Abruptio placentae. A condition in which the placenta begins to detach itself from the wall of the uterus before the birth of the baby.
Absence seizure. A blank stare, beginning and ending abruptly; lasting only a few seconds; most common in children. You may also notice rapid blinking and some chewing movements of the mouth. The child or adult is unaware of what is going on during the seizure, but quickly returns to full awareness once it has stopped. It may result in learning difficulties.
Accidental hemorrhage. Vaginal bleeding usually indicates abruptio placentae; may be hidden for some time.
Alpha-fetoprotein. A protein produced by the fetus that is excreted into the amniotic fluid. Abnormal levels of alpha-fetoprotein may indicate brain or spinal cord defects, multiple fetuses, a miscalculated due date, or chromosomal disorders.
Amniocentesis. A common prenatal test in which a small sample of the amniotic fluid surrounding the fetus is removed and examined. It is often used during the second trimester of pregnancy (usually 15-18 weeks after a woman's last menstrual period) to rule out certain birth defects. Amnio-centesis is the most common prenatal test used to diagnose chromosomal and genetic birth defects.
Amniotic sac. A thin-walled sac that surrounds the fetus during pregnancy.
Anemia. A condition that develops when blood is deficient in healthy red blood cells, the main transporter of oxygen to organs. If red blood cells are also deficient in hemoglobin, then the body is not getting enough iron. Symptoms of anemia, such as fatigue, occur because the organs are not getting enough oxygen. There are many types of anemia, all are very different in their causes and treatments. Iron-deficiency anemia, the most common type, is treatable with diet and iron supplements. Some forms of anemia, such as the anemia that develops during pregnancy, are even considered normal. Some types of anemia, however, may present lifelong health problems. Women in their childbearing years are particularly susceptible to iron-deficiency anemia because of the blood loss from menstruation and the increased blood supply demands during pregnancy. Certain forms of anemia are hereditary, and infants may be affected from the time of birth.
Antiepileptic drug (AED). A medication used to control epileptic seizures.
Astatic seizure. A seizure that causes sudden loss of muscle tension, in which the person falls down and is often injured.
Atonic seizure. A sudden loss of muscle tone that makes the person collapse and fall. In some people, all that happens is a sudden drop of the head. The person recovers and regains consciousness after a few seconds to a minute. Drop attacks can cause injuries because of the force of the fall.
Aura. Many people think an aura is a warning that a seizure may be imminent, but auras are actually the beginning of a seizure. Patients have described auras ranging from abnormal smells or tastes to a funny feeling in the stomach, and sounds, colors, or emotional rushes.
Automatism. Something a person does during a seizure in a state of diminished consciousness, such as pulling at clothing.
Birth defects. Malformations in the fetus. A birth defect may affect how the body looks, function, or both. It may be found before birth, at birth, or anytime after birth. Most defects are discovered within the first year of life. Some birth defects (cleft lip or clubfoot) are easy to see, but others (heart defects or hearing loss) are found using special tests (X-rays, CAT scans, echocardiography, or hearing tests). Birth defects can vary from mild to severe; some may cause the baby to die. Babies with birth defects may need surgery or other medical treatments, but with medical care they usually lead normal lives.
Blind trial. A drug trial in which neither subject nor doctor knows which treatment is being given, drug or placebo.
Braxton-Hicks contractions. Painless contractions during pregnancy that help the uterus to grow and the blood to circulate through the uterus.
Breech birth. An abnormal delivery presentation in which the baby's feet, knees, or buttocks come into the birth canal first, before the baby's head does.
Callosotomy. An operation for epilepsy that involves splitting the callosal body (split brain).
Carbamazepine (Tegretol). An excellent medication in its various forms that is mostly used for partial seizures. In general, it is very well tolerated and has some transient sedation effect, usually resolving in 3 days. Tegretol may cause myoclonic seizures and atypical absence seizures to worsen significantly. It may also cause a life-threatening blood count, liver dysfunction, and severe allergic rashes, including Steven Johnson's disease.
Cardiac defects. Atrial septal defect, tetralogy of Fallot, ventricular septal defect, coarctation of the aorta, patent ductus arteriosus, and pulmonary stenosis.
Cassette EEG (electroencephalography). A recording of long-term EEG by means of a tape recorder that can be hung on the belt.
Central nervous system (CNS). The brain and the spinal cord together form the central nervous system. The CNS is one division of the human nervous system.
Cervix. The lower part of the uterus that projects into the vagina; mostly fibrous tissue and muscle and circular in shape. During pregnancy, the cervix lengthens, serving as a barrier. When labor begins, the cervix begins to shorten, dilating to an opening of about 10 centimeters (4 inches) to allow the fetus to pass through. The cervix also thins and merges with the uterus (effacement) during the first stage of labor.
Cesarean section (C-section). The obstetric operation for delivering a baby through the abdominal wall. This is usually lower uterine segment cesarean section, or LSCS, carried out via a transverse cut in the lower part of the abdomen.
Chorionic villus. A test done during pregnancy to identify certain problems with the fetus. It is usually done when either of the parents has a family history of an inherited disease, or when the age of the mother (35 years old or older) increases her risk of having a baby with a chromosome defect. Chorionic villi are tiny finger-like projections found in the placenta. The genetic material in chorionic villus cells is identical to that in the fetal cells. During CVS, a sample of the chorionic villus cells is taken for biopsy. The general health of the fetus can be predicted by examining the chorionic villus cells for abnormalities. This procedure is usually done during the first 3 months of pregnancy, ideally between the eighth and twelfth weeks. CVS is not generally done after the twelfth week of pregnancy because increasing amounts of amniotic fluid make the procedure more difficult. Also, after 12 weeks it becomes more difficult to distinguish chorionic villus cells from the cells of the mother.
Chromosomes. The carriers of inherited predispositions; found in cell nuclei.
Cleft palate. A birth defect in which there is a split in the roof of the mouth.
Clonic seizures. A type of seizure that starts with a sudden cry, fall, and/ or body stiffness followed by jerking movements as the muscles repeatedly tense and then relax. Skin may be bluish. Possible loss of bladder or bowel control as muscles relax. Usually lasts a minute or two, after which normal breathing returns. The person may be confused or tired afterwards, and fall into a deep sleep. Person may complain of sore muscles or bitten tongue upon awakening.
Clubfoot. A group of deformities of the ankles and feet or sometimes both. These defects are usually present at birth. The defect may be mild or severe, and may affect one or both of the ankles and/or feet. There are different forms of clubfoot. Some may include talipes equinovarus, when the foot is turned inward and downward; calcaneal valgus, when the foot is angled at the heel with the toes pointing upward and outward; metatarsus varus, when the front of the foot is turned inward. If not corrected, babies who are affected may develop an abnormal way of walking.
Colic. Strong abdominal pain, usually of fluctuating severity, with waves of pain seconds or a few minutes apart. Infantile colic is common among babies. It is caused by gas in the intestines, and is associated with feeding difficulties; colic is not dangerous.
Colostrum. Fluid in the breasts that nourishes the baby until breast milk becomes available. Colostrum contains fats, carbohydrates, white blood cells, protein, and antibodies.
Complex partial seizures. Complex and simple partial seizures are similar, but complex partial seizure is accompanied by impaired consciousness and recall. A person having a complex partial seizure will be unresponsive to questions or commands and will not be able to recall what happened during the seizure after it is over. Complex partial seizures used to be called temporal lobe or psychomotor seizures.
Cradle cap. A common condition in young babies in which crusty white or yellow scales form a "cap" on the scalp. Application of oil or a special shampoo usually helps to resolve this condition.
Diagnostic treatment. A trial treatment with antiepileptic medicine when it has not been possible to ascertain whether the person has epilepsy.
Down Syndrome. Named after John Langdon Down, the first physician to identify the syndrome, this is the most frequent genetic cause of mild to moderate mental retardation and associated medical problems; occurs in one out of 800 live births, in all races and economic groups. Down syndrome is a chromosomal disorder caused by an error in cell division that results in the presence of an additional third chromosome 21, or trisomy 21. To understand why Down syndrome occurs, the structure and function of the human chromosome must be understood. The human body is made up of cells that contain chromosomes, which are structures that transmit genetic information. Most cells of the human body contain 23 pairs of chromosomes, half of which are inherited from each parent. Only the human reproductive cells—the sperm cells in males and the ovum in females—have 23 individual chromosomes, not pairs. Scientists identify these chromosome pairs as the XX pair, present in females, and the XY pair, present in males, and number them 1 through 22.
Ectopic pregnancy. An abnormal pregnancy in which the fertilized egg implants outside of the uterus.
EDD. Estimated due date.
EEG (electroencephalography). A registration of the electrical activity of the brain using electrodes placed on the scalp.
Embryo. The fetus is called an embryo during the first 8 weeks after conception.
Enzyme. A substance that stimulates chemical processes.
Enzyme induction. Stimulation of the liver's enzyme systems so that medicine and other substances are broken down faster than normally.
Epilepsy. A group of disorders characterized by unprovoked, recurrent seizures—that is, sudden, transient disturbances of electrical activity in the brain—that disrupt normal neurologic functioning. Symptoms depend on the type of epilepsy and the location of the disturbance in the brain; epilepsy can include loss of consciousness, and motor, psychic, or sensory phenomena.
Epileptic focus. An area in the brain that triggers epileptic activity.
Epileptic syndrome. An age-linked type of epilepsy in which a group of different symptoms make up the picture.
Episiotomy. An incision into the perineum (area of skin between the vagina and the anus) that is made during childbirth to enlarge the opening for delivery.
Ethosuxamide (Zarontin). Medication that is good for absence seizures only; one of the safest anticonvulsants available. Hematological side effects and allergic reactions have been reported. Drowsiness, headaches, and abdominal pains may also occur.
Felbamate (Felbatol). A very effective anticonvulsant, even for severe and resistant seizures such as Lenox-Gastaut syndrome, and generalized absence, myoclonic, and focal seizures. The use of felbamate is extremely limited, because of the severe and possibly fatal blood and liver damage associated with this medication.
Fetal alcohol syndrome. Birth defects caused by a mother's alcohol consumption during pregnancy. Children with the most severe effects have characteristic facial features (a small face, narrow eye openings, a short upturned nose, a flattened groove between the nose and the upper lip, and a thin upper lip), growth retardation, and mental and behavioral problems (central nervous system effects). They may also have birth defects that involve the eyes, ears, heart, urinary tract, and bones. Children with less severe effects may have one or a combination of these characteristics to a milder degree. Some experts use the term fetal alcohol spectrum disorder (FASD) to include all categories of alcohol effects on a fetus. When a pregnant woman drinks alcohol, the alcohol passes from her blood into the fetus. Large amounts of alcohol may damage fetal cells, especially those of the central nervous system. The exact way alcohol causes the damage is not known. From magnetic resonance imaging (MRI) and computed tomography (CT) scans of babies with FASD, it appears that alcohol may target specific areas of the developing brain.
Fetus. An unborn baby from the eighth week after conception until delivery.
Folate. Folate and folic acid are forms of a water-soluble B vitamin, occurring naturally in food. Folic acid is the synthetic form of this vitamin that is found in supplements and fortified foods. A key observation of researcher Lucy Wills nearly 70 years ago led to the identification of folate as the nutrient needed to prevent the anemia of pregnancy. Dr. Wills demonstrated that anemia could be corrected by a yeast extract. Folate was identified as the corrective substance in yeast extract in the late 1930s, and was first extracted from spinach leaves in 1941. Folate is necessary for the production and maintenance of new cells. This is especially important during periods of rapid cell division and growth such as infancy and pregnancy. Folate is needed to make DNA and RNA, the building blocks of cells. It also helps make normal red blood cells and prevents anemia; prevents birth defects.
GABA (Gamma-amino butyric acid). An inhibitory neurotransmitter.
Gabapentin (Neurontin). An anticonvulsant medication design to mimic the GABA molecule. GABA is an inhibitory neurotransmitter; theoretically, increasing GABA concentration decreases brain excitation and stops sei zures. Taking GABA alone (available in health food stores) is useless, because GABA does not cross the blood-brain barrier; Neurontin was designed to have a GABA structure, yet be able to penetrate into the brain. It is a very safe anticonvulsant, but its efficacy is questionable. High doses are needed to achieve good seizure control. Side effects include dizziness and drowsiness. Other uses have been found for Neurontin, including the treatment of migraines (as a preventative agent), neuropathies, and trigeminal neuralgia. The actual mechanism of action of this medication is unknown, but it clearly is not what it was originally designed to be.
Gastric tone. Determines the sensitivity of the stomach to distention.
Generalized seizure. A seizure in which the abnormal electrical activity involves the whole brain.
Generalized tonic-clonic seizure (grand mal seizures). During this type of seizure, the person falls to the ground, the entire body stiffens, and the person's muscles begin to jerk or spasm (convulse).
Gestational diabetes. A type of diabetes that begins during pregnancy in which the body is not able to use the sugar (glucose) in the blood as well as it should, resulting in a high level of sugar in the blood. Gestational diabetes affects about 4% of all pregnant women. It usually begins in the fifth or sixth month of pregnancy (between 24 and 28 weeks). Gestational diabetes usually goes away after the baby is born.
Half-life. The time it takes for the concentration of a drug to fall to half of its peak concentration; important in finding out how many doses should be taken in a day.
Hemoglobin. The substance in red blood cells that carries oxygen.
Human chorionic gonadotropin. A hormone produced by the placenta about 10 days after fertilization.
Hyperventilation. Rapid breathing; used as a method of provocation during EEG. Particularly suited to provoke absences.
Hypsarrhythmia. Special changes in EEG in infantile spasms.
Ictal. That which happens during a seizure.
Idiopathic epilepsy. Epilepsy with no known cause; hereditary factors combined with biochemical changes in the brain may be involved.
Informed consent. A person's agreement to participate in a scientific investigation after being told the relevant facts and risks involved.
Intensive monitoring. Registration by cassette or video EEG.
Interictal. That which happens between seizures.
Jaundice. A condition in which the skin and whites of the eyes are yellowish in color.
Kegel exercises. Strengthen the pelvic-floor muscles; done regularly during pregnancy and after childbirth; can help prevent leakage of urine, as well as increase sexual responsiveness.
Klonopin (clonazepam). A benzodiazepine that is similar to Valium; may be helpful for myoclonic, generalized, and partial seizures. It may also be helpful for infantile spasms or Lenox-Gastaut syndrome. Side effects are mostly related to sedation, drooling, cognitive impairment, and hy-peractivity.
Lamotrigine (Lamictal). An effective, well-tolerated medication good for generalized and partial seizures that may also be effective for absence seizures, atomic seizures, and Lenox-Gastaut syndrome. It may be associated with the development of a severe rash, especially if combined with valproic acid. Studies indicate that the rash does not occur frequently if the dose is gradually titrated upwards. Other side effects are mild, and consist mostly of dizziness, drowsiness, or headaches.
Levetiracetam (Keppra). An effective adjunct medication for partial seizure control; no serious side effects have been reported. It has been used in practice since 2000; in June 2005 it was approved for use in children 4 years of age and older. For resistant partial seizures, however, this medication should be attempted before resorting to invasive managements.
Lobes. The brain can be divided down the middle lengthwise into two halves called the cerebral hemispheres. Each hemisphere of the cerebral cortex is divided into four lobes by various sulci and gyri. The sulci (or fissures) are the grooves, and the gyri are the bumps that can be seen on the surface of the brain. The folding of the cerebral cortex produced by these bumps and grooves increases the amount of cerebral cortex that can fit in the skull. Although most people have the same patterns of gyri and sulci on the cerebral cortex, no two brains are exactly alike.
Lumbar puncture. Puncture of the lumbar spine with a thin needle.
Mastitis. Inflammation of the breast, usually caused by bacterial infection via damaged nipples.
Myoclonic jerk. A sudden jerk of the arm or leg that can occur as a particular seizure type in epilepsy. Many people experience something similar when falling asleep, but it is not epilepsy.
Myoclonic seizures. Sudden brief, massive muscle jerks that may involve the whole body or parts of the body. May cause the person to spill what they were holding or fall off a chair.
Neuron. A nerve cell.
Neurotransmitter. A chemical substance that allows the passing of neural impulses from cell to cell.
Oxcarbazepine. The generic name for the antiepileptic drug Trileptal, an excellent, safe anticonvulsant. It is very similar to carbamazepine (Teg-retol) in structure, but designed to have the epoxide moiety. The epoxide is the part of carbamazepine responsible for drowsiness, severe allergic reactions, and liver damage and blood dyscrasia that may cause fatal side effects. The seizure control obtained with Trileptal is as good and in some situations better than with Tegretol. Side effects are minor, and may cause some temporary drowsiness, mild allergic reaction, and decreased sodium level in the elderly. In short, Trileptal is an improved Tegretol, more effective and better tolerated; it has never been the cause of any fatal side effects.
Partial seizure. A seizure that occurs only in a specific part of brain. Partial seizures often start with an aura; usually arising in the frontal or temporal lobe. The symptoms of a partial seizure depend on area of the brain involved in the seizure.
Pharmacokinetics. The study of the time course of drug and metabolite levels in different fluids, tissues, and excreta of the body, and of the mathematical relationships required to develop models to interpret such data.
Phenobarbital. A drug for generalized and partial seizures that may be used for febrile seizures; more frequently used during the neonatal period, but rarely used after 5 years of age because of its potential to cause learning difficulties. Side effects include hyperactivity and other behavioral difficulties in about half of the children treated (aged 2 to 10). Drowsiness and rashes may also occur. Rare impairments of liver functions and blood counts have been reported. Phenobarbital is best tolerated in children less than 1 year old.
Phenytoin (Dilantin, Phenytek). Medication most effective in partial seizures, but also good for generalized seizures and status epilepticus. It is also helpful for the control of seizures that occur on an intermittent basis. Phenytoin causes many side effects, including hypertrophy (swelling) of the gums, coarsening of facial features, facial hair growth, and brain atrophy over extended use. It may also cause the usual side effects, including allergic reaction, and blood count and liver enzyme dysfunction. The allergic reaction may be severe (Steven Johnson's disease) and life-threatening.
Photosensitive epilepsy. A form of epilepsy in which seizures can be caused by blinking light.
Placebo. Tablets (often called chalk tablets or sugar pills) that have no medicinal content and therefore no physiologic effect (often used in blind studies.)
Plasma volume. The volume of plasma in the blood. Plasma, the noncellu-lar portion of blood, consists of water, inorganic salts (such as sodium, potassium, and calcium), and organic molecules (such as sugars and proteins). Normal plasma volume in an average adult is usually 3 liters, while total blood volume is about 5 liters.
Placenta. An organ shaped similar to a flat cake that grows in the uterus during pregnancy; provides for metabolic interchange between the fetus and mother.
Polycystic ovary syndrome (PCOS). A hormonal imbalance condition in which normal, regular ovulation does not occur. This hormonal imbalance also affects other body systems, such as metabolism and the cardiovascular system. The cause of PCOS is not fully known; occurs in 5% to 10% of women ages 20 to 40.
Polytherapy. A treatment involving more than one medication.
Premature. Born before full term, or 37 weeks, of gestation.
Preterm labor. A typical full-term pregnancy lasts 37 to 42 weeks, calculated from the first day of the last menstrual period to childbirth. Preterm labor, or premature labor, is the early onset of uterine contractions before 37 weeks, but after 20 weeks of pregnancy.
Primidone (Mysoline). Mysoline is the same as phenobarbital; metabolizes to phenobarbital plus PEMA. It causes more sedation than phenobarbital, and may be helpful in some seizures that are poorly controlled with phenobarbital.
Prodromes. Longer prewarning of a seizure, often lasting several days; most commonly depression.
Prognosis. The expected future course of an illness.
Pseudo seizure. A seizure that is caused by psychic factors (not epilepsy).
Psychogenic seizure. Unplike epileptic seizures, psychogenic seizures are not the result of an abnormal electrical discharge from the brain, but rather a physical manifestation of a psychological disturbance. They are a type of conversion disorder that is usually involuntary.
Secondary generalization. A partial seizure that develops into a generalized seizure.
Simple partial seizures. A seizure during which the person is alert and able to respond to questions or commands. People who have had a simple partial seizure can remember what occurred during the seizure.
Slow-release formula. A special form of medicine that can be taken fewer times a day with the same effect.
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