java android barcode library Postherpetic Neuralgia in Objective-C

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4 Postherpetic Neuralgia
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Herpes zoster (shingles) is due to infection of the nervous system by varicella-zoster virus About 15% of patients who develop shingles suffer from postherpetic neuralgia This complication seems especially likely to occur in the elderly, when the rash is severe, and when the first division of the trigeminal nerve is affected A history of shingles and the presence of cutaneous scarring resulting from shingles aid in the diagnosis Severe pain with shingles correlates with the intensity of postherpetic symptoms The incidence of postherpetic neuralgia may be reduced by the treatment of shingles with oral acyclovir or famciclovir, but this is disputed; systemic corticosteroids do not help Zoster vaccine markedly reduces morbidity from herpes zoster and postherpetic neuralgia among older adults Management of the established complication is essentially medical If simple analgesics fail to help, a trial of a tricyclic antidepressant (eg, amitriptyline, up to 100 150 mg/d) in conjunction with a phenothiazine (eg, perphenazine, 2 8 mg/d) is often effective Other patients respond to carbamazepine (up to 1200 mg/d), phenytoin (300 mg/d), gabapentin (up to 3600 mg/d), or pregabalin (up to 300 mg/d) A combination of gabapentin and morphine taken orally may provide better analgesia at lower doses of each agent than either taken alone Topical application of capsaicin cream (eg, Zostrix, 0025%) is sometimes helpful, perhaps because of depletion of painmediating peptides from peripheral sensory neurons, and topical lidocaine (5%) is also worthy of trial
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Gilron I et al Morphine, gabapentin, or their combination for neuropathic pain N Engl J Med 2005 Mar 31;352(13):1324 34 [PMID: 15800228] Mounsey AL et al Herpes zoster and postherpetic neuralgia: prevention and management Am Fam Physician 2005 Sep 15;72(6):1075 80 [PMID: 16190505]
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Recurrent seizures Characteristic electroencephalographic changes accompany seizures Mental status abnormalities or focal neurologic symptoms may persist for hours postictally
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The term epilepsy denotes any disorder characterized by recurrent seizures A seizure is a transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain Epilepsy is common, affecting approximately 05% of the population in the United States
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Epilepsy has several causes Its most likely cause in individual patients relates to the age at onset
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A Idiopathic or Constitutional Epilepsy
Seizures usually begin between 5 and 20 years of age but may start later in life No specific cause can be identified, and there is no other neurologic abnormality
B Symptomatic Epilepsy
There are many causes for recurrent seizures 1 Pediatric age groups Congenital abnormalities and perinatal injuries may result in seizures presenting in infancy or childhood
Nervous System Disorders
2 Metabolic disorders Withdrawal from alcohol or drugs is a common cause of recurrent seizures, and other metabolic disorders such as uremia and hypoglycemia or hyperglycemia may also be responsible 3 Trauma Trauma is an important cause of seizures at any age, but especially in young adults Posttraumatic epilepsy is more likely to develop if the dura mater was penetrated and generally becomes manifest within 2 years following the injury However, seizures developing in the first week after head injury do not necessarily imply that future attacks will occur There is no clear evidence that prophylactic anticonvulsant drug treatment reduces the incidence of posttraumatic epilepsy 4 Tumors and other space-occupying lesions Neoplasms may lead to seizures at any age, but they are an especially important cause of seizures in middle and later life, when the incidence of neoplastic disease increases The seizures are commonly the initial symptoms of the tumor and often are partial (focal) in character They are most likely to occur with structural lesions involving the frontal, parietal, or temporal regions Tumors must be excluded by appropriate imaging studies in all patients with onset of seizures after 30 years of age, focal seizures or signs, or a progressive seizure disorder 5 Vascular diseases Vascular diseases become increasingly frequent causes of seizures with advancing age and are the most common cause of seizures with onset at age 60 years or older 6 Degenerative disorders Alzheimer s disease and other degenerative disorders are a cause of seizures in later life 7 Infectious diseases Infectious diseases must be considered in all age groups as potentially reversible causes of seizures Seizures may occur with an acute infective or inflammatory illness, such as bacterial meningitis or herpes encephalitis, or in patients with more longstanding or chronic disorders such as neurosyphilis or cerebral cysticercosis In patients with AIDS, they may result from central nervous system toxoplasmosis, cryptococcal meningitis, secondary viral encephalitis, or other infective complications Seizures are a common sequela of supratentorial brain abscess, developing most frequently in the first year after treatment
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