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With Motor Symptoms or with Sensory Symptoms
“Simple partial” seizures may involve movement, with jerking of the foot, face, arm, or any other part of the body. They may involve the senses, with a peculiar tingling, burning, or abnormal sensation in any part of the body. The jerking or sensation will depend on where in the brain the electrical activity begins and how it spreads. Since motor and sensory functions are lateralized—one side of the brain controlling the other side of the body—the motor jerking or sensory feeling will be one-sided, on the side opposite the brain’s activity.
Partial seizures may stay local or spread slowly up or down the motor strip or the sensory strip (Fig. 6.1) in a slow spread or “march” that used to be called a “Jacksonian seizure.”
With Autonomic Symptoms
Since a seizure may begin in areas of the brain that control involuntary functions, it may start with the face becoming pale or flushed. The heart may begin to beat rapidly; there may be abdominal cramps and discomfort or a fullness in the chest or throat. Physicians call these “autonomic” symptoms because it is the autonomic part of the nervous system that regulates involuntary body functions like heart rate, blood pressure, and bowel function.
Since the autonomic system has to control both sides of the body simultaneously, not a single half at a time, the physician often cannot identify the side of the origin of the seizure.
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1. Fallacy. A patient who has an infection and who is eating poorly should stop taking his insulin.
Fact. The insulin requirement is usually higher in fevers and infections. The patient should take his insulin and take fluids supplying carbohydrate if he cannot eat solid foods. He should continue to test his urine, and should alert his physician.
2. Fallacy. A “free” diet means the patient can eat anything he wants.
Fact. Patients permitted to eat so-called “free” diets must observe regular meal hours and must eat foods that meet their nutritional requirements. They are generally told not to eat concentrated sweets such as sugar, candy, jelly, cake, and cookies. The single and double sugars are rapidly absorbed thus causing the blood sugar to become sharply elevated and making control more difficult.
3. Fallacy. Honey can be used in place of cane sugar.
Fact. Honey is about 80 per cent carbohydrate, chiefly fructose. The fructose is eventually used as glucose, thereby requiring insulin. Therefore, the use of honey is not desirable.
4. Fallacy. Dietetic foods may be used as desired by diabetic patients.
Fact. Dietetic foods contain some carbohydrate, protein, and fat. Their use is seldom justified, and these foods are relatively expensive. If they are used, the patient should check with the dietitian or physician so that the value can be calculated into the diet.
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Assessing malarial risk requires a detailed knowledge of a patient’s travel itinerary and accommodations. The risk that a traveler will become infected depends on the overall rate of malaria transmission in the geographic area to be visited and on the extent of contact with infected mosquitoes. Transmission rates may vary greatly from region to region, even within the same country. In countries where the overall risk is relatively low, there may be foci of intense transmission.
The assessment of risk of malaria infection depends on several other considerations. Since malaria transmission often follows stringent seasonal patterns linked to rainfall, the timing of the trip may influence risk. The elevation of the destination is important, because malaria transmission is rare above 2000 m attitude. Finally, since the Anopheles mosquito feeds from dusk to dawn, the risk of transmission is influences by a traveler’s nighttime activities and accommodations.
Regular updated maps identifying malaria risk areas and times are available from several sources and can be valuable tools in counseling patients.
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