TATHAGATA

It is estimated that, since 1970, Earth’s various populations of wild land animals have lost, on average, 60 percent of their members. Zeroing in on the category we most relate to, mammals, scientists believe that for every six wild creatures that once ate and burrowed and raised young, only one remains. What we have instead is ourselves. A study published this year in the Proceedings of the National Academy of Sciences found that if you look at the world’s mammals by weight, 96 percent of that biomass is humans and livestock; just 4 percent is wild animals.

It is estimated that, since 1970, Earth’s various populations of wild land animals have lost, on average, 60 percent of their members. Zeroing in on the category we most relate to, mammals, scientists believe that for every six wild creatures that once ate and burrowed and raised young, only one remains. What we have instead is ourselves. A study published this year in the Proceedings of the National Academy of Sciences found that if you look at the world’s mammals by weight, 96 percent of that biomass is humans and livestock; just 4 percent is wild animals.

Scientists have begun to speak of functional extinction (as opposed to the more familiar kind, numerical extinction). Functionally extinct animals and plants are still present but no longer prevalent enough to affect how an ecosystem works

Scientists have begun to speak of functional extinction (as opposed to the more familiar kind, numerical extinction). Functionally extinct animals and plants are still present but no longer prevalent enough to affect how an ecosystem works

URTICARIA DDX

URTICARIA DDX

ENDING MALE CHICK SLAUGHTER

And end to male chick slaughter?
 

More developments are being made to end the culling of male chicks which could soon be a thing of the past in the UK thanks to the launch of a method which identifies the gender of a hatching egg. German company SELEGGT have developed a market-ready process whereby fluid is extracted via a 0.3 millimetre hole. The process is non-invasive and leaves the inside of the egg intact. A colour marker will then use the fluid to identify if the egg is female or not and, if so, only these eggs will hatch after 21 days of incubation. The process will be available to hatcheries by 2020.

P URTICARIA MULTIFORME

Urticaria multiforme is a benign cutaneous hypersensitivity reaction seen in pediatric patients that is characterized by the acute and transient onset of blanchable, annular, polycyclic, erythematous wheals with dusky, ecchymotic centers in association with acral edema. It is most commonly misdiagnosed as erythema multiforme, a serum-sickness-like reaction, or urticarial vasculitis. Since these three diagnoses represent distinct clinical entities with unique prognoses and management strategies, it is important that physicians distinguish urticaria multiforme from its clinical mimics in order to optimize patient care. By performing a thorough history and physical examination, the astute clinician can make the correct diagnosis and develop an appropriate, effective treatment plan while avoiding unnecessary biopsies and laboratory evaluations. The authors report a case of urticaria multiforme in a four-year-old girl in order to emphasize the distinctive morphological manifestations of this rare, albeit unique, disease seen in the pediatric population.

B MTP There’s no switch that turns on enlightenment. You move toward it with your effort. It’s an effort that might be unrecognizable to those who think “effort” means trying hard. You have to try soft—to be curious and open to whatever it is that results. —Nancy Thompson,

There’s no switch that turns on enlightenment. You move toward it with your effort. It’s an effort that might be unrecognizable to those who think “effort” means trying hard. You have to try soft—to be curious and open to whatever it is that results.

—Nancy Thompson,

ALL EN PASSANT 

G20

Argentina, Australia, 
Brazil,
 Canada, China,
 the European Union, 
France, 
Germany, 
India,Indonesia, Italy, 
Japan, 
Mexico, 
Russia, 
Saudi Arabia, South Africa, South Korea, 
Turkey, 
theUnited Kingdom, and the USA

The word vitamin, derived from “vital amine”, was coined by the Polish chemist Casimir Funk in 1913

The word vitamin, derived from “vital amine”, was coined by the Polish chemist Casimir Funk in 1913

STOP EVERY 4 HRS 12- 16-20-00-04-08

The ABCs of STOP: Three Short Mindful Breaks for Your Day

A new take on a well-known mindfulness practice that helps you foster compassion and kind awareness when you need to come down from stress.

• BY CHRISTIANE WOLF
 
• SEPTEMBER 19, 2017
 
• DAILY PRACTICES

Equatore/Adobe Stock

 
 
 

The STOP acronym is one of the most well-known and cherished brief mindfulness practices to use during the day. It’s super simple:

S – Stop
T – Take a breath
O – Observe what’s going on
P – Proceed

This can be done any time during the day when you remember. You become aware of what’s going on around you or inside of you, you ground yourself with some conscious breaths, and then you proceed with more clarity and from a place of choice.

Here are three wonderful ways to practice STOP in more depth: The ABCs of STOP—or practicing STOP for Awareness, Beauty, and Compassion:

STOP — A: STOP for awareness

Using the STOP practice to become fully aware of the present moment: What is going on in the body? The mind? The emotional field? Or asking yourself: What is out of my awareness right now? It can be as simple as noticing your brain is foggy after being on a conference call for two hours (and that you need a stretch break) or that you have been thinking about the upcoming teacher meeting all morning. Simply stop and take a breath.

STOP — B: STOP for beauty

Pause for a moment and notice something beautiful in your surroundings. It can literally be to “stop and smell the roses.” Use all of your senses to find something and then take it in for a breath or two. If that feels too big of a stretch you can ask yourself: “Ok, I know this is a stressful moment right now, but if there was something beautiful about it, what would it be?” Maybe then we notice the flowers on the table, which blend into the background when we are busy. Or the beautiful braids of the woman in front of us in the (long!) check out line at the grocery store.

Compassion is a natural, caring response to suffering, big and small, in ourselves and in others.

STOP — C: STOP for compassion

In a moment of stress or pain, practice STOP to open your heart to kindness and compassion. Compassion is a natural, caring response to suffering, big and small, in ourselves and in others. Sometimes the tug of compassion calls us to stop, at other times we need to stop and really take something in, so we can open the doors of the heart and invite compassion in. Maybe we are a little impatient with our child complaining at length about something that happened at recess. Maybe the adult brain doesn’t see it as hurtful but stopping and truly listening might allow us to connect with the truth of her hurt and allow our heart to melt a little.

SSS

In this culture, we say Shiva without Shakti is like a shava, a corpse. Without Shakti or energy, there would be no existence.

I think it's very healthy to spend time alone. You need to know how to be alone and not defined by another person - Osc ar Wilde

I think it's very healthy to spend time alone. You need to know how to be alone and not defined by another person - Osc ar Wilde

M Taking antidepressants is linked to a 33% higher risk of death, new research finds.

Taking antidepressants is linked to a 33% higher risk of death, new research finds.

SUGAR

P IDA RX Average of 28.7 days to resolve thrombocytosis (post treatment)

IDA RX Average of 28.7 days to resolve thrombocytosis (post treatment)

SC X GUESS

Stuart Firestein, in Failure, agrees that a rejection of guesses is the usual way that scientific progress is made

LONG HUMAN CHILDHOOD

So to build clever humans from such crummy parts, we need a huge interconnected brain with 500 trillion synapses. This takes a lot of space—about 1,200 cubic centimeters (cc). That’s so big that it would not fit through the birth canal. Changes to the pelvis to make a larger birth canal would presumably interfere with upright walking. So the painful solution is to have human babies born with 400-cc brains (about the size of an adult chimpanzee’s brain). Even this size is still a problem—the baby’s head barely fits through the vagina. (In fact, death in childbirth, while common through most of human history, is almost unheard of in other mammals.) Once born, humans undergo an unusually long childhood while that 400-cc brain matures and grows, a process that is not complete until about age twenty. There’s no other animal species in which an eight-year-old cannot live without its parents. Our extra-long human childhoods drive many aspects of human social life, including our dominant mating system of long-term pair bonding, an aspect that is very rare in the mammalian world. Or to put it another way, if neurons could have been optimally redesigned at some point in evolution, we likely wouldn’t have marriage as a dominant cross-cultural institution.

DOUGLAS "Never take a solemn oath. People think you mean it."

"Never take a solemn oath. People think you mean it."

NEURONE X SYNAPSE

Each of these balls, called synaptic vesicles, is loaded with about 1,000 molecules of a special type of chemical called a neurotransmitter. There is a very narrow saltwater-filled gap between the axon terminal of one neuron and the dendrite of the next called the synaptic cleft. On average, each neuron receives about five thousand synapses, mostly on the dendrites, with some on the cell body and a few on the axon. When we multiply 5,000 synapses per neuron by 100 billion neurons per human brain, the result is an enormous number as an estimate of the number of synapses in the brain: 500 trillion. To put this number in perspective, if you wanted to give away your synapses, each person on the planet (in 2017) could receive about 64,000 of them

Around 550 million years ago it was simple to be an animal. You might be a marine sponge, attached to rock, beating your tiny whip-like flagella to pass seawater through your body in order to obtain oxygen and filter out bacteria and other small food particles. You’d have specialized cells that allow parts of your body to slowly contract to regulate this flow of water, but you couldn’t move across the sea floor properly. Or you might be an odd, simple animal called a placozoan, a beast that looks like the world’s smallest crepe—a flattened disc of tissue about 2 millimeters in diameter with cilia sprouting from your underside like an upside-down shag carpet. These cilia propel you slowly across the sea floor, allowing you to seek out the clumps of bacteria growing on the sea floor that are your food. When you found a particularly delicious clump, you could fold your body around it and secrete digestive juices into this makeshift pouch to speed your absorption of nutrients. Once digestion was finished, you would then unfold yourself and resume your slow ciliated crawl. Remarkably, as either a sponge or a placozoan, you could accomplish all sorts of useful tasks—sensing and responding to your environment, finding food, moving slowly, and reproducing yourself—without a brain or even any of the specialized cells called neurons that are the main building blocks of brains and nerves.

Around 550 million years ago it was simple to be an animal. You might be a marine sponge, attached to rock, beating your tiny whip-like flagella to pass seawater through your body in order to obtain oxygen and filter out bacteria and other small food particles. You’d have specialized cells that allow parts of your body to slowly contract to regulate this flow of water, but you couldn’t move across the sea floor properly. Or you might be an odd, simple animal called a placozoan, a beast that looks like the world’s smallest crepe—a flattened disc of tissue about 2 millimeters in diameter with cilia sprouting from your underside like an upside-down shag carpet. These cilia propel you slowly across the sea floor, allowing you to seek out the clumps of bacteria growing on the sea floor that are your food. When you found a particularly delicious clump, you could fold your body around it and secrete digestive juices into this makeshift pouch to speed your absorption of nutrients. Once digestion was finished, you would then unfold yourself and resume your slow ciliated crawl. Remarkably, as either a sponge or a placozoan, you could accomplish all sorts of useful tasks—sensing and responding to your environment, finding food, moving slowly, and reproducing yourself—without a brain or even any of the specialized cells called neurons that are the main building blocks of brains and nerves. 

rd BK THINK TANK

Preface Primer: Our Human Brain Was Not Designed All at Once by a Genius Inventor on a Blank Sheet of Paper David J. Linden Science Is an Ongoing Process, Not a Belief System William B. Kristan, Jr., and Kathleen A. French DEVELOPING, CHANGING Genetics Provides a Window on Human Individuality Jeremy Nathans Though the Brain Has Billions of Neurons, Wiring It All Up May Depend upon Very Simple Rules Alex L. Kolodkin From Birth Onward, Our Experience of the World Is Dominated by the Brain’s Continual Conversation with Itself Sam Wang Children’s Brains Are Different Amy Bastian Your Twelve-Year-Old Isn’t Just Sprouting New Hair but Is Also Forming (and Being Formed by) New Neural Connections Linda Wilbrecht How You Use Your Brain Can Change Its Basic Structural Organization Melissa Lau and Hollis Cline Tool Use Can Instantly Rewire the Brain Alison L. Barth Life Experiences and Addictive Drugs Change Your Brain in Similar Ways Julie Kauer SIGNALING Like It or Not, the Brain Grades on a Curve Indira M. Raman The Brain Achieves Its Computational Power through a Massively Parallel Architecture Liqun Luo The Brain Harbors Many Neurotransmitters Solomon H. Snyder ANTICIPATING, SENSING, MOVING The Eye Knows What Is Good for Us Aniruddha Das You Have a Superpower—It’s Called Vision Charles E. Connor The Sense of Taste Encompasses Two Roles: Conscious Taste Perception and Subconscious Metabolic Responses Paul A. S. Breslin It Takes an Ensemble of Strangely Shaped Nerve Endings to Build a Touch David D. Ginty The Bane of Pain Is Plainly in the Brain Allan Basbaum Time’s Weird in the Brain—That’s a Good Thing, and Here’s Why Marshall G. Hussain Shuler and Vijay M. K. Namboodiri Electrical Signals in the Brain Are Strangely Comprehensible David Foster A Comparative Approach Is Imperative for the Understanding of Brain Function Cynthia F. Moss The Cerebellum Learns to Predict the Physics of Our Movements Scott T. Albert and Reza Shadmehr Neuroscience Can Show Us a New Way to Rehabilitate Brain Injury: The Case of Stroke John W. Krakauer Almost Everything You Do Is a Habit Adrian M. Haith RELATING Interpreting Information in Voice Requires Brain Circuits for Emotional Recognition and Expression Darcy B. Kelley Mind Reading Emerged at Least Twice in the Course of Evolution Gül Dölen We Are Born to Help Others Peggy Mason Intense Romantic Love Uses Subconscious Survival Circuits in the Brain Lucy L. Brown Human Sexual Orientation Is Strongly Influenced by Biological Factors David J. Linden DECIDING Deep Down, You Are a Scientist Yael Niv Studying Monkey Brains Can Teach Us about Advertising Michael Platt Beauty Matters in Ways We Know and in Ways We Don’t Anjan Chatterjee “Man Can Do What He Wants, but He Cannot Will What He Wants” Scott M. Sternson The Brain Is Overrated Asif A. Ghazanfar Dopamine Made You Do It Terrence Sejnowski The Human Brain, the True Creator of Everything, Cannot Be Simulated by Any Turing Machine Miguel A. L. Nicolelis There Is No Principle That Prevents Us from Eventually Building Machines That Think Michael D. Mauk

Do you know the difference between education and experience? Education is when you read the fine print; experience is what you get when you don't." -- Pete Seeger

Do you know the difference between education and experience? Education is when you read the fine print; experience is what you get when you don't."

-- Pete Seeger

What you're supposed to do when you don't like a thing is change it. If you can't change it, change the way you think about it. Don't complain." -- Maya Angelou

What you're supposed to do when you don't like a thing is change it. If you can't change it, change the way you think about it. Don't complain."

-- Maya Angelou

B

MW

MW

MW

The Middle Way is achieved when one reaches that point of cosmic balance between austerity and the creature comforts of the world

The Middle Way is achieved when one reaches that point of cosmic balance between austerity and the creature comforts of the world

BCG X SEPSIS

 BCG did not affect hospitalization rates but reduced in-hospital mortality significantly, primarily by preventing fatal cases of sepsis. The observed beneficial effects of BCG on in-hospital mortality were entirely non-specific.

BCNJ

VIPS

Bhavatu Sabba Mangalam” - thrice and I’m gonna break this down in 3 parts:

1. Why chant? There are several resources online as to why chanting is good - vibrations, balance, soothing, etc. I believe that mindless chanting is not always going to help induce the purpose, one should know and understand and relate to the meaning of the mantra to be able to effectively use it.
2. Why chant “Bhavatu Sabba Mangalam”? One of the key learnings from the Vipassana course is compassion and Bhavatu Sabba Mangalam” is just that - as it translates to “May all beings be happy”. This chant is not connected to any religion or deity in my understanding and only means that we wish, send & share good thoughts for everyone. As most practices believe in doing good & being good will eventually change your karma for the better. Club this understanding with benefits of chanting and you’re good to go! :)
3. Why chant thrice? Many mantras are chanted thrice to align with the 3 pillars of Buddhism which are Wisdom, Courage & Compassion.

During Vipassana, the audience generally follows with this chant with the word “sadhu, sadhu, sadhu” which basically means “so be it, so be it, so be it” which is more like a reinforcement.

DOUGLAS The pine stays green in winter... wisdom in hardship."

The pine stays green in winter... wisdom in hardship."

EXISTENTIAL DREAD

In 1982, Michael Jackson's album Thriller became the biggest selling album of all time. It still holds that title, now having sold over 66 million copies:

In 1982, Michael Jackson's album Thriller became the biggest selling album of all time. It still holds that title, now having sold over 66 million copies:

VIPS B

VIPS- FUTURE PAST PLEASANT UNPLEASANT FPUP MIND JUMPING

philadelphia

XYY SYNDROME

47, XYY syndrome is a syndrome (group of signs and symptoms) that affects males. For some males with this syndrome, signs and symptoms are barely noticeable. For others, signs and symptoms may include learning disabilities, speech delay, low muscle tone ( hypotonia ), and being taller than expected.


Some researchers have suggested that the extra Y chromosome is lost before meiosis,3,6–8 thus conserving fertility in these patients. Studies comparing sperm aneuploidy between fertile and infertile XYY men reveal that most sperm produced by XYY men have a normal karyotype.


Superman Syndrome is a genetic disorder in which a male is born with an extra "Y" chromosome. This is a non-disjunction of the 23rd chromosome. There is a theory that men with this disorder tend to have criminal behavior but that is only with rare few men. Most men live normal lives with this disorder


According to Dr Helen Morrison, an American forensic psychologist and writer,chromosome abnormality in serial killers begins to express itself during puberty. ... Conversely, serial killer Richard Speck's had an extra Y chromosome, which his lawyers argued was the cause of his violent crimes




Treatment may include speech therapy or extra help with schoolwork.^[3] Outcomes are generally good.^[3]Prevention is not possible.^[2] The condition occurs in about 1 in 1,000 male births.^[1] Many people with the condition are unaware that they have it.^[2] The condition was first described in 1961

People with the 47,XYY karyotype have an increased growth velocity from early childhood, with an average final height approximately 7 cm (3") above expected final height.


In contrast to the other common sex chromosome aneuploidies—47,XXX and 47,XXY (Klinefelter syndrome)—the average IQ scores of 47,XYY boys identified by newborn screening programs were not reduced compared to the general population

P Significant differences between CSF pleocytosis and nonpleocytosis in EVM appear to be associated with distinct levels of CSF cytokines.

 Significant differences between CSF pleocytosis and nonpleocytosis in EVM appear to be associated with distinct levels of CSF cytokines.


Routine EV and HPeV testing of CSF samples in children has the potential to reduce length of stay and antibiotic use. What is Known: • EV and HPeV are frequent cause of meningitis and sepsis-like illness among young children. • There is increasing evidence supporting routine EV and HPeV testing of paediatric CSF. What is New: • Outcome of routine EV and HPeV testing in Cornwall, UK. • The value of testing all paediatric CSF without any screening criteria. • A rapid diagnosis of EV/HPeV can significantly reduce length of hospital stay and unnecessary antibiotics.

Am I small? Je suis petite, moi ?

Am I small? Je suis petite, moi ?

Anthropocene —an epoch whereby human beings now represent an independent geo-physical force impacting upon the planet

Anthropocene —an epoch whereby human beings now represent an independent geo-physical force impacting upon the planet

Humility learns even from success; pride, not even from failure

Humility learns even from success; pride, not even from failure

RIG VEDA

B

B 52 MENTAL STATES

52 Kinds of Mental States

Dvipaññāsa Cetasika

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parent: Chapter II - Mental States

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(Sabbacittasādhāranā-7) 

Katham?

§ 2. (i)

1. Phasso, 2. Vedanā, 3. Saññā, 4. Cetanā, 5. Ekaggatā, 6. Jīvitindriyam, 7. Manasikāro c'āti satt'ime Cetasika Sabbacittasādhāranā nāma.

c'āti satt'ime Cetasika Sabbacittasādhāranā nāma.

(Pakinnakā - 6)

§ 3. (ii)

1. Vitakko, 2. Vicāro, 3. Adhimokkho, 4. Viriyam, 5. Pīti, 6. Chando c'āti cha ime Cetasikā pakinnakā nāma.

c'āti cha ime Cetasikā pakinnakā nāma.

Eva'mete Cetasikā Aññasamānā'ti veditabbā. (13)

(Akusala - 14)

§ 4. (iii)

1. Moho, 2. Ahirikam, 3. Anottappam 4. Uddhaccam, 5. Lobho, 6. Ditthi, 7. Māno, 8. Doso, 9. Issā, 10. Macchariyam, 11. Kukkuccam, 12. Thīnam, 13. Middham, 14. Vicikicchā

c'āti cuddas'ime Cetasikā Akusalā nāma.

§ 5. (iv)

1. Saddhā, 2. Sati, 3. Hiri, 4. Ottapam, 5. Alobho, 6. Adoso, 7. Tatramajjhattatā, 8. Kāya-passaddhi, 9. Citta-passaddhi, 10. Kāya-lahutā, 11. Citta-lahutā, 12. Kāya-mudutā, 13. Citta-mudutā, 14. Kāya-kammaññatā, 15. Citta-kammaññatā, 16. Kāya-pāguññatā, 17. Citta-pāguññatā, 18. Kāyujjukatā, 19. Cittujjukatā,

c'ati ek' unavīsat'ime Cetasikā Sobhanasādhāranā nāma.

(Viratiyo-3)

§ 6. (v)

1. Sammā-vācā, 2. Sammā-kammanto, 3. Sammā-ājīvo

c'āti tisso Viratiyo nāma.

(Appamaññā-2)

§ 7. (vi)

1. Karunā, 2. Muditā pana Appamaññāyo nāmā'ti sabbathā'pi-

(Paññindriya-1)

§ 8. (vii)

Paññindriyena saddhim pañcavīsat'ime Cetasikā Sobhanā'ti veditabbā.

§ 9.

Ettāvatā ca - Teras' aññasamānā ca - cuddasākusalā tathā 
Sobhanā pañcavīsā'ti - dvipaññāsa pavuccare.

(translation)

(Universals-7)

[these 'Universal' cetasikas are in variably found in every consciousness]

§ 2. How ? (i)

1. Contact^[1],
2. Feeling,
3. Perception,
4. Volition,
5. One-Pointedness,
6. Psychic life,
7. Attention.

These seven mental states are common to every consciousness.

(Particulars-6)

[unlike the Universals these cetasikas are found only in certain classes of consciousness]

§ 3. (ii)

1. Initial Application,
2. Sustained Application,
3. Decision,
4. Effort,
5. Joy,
6. Conation.

These six mental states are termed Particulars.

Thus these (thirteen) mental states should be understood as 'common to each other' (aññasamāna^[2]).

(Immorals-14)

§ 4. (iii)

1. Delusion,
2. Shamelessness,
3. Fearlessness (of consequences, or to commit wrong),
4. Restlessness,
5. Attachment,
6. Misbelief,
7. Conceit,
8. Hatred,
9. Jealousy,
10. Avarice,
11. Worry,
12. Sloth,
13. Torpor,
14. Doubt.

These fourteen mental states are termed 'Immorals'.

(Beautiful-19)

§ 5. (iv)

1. Confidence,
2. Mindfulness,
3. (Moral) Shame,
4. (Moral) dread,
5. Non-attachment,
6. Goodwill,
7. Equanimity,
8. Tranquillity of mental states,
9. Tranquillity of mind,
10. Lightness of mental states,
11. Lightness of mind,
12. Pliancy of mental states,
13. Pliancy of mind,
14. Adaptability of mental states,
15. Adaptability of mind,
16. Proficiency of mental states,
17. Proficiency of mind,
18. Rectitude of mental states,
19. Rectitude of mind.

These nineteen mental states are termed 'Common to Beautiful.'

(Abstinences-3)

§ 6. (v)

1. Right Speech,
2. Right Action,
3. Right Livelihood.

These three are termed 'Abstinences.'

(Illimitables-2)

§ 7. (vi)

1. Compassion,
2. Appreciative or Sympathetic Joy.

These are termed 'Illimitables.'

(Wisdom-1)

§ 8. (vii)

With the Faculty of Wisdom these twenty-five mental states are in every way to be understood as 'Beautiful.'

Summary

§ 9. Thus:-

Thirteen are common to each other. Similarly fourteen are common to Immorals Twenty-five are 'Beautiful.'

Thus fifty-two have been enumerated.

B MIND

INDE

6 RIPU

6 ripu

Lalach

Vasna

Nafrat 

Krodh 

Ahankar 

Jwalan 

""When the five senses, along with the mind, remain still and the intellect is not active, that is known as the highest state. They consider yoga to be firm restraint of the senses. Then one becomes un-distracted for yoga is the arising and the passing away" Bhagavad Gita"

""When the five senses, along with the mind, remain still and the intellect is not active, that is known as the highest state. They consider yoga to be firm restraint of the senses. Then one becomes un-distracted for yoga is the arising and the passing away" Bhagavad Gita"

only men saw increased risk of lung cancer from taking B6 or B12 supplements.

only men saw increased risk of lung cancer from taking B6 or B12 supplements. 

"Life is not about how fast you run or how high you climb, but how well you bounce." -- Vivian Komori

"Life is not about how fast you run or how high you climb, but how well you bounce."

-- Vivian Komori

VPSNA- AVOID CRAVING AND AVERSION

VPSNA- AVOID SHIFT AND SCRATCH

B

P EPILEPSY SD

Dr a and iyer

Rx of ep

When to start Rx

If 2nd unprovoked szr

Sprinkle capsules

Benign focal now. Called self limiting focal now

Absence. Ethos or valproate. Avoid cbz

Sanad study

Epileptic spasm. Previously infantile spasm. West. TS. Vigabatrin. 

ACTH or pred. 2 wks then stop

Also kg diet

Doose syndromes

Initial west then LG

Cbd. Soon for Dravet and LG

Cbd. Epidiolex. GW pharmaceutical

Artisanal cannabis being used by parents

PolyRx. Avoid 3 or more drugs at Any one time

Drug res ep. If 2 aed failed

Eg no szr free in 12 mo

Think KGD. Ep Sx. VNS. Immunomodulatn

KG diet

SpeciList diet

3 to 1 fat to carb ratio

GLUT1. Long term

Movie. First do no harm

Kgd Not in mcad

Immmodulation

Limboc encephalitis

FIRES

Rasmussen ep partls continuA

Cstd ig plSmapharesiis

Surgical referral criteria

CESS

Altered awareness. 

Seizures are cortical

TLS. 

Temporal lobe Sx

Gelastic szr. Hypothal hamartoma. Rage. May need surgical resection

SEEG

VNS. LGS. Myoclonus astatitoc ep

Dacrocystic szr. Mad chuckle. 

//////////////////////////////////////////////////////////

To be seen within 2 weeks 

See video

Ep nurse specialist 

YP is 12-18

Child 1 mo to 12 yrs

To refer under 2 yr old ep to terty unit so that neurologist can optimise ep control and neurocogn dvptw

Always rule out long qtc on seizure as next one may kill.  ECG essential

MRI is essential. Not to miss subtle lesion eg. Cortical dysplasia 

Also MR I if not responding to first line aed as May be evolving lesional epilepsy

Consistent aed supply. Try to stick to the brand as well

Buccolam if previous prolonged or serial convulsive szr 

Medicolegal firms are using nice Apls guidance

OPEN UK ep network 

CG137

MHRA guidance on sod valproate 

Pregy prevention program 

Valproate decision on teenage girl is with parents. We give options 

MHRA guideline.  Pragmatic for sev LD pts who are unlikely to have consented sex

//////////////////////////////////////////////////

.Shuddering episodes

Non epileptic seizure

Stereotyped vocal seizure.  Hello are you hypnotised.  Brain tumour frontal lobe

Benign tonic up gaze of infancy.  

Referral pathway of fits faints and funny turns

After 1st seizure only 40 pc will have recurrence.  60 pc will never recur

Day dream. 

Tics 

Migraine 

Enough traction to merit a referral

Breath holding causing opisthotonos decerebrate.  Breath hold with valsalva

Lamotrigine rash

Epilepsy 12

///////////////////////////////////////////////////////////////

ombined genl and focal ep

Metabolic panel

EIEe panel. 

LG usually tonic.  Not myoclonic

Video eeg

1 ha photic stimulus

Causing myoclonic jerks.    Batten late infantile

Angel an have absence and tonic clonic

Doose not photosens

Infantile epileptic encephalopathy. 

///////////////////////////////////

Complex cases

Focal seizure.  Gulp vomit retch clutches blanket

Temporal lobe ep

Seizure.  Beginning. Middle.  End.  

Frontal lobe usually no aura.  Gets out of it suddenly.  Remember.  Are you hypnotised boy

Routine erg is for 20 min

Focal cortical dysplasia.  Temporal lobe

Fcd treated surgically.  Slowly weaned off serial aed

If not self limiting think NRI structural. 

If structural think surgical referral. Local CESS team

Focal.  Frontal and temporal are common

Convulsive SE

5 min rule. 

After 4 min most will continue

CSE

Case risk is syndrome dependent eg v high in dravet s

20 pc case may be de novo ep

Ilae se

Refractory SE

Super refractory cse

Par aldehyde and phenytoin should be given at same time

Call anaesthetist if starting phenytoin

Cluster seizures have to be treated individualistic ally after d/w terty neurologist

Phenytoin can cause profound hypotension needed dopamine support

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Lafora disease

NHLRC1 mutation

Life limiting

Transition

From pond to sea

In spl school children can be looked upto age 19 

Perampanel

Transition clinic more like Handover clinic 

Transition.  Ready.  Steady. Go

Works well for mainstream children but not on ones with high LD burden

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Difficult epilepsy

May need portacath

Accepting stockpile explanation

Ss issue.  If aed compliance problems

If po aed completely refused sometimes may need peg

Sometimes 3 days in ward to be observed her aed compliance

Young Epilepsy. Detailed look at

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