Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Epilepsies Episcleritis and Scleritis 537

■Psychogenic attacks: may simulate convulsions but may relate to

external circumstances or stress, in company of others, & after

preparation; despite apparent LOC, may be goal-directed or other

atypical behavior; no postictal changes; EEG unchanged in attacks;

may occur in pts also having seizures

management

■Do not restrain during seizures

■Maintain airway during status epilepticus

specific therapy

■Antiepileptic medication, selected based on seizure type; monother-

apy preferable to polytherapy; continue treatment until seizure-free

for 2 yr; discontinue medication gradually; monitor for compliance

clinically & by blood drug measurements; poor compliance predis-

poses to status epilepticus; side effects depend on anticonvulsant

■Advise about lifestyle: avoid situations that could be dangerous or

life-threatening if a further seizure occurs or that may precipitate

further seizures

■Follow requirements concerning reporting of patients to state

authorities

follow-up

■Depends on underlying cause

■Pts with well-controlled idiopathic seizures should be followed at

least once annually

complications and prognosis

■Delay in initiating effective treatment may lead to greater difficulty

in obtaining seizure control

Episcleritis and Scleritis...............................

C. STEPHEN FOSTER, MD

history & physical

History

■Red eye, usually but not always without change in vision, no dis-

charge

■Pain/tenderness to touch=scleritis

Signs & Symptoms

■Conjunctival injection