The term epilepsy denotes any disorder characterized by recurrent, unprovoked seizures. Seizures are disturbances of cerebral function that are electrical discharges in the brain. It may consist of violent shaking, convulsions, absence spells, automatisms (unusual recurrent behaviors), up to the loss of consciousness. Epilepsy is quite common and occurs in up to one in every two hundred people. Even though it is common, there can be times where living with this condition can be tough on many people. With this being said, it then comes as no surprise to find that some residents of Utah may choose to get a cannabis card in Salt Lake City. This way, they’ll be able to get their hands on medical marijuana, which is said to help manage the symptoms of Epilepsy (and other ailments/conditions). Making sure you have a local supply is important so if you aren’t in the Salt Lake City area and you live in Vermont, it might be wise to try out i49 as a local source for your medical marijuana needs.
The unprovoked seizures are generally recurrent and may persist for seconds (in absence seizures) up to hours when the post-seizure state (also known as the post-ictal state) persists. People may have seizures provoked by reversible causes, such as withdrawal from alcohol or drugs, low blood sugar and kidney failure from severe electrolyte imbalance, but these seizures are not considered to be under the true definition of epilepsy.
Most epilepsy is either structural or metabolic in origin, although genetic epilepsy does exist. Abnormalities a person is born with or injuries acquired during the birth process may cause epilepsy. Metabolic causes, vascular diseases, degenerative disorders and infectious diseases are causes. Seizures associated with infectious diseases are generally reversible when the disease passes. Trauma is a very important cause of seizures, especially in young adults.
Seizures are generally classified as either focal or generalized. Focal seizures may or may not involve loss of consciousness. They can consist of anything from jerking rapid movements to involvement of visual, auditory, olfactory and other sensations bordering on hallucinations. Generalized seizures can run the gamut from absence seizures (where someone is unaware of an impairment of consciousness for a short period of time) to tonic-clonic, or grand mal seizures. These types of seizures generally involve a sudden loss of consciousness, a fall to the ground, and rhythmic, jerky contractions followed by a period of drowsiness. Grand mal seizures are most common in adolescence and early adulthood.
Since there is a large differential diagnosis of neurologic seizures, testing is always indicated. An EEG (electroencephalogram) is the single most useful test in the diagnosis of epilepsy, with evidence of seizure activity being shown with characteristic spike and wave patterns. CT scanning (or MRI) also help to exclude lesions (such as tumors) as a cause, as a sudden seizure later in life may be the first sign of a malignancy. Focal seizures may be confused with transient ischemic attacks (TIAs), the aura to migraine headache, panic attacks and even rage attacks. Generalized seizure disorder has to be differentiated from syncope and cardiac disease. Getting the proper diagnosis is essential to providing the most appropriate treatment.
Medical and surgical treatment are both used to control epilepsy. Numerous medications, similar to cbd oil and water soluble cbd for example, are used depending on the type of seizure involved, as some may provide excellent control of the disorder. Often they are trial and error until the right medication with the least side effects is found. Surgery may also be tried, in the people who are not responsive to medical therapy, to disrupt the focus of seizure provocation.
Mortality and morbidity in general are higher in epileptics. Sudden death is a risk in those who have grand mal seizures and who are not well controlled on medication. Accidents, and in particular motor vehicle incidents, can have quite adverse consequences with the development of a seizure while driving. Falls, particularly in the elderly who have epilepsy, can result in severe consequences. Industrial accidents in those who have epilepsy and may be affected during mechanical work are also problems that have to be taken into account.
Certain information is helpful to the underwriter in assessing epilepsy and especially in evaluating the more difficult cases. Compliance with medication is foremost in a favorable outcome. Single seizures do better than multiple ones. Concurrent use of alcohol is a poor prognostic factor. Single medication use as opposed to multiple medications and the duration of time since the last attack are considered. Older age and the results of trauma from a fall also have poorer outcomes.
Many to most epilepsy cases may be handled with standard classification, and occasionally preferred status can be used when there are single seizures, no prolonged treatment, no history of alcohol use and no high risk avocations (like aviation or scuba diving). Medication records as well as MVR records are reflexed and looked at in evaluation. Medications and surgery over the recent past have shown very positive results in seizure control.
Liver Fibrosis
Liver fibrosis is the replacement of functioning hepatic tissue with fibrous tissue. Alcohol overuse, hepatitis of any kind, and nonalcoholic steatohepatitis (NASH) often leave behind damage with not only an active process but one where compromise may persist long after the cause has been controlled or eradicated. Knowing how to assess liver fibrosis in the aftermath of these conditions is an important part of underwriting liver disease.
Chronic liver disease may occur in over 10 percent of the population, and the National Vital Statistics Registry lists it as the 12th leading cause of death in the United States. The most common causes of chronic liver disease are nonalcoholic fatty liver disease (NAFLD—very commonly associated with obesity and present in over one quarter of the US population), the aforementioned NASH (a more aggressive form of the disease) and post hepatitis C infection. Hepatitis C is now potentially curable, but the damage left behind from the course of the illness may be permanent. A way to determine liver disease aside from just the blood testing that is done is certainly necessary in determining both prognosis and treatment.
Liver fibrosis (depending on the staging system used) has 4-6 stages. Stage 0 represents no fibrosis, stage 4-6 marked fibrosis with cirrhosis of the liver, and the remainder some degree in-between. Liver failure is the most extreme consequence and staging is a predictive factor for it. Additionally, conditions like hepatocellular cancer and bleeding vessels in the esophagus (varices) are high risks of advanced liver failure and have to be accounted for as well. Even potential treatments (like those for hepatitis C) need to have the degree of fibrosis assessed to choose the most appropriate drug treatment.
Historically, a liver biopsy was the only way to know for sure the degree of fibrosis and residual liver damage. Biopsies are not only painful but may result in excessive bleeding and complications that may require hospitalization. Additionally, a biopsy report is only as good as the area it is representative of. If placed in the most affected area (or least affected) a result may be misrepresentative of the overall state of disease.
Staging scores have been developed based on various testing. FIB-4 is based on the use of four factors that are representative of fibrosis: Age, AST and ALT levels (liver function tests), and platelet count. NAFLD score generally is in post biopsy patients and additionally adds body mass index as well as the absence or presence of diabetes. These are helpful but not fully diagnostic of the degree of liver involvement with fibrosis.
Newer testing has been developed with better accuracy. Fibrosure is a formula that takes into account age, sex, bilirubin, haptoglobin, GGTP, apolipoprotein A and alpha-2-macroglobulin to assess fibrosis. It has good predictive value—better than its predecessors. Imaging such as transient elastography (done with ultrasound waves), acoustic radiation force imaging (where a transducer is involved) and MRI elastography are also used and provide more definitive quantification of the degree of fibrosis that is being measured.
Many Attending Physician Statements reference this advanced testing, especially in biopsy proven disease, in assessment of post hepatitis C infection, and in diagnosing the more virulent NASH. Many drug companies are spending millions of dollars in attempting to find medication that treats or improves NASH finding or slows fibrosis. The common fatty liver disease associated with obesity generally has very limited fibrosis and is underwritten on the basis of underlying conditions. NASH is often ratable based on biopsy results or higher score indices based on the testing involved, including liver enzyme results. Even successfully treated hepatitis may be rated if the disease resulted in substantial liver damage left behind after the successful cure.