The electrical discharge of neurons associated with seizure activity stimulates a marked rise in cerebral metabolic activity. Estimates from animal experiments indicate that energy utilization during seizures increases by more than 200", while tissue adenosine triphosphate (ATP) levels remain at more than 95" of control, even during prolonged status epilepticus. The brain generally withstands the metabolic challenge of seizures quite well because enhanced cerebral blood flow delivers additional oxygen and glucose. Mild to moderate degrees of hypoxemia that commonly accompany seizures are usually harmless. However, severe seizures and status epilepticus can sometimes produce an imbalance between metabolic demands and cerebral perfusion, especially if severe hypotension or hypoglycemia is present. A marked increase in glutamate release, which occurs during a prolonged seizure, is likely to result in the activation of all types of glutamate receptors. Although kainic acid produces seizures in the immature brain, it produces little cytotoxicity.
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Recent advancements in molecular genetics have expanded our understanding of the etiology of many neurological diseases and neurodevelopmental abnormalities. Having a comprehensive understanding of genetics is essential in treating patients with metabolic epilepsies. Genetic counseling has been defined as a process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. Some of the components of a genetic counseling interaction include interpretation of family and medical histories to assess the chance of disease occurrence or recurrence; education about inheritance, testing, management, prevention, resources, and research; and counseling to promote informed choices and adaptation to the risk or condition. The genetic counselor may also educate patients and their families about the underlying genetics of their epilepsy and the relevance of a genetic cause of epilepsy for family members, including recurrence risk, reproductive options and the possible teratogenic effect of antiepileptic drugs.Source:
This chapter presents a brief review of the enzymes, transporters, and cofactor producers of the urea cycle. Seizures have long been associated with urea cycle disorders (UCDs), thought to be caused by high levels of ammonia. Furthermore, the brain damage obtained during metabolic crisis has been thought to damage critical structures, leading to epilepsy after the conclusion of the crisis. The first and most critical step of successful treatment of UCDs is recognition. Neurologic monitoring is an essential part of the emergency management of UCDs. The neurological abnormalities observed in patients with urea cycle defects are vast. Controlling ammonia levels by dialysis and complementary medication are needed. EEG monitoring should be initiated early, as this may be very useful for clinical management and indication of untreated metabolic crises. Furthermore, aggressive treatment of clinical and subclinical seizure activity may be helpful in optimizing outcomes for these patients.Source:
Clinical neurophysiology (CNP) is a time-honored medical specialty that continues to make great strides, bolstered by rapid advances in neuroscience, biomedical engineering, and computer technology. It encompasses a wide range of methods and techniques for recording, presenting, and analyzing neurophysiologic signals in order to diagnose sensory, motor, autonomic, and central nervous system disorders. Testing performed in CNP or procedures used in current neurological practice include a variety of modality-specific and mixed-modality tests. Modality-specific CNP tests are performed to assess specific functional modalities using biomedical instruments that measure changes in neurophysiologic signals that occur spontaneously or with activation. Mixed-modality CNP tests utilize two or more test modalities to assess complex states (e.g., sleep, coma), to track multiple physiologic parameters, or to obtain more accurate results. CNP tests are classified based on functional anatomy or neural pathway tested. This chapter discusses artifact recognition and presents sources of artifacts in clinical neurophysiologic testing.
This chapter provides new data and a critical look at the comparative assessment of different ethnic groups’ overall levels of savings given their different experiences in the labor market. It focuses on how employers differentially treat minorities to their disadvantage with a multiple regression analysis that identifies the independent negative impact of being a minority on retirement sponsorship and pension plan participation. Minorities have lesser access to employer-sponsored retirement plans because they are particularly affected by the substitution of defined benefit (DB) plan coverage for less secure and less comprehensive defined contribution (DC) plans. Social Security is an important source of retirement income for all Americans. Minorities are disproportionately employed in lower-paid industries and occupations, which have lower rates of retirement account coverage. Qualitative research and interdisciplinary collaborative studies of minority retirement behavior have emerged.
- Go to chapter: What Does Knowing About Genetics Contribute to Understanding the Health of Minority Elders?
This chapter discusses the identification of individual differences in health behaviors and health status among minorities. Sickle cell disease (SCD), a genetic disorder, may serve as an optimal model for understanding issues of aging in minority populations. SCD is an important model of multifactorial conceptualization of genetic-based chronic disease among aging populations. Generally, molecular genetic methodologies are called to mind when people consider the role of genetic factors in health and disease. Behavioral genetic methods will be particularly useful if one begins studying minorities from the perspective that there is significant heterogeneity within populations of minorities. Conceptual and methodological discussions of heterogeneity within minority populations are particularly timely given the changing sociodemographic features of ethnic/racial populations related to health disparities. Socioeconomic status and education have been found to be important variables associated with the development of chronic illness.
This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.
- Go to chapter: Introduction: Psychology—Rising as a Discipline to Meet the Challenges of an Aging, Increasingly Diverse Society
Introduction: Psychology—Rising as a Discipline to Meet the Challenges of an Aging, Increasingly Diverse Society
This chapter presents an illustration of the complexities involved in studying ethnic and racial influences on psychosocial processes and how they are intimately tied to physical outcomes in later life. It focuses on psychology as a discipline, minority aging research during the last several decades has revealed the need for multidisciplinary and intersectional conceptual and research approaches. The chapter also focuses on the age, gender, socioeconomic, cultural, and racial and ethnic graded influences on life course development that eventuate in unequal burdens of psychological and physical health morbidity and mortality for certain groups in late life. No section on psychology could be complete without a discussion of religion and spirituality among racial and ethnic minorities. Generational processes are clearly implicated in ideas about the cyclical nature of poverty and health behaviors that are intricately linked with environmental factors and social influence.
This chapter examines the Older Americans Act (OAA) through the prism of the coming nexus of aging and ethnic/racial diversity. It explains that the OAA can serve as a foundation for building a home- and community-based set of services for all older adults and persons with disabilities and for addressing aging in the 2lst century. The OAA is the primary federal program providing a host of services that enable older persons and their families to live in their homes and communities with a measure of dignity and independence. The OAA, Administration on Aging (AOA), and aging network today provide five major categories of services: access to social and legal services, nutrition, home- and community-based long-term social and supportive services, disease prevention and health promotion, and vulnerable elder rights protections. The OAA and the AOA remain secondary players in national agenda setting for an aging population.
This chapter focuses on informal caregiving among minority groups. It also focuses on context of caregiving and discuss the various specific challenges caregivers of minority older adults face. The chapter examines some of the specific caregiving interventions tailored for families of color and discuss the implications for practice, policy, and research. Medical advances and greater longevity point to healthier and longer lives for many, but both formal and informal caregiving remain a concern as individuals age and develop conditions that require care. Caregivers are often able to realize the positive aspects of caregiving when they are not struggling with financial or social support challenges. Despite the vast literature on caregiving in general, research pertaining to the needs and experiences of racial/ethnic minority older adults and their caregivers is limited, particularly for American Indians, Pacific Islanders, specific Asian American and Latino subgroups, and religious minorities groups such as Muslim Americans.