of copper into ceruloplasmin is reduced and biliary excretion decreases to 20 to 40% the normal rate. 

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