Saturday, January 9, 2016
Artemis Health Institute uses pacemaker to treat Epilepsy
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Artemis Health Institute uses pacemaker to treat Epilepsy |
Artemis Health Institute (AHI), a multi-specialty hospital in Gurgaon, achieved a new milestone with a breakthrough treatment of an epileptic patient by implanting a pacemaker as a cure for intractable epilepsy.
Dr Alok Gupta, Head, Department of Neurosurgery, Artemis Health Institute, Gurgaon, along with his team, took on the challenge of treating 33-year-old Shalini Arora, suffering from intractable epilepsy. She was diagnosed with epilepsy when she was only 18 months old and was on medication ever since. Post her 12th birthday, the frequency of Shalini’s epileptic fits increased from once or twice in a month to 2 to 3 fits every other day. Medicines did not help in controlling her fits, and as a result Shalini had to be hospitalised often. Invasive surgery as an option too was ruled out due to epileptic discharges occurring from multiple locations in the brain.
Dr Gupta, in a breakthrough intervention that lasted 10 hours, implanted a pacemaker to treat Shalini Arora’s recurring epileptic fits. In this highly specialised procedure, called ‘Deep Brain Stimulation’ (DBS), a wire, as thin as a strand of hair, is implanted with precision in the specific area of the brain called Anterior Thalamus — the region that controls discharges going to the brain and through the brain to all limbs. In this treatment, impulses to the Anterior Thalamus in the brain are supplied and controlled with an externally programmed pacemaker implanted below the left collar bone. It is a key-hole surgery and can prove to be very effective in such cases.
“Epilepsy affects the day-to-day life of a patient since they can suffer from fits any time of the day or night. The disease takes a toll on the patient and his/her family, relationships, education and career. With this new line of effective treatment, it would be possible to control this inconvenience caused to patients and give them a seizure free life,” said Dr Gupta.
Dr Devlina Chakravarty, COO & Medical Director, Artemis Health Institute said, “Since its inception in 2007, Artemis has been a pioneer in performing many cutting edge treatments and surgeries. Our 360 degree approach to patient care has helped us offer relief to our patients and their families from the burden of diseases.”
brainmachine
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| brainmachein |
Epilepsy is a common, chronic disabling neurological condition which affects people of all ages. It is characterised by recurrent epileptic seizures, occurring when there is abnormal and/or excessive neuronal activity in the brain.
Of those people diagnosed with epilepsy in the UK, around 30 percent do not respond to initial epilepsy treatments and remain uncontrolled. This group is considered refractory 2 and equates to approximately 60,000 people in the UK.3-9
Refractory epilepsy has a negative impact on the quality of the lives of patients with the disorder. A 2008 review by Jacoby et al10 concluded that having active epilepsy can profoundly affect the quality of life (QoL) of patients with the condition. Refractory epilepsy is also associated with an increased risk of sudden death and significant costs to society and to the healthcare system.11,12
Retigabine is the first in a new class of epilepsy treatments and is currently the only AED to target neuronal potassium channels13 which are involved in inhibitory mechanisms in the brain, and are thought to have a role in seizure control.14-15
The efficacy and safety of retigabine was established in two pivotal multicentre, randomised, double-blind, placebo-controlled, fixed dose studies .16-17
The NICE recommendation of retigabine will offer patients and clinicians an additional option for difficult to control epilepsy.
Come combattere la forfora
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| Come combattere la forfora |
LE MALATTIE CUTANEE SI PREVE
"Dieta mediterranea è un fattore protettivo”
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| LE MALATTIE CUTANEE SI PREVE |
Molte patologie cutanee, come ad esempio l’acne e la psoriasi, si manifestano anche a causa di malattie legate all’alimentazione, come l’ipercolesterolemia familiare e il diabete, ma è sempre a tavola che possono essere efficacemente prevenute. Ne è convinta laProf.ssa Gabriella Fabbrocini, docente di dermatologia e venereologia presso l’Università di Napoli Federico II, che oggi, a Palazzo Poli, nell’ambito della sesta edizione del convegno “Dermart”, ha tenuto un interessante intervento sul tema “Gli alimenti che guariscono le malattie cutanee”.
In tal senso sono stati ampiamente documentati i benefici della dieta mediterranea come fattore protettivo della pelle. “E’ scientificamente dimostrato – dichiara la Prof.ssa Fabbrocini - che una dieta ricca di olio extra-vergine di oliva, quindi di acidi grassi insaturi, ci consente di ridurre in maniera significativa l’invecchiamento cutaneo che, insieme al photoaging, è l’anticamera del cancro. Di conseguenza, se curiamo bene questo aspetto, possiamo ridurre anche la possibilità di contrarre il melanoma”.
La carcinogenesi viene inibita altresì dai polifenoli e dagli acidi grassi n-3, in particolare gli acidi grassi polinsaturi a catena lunga presenti nel pesce, mentre altri effetti benefici derivano anche dagli agrumi, principali fonti di b-criptoxantina, e dalle carote, ricche di b-carotene, ma anche dalle verdure di colore verde scuro e dal tè verde, che hanno proprietà anti-tumorali e di foto-protezione, inibendo la proliferazione cellulare e riducendo l’eritema indotto dalle radiazioni ultraviolette. Il licopene contenuto nei pomodori, infine, contribuisce al mantenimento dell’omeostasi cutanea.
Prima ancora che per prevenire il tumore della pelle, tuttavia, un’alimentazione corretta è sicuramente un deterrente anche per l’acne. Centrale in tal senso è il ruolo della Mtorc, una protein-chinasi che media le conseguenze di una dieta ipercalorica regolando gli effetti dell’insulina, ovvero l’ormone che fa bruciare i grassi, e di alcune proteine, tra cui quelle ricche in leucina (sostanza presente, ad esempio, nel latte), che agirebbe favorendo l’ipersecrezione di sebo e, quindi, l’acne. “Per questo motivo – spiega la Prof.ssa Fabbrocini – è assolutamente auspicabile una dieta povera di grassi saturi e di zuccheri, quindi con poca carne e senza piatti iper-glicemici. Viceversa, va incrementato l’apporto degli alfa-idrossi acidi, ossia di quegli acidi organici contenuti principalmente nella frutta, come agrumi, mele, uva, ma anche nella soia, negli spinaci e nella birra, che comportano innumerevoli benefici per la pelle e che per questo vengono utilizzati, sotto forma sia di creme che di integratori, per la cura del photoaging, delle allergie cutanee e dell’acne”.
Non manca, infine, una serie di accorgimenti per tenere lontana la psoriasi. “Studi condotti sull’interazione tra alimentazione e psoriasi – afferma la dermatologa – consigliano di limitare il consumo di carne, nello specifico quella di maiale o rossa, evitare gli insaccati, eliminare il consumo dei fritti e delle spezie piccanti, ridurre il consumo di sale e tenere sotto controllo invece quello dei formaggi stagionati, del latte e delle uova”. Via libera, invece, a frutta e verdura, ma con delle eccezioni.“No a melanzane, peperoni, pomodori crudi e verdure ricche di amidi come le patate. Assolutamente consigliati, invece, carote, barbabietole, cetrioli, radicchio, cicorie e bietole, ma anche alimenti ricchi in fibre, come pane, riso e pasta integrale. Tra la frutta sono da evitare le mele crude, che potrebbero essere persino un alimento scatenante, insieme a grano, crostacei, carne, uova e caffè. Viceversa, spiccano le proprietà benefiche dello yogurt, ricco di batteri probiotici
Multiple options for treatment and management of epilepsy
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Multiple options for treatment and management of epilepsy |
Multiple options for treatment and management of epilepsy
Treatment and management of epilepsy may involve medication, special dietary therapy and surgery. In children who have a benign form of epilepsy, treatment may be started if the seizures are frequent. Treatment for a few years can help control the seizures, giving the child time to outgrow the disease while avoiding the side effects of the seizures – cognitive and behavioural impairment. In the more severe cases, despite treatment, the seizures can continue or even worsen as the child gets older.
At KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group, a number of doctors take a holistic view to the treatment of epilepsy. “While anti-seizure medicine is the first line of treatment, management is tailored to each individual case,” adds Dr Derrick Chan, Head and Senior Consultant, Paediatric Neurology Service, KKH.
Anti-seizure medicine
Half of patients will respond to the first medicine prescribed and a further 20 per cent will respond to the second medicine. However, about one-third of patients won’t respond to any drug. “We then have to consider other options such as surgery which may be better than trying multiple medicines.”
Epilepsy surgery
Epilepsy patients for whom epilepsy surgery may be an option have to undergo a thorough evaluation to determine if there is any structural cause for their seizures. “In these cases, surgery can be curative. We have some patients who are seizure-free and off medication after surgery,” says Dr Chan.
The ketogenic diet
Another treatment method is the ketogenic diet, a high-fat, moderate-protein and low-carbohydrate diet that forces the body to burn fat for fuel. This diet has been found to be effective in treating epilepsy in some patients.
“We’ve treated patients who can’t be helped by surgery but the ketogenic diet worked for them and brought the disease under control,” says Dr Chan. “We usually use this diet for children in whom medicines haven’t worked, and who typically aren’t candidates for surgery.”
KKH has a multidisciplinary ketogenic diet clinic where children are evaluated for their suitability for this type of treatment and managed. Patients are given the diet for 3-6 months and if they respond to it, the diet is continued for a few years under close monitoring. Patients can eventually be slowly weaned off the diet.
“The ketogenic diet is strict and can be difficult to follow. It requires a lot of discipline with portions weighed carefully. This diet is also not healthy so we have to monitor the child closely for constipation, cholesterol levels and kidney stones,” says Dr Chan.
Facts about childhood epilepsy
At KKH, about 150 new patients are diagnosed with afebrile seizures and epilepsy every year.
Around 50 million people worldwide have epilepsy according to the World Health Organization (WHO).
The proportion of the general population with active epilepsy requiring treatment is estimated to be between 4 to 10 per 1,000 people (WHO).
Epilepsy Action Plan
KK Women’s and Children’s Hospital has prepared an Epilepsy Action Plan to guide parents and caregivers in providing safe and effective care for children with epilepsy. This handy instructional guide features pictures to illustrate the appropriate positioning of the child and the administration of medication during a seizure. It also uses colour-coding to represent the three levels of severity of the child’s seizures – green is for short seizures, yellow for prolonged or a cluster of seizures, and red for more severe seizures – and the action and medication required in each case.
At KKH, caregivers of children who are at risk of repeat epilepsy seizures now receive the Epilepsy Action Plan, which is customised with the type, dosage and frequency of medication for short and prolonged seizures. The plan is complemented by epilepsy counselling by pharmacists to educate caregivers on the medication and dosage instructions.
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