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Laboratory studies to determine the serum anticonvulsant drug concentrations are indicated for known or suspected patients with epilepsy. Epileptiform discharges can indicate the type of seizure and site of the seizure focus. Lumbar puncture should be performed when an inflammatory or infectious brain disorder. Treatment and Management Anticonvulsant therapy is generally indicated when patients have more than one seizure. These drugs include gabapentin, lamotrigine, levetiracetam, oxcar bazepine, pregabalin, tiagabine, topiramate, and zonisamide. If a diagnosis of absence seizures is made, often in association with a syn drome, the likelihood of other coexistent seizure types, such as myoclonic or tonic-clonic, should be considered. Ethosuximide is one anticonvulsant that is only indicated for absence seizures and would not be indicated for this case presentation. Although many anticonvulsants are listed as category D (unsafe in preg nancy), the use of anticonvulsants during pregnancy is warranted if necessary to control seizures. Of the anticonvulsants, valproate is more likely than other anticonvulsants to cause congenital birth defects in a dose-related fashion. Initiation of anticonvulsant therapy requires laboratory screening and mon itoring and regular patient evaluation for efficacy and/or side effect. Once ther apy is initiated and maintained at therapeutic doses, subsequent, periodic blood and urine monitoring in otherwise asymptomatic patients receiving anti convulsants does not help in identifying patients at risk for life-threatening adverse drug reactions. Patients should be educated about how to recog nize the signs of a severe adverse drug reaction, which can vary depending on the drug but include dizziness, vertigo, double vision, gait disturbances or ataxia, rash, and mental confusion. For patients in which diagnostic studies are unyielding or seizures remain refractory to adequate treatment, a referral to an epilepsy specialist is indi cated. Such procedures include temporal lobectomy, extratem poral resections, corpus callosotomy, placement of a vagus-nerve stimulator, hemispherectomy, and multiple subpial transections. These activities include, but are not limited to the following: operating a motor vehicle, operating a stove or other dangerous machinery, and working at heights. Momentary lapses in awareness, accompanied by motionless star ing and cessation of any ongoing activity C. He also denied feeling ill or dis oriented on awakening, and he was immediately aware of his surroundings. The patient admitted to two previous syncopal episodes, both in his office, and both without provocation. On one occasion he was seated, on the second occasion he was standing and suffered a fall. On review of systems, the patient complained of frequent fatigue and lack of energy over the last year but attrib uted it to work schedule and lack of adequate exercise. These episodes were not associated with warning signs or symptoms nor followed by persist ent confusion, weakness, or findings on examination. Clinical Considerations In this case, the patient suffered an acute loss of consciousness that was with out any provocation or premonitory symptoms including nausea, sweating, or abdominal discomfort.
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Since you do want dinner, and since dinner has to consist of something, you actively ll the plate-image with whatever other images you intend to see later, all stacked on the plate-image, as the real cooked ingredients you will eat. Are you wondering why we would ever put our deepest secrets into the secret place someone else has constructed in our dreamworld But nothing is quite as hard to resist as an empty space, imagined, real, or dreamt. Even though I and the lasagna were covariant, I varied less than did the dinner, which gives me fair claim to the nominative spot in the grammar of the contrast. You can arrange the narratives and vary the virtual spaces (in which the narratives end) almost in nitely without destroying their intelligibility and usefulness. Recognizing the relations between the narrative and the destined space, and how these are covariant, is the whole secret to thinking clearly about change, and kicking yourself from one level of generalization to another. And there is a rule: the space is always more stable than the story it co-ordinates. Whitehead says that philosophy is more closely akin to poetry than to science, and that the practice of philosophy, the discipline it requires, is very much that of learning to create spaces and tell stories that follow, well, not the order and demands of pure expression, as poetry does, but those of possible patterns of order.
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After approximately 30 seconds he fell to the ground and had a 2-minute generalized tonic-clonic event. Immediately afterwards he was drowsy and confused but now is completely back to his normal baseline. His vital signs are within the range of normal for his age, and his physical examination, including a detailed neurologic exami nation, are normal. He has never experienced any similar events, and there is no history of febrile seizures, central nervous system infections, significant head trauma, headaches, developmental or behavioral problems, or changes in personality. He was born at 38 weeks of gestation after an uneventful preg nancy and went home on the second day of life. Considerations this 7-year-old boy experienced a nocturnal seizure with secondary general ization and not associated with any obvious provocation. Generally, the seizures stop before patients turn 20 years of age, and about two-thirds of patients will have only one or very few seizures. Unilateral oral paresthesias as well as facial clonic and/or tonic activity are common. This would appear to be what happened in the case under consideration because the child initially had focal manifestations (speech arrest and right hemifacial clonus) followed by generalized motor activity (a generalized tonic-clonic seizure). A partial seizure is by definition a manifestation of a focal physiologic abnormality in the cortex. In this case, the disorder would be considered cryptogenic (indicating that the cause remains hidden). The third category of epilepsies is idiopathic, which refers to condi tions in which there is a known or presumed genetic etiology. This would be consistent with a peri-rolandic location involving the lateral aspect of the left hemisphere near the central sulcus (formerly referred to as the rolandic fissure). Another reason for this is that approximately two-thirds of patients will have only one or very few seizures, which is important when considering whether or not to begin anticonvulsant therapy. Some variability in seizure symptomatology between seizures can be seen for any given patient with some having two distinct seizure types. The patient has had one witnessed seizure 2 weeks ago and had one unwitnessed event 1 year ago, which may have been a seizure. These are not acute symp tomatic seizures as described because there is no provoking factor present. Seizures in these patients begin with visual symptoms followed by psychomotor, sensorimotor, or migraine like phenomena. Localization-related epilepsies: simple partial seizures, complex partial seizures, benign focal epilepsy of childhood, and epilepsia partialis continua.
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However, Flechsig 48), on the basis of myeloarchitectonic observations, has recently proposed that the auditory cortex occupies only a tiny cortical area mainly limited to the anterior transverse gyrus and comprising scarcely two square centimeters of the exposed surface of the superior temporal gyrus. Against this last view apart from basic objections to such an interpretation of physiological localisational based on developmental, and particularly of myelogenetic, processes the following three facts about histological localisa tion 49) should now be emphasised. As was already described in detail above (page 121), it can be divided on cytoarchitectonic and myeloarchitectonic grounds into several structural areas that possess common architectonic features within themselves and with neighbouring cortex of the rest of the superior tem poral gyrus and, together with these represent a larger, homogeneous structur al zone. Further, the zone in question is not just limited to the anterior trans verse gyrus but climbs significantly beyond it anteriorly and equally surrounds the whole posterior transverse gyrus and a considerable part of the free surface of the superior temporal gyrus (Figure 89). As to the first point, I prefer to pass over it in silence; as to the second the following should be noted. Using the same argument, one must qualify all morphological studies as useless, for the goal of all biological investigation consists not in recognising criteria of shape but rather life processes. Or is he today trying in all seriousness to make us believe that, with his myelogenetic studies, he is pursuing pure physiology In addition, there is a third very important observation from comparative localisation, that was also already mentioned above, the observation that the extremely characteristic cell and fibre architecture, typical of both transverse gyri in man, is lacking in all other animals. In other words, a human structural zone in which Flechsig places the cortical end-station of the auditory pathway, the auditory cortex, is completely absent in animals, and even in monkeys that otherwise possess a very similar cortical structure to that of man 51) thus facilitating the homologising of cortical areas between man and monkeys. What is more, its composition from several, histologically widely different, individual areas (41, 42 and 52 of the brain map) suggests a physiologically more complex function (*265) of the region in question. The solution to this question will only be furnished by an impartial exam ination of pathological cases with reference to anatomical localisational data, as well as by a detailed comparative study of cortex, using both anatomical (espe cially myeloarchitectonic) and physiological methods. It would be particularly tempting in this connection, considering the controversy recently engendered by Pierre Marie about aphasia, to also engage in a discussion of the specific localisation of speech. However, it seems to us that the time is hardly ripe for this for most of the necessary physiological preparatory work is lacking. What is more, it is in no way to be seen as definite that the cortical localisation of speech coincides with that of aphasia. In relation to aphasia, however, one can already immediately conclude two things from the psychophysiological considerations described above. Firstly, an aphasia, regardless of whether it belongs to the motor or sensory subcategory, can never be linked to a single structural centre, and therefore to an individual one of our cytoarchitectonic areas, but rather it always includes a complex of such areas, forming a larger region.
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Loosely speaking, if we allow these creatures to reproduce differentially in response to their musi cal behaviors. By tailoring the selective forces of the arti cial environment and behavioral endowments of the arti cial creatures, we can set up evolutionary simulations to answer a variety of questions about the evolution of musical behavior. Further more, we can listen in on the process of arti cial evolution in a way that we could never do in nature. The kinds of questions that evolutionary computer simulations can address fall into two main categories. First, simulation models can act as proofs of concept, demonstrating that a certain behavior could evolve from some initial state through a series of cumulative stages. For instance, they could help us explore whether and how a particular kind of proposed mental mechanism, say, a neural network with certain learn ing capacities, could evolve into a system capable of learning and pro ducing hierarchically structured musical sequences. Second, simulations are one of the best tools for elucidating the dynamics of an evolutionary process, showing what the course of evolution of a certain behavior could have looked like over time. For instance, one could show how a popula tion of singing creatures with some memory ability may build up a shared culture of songs over time. This provides a means of discov ering the implications of ideas that may be too complex to explore purely verbally. Simulations also can be used to generate hypotheses about the evolution of real behaviors or about reasons that certain behaviors might not have evolved. Evolutionary simulations have several advantages for exploring behavioral questions (Todd 1996). Perhaps the most obvious and impor tant is that they can proceed much more rapidly than natural evolution. This allows observation of many generations of behavioral adaptation, and, combined with precise parametric control of simulations, makes it possible to replay the evolutionary movie under different experimental conditions. To make simulations run quickly, the evolutionary models they instantiate must be relatively simple and clear, and to run at all, they must be coherent and complete (as in any computer program). This is also an advantage, since it requires that models be carefully thought out by the researcher and understandable by others. Simulations can also include a degree of complexity much greater than that allowed, for instance, by mathematical modeling. Numerous levels of adaptive processes, including information processing, learning, development, 363 Simulating the Evolution of Musical Behavior culture, and evolution, can all be incorporated into the models, adding greatly to their realism and predictive power. But we must be careful to avoid the attraction of building complex models for their own inherent interesting behavior, and instead construct speci c models to address speci c questions in an accurate and analyzable fashion.
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