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Wiki: Warrior Priest (Renown Items Guide) :: Warhammer Online :: Allakhazam.com on 2009-10-18
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Monster Missions on Test - Sequel Forums on 2009-10-03
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Rallos Returns - Hard or Standard
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Stasis Room - Hard or Standard
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Scrying Room - Hard or Standard
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Altar Room - Hard or Standard
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AC vs Heroic Agility on 2009-09-29
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Patient Health Questionnaire (PHQ) Screeners on 2009-09-14
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Seizure Disorders: Brain, Spinal Cord, and Nerve Disorders: Merck Manual Home Edition on 2009-08-27
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Causes
Which causes are most common depend on when seizures start:
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After age 25: A head injury, stroke, or tumor may damage the brain, causing a seizure. Alcohol withdrawal (caused by suddenly stopping drinking) is a common cause of seizures. However, in about half of people in this age group, the cause is unknown.
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People with a seizure disorder are more likely to have a seizure when they are under excess physical or emotional stress or deprived of sleep. Avoiding these conditions can help prevent seizures.
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Rarely, seizures are triggered by repetitive sounds, flashing lights, video games, or even touching certain parts of the body. In such cases, the disorder is called reflex epilepsy.
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Symptoms
In about 20% of people who have a seizure disorder, seizures are preceded by unusual sensations (called aura), such as the following:
Abnormal smells or tastes
Butterflies in the stomach
A feeling of déjà vu
An intense feeling that a seizure is about to begin
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Almost all seizures are relatively brief, lasting from a few seconds to a few minutes. Most seizures last 1 to 2 minutes. When a seizure stops, people may have a headache, sore muscles, unusual sensations, confusion, and profound fatigue. These after-effects are called the postictal state. In some people, one side of the body is weak, and the weakness lasts longer than the seizure (a disorder called Todd's paralysis). Most people who have a seizure disorder look and behave normally between seizures.
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Symptoms vary depending on which area of the brain is affected by the abnormal electrical discharge
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brief episodes of unresponsiveness
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confusion, and loss of muscle
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Partial Seizures:
Only one side of the brain is affected. Partial seizures may be simple or complex.
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In complex
partial seizures, abnormal electrical discharges begin in a small area of the temporal lobe or frontal lobe and quickly spread to other nearby areas. The seizures usually begin with an aura that lasts 1 to 2 minutes. During the aura, people start to lose touch with the surroundings. During the seizure, consciousness is impaired but not completely lost. People may do the following:
Stare
Chew or smack the lips involuntarily
Move the hands, arms, and legs in strange, purposeless ways
Utter meaningless sounds
Not understand what other people are saying
Resist help
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Some people can converse, but their conversation lacks spontaneity, and the content is somewhat sparse. They may be confused and disoriented. This state may last for several minutes. Most people do not remember what happened during the seizure (a condition called postictal amnesia). Some people then recover fully.
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Carbamazepine
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Generalized seizures
Partial seizures
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A low white blood cell count (granulocytopenia), production of too few blood cells (aplastic anemia, which can be fatal disorder), a low platelet count (thrombocytopenia), digestive upset, inability to articulate words, lethargy, dizziness, and visual disturbances
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Clonazepam
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Atonic seizuresAtypical absence seizures
Infantile spasms
Myoclonic seizures
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Drowsiness, abnormal behavior, loss of coordination, and lost effectiveness of the drug after 1 to 6 months |
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Partial complex seizure on 2009-08-27
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Complex partial status epilepticus is a condition in which partial complex seizures recur frequently in minutes. It is characterized by
changes in mental status,
decreased alertness,
confusion, decreased responsiveness, and automatic behaviors. It may be very difficult to diagnose and may require and EEG to confirm.
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Partial complex seizure Medical Information on 2009-08-27
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Complex Partial Seizures Present Diagnostic Challenge - Psychiatric Times on 2009-08-27
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John Hughlings Jackson observed in the late 1800s that seizures originating in the medial temporal lobe often result in a "dreamy state" involving vivid memory-like hallucinations sometimes accompanied by déjà vu or jamais vu (interpreting frequently encountered people, places or events as unfamiliar). Jackson wrote of "highly elaborated mental states, sometimes called intellectual aura," involving "dreams mixing up with present thoughts," a "double consciousness" and a "feeling of being somewhere else." While the "dreamy state" can occur in isolation, it is often accompanied by fear and a peculiar form of abdominal discomfort associated with loss of contact with surroundings, and automatisms involving the mouth and GI tract (licking, lip-smacking, grunting and other sounds).
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Even those patients describing feelings of unreality state that they know at the same time what reality is, observed Penfield. This is an important distinction from schizophrenia and other psychotic states.
For example, a patient of mine with temporal lobe epilepsy often feels compelled to stare for brief moments at a coffee table in her living room since, as she put it, "It just doesn't look exactly like my coffee table." After a few seconds, the feeling disappears. At no time does she think that the table has actually changed; the only thing that varies is her perception and "interpretation" of it.
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Altogether Penfield (Mullan and Penfield 1959) divided the illusions of interpretation into four groups:
Auditory illusions accompanied by the perception that sounds were louder or clearer, fainter or more distinct, nearer or farther away;
Visual illusions where things seemed clearer or blurred, nearer or farther away, larger or smaller; fatter or thinner;
Illusions of recognition where present experience seemed familiar, strange, altered or unreal; and
Illusions of emotion consisting of feelings of fear, loneliness, sorrow or disgust.
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Certainly, many of the patients tend to be obsessive and over-inclusive in their thinking, often satisfying some or all of the requirements for obsessive-compulsive personality: hyperphogia may be seen in some patients. Their speech and thinking is "viscous" and ponderous with a tendency toward loquacity and the insistence on the elaboration of fine and often tedious distinctions. Outbursts of irritability, rather than frank violence, are hallmarks of TLE.
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Finally, the clinician should inquire as to a family history of migraine, since migraine is overrepresented in families with TLE and can mimic the majority of TLE symptoms.
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During the seizures, the patients may also experience genital sensations, even feelings of sexual excitement evoked by the epileptic discharges.
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In retrospect, the most likely explanation was this: The lack of sleep and food coupled with stress led to the onset of a schizophreniform episode in a person with a latent seizure disorder. Because the episode was not associated with any signs of generalized epilepsy, it was not recognized as an example of complex partial seizure disorder by either psychiatrist or neurologist . After the psychosis had cleared, the patient was still left with a problem involving memory and focus originating from the hippocampus, a secondary effect of the abnormality in the right temporal region. The memory disturbance improved with anticonvulsant administration.
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In addition to the history, the diagnosis of complex partial seizure disorder can be aided by EEG. However, since such diagnosis remains a clinical one, it should be noted that several negative EEGs do not rule out the diagnosis of TLE in a given patient. Other diagnostic aids include MRI, single photon emission computed tomography (SPECT) and positron emission tomography (PET). Interictal SPECT of cerebral blood flow is not nearly as helpful as ictal SPECT. Even more sensitive, although not generally available, is PET imaging of interictal cerebral metabolism. PET permits greater spatial resolution and versatility. Only MRI can image the structural changes associated with the underlying epileptic process. Quantitative evidence of hippocampal volume loss is correlated with seizure onset in medial temporal structures.
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Schizophrenia-like epileptic psychoses often emerge when anticonvulsants are normalizing or improving the seizure activity. If this antithesis isn't recognized, the psychosis will soon become more of a problem than the seizures
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TLE management presents a conundrum. While the illness is an epileptic one and treated by neurologists, many neurologists remain unfamiliar with and even uninterested in its neuropsychiatric components. But by ignoring the experiential symptoms, the neurologist deprives the patient of the opportunity to coherently integrate all aspects of the epilepsy. It may also cement the patient's misconception that in addition to the epilepsy, he or she suffers from a "mental illness."
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Total management of TLE by a psychiatrist is also not without problems. Although temporal lobe epileptic patients are particularly intriguing to psychiatrists because of the nature of the symptoms, these "psychic" seizures can generalize at any time into psychomotor status or grand mal attacks. What's more, neither the timing nor the seriousness of grand mal episodes can be predicted; the initial generalized seizure sometimes occurs many years after the first manifestations of the illness and may culminate in status epilepticus and death.
For these reasons, a physician should undertake the treatment of TLE patients only if he or she has sufficient training and experience in the overall management of epilepsy. When this isn't the case, close collaboration between psychiatrist and neurologist offers the best venue for successful management of this fascinating "bridge" between neurology and psychiatry.
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Crossing Siren's Grotto on 2009-06-25
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Twice I have tried to cross SG without a druid or wizard, and twice I made it without a single thing agroing.
From CS zone archway at water, you are facing the big waterfall with bits of land on the right and left of the base of the falls. Put invis up and swim directly over to the nearest corner of the right bit of land. Take a couple steps towards the falls, just a couple, and swim directly across to the left bit of land. Once there move to the far front corner just above the underwater tunnel that is guarded by two seahorses. Hug the wall and take a teeny tiny step to slip into the water, and immediately turn to your right to swim into the tunnel. As long as you don't dawdle you shouldn't get agroed. (I was level 53 both times I tried this, and the seahorses were white.)
Swim into the tunnel hugging the bottom left corner. You'll pass one horse which will not agro if you are glued to the corner and don't stop. When you reach the point where the tunnel bends up, swim up to air. This is a good point to reinvis if you need to. Swim over the ledge that is the only way down, and you'll land in a pool with some fish that do not see invis. On the left is land, and if you get into the near corner of it as far back as you can sit you will not be agroed even if you lose invis. Be careful, though, as one wandering mob comes pretty close if you're not all the way back.
From there, follow the left wall around the big golden fish statue and down the tunnel in the left wall. Take the left branch when it forks and you'll hit the WW zone. The WW/SG zone should be safe on either side unless it has been trained.
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Allakhazam.com: Everquest: Quest: Bard Epic 1.5 Pre-Quest on 2009-06-25
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The smallest flicker of a grin crosses over Lantaric`Dar's draconic features. 'I was hoping you'd say that. There are three giants that act as heralds for Tormax in this region. Find them, kill them, and bring me their heads to prove your loyalty.'
Kill 3 x "a giant herald," level 60, elsewhere in the Wakening Land and loot a Storm Giant Herald Head from each. Bring back all three heads to Lantaric`Dar.
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"a giant messenger" at +265, +3150, level 60, carries Kromzek Supply Orders. Kill the messenger (shoot it?) and bring the orders back to Lantaric`Dar.
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A mob called Cristoc Bonethug will spawn in the geonid caves (/loc?), along with several of his buddies called "a bonethug mercenary." He summons but is otherwise a straight melee fight. Loot a sealed note (text of note?). Give the note to Lantaric`Dar.
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as Thorel is a black drake found in Iceclad Ocean on the very southern edge of the island after the bridge to the Eastern Wastes, at -5610, +8635.
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The Kromzek Escort will spawn in front of the bridge to the Eastern Wastes. It's composed of 1 named giant called Noble Oldencamp, 4 necros (Puella Opalis, Amilia Verisue, Locis V`Sek, and Nihilist Xeegarn) and their pets, and several of "a frost giant warrior" and "a frost giant escort." The named will summon. Once they're all dead, loot Puella's Head, Amilia's Head, Locis' Head, Xeegarn's Head, and a Sealed Kromzek Scroll. Bring the scroll back to Vas Thorel.
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Give the four heads to Lantaric`Dar.
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