Postural tachycardia syndrome
Postural tachycardia syndrome (POTS) is characterized by an excessive increase in heart rate upon standing and can cause symptoms like lightheadedness and palpitations. It may be caused by genetic or acquired factors such as hypovolemia or kidney issues. Diagnosis involves a significant heart rate increase upon changing posture. Non-pharmacological measures like hydration and exercise are helpful. Medications like fludrocortisone, midodrine, pyridostigmine, and propranolol can be used for treatment.
Orthostatic hypotension
Orthostatic hypotension, a drop in blood pressure upon standing, can result from various causes like diabetes or medications. Symptoms include dizziness and fainting. Non-drug measures like exercise and proper hydration are first-line treatments. If necessary, medications like fludrocortisone or pressor agents such as midodrine and droxidopa may be prescribed for moderate to severe cases. Second-line treatments like erythropoietin, caffeine, and pyridostigmine may also be considered but have limited evidence of effectiveness.
Transient global amnesia
Transient global amnesia (TGA) is a sudden memory loss condition, usually resolving within 24 hours. Its causes can vary. Diagnostic evaluation involves a neurological exam and brain MRI. No specific treatment is needed, but reassurance is important, and driving restrictions may apply during recurrent episodes. Stroke risk factors may be managed based on specific findings.
Status Epilepticus
Status epilepticus is a medical emergency characterized by prolonged seizures. It has serious long-term consequences, including injury and death. Treatment involves three phases: assessment and supportive care, initial benzodiazepine treatment, and long-term nonbenzodiazepine antiseizure drug therapy. Various drugs like lorazepam, diazepam, fosphenytoin, phenytoin, valproate, and levetiracetam can be used in these phases. In refractory cases, alternative agents like lacosamide, topiramate, and midazolam, propofol, or pentobarbital infusions may be considered, but the prognosis remains poor. Focal and myoclonic status epilepticus follow similar principles of treatment.
Refractory epilepsy
Refractory epilepsy, affecting 20% of patients, doesn't respond to two tolerated antiseizure drugs. Diagnosis involves brain MRI and video-EEG monitoring. Resective epilepsy surgery is the main curative option, while other approaches offer palliative relief. Surgery is most effective when the focus is consistently identified. Further antiseizure drug treatment, selecting different drugs or combinations, and participating in clinical trials are alternative options for management.
Absence seizures
Absence seizures, typically seen in children, are characterized by brief episodes of staring, eye blinking, and lip smacking lasting 5 to 10 seconds. Myoclonic seizures involve sudden muscle contractions. First-line treatment for absence seizures is ethosuximide, with a typical starting dose of 5-10 mg/kg/day for younger children and 250 mg twice daily for older children. Valproate or lamotrigine can be considered if ethosuximide is ineffective or not tolerated. Carbamazepine, vigabatrin, tiagabine, gabapentin, phenytoin, and phenobarbital should be avoided. Seizures often respond well to treatment, and drug therapy may be tapered after a minimum of two years of seizure-free intervals.
Epilepsy
Epilepsy is diagnosed when a person experiences two or more unprovoked seizures occurring over 24 hours apart. It encompasses various seizure types, including generalized tonic-clonic, absence, myoclonic, tonic, and atonic seizures, with causes ranging from genetic factors to structural, metabolic, immune, and unknown factors. Treatment primarily involves antiseizure drugs, with approximately 50% of patients achieving seizure freedom on their initial medication. Initial drug selection considers factors like efficacy, side effects, drug interactions, and patient preferences, and treatment should include patient education on medication compliance and side effect monitoring.
First time seizure
Seizures can be generalized or focal, with various subtypes. Initial evaluation includes history, lab tests, and neuroimaging, primarily for loss of consciousness. Not all seizures need medication; it depends on recurrence risk and causes. Hospitalization may be necessary in certain cases. Decisions on starting medication after a first seizure depend on factors like abnormal neurological findings and EEG results. Patients should be aware of triggers and activities to avoid, especially regarding driving. Common antiseizure drugs include levetiracetam, phenytoin, and valproic acid, with regular monitoring for side effects and drug levels.