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This chapter discusses the burden and the changing epidemiology of acute bacterial meningitis (ABM) and the incidence of epilepsy following ABM and intracranial abscesses in children. It identifies the predictive factors, therapeutic implications, and prevention of ABM and consequent epilepsy in these conditions. Of the acquired causes, central nervous system (CNS) infections are common in childhood and include bacterial meningitis, viral encephalitis, and intracranial suppurative infections such as brain abscess, subdural empyema, and cranial epidural abscess. The changing epidemiology of bacterial meningitis and the emergence of antibiotic resistant strains of pneumococcal meningitis demand regional guidelines for initial empirical treatment of ABM based on the knowledge of regional epidemiologic factors. The effectiveness of administration of dexamethasone before the first effective parenteral antibiotic dose in reducing neurologic and/or audiologic sequelae in children with Haemophilus influenzae type B (HiB) meningitis has been demonstrated in several studies.
Patrica O. Shafer, Beth Israel Deaconess Medical Center, Comprehensive Epilepsy, Center, 300 Brookline Avenue, Boston, MA 02215, USA,
Andrew G. Herzog, Beth Israel Deaconess Medical Center, Harvard Neuroendocrine Unit, 330 Brookline Avenue, Boston, MA 02215, USA
This chapter provides an overview of the normal menstrual cycle and what changes may be seen in women with epilepsy. Catamenial epilepsy, as well as the effects of seizures and medications on menstruation and of hormonal changes on seizures, are explained. Typically, catamenial seizures were thought to occur only immediately before or during menstruation. Both estrogen and progesterone affect the excitability of brain cells, especially in the temporal and frontal lobes of the brain. Hormones from the hypothalamus and pituitary gland regulate the amount of estrogen and progesterone circulating in a woman's body. Estrogen and progesterone levels change throughout the menstrual cycle. The easiest way to determine if seizures are related to the menstrual cycle is to record the occurrence and type of seizures and the day menstruation starts on a calendar. Progesterone therapy may be helpful for some women with catamenial seizures.
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