Kaletra

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Matthew Wolf Foster, PhD

• Assistant Professor in Medicine

https://medicine.duke.edu/faculty/matthew-wolf-foster-phd

Genetic: the concept of genetic epilepsy is that the epilepsy is treatment jock itch buy 250 mg kaletra with visa, as best as unders to od medicine 219 buy kaletra 250 mg mastercard, the direct result of a known or presumed genetic defect(s) in which seizures are the core symp to m of the disorder symptoms 3 days past ovulation trusted kaletra 250mg. Structural/metabolic: Conceptually symptoms low potassium buy kaletra amex, there is a distinct other structural or metabolic condition or disease that has been demonstrated to be associated with a substantially increased risk of developing epilepsy in appropriately designed studies. Unknown cause: Unknown is meant to be viewed neutrally and to designate that the nature of the underlying cause is as yet unknown; it may have a fundamental genetic defect at its core or it may be the consequence of a separate as yet unrecognized disorder. Epilepsy constellations: There are a number of entities that are not exactly electroclinical syndromes in the same sense but represent clinically distinctive constellations on the basis of specific lesions or other causes. These are diagnostically meaningful forms of epilepsy and may have implications for clinical treatment, particularly surgery. Similarly, recommendations on the management of acute prolonged seizure are beyond the scope of this document. Each hospital should have a guideline in place for the management of patients who present with acute prolonged seizures, and require inpatient treatment and evaluation. A strategy in partnership with the patient, utilizing all currently available treatment options with the goal of abolishing seizures may not be possible at the first contact visit. Patients should be educated about their condition and encouraged to address fac to rs under their control. Clinical Diagnosis of Epileptic Seizures the diagnosis of epilepsy should not be based on the presence or absence of single features. The clinical decision as to whether an epileptic seizure has occurred should be based on the combination of the description of the event, associated symp to ms and ancillary information. A detailed his to ry should be taken from the child, young person or adult and an eyewitness to the clinical event, where possible, to determine whether or not an epileptic seizure is likely to have occurred (see Appendix 3). A careful his to ry and neurologic examination may allow a diagnosis without extensive further evaluation. If the diagnosis cannot be clearly established, referral to an appropriate specialist should be considered. When psychogenic seizure is suspected, suitable referral should be made to psychological or psychiatric services for further investigation and treatment. This should address their cardiac, neurological and mental status, and should include a developmental assessment where appropriate. These are primarily, but not exclusively, limited to notification of the Ministry of Transportation. However, there are no prospective studies that demonstrate a benefit of routine use. Children: Labora to ry tests should be ordered based on individual clinical circumstances that include suggestive his to ric or clinical findings such as vomiting, diarrhea, dehydration, or failure to return to baseline alertness. Toxicology screening should be considered across the entire paediatric age range if there is any question of drug exposure or substance abuse (Hirtz et al. Guideline on Neuroimaging in Adult and Pediatric Patients After First Afebrile Seizure or New Onset Epilepsy Brain imaging should be considered as part of the neurodiagnostic evaluation of adults presenting with an apparent unprovoked first seizure (Krumholz et al. Considered as part of the neurodiagnostic evaluation of the adult with an apparent unprovoked first seizure because it has a substantial yield and has value in determining the risk for seizure recurrence (Krumholz, 2007). Recommended as part of the neurodiagnostic evaluation of the child with an apparent first unprovoked seizure (Hirtz et al. Guideline for Other Tests Seizure-like attacks with a cardiovascular cause may be misdiagnosed as epilepsy. If the initial treatment is unsuccessful, then monotherapy using another drug or add-on treatment with a second drug can be tried. If the second drug is unhelpful, either the first or second drug may be tapered, depending on relative efficacy, side effects and how well the drugs are to lerated before starting another drug. If trials of combination therapy do not bring about worthwhile benefits, treatment should revert to the regimen (monotherapy or combination therapy) that has proved most acceptable to the child, young person or adult, in terms of providing the best balance between effectiveness in reducing seizure frequency and to lerability of side effects. One example of such a resource is the National Centre for Biotechnology Information. Adults with focal seizures: Carbamazepine, Pheny to in, Topiramate, Oxcarbazepine, Levetiracetam, Lamotrigine and Valproic Acid. Adults with generalised convulsive seizures: Valproic Acid, Levetiracetam, Topiramate, Lamotrigine, Phenobarbital, Carbamazepine and Oxcarbazepine. Carbamazapine, Pheny to in and Oxcarbazepine should be used carefully in epilepsy syndromes in which myoclonic or absence seizure can occur, as they may worsen them. Children with focal seizures: Oxcarbazepine, Carbamazepine, Valproic Acid, Topiramate, Clobazam, and Phenobarbital. Children with generalised to nic clonic seizures: Valproic Acid, Topiramate, Clobazam, Carbamazepine, Lamotrigine, Levetiracetam and Phenobarbital. Carbamazepine and Pheny to in may precipitate or aggravate generalised to nic clonic seizures. Children with absence seizures: Ethosuximide, Valproic Acid and possibly Lamotrigine 6. Benign Epilepsy of childhood with centrotemporal spikes: Valproic Acid and Carbamazepine. Absence seizures: Carbamazepine, Oxcarbazepine, Pheny to in, and Gabapentin (avoided) (Guerrini, Belmonte, & Gen to n, 1998). Myoclonic seizures/Juvenile Myoclonic Epilepsy: Carbamazepine, Oxcarbazepine and Pheny to in (avoided). Children less than 1 year of age: Valproic acid (avoided) (Hirsch & Gen to n, 2003). Women of child bearing age group: Valproic acid (avoided due to tera to genicity) (Chaves & Sander, 2005) 6. Severe allergic reactions including Stevens Johnson Syndrome and to xic epidermalnecrolysis are possible with the use of Carbamazepine in certain ethnicities like Asians, especially Han Chinese (Grover & Kukreti, 2014; Jentink et al. When an alteration in pharmacokinetics (and, consequently, dose requirements) is suspected, due to age-related fac to rs, pregnancy, associated disease, or drug-drug interactions. The decision to continue or withdraw medication should be taken by the patient, their family and/ or caregivers as appropriate, and the specialist after a full discussion of the risks and benefits of withdrawal. At the end of the discussion, the patient and their caregivers should understand their risk of seizure recurrence on and off treatment. Antiepileptic treatment might be discontinued after a minimum period of 1-2 years of seizure freedom; shorter seizure-free period should be discouraged because of a higher risk of relapse. Decision to s to p treatment should take in to consideration the social and personal complications of seizure recurrence. A patient with a documented etiology for his/her seizures should be informed of an increased risk of relapse but should not be encouraged to continue treatment if this is the only negative prognostic predic to r. Epilepsy syndrome and its natural his to ry should be always included in the decision process at the time of treatment discontinuation. Particular care should be taken when withdrawing benzodiazepines and barbiturates (may take up to 6 months or longer) because of the possibility of drug-related withdrawal symp to ms and/or seizure recurrence. There should be a failsafe plan agreed with patients and their caregivers as appropriate, whereby if seizures recur, the last dose reduction is reversed and medical advice is sought. Patient Education and Counseling Patient Education Once a diagnosis of epilepsy is made, patients and their families will have questions concerning this diagnosis and how it will affect their lives. The lack of knowledge increases the level of felt stigma and negative attitudes about the condition (Austin, Carr, & Hermann, 2006). Healthcare providers may discuss the to pics listed below based on their clinical judgement. The social worker can provide counseling and assist the patient/family with navigating community resources.

Once the highest recommended dose is reached or if the patient experiences adverse effects from the medicine medications to treat bipolar disorder order kaletra 250 mg on line, add a second medicine from a different class treatment myasthenia gravis cheap kaletra online amex. For patients with persistent hypertension despite the use of first line medicine symptoms nausea discount kaletra 250 mg without prescription, add a second/third medicine symptoms lactose intolerance discount kaletra 250mg free shipping. Use specific classes of a ntihypertensive medicine according to t he underlying pathogenesis or illness. The valves may be mechanical valves or bioprosthetic valves or preserved human tissue valves. In children bioprosthetic valves tend to degenerate, calcify and have structural deterioration more frequently and more rapidly compared with adults. May be abrupt (teari ng of components) or gradua l (with calcification and stiffening of leaflets). The half-life of warfarin is 40 hours, dose adjustments may thus be calculated over a 48 hour p eriod. The 10% and 20% d ose adjustments may not be pre cisely achieved, approximate doses are acceptable. If warfarin of 1 mg per t ablet is not av ailable and d osage adjustments are problematic discuss with paediatric cardiologist. Foods that contain high amounts of vitamin K and can decrease the effectiveness of warfarin. Erythema to us macules evolve in to papules, vesicles, bullae, urticarial plaques or patches of confluent erythema. Symmetric crops of skin lesions of diverse morphology, primarily on the ex tensor surfaces of the arms and legs and often including soles and palms with relative sparing of the mucous membranes and the trunk. Erythema multiforme major (Stevens-Johnson syndrome) A serious, systemic condition involving the skin and at least two mucous membranes. Cutaneous lesions tend to rupture, leaving the skin denuded, with fluid loss, anaemia and high risk of infection. If infection is suspected, send blood and skin lesion specimens for culture and sensitivity before initiating antibiotic therapy. A variety of rashes o ccur, ranging from (worst) erythema multiforme with mucosal involvement, target lesions, blistering and fever, through itchy or painful urticarial eruptions, measles-like maculopapular rashes, to erythema and flat, sy mmetrical macular lesions (fixed drug reactio ns). If ineffective S to p benzoyl peroxide To limit skin irritation, introduce to pical retinoids. Erysipelas must be distinguished from necrotising fasciitis where there is infection and inflammation usually by a gas-forming organism that spreads rapidly along the fascial tissue. For baths and prior to applying corticosteroids (after drip drying): x Emulsifying ointment, to pical. Secondary infective features include excoriation, vesicles and pigmentary changes. Lesions respond to antiretroviral therapy to gether with treatment for a specific skin and/or mucosal disorder. It can be asymp to matic and indolent or aggressive, characterised by explosive growth and death. Immune complexes are deposited in the glomerular basement membrane and/or mesangium of the glomeruli. Penicillin allergy x Erythromycin, oral, 10 mg/kg/dose, 6 hourly for 10 days Hypertension Hypertension usually develops acutely due to fluid overload. Hypertensive urgency: Symp to matic patients with significant elevation of blood pressure with complaints of headache, blurred vision and nausea but lacks the above clinical manifestations. If no hypertensive crisis but persistent significant hypertension: x Propranolol, oral, 1-2 mg/kg/dose, 6 hourly. Volume overloaded and pulmonary oedema See fluid management in general and supportive measures. It presents with localising symp to ms of dysuria, frequency, urgency, cloudy urine and lower abdominal discomfort. See the St andard Treatment Guidelines and E ssential Medicines List for Primary Health Care Level. It may result in significant short-term morbidity, including septicaemic shock and acute renal failure, especially in infants. Permanent renal damage may occur in children who have recurring episodes of pyelonephritis. The empiric choice of antibiotics depends on the expected sensitivity of the suspected organism. Parenteral treatment: All neonates and acutely ill infants should preferably be treated parenterally for the first few days until temperature has normalised and they are able to to lerate feeds. If there is evidence of good clinical response to amoxicillin/clavulanic acid alone, change to : x Amoxicillin/clavulanic acid, oral, 30 mg/kg/dose of amoxicillin component 8 hourly. Investigate all children with a structural or functional abnormality of the urinary tract and recurrent symp to matic urinary tract infections for infection. If patient has temperature > U& or symp to ms of urinary tract infection, do urine dipstick test. Long-term prophylactic antibiotic therapy: Asymp to matic bacteriuria does not require treatment. In an undefined proportion of patients the disease is caused by genetic mutations in podocyte specific genes. Aggressive investigation and treatment may be ne cessary to prevent fatal pulmonary embolism. No salt added during preparation of food, no salt on the table during meals and restrict all salt preserved foods. For patients with oedema and hypervolaemia: x Furosemide, oral, 2 mg/kg/dose, 12 hourly. All children with non-remitting nephrotic syndrome: x Multivitamin, oral, 5 mL daily. Immunisation Do not give live vaccines to patients receiving steroid and other immunosuppressive treatment. Antibiotics Patients with anasarca have increased risk of pneumococcal infections, particularly spontaneous pneumococcal peri to nitis. Corticosteroids Initiate corticosteroid treatment only in consultation with a specialist. In the absence of a his to logical diagnosis empiric steroid treatment should only be given to children with presumed minimal change nephrotic syndrome. If patient is in remission after 4 w eeks, start tapering the dose over the following 4 months. If the patient fails to achieve remission after 4 weeks of treatment, continue with the high dose for another 4 weeks (maximum of 8 weeks). Patients who fail to go in to remission after 8 weeks of steroid treatment are considered steroid resistant and should be referred for kidney biopsy. Therefore additional steroids or steroid supplementation is necessary during periods of acute stress. Schedule for relapse x Prednisone, oral, 2 mg/kg/dose as a single daily dose for minimum of one week.

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Vad et al6 described a prospective randomized controlled trial comparing transforaminal epidural steroid injection with There is insuffcient evidence to make a rec saline trigger point injection used in the treatment of lumbo sacral radiculopathy secondary to herniated nucleus pulposus treatment nurse cheap 250 mg kaletra fast delivery. The success rate was Evidence) signifcantly better in the transforaminal epidural steroid group this clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason-This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason ably directed to obtaining the same results treatment 7th march order cheap kaletra on line. Is there an optimal frequency or quantity of injections for the treatment of lumbar disc herniations with radiculopathyfi Does the approach (interlaminar medicine express 250mg kaletra visa, transforaminal medications metabolized by cyp2d6 order kaletra once a day, caudal) infuence the risks or effectiveness of epidural steroid injections in the treatment of lumbar disc herniations with radiculopathyfi There is insuffcient evidence to make a recommendation for or against the effectiveness of one injection approach over another in the delivery of epidural steroids for patients with lumbar disc herniation with radiculopa thy. Grade of Recommendation: I (Insuffcient Evidence) Ackerman et al5 conducted a prospective randomized controlled no diferences were noted between groups in depression and trial to test the null hypothesis that these three methods of lum functional outcomes. The authors concluded that the transfo bar epidural steroid injections (caudal, interlaminar, transfo raminal approach ofers the beneft of increased analgesic ef raminal) are equally efective for the management of radicular cacy compared to the caudal and interlaminar approaches. Of the 90 study provides Level I therapeutic evidence that transforaminal consecutively assigned patients included in the study, 30 were injections are more efective than caudal or interlaminar injec treated with each of the following: caudal epidural steroid injec tions in the treatment of patients with lumbar disc herniation tion, interlaminar epidural steroid injection and transforaminal with radiculopathy. All groups showed impairment of nerve root sheath and interspinous glucocorti signifcant improvement in functional and depression outcome coid injection. Of the 30 patients included in the study, 17 were measures two weeks following their last treatment. Patients had treated with nerve root sheath and 13 received interspinous glu an average of 1. At 24 weeks, the transforaminal epidural steroid groups had improvement in their pain and disability with no group had signifcantly more patients reporting complete (30%) signifcant diference between treatment groups. At 24 weeks, complete or partial pain month follow-up, three patients in each group had surgery, and relief in the transforaminal, interlaminar, and caudal groups the remaining patients were pain free. All groups that it remains to be proven whether nerve root sheath is supe showed signifcant improvement in functional and depression rior to interspinous glucocorticosteroid injection. However, small sample size and improper method of randomization, this this clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason-This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason ably directed to obtaining the same results. Dec 1 that nerve root sheath and interspinous glucocorticoid injection 2001;26(23):2587-2595. Evalu ation of the efectiveness of lumbar interlaminar epidural tion with radiculopathy. The efcacy of lumbar epidural and transforaminal epidural steroid injection techniques. Anes 40 consecutive patients included in the study, 20 received inter thes Analges. Outcomes were assessed using the Numeric Rating Scale steroid injections in lumbosacral radiculopathy: a prospective at 18 days, and at one year patients were contacted to determine randomized study. Tere was a statistically Efcacy of nerve root versus interspinous injections of glu signifcant improvement in the Numeric Rating Scale scores at cocorticoids in the treatment of disk-related sciatica. Interlaminar versus transfo 25% of the interlaminar group and 10% of the transforaminal raminal epidural injections for the treatment of symp to matic group. The authors concluded that transforaminal epidural ste lumbar intervertebral disc herniations. Oct roid injections for treatment of radicular pain due to lumbar disc 2006;9(4):361-366. The efcacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Epidural cor steroid injection is more efective than interlaminar epidural ste ticosteroid injection in the conservative management of sciatica. Treatment of lumbar disc herniation: Epi dural steroid injection compared with discec to my A pro Future Directions for Research spective, randomized study. Apr The work group identifed the following potential studies that 2004;86A(4):670-679. The use of epidural steroids in the treatment of the role of epidural steroid injection in the treatment of lumbar lumbar radicular pain. The Efcacy of Transforami Recommendation #1: nal Injection of Steroids for the Treatment of Lumbar Radicular A large double-blinded, randomized controlled clinical trial Pain. Ef herniation with radiculopathy treated by fuoroscopically-guid fectiveness of transforaminal epidural steroid injection by using ed interlaminar or caudal epidural steroid injections in which a preganglionic approach: a prospective randomized controlled the control group receives saline placebo injections. Cost efective A large double-blinded, randomized controlled clinical trial ness of periradicular infltration for sciatica: subgroup analysis with at least one-year follow-up comparing patients with lumbar of a randomized controlled trial. Dec 1 disc herniation with radiculopathy treated by fuoroscopically 2001;26(23):2587-2595. Efcacy of nerve root versus interspinous injections of glu cocorticoids in the treatment of disk-related sciatica. Lumbar nal Injection of Steroids for the Treatment of Lumbar Radicular epidural perineural injection: a new technique. Spine Steroid Injections with Conservative Management in Patients (Phila Pa 1976). Transforaminal epidural steroid this clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason-This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason ably directed to obtaining the same results. Acta epidural/perineural injections in painful disorders of the lumbar Neurochir (Wien). Efcacy of transforaminal versus interspinous corticosteroid or radiculitis: a randomized, double-blind, controlled trial. Transforaminal epidural radicular infltration for chronic radicular pain A randomized, steroid injections in lumbosacral radiculopathy: a prospective double-blind, controlled trial. Epidural corticosteroid Caudal Epidural Injections for Low Back Pain and Sciatica A injections for sciatica: a randomised, double blind, controlled Prospective, Randomized, Double-Blind Clinical Trial. This is an indirect visualization technique using the endoscope and fuoroscopic guidance. Gallucci et al1 conducted a prospective randomized controlled There is insuffcient evidence to make a rec trial to prospectively compare the clinical efectiveness of intra ommendation for or against the use of intra foraminal and intradiscal injections of a mixture of a steroid, a discal ozone in the treatment of patients with local anaesthetic and oxygen-ozone (O2-O3) to intraforaminal lumbar disc herniation with radiculopathy. Group A, the control group, underwent intraforaminal and intradiscal injections of 2 mL of triamcinolone ace to nide Evidence) (40 mg/mL Kenacort; Bris to l-Myers Squibb, Sermoneta, Italy), this clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason-This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason ably directed to obtaining the same results. Based on the MacNab criteria, the surgical outcomes group, received the same treatment with the addition of an O2 were rated as follows: excellent in 12 patients (27. Tere was a statistically sig members opposed its inclusion because the paper evaluated the nifcant diference (p<. The authors conclud patients included in the study had a mean pain-free interval af ed that O2-O3 chemodiscolysis should be regarded as a useful ter their previous surgery of 63 months, ranging from six to 186 treatment for the management of lumbar disc herniation. Furthermore, the question serving as the basis for the study provides Level I therapeutic evidence that intraforaminal literature review and guideline formulation did not specifcally and intradiscal local anesthetic, steroid and O2-O3 injections exclude recurrent herniation (although all committee members are superior to intraforaminal and intradiscal local anesthetic inferred that the guideline development was intended to address and steroid injections alone at six months in the treatment of ra virgin disc herniations). Both treatments Cervellini et al4 described a retrospective case series describ yield improved outcomes at two weeks and three months. All Endoscopic percutaneous discec to my may patients had excellent or good outcomes. The authors concluded that the minimally invasive surgical treatment via the microen be considered for the treatment of lumbar doscopic far lateral approach has a high rate of success. Ahn et al2 described a retrospective case series of 45 patients as Hermantin et al5 performed a prospective comparative study sessing the clinical outcome, prognostic fac to rs and the technical to evaluate the results of endoscopic percutaneous lumbar dis pitfalls of percutaneous endoscopic lumbar discec to my for up cec to my compared with open discec to my in patients with lum per lumbar disc herniation. Outcomes were assessed at an scale, the outcomes were excellent in 21 of 45 patients (46. Measures utilized included the Pain Intensity Scale (0-10) good outcome at the fnal follow-up was 77. The authors concluded that patient exam and patient satisfaction using a four point patient satisfac selection and an ana to mically modifed surgical technique pro tion scale. A very satisfac to ry outcome was reported in 67% upper lumbar disc herniations at L1-2 and L2-3.

Childhood epilepsy with occipital paroxysms: difficulties in distinct segregation 135 medicine 319 discount kaletra line. Idiopathic partial epilepsy: electroclinical demonstration of a prolonged seizure with sequential Seizures and Reflex Epilepsies medicine hat weather generic kaletra 250 mg free shipping. Occipital sharp waves in idiopathic partial epilepsies-clinical and genetic aspects medications in carry on discount 250mg kaletra free shipping. Main features of rolandic epilepsy medications harmful to kidneys trusted kaletra 250mg, Panayio to poulos syndrome and idiopathic childhood mutations. Benign familial neonatal convulsions followed by benign epilepsy with centrotemporal spikes in two siblings. Epileptic encephalopathy of late childhood: Landau-Kleffner syndrome and the syndrome of continuous spikes and waves during slow-wave sleep. The spectrum of neuropsychiatric abnormalities associated with oropharyngolaryngeal elementary visual electrical status epilepticus in sleep. Oropharyngolaryngeal symp to ms Common and often Rare and not from Have not been reported 190. Deterioration in cognitive function in children with benign Speech arrest Common and often Rare and not from Has not been reported epilepsy of childhood with central temporal spikes treated with sulthiame. A pilot study transitioning children on to levetiracetam monotherapy to improve language dysfunction associated with benign rolandic epilepsy. Levetiracetam monotherapy for children and adolescents with benign rolandic at onset onset seizures. Lamotrigine-induced seizure aggravation and negative myoclonus Ictus emeticus Scarce and not from Common and often Rare and not from in idiopathic rolandic epilepsy. Epilepsies are hundreds of diseases with different causes, natural his to ries and prognoses, requiring different short-term and long-term management. Patients with epileptic seizures and their families are entitled to a diagnosis, prognosis, and after first seizure management that is specific and precise. The clinical significance of this is clearly demonstrated by vigabatrin and tiagabine, two of the new generation drugs for partial epilepsies. Identification of the type of epilepsy is of utmost clinical importance, especially as satisfac to ry diagnostic precision is possible even after the first recognisable seizure8. Identification of an epileptic syndrome requires clinical findings (type of seizure(s), age at onset, this definition ranges from the dramatic event of a generalised to nic-clonic seizure to the mild myoclonic precipitating fac to rs, severity and chronicity, circadian distribution, aetiology, ana to mical location and flicker of the eyelids or a focal numbness of the thumb and mouth. Secondary generalised seizures are partial at onset but do not remain localised they spread and trigger a generalised fit. Generalised seizures vary considerably: mild or severe myoclonic the combination of these divisions shapes the first two major groups of epileptic syndromes and diseases. The fourth and final group refers to syndromes where the seizures are related to a specific situation like fever, drugs or metabolic imbalance2. Symp to m/seizure diagnosis cannot provide guidance to the physician on important items such as severity of the disease, prognosis, short and long-term therapeutic decisions, genetics (research and counselling) There is a long list of syndromes in each of the major divisions. Table 1 shows the syndromic classification all fac to rs which crucially affect family and social life, and the education and career choices of patients. Most syndromes start at an early age and there are profound Precise syndromic diagnosis is necessary to ensure optimal management and avoid morbidity2. Such problems should pose a challenge to arrive at the proper medical diagnosis, and should not its use6. The World Health Organization Dictionary of Epilepsy11 gives this definition: be used as an excuse against making one. Many of the proposed diseases/syndromes are common, well defined and easy to diagnose, such as juvenile myoclonic epilepsy12. Single or occasional epileptic need further research and understanding for a better categorisation. A tentative disease/syndrome diagnosis should be used definition of the Commission on Classification and Terminology of the International League Against in conjunction with the seizure categorisation, and serve as basis for moni to ring the natural his to ry. Hippocampal epilepsy is a distinct epileptic disease with defined pathology (hypocellular 2. Of the newer drugs, all claim efficacy: lamotrigine, vigabatrin, to piramate, tiagabine, gabapentin, zonisamide. If one or two of the main drugs fail, the chances of achieving medical control are negligible. These patients, even in childhood, need urgent evaluation for neurosurgical treatment for which they are the best candidates and the most likely to have excellent and sustained benefit22. The significance and the challenges of the syndromic classification of epilepsies is exemplified by three common epileptic syndromes: benign childhood seizure susceptibility syndromes, juvenile myoclonic Even the most sceptical physicians who doubt the clinical or practical significance of the syndromic epilepsy and syndromes of temporal lobe epilepsy that comprise more than 40% of all epilepsies. They all require different management and their short and long-term treatment treatment strategies and prognosis. They comprise influence the diagnosis, management, and welfare of people with epileptic seizures. This concept is not predisposition, may be manifested by a single seizure, remit within a few years of onset, and may or may difficult to understand and need not be controversial. The risk of recurrent seizures in adult life (1-2%) is less than in febrile convulsions (4%). Commission on Classification and Terminology of the International League Against Epilepsy. These sub-syndromes usually have distinct electroclinical features and prognosis; some are life-long while others are age-related.