- various types of antiepileptic drugs and intravenous anesthetic drugs
- immunomodulating agents
- ketogenic diet
- mild hypothermia
- resective epilepsy surgery
- disconnection procedures
- neuromodulation via electrical stimulation
Acute Resective Surgery for the Treatment of Refractory Status Epilepticus
Maysaa Merhi Basha1 • Kushak Suchdev1 • Monica Dhakar2 • William J. Kupsky1,3 • Sandeep Mittal4 • Aashit K. Shah1
Key sensory points:
- C2 At least one cm lateral to the occipital protuberance at the base of the skull. Alternately, it can be located at least 3 cm behind the ear.
- C3 In the supraclavicular fossa, at the midclavicular line.
- C4 Over the acromioclavicular joint.
- C5 On the lateral (radial) side of the antecubital fossa just proximal to the elbow (see image below).
- C6 On the dorsal surface of the proximal phalanx of the thumb.
- C7 On the dorsal surface of the proximal phalanx of the middle finger.
- C8 On the dorsal surface of the proximal phalanx of the little finger.
- T1 On the medial (ulnar) side of the antecubital fossa, just proximal to the medial epicondyle of the humerus.
- T2 At the apex of the axilla. T2 T1 C5 International Standards for the Classification of Spinal Cord Injury Key Sensory Points June 2008
- T3 At the midclavicular line and the third intercostal space, found by palpating the anterior chest to locate the third rib and the corresponding third intercostal space below it.
- T4 At the midclavicular line and the fourth intercostal space, located at the level of the nipples.
- T5 At the midclavicular line and the fifth intercostal space, located midway between the level of the nipples and the level of the xiphisternum.
- T6 At the midclavicular line, located at the level of the xiphisternum.
- T7 At the midclavicular line, one quarter the distance between the level of the xiphisternum and the level of the umbilicus.
- T8 At the midclavicular line, one half the distance between the level of the xiphisternum and the level of the umbilicus.
- T9 At the midclavicular line, three quarters of the distance between the level of the xiphisternum and the level of the umbilicus.
- T10 At the midclavicular line, located at the level of the umbilicus.
- T11 At the midclavicular line, midway between the level of the umbilicus and the inguinal ligament.
- T12 At the midclavicular line, over the midpoint of the inguinal ligament.
- L1 Midway between the key sensory points for T12 and L2.
- L2 On the anterior-medial thigh, at the midpoint drawn on an imaginary line connecting the midpoint of the inguinal ligament and the medial femoral condyle.
- L3 At the medial femoral condyle above the knee.
- L4 Over the medial malleolus.
- L5 On the dorsum of the foot at the third metatarsal phalangeal joint.
- T12 L1 L2 L3 L4 L5 International Standards for the Classification of Spinal Cord Injury Key Sensory Points June 2008
- S1 On the lateral aspect of the calcaneus.
- S2 At the midpoint of the popliteal fossa.
- S3 Over the ischial tuberosity or infragluteal fold (depending on the patient their skin can move up, down or laterally over the ischii).
- S4/5 In the perianal area, less than one cm. lateral to the mucocutaneous junction.
ASIA WORKSHEET <pdf>
“ASIA Learning Center”. Asia-spinalinjury.org. N.p., 2017. Web. 23 Mar. 2017.
Parenteral Antimicrobial Treatment of Common Microorganisms Causing Native Vertebral Osteomyelitis
Berbari, Elie F. et al. “2015 Infectious Diseases Society Of America (IDSA) Clinical Practice Guidelines For The Diagnosis And Treatment Of Native Vertebral Osteomyelitis In Adults”. Clinical Infectious Diseases 61.6 (2015): e26-e46. <PDF link>
Scheffer, Ingrid E. et al. “ILAE Classification Of The Epilepsies: Position Paper Of The ILAE Commission For Classification And Terminology”. Epilepsia (2017): n. pag. Web. 19 Mar. 2017.
Plus (+) and Minus (-) Grades Use of a plus (+) or minus (-) addition to a manual muscle test grade is discouraged except in three instances: Fair+, Poor+, and Poor-. Scalable gradations in other instances can be described in documentation as improved or deteriorated within a given test grade (such as Grade 4) without resorting to the use of plus or minus labels. The purpose of avoiding the use of plus or minus signs is to restrict the variety of manual muscle test grades to those that are meaningful and defendable.
Hislop, Helen J et al. Daniels And Worthingham’s Muscle Testing. 1st ed. Print.
Drugs to avoid in patients with sulfonamide allergy:
Nonantimicrobials (diuretics, triptans, oral hyopglycemics, antiinflammatories)
- Hydrochlorothiazide Diazoxide
Uptodate. “Sulfonamide allergy in HIV-uninfected patients.” Accessed 03/13/2017.