By Y. Mitch. Texas Chiropractic College. 2017.

Magnetic resonance there have been no recurrent seizures after imaging (MRI) 50 mg luvox overnight delivery, a noninvasive procedure in this time order 50 mg luvox mastercard, the physician may consider which rapid detailed pictures of body withdrawing the medication. Individuals structures are produced, may also be used who have had no additional seizures after to identify structural anomalies in the beginning the medication, or who have brain that may be related to seizures. Treatment and Management of Epilepsy The consequences could be dangerous and at times life-threatening. Consequently, Treatment of epilepsy is dependent on the individuals should never attempt to alter cause of the seizure activity and the types or discontinue their medication without of seizures experienced. Al- the type of seizure and on whether more though they may be thoroughly evaluat- than one type of seizure is experienced. Based tion to remove or repair the abnormality on medication blood level and its effec- may be indicated. In most instances, how- tiveness in controlling seizure activity, the ever, when epilepsy is diagnosed, the stan- physician may alter medication dosages dard treatment of most types of seizures accordingly. Measuring the blood levels of is the regular use of one or more anticon- the anticonvulsant also helps the physi- vulsant or antiepileptic medications. Successful con- compliant with taking anticonvulsant med- trol of seizures, however, requires the indi- ications, seizures remain uncontrolled. The anticonvul- several seizures a month or, at times, sev- sant medications used to treat epilepsy are eral seizures a day, despite following a also not without side effects, and toxic strict treatment regimen of medication. Depending on the medication, cannot be controlled by medication, sur- side effects can include gum overgrowth, gery may be recommended to treat epilep- 64 CHAPTER 2 CONDITIONS OF THE NERVOUS SYSTEM: PART I sy. Under these circumstances, surgery well controlled seizures are, individuals may involve removing a portion of the live with the possibility, even if remote, brain structure, resecting a portion of the that another seizure will occur. The time, brain, or disconnecting the affected por- place, and social circumstances under tion from the rest of the brain. The amount If individuals experience a seizure in pub- of disability experienced, if any, after this lic, they risk feelings of embarrassment type of surgery depends on individual cir- and onlookers’ potential misperception of cumstances. Alcohol can lower the seizure threshold At times, even when seizures are adequate- and therefore precipitate seizures.

This page intentionally left blank C HAPTER 4 Conditions of the Eye and Blindness NORMAL STRUCTURE AND ing the eyeball is the choroid coat buy generic luvox 100 mg on line, which FUNCTION OF THE EYE contains most of the blood vessels that nourish the eye generic luvox 50 mg without a prescription. The eyeballs are spherical organs The colored part of the eye is called the encased in the orbital cavities of the skull. At the center of the iris is a round Muscles located on the top, bottom, and opening called the pupil, which admits side of each eye enable it to rotate in dif- light to the inner part of the eye. Through fre- Smooth muscle fibers on either side of the quent blinking, the eyelid helps keep the pupil cause it to contract or dilate, there- eye moist, preventing irritation. The by automatically regulating the amount of lacrimal glands, which lie in the upper out- light that enters the eye. In bright light er side of the eye behind the eyelid, secrete the pupil contracts to reduce the amount tears to keep the eyeball moist and help of light admitted. In front of the eye lies a transparent Directly behind the iris is a space called curved structure called the cornea, which the posterior chamber. Contained in the admits light and protects the inner eye posterior chamber is a structure called the from foreign particles and organisms. The vessels, it is richly supplied with nerve aqueous humor escapes from the posteri- cells. Connected to the cornea and com- or chamber through the pupil into a space pletely covering the eyeball except for the lying between the iris and cornea called part covered by the cornea is a fibrous the anterior chamber, which lies between membrane called the sclera. The aqueous forms the white part of the eye and has humor then drains from the eye into the primary function of supporting and lymph channels and into the venous sys- protecting the eye and maintaining eye tem through a sievelike structure called shape. Lining the exposed area of the scle- the canal of Schlemm (trabecular network), ra and inner eyelid is a sensitive mem- which is located at the junction of the iris brane called the conjunctiva. The balance between the underneath the sclera and also surround- amount of aqueous humor produced and 123 124 CHAPTER 4 CONDITIONS OF THE EYE AND BLINDNESS Muscle Chorid Retina Conjunctiva Ciliary muscle Iris Aqueous humor Fovea Cornea (Macular area) Pupil Optic nerve Lens Optic disc Vitreous Anterior chamber humor Posterior chamber Canal of Schlemm Sclera Figure 4–1 The Eye. This space is filled with a jelly- cornea and a structure located directly like, translucent substance called the behind the iris called the lens. The lens is vitreous humor, which helps to maintain a small transparent disk enclosed in a the form and shape of the eyeball. Attachments around At the very back of the eye is the inner- the circumference of the lens, called ciliary most coat of the eye, the retina.

Accordingly generic luvox 50 mg visa, compensation for medical injury is paid mainly by physicians’ malpractice insurance because physicians’ decisions largely determine what care patients 262 Sage receive and how it is delivered generic 100mg luvox with mastercard. This made perfect sense when most medical costs consisted of physician time and hospitals were chari- table institutions performing a low-technology, supportive role. As medicine has become industrialized—requiring the coordinated appli- cation of a range of professional services, technical facilities, and sophisticated products—physician direction has become more diffi- cult and the results of faulty management more costly. Physician ser- vices now account for roughly 20% of national health expenditures, creating a trillion-dollar gap between physician revenues and total revenues because of sustained medical inflation. This puts the deter- rent objective of liability in tension with the risk-bearing and compen- sation objectives. Physicians still plausibly control roughly two-thirds of health expenditures through their ordering and referral decisions, but they are insufficiently capitalized to fund insurance costs to an equivalent degree, particularly when the burden falls mainly on a few specialties. Another byproduct of the preindustrial structure of liability insur- ance is that focusing on physicians distracts policymakers from an equally important set of concerns affecting hospitals and other medi- cal institutions. Even in crisis periods, primary layers of coverage for institutional providers remain financially viable because they deal with commercial carriers who base premiums on loss experience across a range of revenue-producing clinical activities, they have access to alternative arrangements such as captive insurers and risk- retention groups, and they can self-insure to a considerable degree if necessary (31). On the other hand, institutions in high-exposure states face significant difficulties securing excess coverage, which they keep at high levels to allay shareholder concerns or trustees’ fears of per- sonal liability. External shocks to global reinsurance markets, includ- ing but not limited to the terrorist attacks of 2001, have significantly reduced available capacity. In this environment, reinsurers are reluc- tant to devote scarce capital to areas, such as medical malpractice, that are characterized by infrequent but high-dollar losses. This reluctance derives, at least in part, from the publicity that attends occasional jury verdicts against hospitals or HMOs for amounts exceeding $50 mil- lion, even if the highest awards are often reduced or the cases are settled for lesser amounts.