Lecture Lecture №№1010MoodMood ( (affectiveaffective) ) disordersdisorders. . Bipolar affective disordersBipolar affective disorders. .

CyclothymiaCyclothymia. Clinical displays. Clinical displays, , types of motiontypes of motion. . Principles of Principles of

therapy. therapy. Mental disorders of epilepsy. Mental disorders of epilepsy. Clinical pictures, diagnosis, Clinical pictures, diagnosis,

treatment, rehabilitation. The treatment, rehabilitation. The first aid at epileptic status. first aid at epileptic status.

Examination.Examination.Lecturer Savka Svitlana DmitryvnaLecturer Savka Svitlana Dmitryvna

Mood Mood ((affectiveaffective)) disordersdisorders

Mood Mood ((affectiveaffective)) disorders disorders contains disorders in contains disorders in which the fundamental disturbance is a change which the fundamental disturbance is a change in affect or mood to depression or to elation. in affect or mood to depression or to elation. The mood change is usually accompanied by a The mood change is usually accompanied by a change in the overall level of activity; most of change in the overall level of activity; most of the other symptoms are either secondary to, or the other symptoms are either secondary to, or easily understood in the context of, the change easily understood in the context of, the change in mood and activity. Most of these disorders in mood and activity. Most of these disorders tend to be recurrent and the onset of individual tend to be recurrent and the onset of individual episodes can often be related to stressful episodes can often be related to stressful events or situations. events or situations.

Bipolar affective disorderBipolar affective disorder A disorder characterized by two or more A disorder characterized by two or more

episodes in which the patient's mood and episodes in which the patient's mood and activity levels are significantly disturbed, activity levels are significantly disturbed, this disturbance consisting on some this disturbance consisting on some occasions of an elevation of mood and occasions of an elevation of mood and increased energy and activity (hypomania increased energy and activity (hypomania or mania) and on others of a lowering of or mania) and on others of a lowering of mood and decreased energy and activity mood and decreased energy and activity (depression). Repeated episodes of (depression). Repeated episodes of hypomania or mania only are classified as hypomania or mania only are classified as bipolar. bipolar.

Mania without psychotic symptoms Mood is elevated out of keeping with the Mood is elevated out of keeping with the

patient's circumstances and may vary from patient's circumstances and may vary from carefree joviality to almost uncontrollable carefree joviality to almost uncontrollable excitement. Elation is accompanied by excitement. Elation is accompanied by increased energy, resulting in hyperactivity, increased energy, resulting in hyperactivity, pressure of speech, and a decreased need for pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is is often marked distractibility. Self-esteem is often inflated with grandiose ideas and often inflated with grandiose ideas and overconfidence. Loss of normal social overconfidence. Loss of normal social inhibitions may result in behaviour that is inhibitions may result in behaviour that is reckless, foolhardy. reckless, foolhardy.

Mania with psychotic symptoms In addition to the clinical picture In addition to the clinical picture

described in manic syndrome and described in manic syndrome and delusions (usually grandiose) or delusions (usually grandiose) or hallucinations (usually of voices hallucinations (usually of voices speaking directly to the patient) are speaking directly to the patient) are present, or the excitement, excessive present, or the excitement, excessive motor activity, and flight of ideas are so motor activity, and flight of ideas are so extreme that the subject is extreme that the subject is incomprehensible or inaccessible to incomprehensible or inaccessible to ordinary communication. ordinary communication.

Episode depression In typical depressive episodes, the patient In typical depressive episodes, the patient suffers from lowering of mood, reduction of suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is enjoyment, interest, and concentration is reduced, and marked tiredness after even reduced, and marked tiredness after even minimum effort is common. Sleep is usually minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or and, even in the mild form, some ideas of guilt or worthlessness are often present. Somatic worthlessness are often present. Somatic symptoms: loss of interest and pleasurable symptoms: loss of interest and pleasurable feelings, waking in the morning several hours feelings, waking in the morning several hours before the usual time, depression worst in the before the usual time, depression worst in the morning, marked psychomotor retardation, morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss agitation, loss of appetite, weight loss, and loss of libido. of libido.

Episode depression mildmild moderate moderate severesevere

Type of depression Anesthetic depressionAnesthetic depression Agitate depressionAgitate depression Masked depressionMasked depression Adynamic depressionAdynamic depression

Warning Signs of Clinical Depression

Feeling depressed and irritable Feeling depressed and irritable most of the day most of the day

Feeling of hopelessness Feeling of hopelessness Social withdrawl Social withdrawl Impaired concentration Impaired concentration Sleeping more/less than usual Sleeping more/less than usual Increased/decreased appetite Increased/decreased appetite Siginificant weight gain/loss Siginificant weight gain/loss Diminished ability to think Diminished ability to think

Warning Signs of Clinical Depression Indecisiveness Indecisiveness Loss of interest in activities that used Loss of interest in activities that used

to be enjoyed to be enjoyed Fatigue, low energy Fatigue, low energy Missing class Missing class Low self-esteem Low self-esteem Feeling guilty or worthless Feeling guilty or worthless Moving or speaking more slowly than Moving or speaking more slowly than

usual usual More agitated than usual More agitated than usual Recurrent thoughts of deathRecurrent thoughts of death

Cycle of DepressionCycle of Depression

CCyclothymiayclothymia A persistent instability of mood involving A persistent instability of mood involving

numerous periods of depression and mild numerous periods of depression and mild elation, none of which is sufficiently elation, none of which is sufficiently severe or prolonged to justify a diagnosis severe or prolonged to justify a diagnosis of bipolar affective disorder or recurrent of bipolar affective disorder or recurrent depressive disorder. This disorder is depressive disorder. This disorder is frequently found in the relatives of patients frequently found in the relatives of patients with bipolar affective disorder. with bipolar affective disorder. Some Some patients with cyclothymia eventually patients with cyclothymia eventually develop bipolar affective disorder. develop bipolar affective disorder.

Dysthymia Dysthymia

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder.

Treatment of Depressive DisorderTreatment of Depressive Disorder

Antidepressant DrugsAntidepressant Drugs Mood stabilisersMood stabilisers Electroconvulsive TherapyElectroconvulsive Therapy PsychotherapyPsychotherapy

Classification anti-anti-

depressantsdepressants 1. TRICYCLICS1. TRICYCLICS2. MONOAMINE OXIDASE INHIBITORS 2. MONOAMINE OXIDASE INHIBITORS 3. REVERSIBLE INHIBITOR OF MONOAMINE 3. REVERSIBLE INHIBITOR OF MONOAMINE

OXIDASE OXIDASE 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS 5. SELECTIVE SEROTONIN NORADRENALINE 5. SELECTIVE SEROTONIN NORADRENALINE

REUPTAKE INHIBITORREUPTAKE INHIBITOR6. NORADRENERGIC AND SPECIFIC SEROTONIN 6. NORADRENERGIC AND SPECIFIC SEROTONIN

ANTAGONIST ANTAGONIST 7. HETEROCYCLIC 7. HETEROCYCLIC 8. SELECTIVE NORADRENALINE REUPTAKE 8. SELECTIVE NORADRENALINE REUPTAKE

INHIBITORS INHIBITORS

1.Tricyclics antidepressants1.Tricyclics antidepressants

GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) amitriptyline Tryptanol, Endep amitriptyline Tryptanol, Endep clomipramine Anafranil, Placil, ETC clomipramine Anafranil, Placil, ETC dothiepin Prothiaden, Dothep dothiepin Prothiaden, Dothep doxepin Sinequan, Deptran doxepin Sinequan, Deptran imipramine Tofranil, Melipramine imipramine Tofranil, Melipramine nortriptyline Allegron nortriptyline Allegron trimipramine Surmontil trimipramine Surmontil

2. MONOAMINE OXIDASE INHIBITORS2. MONOAMINE OXIDASE INHIBITORS

These were used in patients These were used in patients resistant to tricyclic treatment and in resistant to tricyclic treatment and in phobic anxiety disorders, but are now phobic anxiety disorders, but are now rarely prescribed. rarely prescribed.

GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME phenelzine Nardil phenelzine Nardil tranylcypromine Parnaletranylcypromine Parnale

3. REVERSIBLE INHIBITOR OF 3. REVERSIBLE INHIBITOR OF MONOAMINE OXIDASEMONOAMINE OXIDASE A A

Reversible inhibition of the MAO enzyme Reversible inhibition of the MAO enzyme limits the problem of food and drug limits the problem of food and drug interactions. This class of drug is a safer interactions. This class of drug is a safer alternative to MAOIs and no major alternative to MAOIs and no major dietary precautions are needed. RIMAs dietary precautions are needed. RIMAs have fewer interactions, fewer have fewer interactions, fewer cardiovascular effects and greater safety cardiovascular effects and greater safety in overdose. in overdose.

GENERIC NAME BRAND NAME(S) GENERIC NAME BRAND NAME(S) moclobemide Aurorix, Arima moclobemide Aurorix, Arima

4. SELECTIVE SEROTONIN 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORSREUPTAKE INHIBITORS

This class of antidepressant is well tolerated, This class of antidepressant is well tolerated, and relatively safe in overdose. and relatively safe in overdose.

GENERIC NAME BRAND NAME(S) GENERIC NAME BRAND NAME(S) citalopram Cipramil, Celepram, citalopram Cipramil, Celepram,

Talohexal,etc Talohexal,etc Escitalopram Lexapro Escitalopram Lexapro fluoxetine Prozac-20, Lovan, Erocap, fluoxetine Prozac-20, Lovan, Erocap,

Zactin, etc Zactin, etc fluvoxamine Luvox, Faverin, Movox fluvoxamine Luvox, Faverin, Movox paroxetine Aropax, Paxtine, Oxtine, etc paroxetine Aropax, Paxtine, Oxtine, etc sertraline Zoloft,Xydem sertraline Zoloft,Xydem

5. SELECTIVE SEROTONIN NORADRENALINE 5. SELECTIVE SEROTONIN NORADRENALINE REUPTAKE INHIBITORREUPTAKE INHIBITOR

At low doses venlafaxine acts like an At low doses venlafaxine acts like an SSRI.and at higher doses it is a bit more SSRI.and at higher doses it is a bit more like a tricylic without some of the adverse like a tricylic without some of the adverse effects. effects.

GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME venlafaxine Efexor, Efexor XRvenlafaxine Efexor, Efexor XR

6. NORADRENERGIC AND SPECIFIC 6. NORADRENERGIC AND SPECIFIC SEROTONIN ANTAGONISTSEROTONIN ANTAGONIST

GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) mirtazapine Avanza, Remeron.mirtazapine Avanza, Remeron.

7. 7. Heterocyclic GENERIC NAME BRAND NAME(S) mianserin Tolvon, Lumin

8. Selective noradrenaline reuptake inhibitors

GENERIC NAME BRAND NAME reboxetine Edronax

Treatment for maniaTreatment for mania Antipsychotic DrugsAntipsychotic Drugs Mood stabilisersMood stabilisers ECT (Electroconvulsive Therapy)ECT (Electroconvulsive Therapy) PsychotherapyPsychotherapy

Mood stabilisersMood stabilisersThis group of drugs effectively treat a current episode of mania or depression. They also help prevent future episodes of mania and depression when taken consistently.

GENERIC NAME GENERIC NAME BRAND NAME(S) BRAND NAME(S) lithium carbonate Lithicarb, Quilonum SR lithium carbonate Lithicarb, Quilonum SR carbamazepine Tegretol, Teril carbamazepine Tegretol, Teril sodium valproate Epilim, Valpro sodium valproate Epilim, Valpro lamotrigine Lamictillamotrigine Lamictil

TYPICAL ANTIPSYCHOTICSTYPICAL ANTIPSYCHOTICS

SHORT SHORT ACTING INJECTIBLESACTING INJECTIBLES GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME chlorpromazine Largactil chlorpromazine Largactil haloperidol Serenace haloperidol Serenace trifluoperazine Stelazinetrifluoperazine Stelazine LONG ACTING INJECTIBLESLONG ACTING INJECTIBLES flupenthixol decanoate Fluanxol flupenthixol decanoate Fluanxol fluphenazine decanoate Modecate fluphenazine decanoate Modecate haloperidol decanoate Haldohaloperidol decanoate Haldo zuclopenthixol decanoate Clopixol zuclopenthixol decanoate Clopixol

Depot Depot

ATYPICAL ANTIPSYCHOTICSATYPICAL ANTIPSYCHOTICS

GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) amisulpride Solian amisulpride Solian aripiprazole Abilify aripiprazole Abilify clozapine Clozaril, Clopine clozapine Clozaril, Clopine olanzapine Zyprexa, Zydis (wafers) olanzapine Zyprexa, Zydis (wafers) quetiapine Seroquel quetiapine Seroquel risperidone Risperdal risperidone Risperdal

Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT)

Electroconvulsive therapyElectroconvulsive therapy, also known as , also known as electroshock, is a well-established, albeit electroshock, is a well-established, albeit controversial, psychiatric treatment in which controversial, psychiatric treatment in which seizures are electrically induced in anesthetized seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is patients for therapeutic effect. Today, ECT is most often used as a treatment for severe most often used as a treatment for severe major depression which has not responded to major depression which has not responded to other treatment,other treatment, and is also used in the and is also used in the treatment of mania (often in bipolartreatment of mania (often in bipolar disorder),disorder), catatonia andcatatonia and schizophrenia.schizophrenia.

PsychotherapyPsychotherapy PsychoanalyticPsychoanalytic Cognitive behavioral Cognitive behavioral PsychodynamicPsychodynamic ExistentialExistential HumanisticHumanistic TranspersonalTranspersonal HypnotherapyHypnotherapy Gestalt TherapyGestalt Therapy

EpilepsyEpilepsy

is a chronic psychoneurological disorder caused by impaired brain function, which manifests in recurrent, periodic, paroxysmal states (seizures), and in some cases causes concomitant chronic alterations of personality and/or cognitive processes.

Genuine (idiopathic) epilepsyGenuine (idiopathic) epilepsy or the or the epileptic disease is an illness with epileptic disease is an illness with hereditary predisposition and belongs to hereditary predisposition and belongs to the group othe group oа а endogenous mental endogenous mental disorders;disorders;

Organic (symptomatic) epilepsyOrganic (symptomatic) epilepsy may may develop as the consequence of a brain develop as the consequence of a brain injury (traumatic epilepsy), encephalitis, injury (traumatic epilepsy), encephalitis, meningitis, cerebrovascular haemorrhage meningitis, cerebrovascular haemorrhage or thrombosis or any other organic brain or thrombosis or any other organic brain damage, in which an epileptogenic focus damage, in which an epileptogenic focus is formed. is formed.

Symptoms of EpilepsySymptoms of Epilepsy Seizures Seizures

Centrencephalic (generalised)Centrencephalic (generalised)

a) grand mal a) grand mal b) petit malb) petit mal

FocalFocal Mental equivalents (psychic seizures)(psychic seizures)

Changed states of consciousness.

Perceptual changes,changes of thought,Perceptual changes,changes of thought,

changes of mood.changes of mood. Chronic impairment of mental functions:

Epileptic personality, cognitive changes

DiagnosisDiagnosis Skull X-rays; Lumbar puncture; Blood serology; Fasting blood sugar; Brain scan; Electroencephalogram (EEG). Physical examination; Neurological examination; Psychical examination; Routine clinical laboratory examination; Careful history (recent drug intake).

Classification of Epileptic SeizuresCentrencephalic

Grand mal - 50% have brief aura, unconsciousness, followed by tonic-clonic seizure.

Petit mal - no aura; 2 to 15 seconds of unconsciousness may show 3 per second blinking.

Myoclonic - lightning muscle twitches. Salaam - falling forward and

unconsciousness. Akinetic (atonic) - loss of muscle tone and

unconsciousness.

Classification of Epileptic SeizuresFocalFocal

Jacksonian - onset is most common I thumb of Jacksonian - onset is most common I thumb of face, motor or sensory march of symptoms.face, motor or sensory march of symptoms.

Psychomotor (temporal lobe) - may end with Psychomotor (temporal lobe) - may end with grand mal; may have independent grand mal grand mal; may have independent grand mal seizures.seizures.

Frontal - aura common; related to localization; Frontal - aura common; related to localization; onset with adversive eye movements in grand onset with adversive eye movements in grand mal, focal fits.mal, focal fits.

Midtemporal - facial movements at onset.Midtemporal - facial movements at onset. Occipital - visual aura; grand mal seizure; Occipital - visual aura; grand mal seizure;

strabismus common.strabismus common.

AuraAura The aura is perhaps of equal importance to

the epileptic himself, for it warns him of the onset of a seizure and allows him a little time to find a safe place. The aura is often present, even in the primary grand mal epileptic, although not in the petit mal. The acute phenomenon is frequently described as diffusely visceral. This feeling may last for a few seconds or days of increasing irritability, restlessness, mild depressive symptoms may precede a major seizure. These symptoms usually disappear after the seizure himself.

Grand Mal seizuresGrand Mal seizures may have a brief aura;may have a brief aura; are often initiated by a cry;are often initiated by a cry; loss of consciousness;loss of consciousness; falling to the floor;falling to the floor; often physical injury;often physical injury; the advent of extreme tonic spasm;the advent of extreme tonic spasm; the extensor muscles dominating the flexors;the extensor muscles dominating the flexors; cyanosis is often marked until the seizure cyanosis is often marked until the seizure

terminates;terminates; may be relaxation of the sphincters;may be relaxation of the sphincters; the EEG is dominated with high voltage and fast the EEG is dominated with high voltage and fast

activity;activity; on recovery he often complains of muscular on recovery he often complains of muscular

aches and of a severe headache;aches and of a severe headache; after depression, despair.after depression, despair.

Petit Mal seizure

the classic absence;the classic absence; myoclonic seizures;myoclonic seizures; lightning jerks;lightning jerks; atonic seizures;atonic seizures; bilaterally synchronous EEG wave;bilaterally synchronous EEG wave; duration 10 to 30 seconds;duration 10 to 30 seconds; total unconsciousness.total unconsciousness.

Psychic seizuresPsychic seizures1.Perceptual changes: 1.Perceptual changes: - changes in the size of an object (everything may - changes in the size of an object (everything may

look very small or quite large)look very small or quite large)2. Changes of Self-Awareness:2. Changes of Self-Awareness:- depersonalization- depersonalization; serialization; déjà vu; jamais vu.; serialization; déjà vu; jamais vu.

3. Changes of thought: 3. Changes of thought: - forced thought; disorganization of thought.- forced thought; disorganization of thought.4. Changes of mood and affect: 4. Changes of mood and affect: - fear; anxiety; despair and depression; - fear; anxiety; despair and depression;

dysphonic.dysphonic.5. Complex Hallucinatory Experiences;5. Complex Hallucinatory Experiences;6. Complex stereotyped automatisms.6. Complex stereotyped automatisms.

Twilight StatesTwilight StatesPostictal Twilight State:

- usually follows one or several seizures;

- lasts from minutes to (rarely) several days;

- the excitement may include the agitation, paranoid ideation, hallucinations, delusions;

- complete amnesia for this status;

- clear completely and with surprising abruptness;

- the EEG shows diffuse symmetrical slow activity, not the paroxysmal activity of the seizure state.

Twilight StatesTwilight StatesIctal Twilight State:Ictal Twilight State:

- focal disturbance (temporal lobe);- focal disturbance (temporal lobe);

- searching movements of the head and - searching movements of the head and eyes, lip-smacking, masticatory eyes, lip-smacking, masticatory movements, and swallowing;movements, and swallowing;

- allo disorientation;- allo disorientation;

- last for 5 – 10 minutes;- last for 5 – 10 minutes;

- agitation, expressions of fear, anxiety, - agitation, expressions of fear, anxiety, incoherent talk, aggressive acts.incoherent talk, aggressive acts.

““Epileptic Personality”Epileptic Personality” Slowness of reactions; Perseveration; Rigid emotional Slowness of reactions; Perseveration; Rigid emotional

attitudes;attitudes; Kind of “black-and-white” assessment of people and Kind of “black-and-white” assessment of people and

events;events; Fixed opinions;Fixed opinions; Particularly concerning religious issues;Particularly concerning religious issues; Excessive accurateness;Excessive accurateness; Preciseness and punctuality;Preciseness and punctuality; Strict adherence to social norms and rules;Strict adherence to social norms and rules; Unresponsiveness to external factors;Unresponsiveness to external factors; Sometimes – self-centeredness anSometimes – self-centeredness anв в hypochondriasis;hypochondriasis; A tendency to hobbies which demand great patience A tendency to hobbies which demand great patience

and persistence;and persistence; Tendency to long-lasting emotional states (emotional Tendency to long-lasting emotional states (emotional

rigidity) or explosion readiness. rigidity) or explosion readiness.

Status epilepiicus.Status epilepiicus.

The recurrence without interruption The recurrence without interruption of grand mal seizures in an epileptic. of grand mal seizures in an epileptic. Seizures repeat approximately every Seizures repeat approximately every 10 minutes, and the patient remains 10 minutes, and the patient remains unconscious between them.unconscious between them.

TreatmentTreatment

Medication;Medication; Psychotherapy;Psychotherapy; Surgical Intervention;Surgical Intervention; Ketogenic diet Ketogenic diet ;; Prevention of Epilepsy.Prevention of Epilepsy.

The main principles of medicationThe main principles of medication

1. Selectivity and combined treatment.

2. Gradual beginning of treatment.

3. Constant prolonged use of drugs without intermissions.

4. In the absence of seizures for a prolonged time (1 to 3 years), termination of medication can be considered.

MedicationMedicationTridione (Trimethadione )Tridione (Trimethadione )

DilantinDilantin

PhenuronePhenurone

DiamoxDiamox

PhinlepsinPhinlepsin

DepacinDepacin

Depacin-chronoDepacin-chrono

Paradione (Paramethadione)Paradione (Paramethadione)

Psychotherapy

The physician may have to intervene The physician may have to intervene in some situations, especially in those in some situations, especially in those school systems that exclude epileptic school systems that exclude epileptic children of normal intelligence from children of normal intelligence from classroom activities.classroom activities.

Surgical interventionSurgical intervention Epilepsy surgery is an option for patients Epilepsy surgery is an option for patients

whose seizures remain resistant to whose seizures remain resistant to treatment with anticonvulsant medications treatment with anticonvulsant medications who also have symptomatic localization-who also have symptomatic localization-related epilepsy; a focal abnormality that related epilepsy; a focal abnormality that can be located and therefore removed. The can be located and therefore removed. The goal for these procedures is total control goal for these procedures is total control of epileptic seizures, although of epileptic seizures, although anticonvulsant medications may still be anticonvulsant medications may still be required.required.

Ablation of the anterior temporal lobe.Ablation of the anterior temporal lobe.

Treatment of status Treatment of status epilepticus.epilepticus.

The complications caused by this state are various The complications caused by this state are various and dangerous: brain or lung oedema, inhibition of and dangerous: brain or lung oedema, inhibition of the breathing centre in the brain, heart failure. Status the breathing centre in the brain, heart failure. Status epilepticus demands urgent treatment measures. All epilepticus demands urgent treatment measures. All the drugs are injected by parenteral way.the drugs are injected by parenteral way.

solutions of magnesium sulfate (25 %-20.0)solutions of magnesium sulfate (25 %-20.0) anxiolytic drugs, in particular benzodiazepines anxiolytic drugs, in particular benzodiazepines

(chlordiazepoxide). (chlordiazepoxide). If seizures prevail in spite of medication, it is If seizures prevail in spite of medication, it is

sometimes necessary to narcotize the patient. sometimes necessary to narcotize the patient. Symptomatic treatment toSymptomatic treatment to prevent complications prevent complications (diuretics, drugs to support heart activity, breathing (diuretics, drugs to support heart activity, breathing analeptics).analeptics).

Ketogenic dietKetogenic diet

a high fat, low carbohydrate diet a high fat, low carbohydrate diet developed in the 1920s, largely developed in the 1920s, largely forgotten with the advent of effective forgotten with the advent of effective anticonvulsants, and resurrected in anticonvulsants, and resurrected in the 1990s. The mechanism of action the 1990s. The mechanism of action is unknown. It is used mainly in the is unknown. It is used mainly in the treatment of children with severe, treatment of children with severe, medically-intractable epilepsies.medically-intractable epilepsies.