Lumbar arthritis: Symptoms, causes, diagnosis, and treatment
Identification, Assessment And Treatment
Executive dysfunction occurs in many clinical conditions and has significant impact on multiple facets of life. This book summarizes executive function and dysfunction for practitioners, researchers and educators, covering lifespan development, assessment, impact and interventions. Drawing together clinical, neurobiological and developmental viewpoints, the authors summarize the latest research findings in practical and applied terms, and review conceptual approaches to assessing and identifying executive function and dysfunction. Several chapters are devoted to practical aspects of executive dysfunction, including research-based treatment strategies, educational implications, forensic cautions and intervention resources. Executive dysfunction in ADHD, LD, MR, autism, mood disorders, epilepsy, cancer and TBI is covered, with test performance, neuroimaging and clinical presentation for these clinical conditions. The book concludes with anticipation of future work in the field. This is a key reference for medical, psychological and educational professionals who work with children, adolescents and young adults in clinical and educational settings.
"This book represents an important contribution to the quickly growing literature on executive functions in childhood and adolescence and will be useful to a variety of child clinicians, including pediatricians, neurologists, psychiatrists, and other neuropsychologists."Journal of Clinical Psychiatry
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× Product detailsPrefaceIntroduction to the volume Elizabeth P. Sparrow and Scott J. HunterPart I. Foundations of Executive Function/Dysfunction:1. Models of executive functioning Scott J. Hunter and Elizabeth P. Sparrow2. The developmental neuropsychology of executive functions Scott J. Hunter, Jennifer P. Edidin and Clayton D. Hinkle3. The neurobiology of executive functions Scott J. Hunter, Clayton D. Hinkle and Jennifer P. Edidin4. Assessment and identification of executive dysfunction Elizabeth P. SparrowPart II. Executive Dysfunction in the Neurodevelopmental and Acquired Disorders: Introduction to Part II Elizabeth P. Sparrow5. Executive functions in disruptive behavior disorders Laura E. Kenealy and Iris Paltin6. Executive functions in autism spectrum disorders Lauren Kenworthy, Laura Gutermuth Anthony and Benjamin E. Yerys7. Executive functions in intellectual disability syndromes Kelly Janke and Bonnie Klein-Tasman8. Executive functions in pediatric movement and motor control disorders Emily J. Helder and Tory L. Larsen9. Executive functions in learning disorders Laura A. Barquero, Lindsay M. Wilson, Sabrina L. Benedict, Esther R. Lindström, Heather C. Harris and Laurie E. Cutting10. Executive functions in mood and anxiety disorders Jennifer P. Edidin and Scott J. Hunter11. Executive functions in childhood epilepsy Frank A. Zelko and Lev Gottlieb12. Executive functions in pediatric cancer Marsha Nortz Gragert and Lisa S. Kahalley13. Executive functions in human immunodeficiency virus Sharon Nichols14. Executive functions and neurotoxic exposure Jill Kelderman15. Executive functions after congenital and prenatal insults Jillian M. Schuh and Scott J. Hunter16. Executive functions in acquired brain injury Cynthia SalorioPart III. Applications:17. Empirical status regarding the remediation of executive skills Beth Slomine, Gianna Locascio and Megan Kramer18. Educational implications of executive dysfunction Lisa A. Jacobson and E. Mark Mahone19. Executive functions, forensic neuropsychology, and child psychiatry: opinions, cautions, and caveats Scott J. Hunter, Niranjan S. Karnik and Jennifer P. Edidin20. Reflections on executive functioning Elizabeth P. Sparrow and Scott J. Hunter.
Look InsideScott J. Hunter, University of ChicagoScott J. Hunter is Associate Professor of Psychiatry, Behavioral Neuroscience and Pediatrics in the Pritzker School of Medicine at the University of Chicago, Chicago, IL, USA.
Elizabeth P. Sparrow, Sparrow NeuropsychologyElizabeth P. Sparrow is a clinical neuropsychologist at Sparrow Neuropsychology, Raleigh, NC, USA.
ContributorsElizabeth P. Sparrow, Scott J. Hunter, Jennifer P. Edidin, Clayton D. Hinkle, Laura E. Kenealy, Iris Paltin, Lauren Kenworthy, Laura Gutermuth Anthony, Benjamin E. Yerys, Kelly Janke, Bonnie Klein-Tasman, Emily J. Helder, Tory L. Larsen, Laura A. Barquero, Lindsay M. Wilson, Sabrina L. Benedict, Esther R. Lindström, Heather C. Harris, Laurie E. Cutting, Frank A. Zelko, Lev Gottlieb, Marsha Nortz Gragert, Lisa S. Kahalley, Sharon Nichols, Jill Kelderman, Jillian M. Schuh, Cynthia Salorio, Beth Slomine, Gianna Locascio, Megan Kramer, Lisa A. Jacobson, E. Mark Mahone, Niranjan S. Karnik
Leading The Way In The Treatment Of Autoimmune Diseases
BINGYIN SHI, Dean, The First Affiliated Hospital of Xi'an Jiaotong UniversityCredit: The First Affiliated Hospital of Xi'an Jiaotong University
Graves' disease (GD), is one of the most common problems affecting the thyroid. This autoimmune disorder, named after the Irish physician, Robert Graves, who first described it in the early 19th century, is characterized by an overproduction of thyroid hormones, and can lead to bulging of the eyes, pain, and visual impairment. Bingyin Shi, head of The First Affiliated Hospital of Xi'an Jiaotong University, and a renowned endocrinologist, has focused on autoimmune diseases, including GD, for years. His team pioneered the fine-needle aspiration technique in China for diagnosing thyroid disease, and is now working on a vaccine for GD. Here, Shi discusses their latest breakthroughs on the prevention and treatment of autoimmune diseases.
What led you to focus on Graves' disease (GD)?
Hyperthyroidism has a prevalence rate of 1% to 2%, and its most common cause is GD. Working as a front-line doctor, I have met many GD patients, who rarely fully recover. One common and serious complication, Graves' ophthalmopathy (GO), causes inflammation of orbital tissue in the eyes, which may lead to irreversible visual impairment.
The treatment for autoimmune diseases, such as lupus, rheumatoid, and chronic kidney diseases, is also ineffective, and prognosis is poor.
An organ-specific autoimmune disease with a well-known etiology and a clearly defined autoantigen, GD may serve as an ideal model for studying the pathogenesis, prevention and treatment of autoimmune diseases, so we have put great effort into studying it.
What are the challenges in treating GD?
Currently, principal treatment options for GD are anti-thyroid drugs, radioactive iodine therapy, and surgery. While they can be effective, there are also drawbacks and side- effects, such as high relapse rate for drug use, given the long treatment course, and hypothyroidism, or inadequate production of thyroid hormone after radioactive therapy or thyroidectomy. Another side- effect is hypocalcaemia, which is low calcium levels in the blood. It is therefore important to develop novel therapeutic and preventive strategies for GD, and this requires a comprehensive understanding of the fundamental mechanism of diseases. Our research directly tackles GD's root causes and explores all possible preventive measures. We want to go beyond perfecting a cure, and to eradicate the disease altogether.
What makes your GD strategy different?
By exploring the mechanisms for disease pathogenesis, our strategy for GD focuses comprehensive multi-omics research, and have shown that it is critical to induce immune tolerance against GD during the neonatal period, earlier rather than later, to attenuate host immunity, which has proved to be effective in preventing the onset of acquired hyperthyroidism in mice, rhesus monkeys and tree shrews.
Based on these results, we are now developing the world's first vaccine for hyperthyroidism. After four years of intensive research and animal tests, we are excited that our vaccine boasts an expected prevention rate of 90% for GD in non- human primates. Given their similar physiological processes and immune responses, the results indicate the potential safety and effectiveness of our vaccine for clinical use.
How do you view the role of translational research?
As a physician-scientist, I have high expectations for the role of translational research in clinical practice. Our team has made several firsts in the translational studies of GD, including developing the first hyperthyroid mouse model in China, and the first model of rhesus monkey and tree shrew for GD in the world. We are also the first to develop induced immune tolerance against GD in newborn mice and macaque monkeys, which has helped improve the method of introducing neonatal tolerance for preventing and treating GD. Furthermore, we have employed single cell sequencing technology to investigate the molecular mechanism of GO, allowing for the identification of specific genes associated with the disease. Our translational studies have provided a solid foundation for understanding the pathogenesis of GD and its complications, leading to novel therapeutic and preventive strategies.
What is your vision for future research?
We believe that similar approaches could be used in preventing other autoimmune diseases. To advance our understanding of their pathogenesis, we are developing a biobank for immunomics research. We are also building research platforms to allow for valuable academic and business collaborations on developing precision medicine approaches. At our hospital, the attempt to harness the newest technology to advance treatment extends beyond autoimmune diseases. Leveraging our university's strength in engineering, we are developing magnetic systems to make surgeries less invasive. We are also pioneering using CAR-T therapy, which is known for its effect on leukaemia, to treat liver cancer. All these efforts are guided by patients' best interests, which are always at the heart of our research.
Credit: The First Affiliated Hospital of Xi'an Jiaotong University
Revolutionizing medical progress in northwest China
Established in 1956, The First Affiliated Hospital of Xi'an Jiaotong University is one of the best comprehensive tertiary hospitals in northwest China. This prestigious centre has integrated medical treatment, teaching, scientific research, rehabilitation and prevention, with specialist strengths in endocrinology, cardiology, organ transplantation, and oncology.
Epilepsy Treatment
Treatment of epilepsy involves medications as well as surgical methods. There should be a complete care plan of treatment for epileptics that addresses lifestyle issues as well as medical issues.
MedicationsThe anti-epileptic drug (AED) treatment is individualized based on:-
Before starting on a medication the diagnosis should be critically evaluated especially if seizures continue despite an optimal dose of a first-line AED. Treatment with AED therapy is generally recommended after a second epileptic seizure.
In some cases AED may be started after the first seizure. These special cases include presence of neurological deficit, the EEG shows unequivocal epilepsy or brain imaging shows a structural abnormality. AED may also be started if the patient finds the risk of another seizure unacceptable.
First-line and second-line drugsFirst-line drugs are older and have treated epilepsy for decades. Second-line drugs are much newer. The first line AEDs include:
Newer second-line AEDs include:
Another vitally important issue is availability of the AED in constant supply. Treatment should be with a single AED wherever possible. If this is unsuccessful then another drug may be tried alone.
To institute a new drug the second drug should be started and dose increased to an adequate and then the first drug should be tapered off slowly and withdrawn. If both drugs have failed singly, a combination therapy is considered.
Where possible, controlled release preparations should be used for single drugs. These preparations have longer duration of action and maintain levels of the drug within the body over a longer period of time and thus a once-daily dose suffices. During continuation of AEDs a check on effectiveness, seizure-free duration and side effects of the AEDs should be monitored. Certain specific clinical conditions, e.G. Status epilepticus, organ failure and pregnancy should be anticipated and handled carefully.
Drug resistanceEpilepsy is resistant to drug treatment in one third of all patients. These patients may be tried with newer AEDs like levetiracetam, topiramate, and zonisamide that have a varied mechanism of action and can help control seizures.
Withdrawal of medicationSometimes after long term seizure-freedom AEDs may be stopped or withdrawn. The decision to continue or withdraw medication should be based on the risks and benefits. Withdrawal of AED treatment should be carried out slowly (at least 2-3 months) and one drug should be withdrawn at a time. There should be an agreed plan that if seizures recur the last reduced dose is reinstated along with consultation with the attending physician.
Side effects of AEDsSide effects of AEDs include:
A significant population of epileptic patients have resistance or refractoriness to AEDs in use. Surgery is increasingly used as treatment for refractory focal epilepsy. There are techniques by which the location of epileptic discharge is found and neurosurgical techniques are applied to achieve a possible cure. Surgical operations for epilepsy include:
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