#Complex Partial Seizures

[ribbitflings]

convinced that god was on drugs when it came to epilepsy bc wtf is this

[echoes-in-the-multiverse]

Dissociative Seizures

Educational post. Trigger warnings: Medical equipment and description of seizure. 

Written by Tom and Blade.

Why will we cover this? 

Although dissociative seizures are not exclusive for those with dissociative disorders. Some people with dissociative disorders will have seizures.

A dissociative seizure is named differently in different parts of the world. 

I will be referring to them as dissociative seizures or Non-epileptic attack disorder (NEAD). 

However, may also be seen as a one of the many symptoms/types of Functional neurological disorders (FND) its matching term in the ICD-11 is Dissociative neurological symptom disorder. And this post will focus specifically on only the non epileptic seizures. 

It is also known as Psychogenic non-epileptic seizures (PNES), Non-epileptic seizures, and Psychogenic seizures.

If you have known these as "pseudo seizures", it is asked that this is no longer a term that should be used because the name suggests that the seizures are not real or faked by the individual having them or cannot have an ever lasting impact.

What causes a dissociative seizure?

Unlike epileptic seizures they are not caused by abnormal electrical activity in the brain.

A person can get triggered by sensations, thoughts, emotions and difficult situations. Memories of painful events can suddenly come into thoughts or awareness or a build up of stress can happen in a moment. The dissociative seizure can happen as a way to cut off stress or bad memories so that they are not relieved. This can cause a person to start to dissociate. This is when they will feel disconnected from the world around them or make it seem like the world is not real. The brain will "shut down" to protect itself from overwhelming stress. The seizure then happens because the emotional reaction of the person becomes physical.  It is known that extreme emotional distress can cause illnesses and disorders such as non epileptic seizures. 

Some people who have dissociative seizures have them caused by traumatic events. For some they may happen after the event or for others they could start years later. They may start to happen suddenly with no apparent reason at the moment. However, in some people they can be caused by the build up of stress overtime.

When seizures start they can be triggered by stressful or frightening events, even the worry of having a seizure can trigger one. They could also occur spontaneously in non stressful events. Patients may not be able to understand why seizures happen as for some it is hard to recognise the level of stress they are feeling.

What do dissociative seizures look like?

Dissociative seizures can look different from person to person.

You could have episodes of uncontrolled movements, sensations or behaviour. Some dissociative seizures may look more like epileptic seizures or may look more like fainting. Someone may have palpitations, sweat, hyperventilate and have a dry mouth. Someone may fall on the ground or have jerking and shaking movements either on one side or the whole body. A person may lose control of their bladder or bowels and may also bite their tongue. Some people may go unresponsive to people around them and may stare and go blank.

Having seizures caused by a delayed response to a traumatic event may be a part of Post Traumatic Stress Disorder (PTSD). In these seizures a person may have flashbacks, scream or cry and they may not remember the seizure afterwards.

Diagnosis of dissociative seizures.

A specialist will have many ways to tell whether the seizures are epileptic or not. The doctor may be able to tell from detailed descriptions of the seizures or a video of one happening. However, a doctor may ask someone to have an electroencephalogram (EEG) to determine whether electrical changes occur within the person's brain during a seizure. It may also be suggested for a person to have a video-telemetry. This could be done as an inpatient in a hospital or at home. A person will wear EEG equipment for a few days and is linked to a camera. This means that during a seizure the EEG and a video of it happening can be taken at the same time. 

Brain scans such as Magnetic resonance imaging (MRI) or Computed Tomography Scan (CT) scans may also be done to rule out any neurological cause for these seizures. 

Treatment for dissociative seizures.

Patients may also be asked to see a psychiatrist or psychologist. They can offer Treatment such as psychotherapy, stress-reduction (such as relaxation and biofeedback training), and personal support to help you cope with their seizures. 

Talking therapy is useful to understand if there are triggers for the seizures and ways to manage these triggers in daily life. Cognitive behavioural therapy (CBT) is often recommended.

Medication will not help treat non epileptic seizures so they will only be suggested if the patient also has epileptic seizures. Taking medication for non epileptic seizures can cause side effects and do not benefit the person.

It is recommended to keep a normal daily routine. And to make sure that their family and friends are aware and understand. This will mean they will likely be able to help the person in a seizure and prevent harm.

First aid for dissociative seizures (Outsider's perspective):

DO:

- Make sure the person is safe. This can include moving objects away from them. If the person is lying on the floor, put a cushion/something soft under their head.

- Speak Calmly and in a reassuring way to the person

- Non epileptic seizures do not cause damage to the brain no matter how long it happens BUT if you are not sure if it is a dissociative seizure and lasts more than 5 minutes an ambulance must be called. If it is epileptic then a seizure longer than 5 minutes can damage the brain. (Again important to note this is advice given by the NHS of the UK)

- Stay with the person until they have recovered

DO NOT:

- Do not restrain the person. This can cause injury and make the seizure worse.

- Do not put anything in the person's mouth 

- Do not attempt to give medication

Self-help tips:

- Write down how you are feeling

- Continue to live normally and not become over cautious. This can help to speed up recovery. It is important to talk to your employer about these seizures and make clear your colleagues know what to do as well.

- Eat and Sleep well

- Build up self confidence

- Green exercise is a great way to boost your mood by being outside even if it is for a short while. Going for a walk outside.

- Fitness programmes can be found online and most can be done from your home 

- Remaining positive 

The sources we have used for this information also have more information on disability rights and benefits for those with dissociative seizures. And on driving regulations. However, these are only applicable to the UK. 

Epilepsy Society, O’Sullivan S. Non-epileptic Seizures and Dissociative Seizures | Epilepsy Society. epilepsysociety.org.uk. Published August 2023.

British Epilepsy Association. Dissociative (non-epileptic) Seizures. Epilepsy Action. Published August 2022.

NHS. What to Do If Someone Has a Seizure (fit). nhs.uk. Published April 9, 2018.

Further information:

People's experiences: 

Documentary film: Photosensitive Epilepsy Trigger Warning at (9:14 - 9:30 ) and at (45:25 - 46:18)

Websites for more information: 

NeuroKid: - This is a website for children and young people with dissociative seizures but also has information for parents of these children. The website is also available in French at https://www.neurokid.co.uk/fr/.

Non-Epileptic Attacks: A page written by professionals. They have more resources and go into more detail about the self help we have addressed.

FNH Hope UK: Has fundraising challenges across the UK. They also have online classes such as dance, painting, mindful meditation and yoga.

Charities:

FND Action: They can provide ID cards for those in the UK struggling with dissociative seizures. 

Brain Charity: Provides Emotional support and social support for those in the UK and has a helpline. 

Trigger warnings: Medical equipment and description of seizure. Educational post.

[lintu-potter]

Wen u feel like crap, but u have to work and act like a normal human bein for 6 hours

[kunaigirl]

Happy Disability Pride and awareness month! Let's talk about Epilepsy!

Hi there! I got tired of seeing my condition (that impacts my literal every day life) being left out or forgotten about during discussions about disabilities, so I made my own post about it! Let's go!

First Off! What the heck is epilepsy? Epilepsy is the fourth most common neurological disorder in the world, and it's a chronic medical condition. Epilepsy is a brain disorder that causes recurring, frequent, triggered, and unprovoked seizures to occur.

The official Epilepsy Foundation describes seizures as follows: "Seizures are sudden surges of abnormal and excessive electrical activity in your brain, and can affect how you appear or act. Where and how the seizure presents itself can have profound effects...Seizures involve sudden, temporary, bursts of electrical activity in the brain that change or disrupt the way messages are sent between brain cells. These electrical bursts can cause involuntary changes in body movement or function, sensation, behavior or awareness." (Source link)

Sounds like a lot of fun right? This is our life. Even with medication, we can be VERY limited to what can be safe for us. Seizure medications are NOT a cure, they only exist (at least as of now) as a tool to help have your seizures less often, or be triggered less intensely. Even on medication, seizures can still happen.

If you have epilepsy as a child like I did, it impacts your entire growing and developing experience. I spent MANY times as a child in and out of hospitals, neurologist and specialist offices, an getting so many EEG tests done. The pain of scrubbing the glue out of your hair for DAYS is horrible.

At a young age my seizures were so frequent and serious, it impacted my brain's ability to retain information. I had to re-learn the names of things at age 8 and 9. I had to re-learn HOW TO READ at age 10. I had to be home schooled because the public school system of my state at the time refused to work with me. I have VERY distinct and vivid memories of crying over my little baby ABC's book that I needed as a 4th and 5th grader. I knew I should've known this by this age. I knew that at one point I already did, and it was TAKEN FROM ME.

As an adult, I'M NOT ALLOWED TO DRIVE A CAR. And I can NEVER go to see a movie in theaters or go to see concerts or live music. There are entire TV shows I don't get to see. I can't go to clubs, arcades, dances, or raves. I miss out on A LOT of fun things. I always do, and I'm WELL AWARE of the fun I'm missing out on. The social, casual, and fun life experiences I'll never get to have. That WE'LL never get to have. And oh yeah! Seizures can KILL SOME OF US. Yep.

And the list goes on, and every person with epilepsy experiences it differently. There are multiple different types of seizures you can have, they're NOT always convulsing on the floor. For example, I have complex-partial-myoclonic-seizures. Meaning my muscles DO twitch when I have seizures, but I'm not always completely unconscious and sometimes I'm even able to stay sitting up. However, I'm still very "off" and can't focus or remember much for a good while after the fact. I can't talk or communicate during one, even with my slight bit of consciousness.

My experiences are not universal, I just wanted to talk about it and bring it up. It helps to talk about it even a little bit. Here's more about different kinds of seizures. Here's more about common seizure triggers. Here's more about CORRECT seizure first aid. And here's more general information/resources.

Please stop leaving us out of disability awareness. Please stop ignoring us or saying we're "not really disabled" or anything else like that. Please. Why does it always feel like the only people who care about epilepsy, are people WITH epilepsy? We're so tired of being ignored by others who don't have our condition.

If you're an epileptic person reading this, I see you. I love you. You're so strong, we all are. I believe in you, I believe in us. We're so much stronger than we get credit for, and it's going to be ok. Your anger and frustration are valid. Your emotions and struggles are real. You're valid, and I see you. Hang in there, we got this.

[m4rkus-gr33n]

Some very quick dissable hcs for some cookies + ASK FOR YOUR FAVS

Kay, so... You guys have been wonderful. It's not everyday that a post of mine does so well. Sadly I'm a bit busy till Saturday... So I'm gonna show a quick hcs I have for cookies that I could think one the spot and that I might go more into later

Before that, I'm just gonna say that you guys can ask me for cookies that you like. If any of you start asking for the same one multiple time, I might make a Thread and pin it. Try to ask for one cookie for ask so I can go in detailed with each one.

NOW, although I play both Kingdom and Ovenbreak, most of the ones I've written for now are mostly from both or Kingdom. SO, LETS BEGING

------------------------------------

Pure Vanilla: Very sensitive Photophobia, as well as compassion fatigue

Shadow Milk: Lazy eye

Wildberry: Missing ar (Post Beast Yeast)

Butter Pretzel: Synesthesia

Butter Roll: Congenital insensitivity to pain (CIP)

Vampire: Narcolepsy (Severe)

Cream Ferret: Dwarfism

Agar Agar: Pica

Black Sapphire: Limp (Not severe, can fake it till he make it)

Mercurial Knight: High sensitivity to vibrations (Very painful)

Burnt Cheese: Photopobia

Tarte Tartin: Partial deafness

Captain Caviar: Also partial deafness

Red Velvet: Alien hand Syndrome

Mystic Flour: Tired Eyes

Lobster: Phatom limb Syndrome

Longan: Prosopagnosia (too busy destroying cookies to remember their faces)

Amber Sugar: Diabetes

Affogato: God Complex

Vagabond: Narcolepsy

Electric Eel: Doose Syndrome (or Myoclonic astatic epilepsy, a type of seizure. He mostly gets them when charging a ton of electricity).

------------------------------------

KAY YALL, THIS IS IT FOR TODAY. ITS ALMOST MIDNIGHT AND IM VERY BUSY TOMORROW. STAY COOL COOKIE RUNNERS. (Also if you can add any missind tag, much appreciated :D)

[literaryvein-reblogs]

hi!! could you possibly make a post about temporal lobe epilepsy/seizures? your account is the bestest ever for resources gosh i love it

Writing Notes: Temporal Lobe Epilepsy

Epilepsy - a chronic (persistent) disorder of the nervous system. The primary symptoms of this disease are periodic or recurring seizures that are triggered by sudden episodes of abnormal electrical activity in the brain.

The term ‘‘seizure’’ refers to any unusual body functions or activities that are under the control of the nervous system.

Temporal Lobe Epilepsy

Also called psychomotor epilepsy, psychomotor seizure, complex partial seizure

The term for recurring seizures beginning in the temporal lobe – the section of the brain located on the sides of the head behind the temples and cheekbones.

An epileptic seizure often associated with temporal lobe disease and characterized by complex sensory, motor, and psychic symptoms such as:

impaired consciousness with amnesia,

emotional outbursts,

automatic behavior, and

abnormal acts.

The temporal lobes are the areas of the brain that most commonly give rise to seizures.

The mesial portion (middle) of both temporal lobes is very important in epilepsy — it is frequently the source of seizures and can be prone to damage or scarring.

Because there are so many diverse functions either in or closely related to the temporal lobes, these seizures may have a dramatic effect on the patient’s quality of life.

Seizures beginning in the temporal lobes may remain there, or they may spread to other areas of the brain.

Depending on if and where the seizure spreads, the patient may experience the sensation of:

A peculiar smell (such as burning rubber)

Strong emotions (such as fear)

Abdominal/chest discomfort

Automatic, unconsciously repeated movements

Staring

Loss of awareness

Uncinate Epilepsy - A form of psychomotor epilepsy initiated by a dreamy state and by hallucinations of smell and taste, usually caused by a medial temporal lesion. Also called uncinate fit.

Furor Epilepticus - The sudden unprovoked attacks of intense anger and violence to which individuals with psychomotor epilepsy are occasionally subject.

Sources: 1 2 3 ⚜ More: Notes & References ⚜ Writing Resources PDFs

Thanks so much for your kind words! And your requests are always interesting, I learned a lot from this. Hope this helps with your writing.

[sooptea]

Saw that some folks don't know how American Private Insurance Works, so I wanted to show some real life examples of how mine works. For transparency I do not use United Healthcare (I have had them in the past), my numbers are from the insurance I have which is called Aetna; and the plan I use is available through my employer (so if I quit or get fired, I lose my insurance).

So, in my experience. Copays (the amount of money you owe upfront for an appointment) varries depending on what doctor you're seeing. I have to pay this every time I see a doctor, and if I do not have an FSA/HSA card then I have to pay with one of my personal cards.

For a Primary / Family Doctor $30 USD -

For a Specialist (Physical Therapy, Therapist, Orthopedics, literally any specialty doctor) $60 USD -

Urgent Care $75 USD -

Emergency Room $300 USD -

And where does that leave me, 6 months into my year plan (because this resets to Zero every time the plan renews)?

What Does that mean? That means if I went to a hospital today and had to stay overnight, I'd be responsible for $2,422.16 USD before my insurance would cover anything. And I would have to spend another $2,135.40 USD before they would 100% cover the cost. If I needed any surgery, any care, anything that gives a bill, I am responsible for it until I meet those "goals"

But the fun part? I don't know what that would mean for my primary care doctor visits after I meet my out of pocket maximum, because I have NEVER met either my deductible or my out of pocket maximum. Not because I didn't have expensive bills! But because they never fucking applied. Because all of this still hinges on you being IN-network. So if you go to a doctor that's out of network, those numbers are different! They're higher.

I did 13 sessions of physical therapy about 1.5 months ago. That was $780 dollars for the copays. Plus an extra $77.84 because of one of the things I was billed for was not covered with my insurance. Oh yeah, even if you go to an in-network doctor there are procedures that aren't covered by your insurance even if they're necessary. If they were out of network I would have been responsible for a total of $3,885 additional dollars on top of my $780 I paid in co-pays. And that would not have counted towards my deductible. It would have been towards my out-of-pocket max.

I have to look up local doctors in my town to make sure they are in network, people have to look up HOSPITALS to make sure they are in network. Our system is fucked up. I have had reoccurring chest pains since childhood that they can't figure out why, and anytime I get a flair up I have to figure out if I want to take the risk of it being a heart attack or not because it costs $300 to be seen by the emergency room (because urgent care cannot help with chest pain). When my father had a grand mal seizure and possibly hit his head, I as a teenager had to figure out in a moment of crisis if I needed to call 911 or not. Because my father is epileptic with a different type of seizure (partial complex) and while he had frequent episodes, he had not had a grand mal seizure for over 12 years at that point, and I didn't know if we could afford the ambulance. That was one of the most terrifying moments in my life, point blank, made worse because of how fucked up our insurance system is.

[gallifreyinstituteforlearning]

🩻 Regeneration: The Moulding Period

We talk about regeneration a lot, for obvious reasons. But what happens after the glow fades? This is the moulding period, the phase where a Gallifreyan's new body adjusts and stabilises.

Moulding is a term coined by GIL to describe an umbrella of quirks and processes observed in the aftermath of regeneration across multiple media. While the term 'moulding' is not officially recognised in the wider Whoniverse medical lexicon (yet), we think it should be.

🌀 What is the Moulding Period?

Moulding is an 8-week window immediately following regeneration when a Gallifreyan's body is in a state of cellular flux. Think of the body as soft, malleable putty that slowly hardens over time inside a mould. During this phase, subtle changes may occur as the body fine-tunes itself/the putty settles inside the mould.

🔬 Key Features of Moulding

1️⃣ Physical Adaptation: The new body isn't fixed in its initial state. During this period, hair length, skin details, taste preferences, or even eye colour might change, or prolonged stays in extreme environments could prompt more complex systems to adapt.

2️⃣ Durability and Energy: In this jelly-like state, a Gallifreyan's cells are incredibly durable and adaptive. Combined with the high energy levels of Post-Regenerative Trauma (PRT), this allows them to shrug off major injuries, survive extreme falls, or even regrow limbs during the early hours.

3️⃣ A Tool for the Skilled: For Gallifreyans skilled in the art of regeneration, moulding is an opportunity to refine their new appearance. They can consciously guide the process, tweaking details to their liking. For those unskilled in regenerating, it's all much more unpredictable.

4️⃣ Kooky Consequences of Consecutive Regenerations: Regenerating during moulding is like resetting during a system update. This could lead to anomalies like partial regenerations or unusual phenomena and possibly explains, in part at least, 14's bigeneration.

5️⃣ Reflections of the Past: Gallifreyans may still see the faint image of their previous body when looking in a mirror during the moulding period.

⚡ How Is This Different from Post-Regenerative Trauma?

Moulding isn't to be confused with Post-Regenerative Trauma (PRT), which typically lasts only a few days. PRT includes far more intense symptoms such as (but not limited to):

Delirium and confusion

Fainting and generalised weakness

Amnesia and personality regression

Spasms and seizure

Pain, including severe headaches

While PRT is an intense, short-term adjustment period, moulding is the body's longer-term fine-tuning process. They overlap, but they are two very different things.

🏫 So ...

The moulding period is essential for allowing the new body to stabilise, adapt, and thrive. For skilled regenerators, it's a chance to refine and personalise. For the less experienced, it's two months of crossing their fingers and hoping they don’t wake up with lime-green hair.

Gallifreyan Biology for Tuesday by GIL

Any orange text is educated guesswork or theoretical. More content ... →📫Got a question? | 📚Complete list of Q+A and factoids →📢Announcements |🩻Biology |🗨️Language |🕰️Throwbacks |🤓Facts → Features: ⭐Guest Posts | 🍜Chomp Chomp with Myishu →🫀Gallifreyan Anatomy and Physiology Guide (pending) →⚕️Gallifreyan Emergency Medicine Guides →📝Source list (WIP) →📜Masterpost If you're finding your happy place in this part of the internet, feel free to buy a coffee to help keep our exhausted human conscious. She works full-time in medicine and is so very tired 😴

[ennard-is-near]

Do you…Do you guys think Scott Cawthon knows what a frontal lobe is? Do you guys know what the frontal lobe is? Because I feel like some people don’t know how much brain that is.

Like holy shit (Brain facts below the cut)

Okay hi welcome to brain facts. So the fascinating thing about human brains is that the basic stuff is in the brain stem and towards the back of the brain, so things like breathing, digestion, and other stuff you do without thinking about it are all back there. The more complex stuff is in the front. Your frontal lobe in particular controls your speech (in an area called Broca’s area I think), motor function and personality. Less severe damage can result in lack of social awareness or increased impulsivity. But we aren’t talking about “less severe” damage so let’s get to the good stuff.

In the 1840s sometime, a man named Phineas Gage had a giant ass metal pole blown (with some sort of explosive gunpowder) through his head (entering under his cheek and exiting the top of his head) and survived. I don’t really think I can do justice how insane this is, but google it if you want to see a photo of a guy holding a rod that went through his head and a couple recreations of it. Gage was alive after this, and was mostly fine except for he had severe personality changes and intense epileptic seizures. What I’m getting at with this is that because the rod shot through his frontal lobe (FNaF reference) he was fine and actually survived about 13 years (just with the personality of an asshole) before he died of a seizure.

A lobotomy was an extremely popular practice in the 1950s that was intended to cure mental illness. Of course nobody knew what was going on back then so really sometimes they were just “curing” like hysteria or melancholy or whatever. The procedure, in its most popular form, involved sticking an ice pick up through a patient’s eye socket and just scrambling their brains (The frontal lobe) with it (extremely simplified). This often resulted in severe damage to their motor and speech skills, their personality, their thinking, etc. But it did make most people easier to deal with, so that’s good I guess. Arguably the most famous lobotomy patient (victim) is Rosemary Kennedy, JFK’s sister.

Okay, this is a FNaF account actually. So I’d like to call attention to a couple things Phone Guy says in reference to the Bite of ‘87. He says that Jeremy survived “without a frontal lobe” which is completely wild but like…probably possible? However it would lead to like total paralysis and complete inability to form coherent thoughts. And while in The Week Before, Ralph does say something about him “not talking anymore. Or doing much else.” And everyone does act like it’s a completely wild thing that he survived (which it is) but I feel like we should probably chalk “without” up to hyperbole, though you don’t have to if you don’t want to.

But even with it still like…partially intact some symptoms of severe injury to that big chunk of your brain are: short-term memory loss, loss of motor (both gross and fine) and speech skills, completely disorganized behavior and thinking, intense personality changes, creating false memories (confabulation, which sounds like a word I made up but it’s not) and probably the wildest one called anosogonia, which is where you just don’t realize that something is wrong with you (or the extent of it)

All this to say: nothing, really. I just really wanted to talk about this.

[ribbitflings]

i wish there was a way to go back to all the doctors and residents that told me that im faking or its all psychogenic and in my head and tell them that they were utterly wrong and they were just too lazy to find the actual answer

[justkidneying]

Blocking the Neuromuscular Junction

Neuromuscular blocking agents (NMBAs) stop transmission at the junction between nerves and muscles, which will cause partial or complete paralysis. Why do we want to do this? The main reason is to cause paralysis for starting endotracheal intubation (relax throat muscles), surgery (keep the patient still), and for putting people on ventilators (stop them from fighting against the machine).

You might also give someone an NMBA if they are coughing up blood, having a severe asthma attack, have high intracranial pressure, or are shivering with hypothermia.

There are two types of these drugs and they work two different ways, though they are all given intravenously.

Depolarizing NMBAs

So to initiate muscle contraction, our body uses a transmitter called ACh. When this binds to a receptor, some ions move around and the muscle contracts. This is called depolarization. After some time, the cell can repolarize as ACh is digested by the enzyme AChE.

The main depolarizing NMBA is Succinylcholine. This also binds to the same receptor, causing muscle contraction. However, it is not digested by AChE, so the cell cannot repolarize. The muscle will keep contracting until it runs out of calcium ions and relaxes. The muscle is paralyzed after that because the receptor is still blocked. Only when the serum enzyme BChE digests it can we reactivate the muscle.

Succinylcholine is mostly used for intubation. It only lasts for a few minutes, which is good because once you trach someone you don't need to paralyze their throat anymore.

The main risks of this drug are hyperkalemia (potassium exits the cell when the muscle is depolarized), muscle pain, hyperthermia, and increased intraocular pressure. Succinylcholine is contraindicated in burn patients.

Nondepolarizing NMBAs

These drugs also act on the ACh receptor, though they do not activate it. The most common ones are atracurium, cisatracurium, vecuronium, and rocuronium. I'll go through a few important notes on each one.

Atracurium (an isoquinoline) is metabolized into the active laudanosine, which has a stimulating effect on the central nervous system and can cause seizures. It also increases histamine, which can cause flushing. Cisatracurium is also an isoquinoline, but it does not cause an increase in histamine or break down into laudanosine. Both of these can be reversed using neostigmine to up the concentration of ACh and outcompete them at the receptor.

Rocuronium and vecuronium are both aminosteroids. Rocuronium has a quick onset and is great for rapid sequence intubation. It also does not require dosage adjustment for those with renal impairment. Vecuronium is slower, and needs to be adjusted for those with renal and liver impairment. These can both be reversed with sugammadex, which will form a complex that can be pissed out. The only thing with sugammadex is that it can cause bradycardia, decrease the effectiveness of contraceptives, and increase the risk of bleeding.

The adverse effects of all of the nondepolarizing NMBAs are apnea, hypotension, and electrolyte imbalance. You also need to increase the dose for those with burns and trauma. These drugs also interact with volatile anesthetics, increasing their effects. However, this is actually a favorable effect, as it lowers the dose of anesthetic required.

Using These Drugs

The main thing to remember here is that NMBAs do not cause sedation or amnesia. You must use them with things like propofol, midazolam, benzodiazepines, opioids, etc. I will repeat: DO NOT USE THESE DRUGS ALONE. The patient will be paralyzed but CONCIOUS and AWARE. For the love of medicine, please. The reason I say this is because I have seen paramedics give "problem patients" a paralytic without a sedative in some sick sort of revenge. Fuck them. I don't care what a patient did, that is not okay to do. Still makes me mad just thinking about it.

Anyways, so these are one part of the drugs required for surgery. If you just sedate someone, they'll still move around, and you don't want that while you are cutting on them.

Writing Tips

There isn't too much to say here, but I think it is important for people to know these drugs exist and only paralyze, not sedate. So shit, if you wanna write some crazy horror stuff happening, you can just have someone be paralyzed. Or also this is how people can be aware during surgery. I think there was a big case about this a few years ago. Sensation is still intact when these drugs are given alone, so go forth and torture people I guess (??) - IN FICTION

Anywho, that's all, thanks for reading. Maybe I will write soon about intubation, sedatives, and other stuff like that. Kinda neuro (which one the poll).

[sunny-uses-aac]

Intro post

My name is sunny/ willow/ lily

Special interests are bluey, cats, trucks and cars

My favourite colour is pink

My dad is my full time caregiver/ my legal caregiver, he gets paid to be my caregiver

partially homebound, meaning only able to leave the house to go to appointments, grocery shopping once a week and school

Autistic medium/high support needs, non verbal, full time aac user

Has a language impairment and may not understand language

Apart of a plural system, lily, sunny and Willow go on this account

Physically disabled, lots of undiagnosed physical disabilities

ADHD, combined type, dyslexic

Has complex ptsd, depression, anxiety, etc

Sensory seeking and sensory advoiding

[seizehopesworld]

She’s finally home! 🥰 Sugar, my incredible epilepsy service dog, has already shown her training in action. She helped me through a complex partial seizure with such calm and precision. I feel so blessed to have her by my side as we begin our life-changing journey together. 💜🐾 🦮

[comic-sans-chan]

cursed modern human garashir au where ds9 is an old ruined resort that was built by some evil rich motherfuckers years ago and was recently seized back by the native people whose land and economy it had destroyed. it's since been converted into an affordable apartment complex sort of situation (just... with a pool, bar, restaraunts, spa and tennis court built into it lol) and is run by sisko and kira. since it is rundown, odo gets hired back on to keep kids from further vandalizing it and o'brien's team gets hired on from the nonprofit organization sisko works for to fix the place up best he can. dukat is the old overseer of the property who drops by sometimes to remind them he and his hospitality business still exist, and my, what a fine job they’ve done renovating the place! it’s actually nice again. sure would be a shame if someone bought the property out from under them (lmao jk kardasi hospitality and starfleet are friends! no hard feelings. they should collaborate on some future projects, actually).

garak's a sad bitch who just lost his amazing morally dubious nepotism career at obsidian corp. (which absorbed kardasi hospitality) and moved into the complex just for the comfortingly familiar architecture. even tho he's not on the payroll for his (secret) dad's evil exploitative company anymore he's still vital to its continued efficiency and is an absolute sucker who still does unpaid shady work for them from time to time. so no one in the complex likes him, but also he's a very pleasant and fastidious queer man who pays his rent on time and has completely taken over the laundry room, to the benefit of everyone, because all the machines actually work now, it's always tidy, and there's a variety of forever-stocked detergents and soaps available, plus an iron?? there was not an iron before garak moved in. which is how it eventually becomes public knowledge that garak has an online tailoring and fashion design business, and he's actually pretty good at restoring clothes that get fucked by the washing machine or eaten by rats, soooo. yeah. they let him stick around.

meanwhile julian's a hot doctor who works at the local hospital and is absolutely buried in student debt that he refuses to let his moderately-wealthy family help him with because they're awful people who had him on illegal drugs without his knowledge since he was a little kid. they were afraid he had something wrong with him, apparently. he was too far behind in his class or w/e. they couldn't handle having a kid with special needs, so they pumped him full of dangerous experimental stimulants. only reason he found out is because he snuck off somewhere to start transitioning and had some tests done that revealed all the crazy shit in his system. he's insanely lucky he didn't end up in the hospital with seizures or fall into a coma or worse. not to mention his parents still dead-name him left and right over a decade later. it's a whole mess and a huge secret, because he technically has a history with illegal drug abuse, and it's a partially ongoing history because going cold turkey off drugs he's been on since he was six is Not A Good Idea, so??? fuck his life, actually. he lives in the apartment just down the hall from garak's. 

garak hates the country his dad's company expanded into and would like nothing better than to move back home, but it's not really logistically possible. especially since everyone there hates him cuz his (secret) dad's company is a mega-corporation that's completely taken over everything p much and is a complete monopoly nightmare, and he did... kinda... work there for decades. no one would hire him if he went back. it would be an extreme conflict of interest, since everyone wants to stay on tain's good side, including garak. but starfleet is interested in him, so he does some begrudging contract work for them sometimes, but he really has no desire to join them. he just wants to resume his old career and reclaim his assets.

julian's hospital is owned by starfleet, tho. his scholarship into medical school was also from starfleet, in fact--they're the only reason he was able to (sort of) afford becoming a doctor at all. so he's a big fan, even tho they are pretty hardcore anti-drugs in a way that's made him have to forge medical records and risk serious legal charges and prison time. julian comes across as a squeaky clean medical professional and an adorable idiot, but he's intimately familiar with back-alley dealings. which is kind of how he ends up helping garak with his drug addiction, and keeps said addiction off the record.

but basically, how it begins is julian likes to support the local restaurants in the complex and garak finds him there and thinks he's gorgeous, and it proceeds as expected. they fuck nasty and become codependent. ten years later, julian lives in a modest house with garak in his home country and garak irons all his old university hoodies.

[bigticenergy1]

What is PANDAS? 💚 🐼

Yes, PANDAS. Like the animal, but not cute!

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections — Though there is push to change the label to just basal ganglia encephalitis, taking Pediatric out of the name. These illnesses can be developed by adults as well.

——

When I was 10 years old, I developed a strep infection but my immune system attacked healthy cells in my brain instead of the infection itself, leaving my brain permanently inflamed.

This became a chronic condition and now every time my immune system preceives a threat, it attacks my brain, increasing inflammation.

PANDAS inflames the part of the brain called the basal ganglia.

PANDAS is basal ganglia encephalitis 🧠 🔥

What is the basal ganglia?

The basal ganglia is the part of the brain responsible for speech, movement and emotional regulation. It is attached to the spine.

(PANS is BGE caused by other infections)

PANDAS SYMPTOMS :

“Tourette’s like tics” (motor and vocal tics, often complex)

OCD

Seizures

Dilated pupils

Memory loss

Depersonalization and derealization

Rage episodes

Rapid mood changes

Regression

Dystonia (involuntary muscle contractions, limb locking, pictured above)

Bouts of partial paralysis

Tip toe walking

Delusions and hallucinations

Why is PANDAS/PANS/BGE awareness so important???

Because it is so rarely diagnosed! It is half as common as Autism but a huge percentage of us are misdiagnosed. I went misdiagnosed for over a decade! FND is a very common misdiagnosis.

✨ thanks for reading. A share would be lovely!

[william-m-lucipher]

RATING A FEW OF MY PUPPETS!

THEY ALL HAVE THEIR UPSIDES AND DOWNSIDES! HERE ARE MY OPINIONS ON A HANDFUL OF 'EM!

SIXER: MASSIVE AMOUNT OF BRAIN SPACE, FILLED WITH COMPLEXITIES! ALSO A GOOD CHUNK OF EMBARRASSING NERD MEMORIES. HIS MIND IS WHERE ALL THE LUXURY WAS!

BODILY EXPERIENCE WAS INTERESTING, HIS EYESIGHT WAS LACKING EVEN WITH THE GLASSES. IT SEEMS HE'D GONE A WHILE WITHOUT RENEWING HIS PRESCRIPTION. SURE, THE GLASSES LESSENED THINGS, BUT YEESH! ONE EYE WAS ALWAYS WORSE THAN THE OTHER, BUT THEY WERE BOTH IN BLURRYTOWN. TALK ABOUT A LACK OF DEPTH PERCEPTION! THE EXTRA FINGERS THOUGH, THEY WERE FUN! AND THAT GUY HAD A DECENT-ISH PAIN TOLERANCE THANKS TO THOSE OLD BOXING LESSONS HE AND HIS BROTHER WERE FORCED TO DO. IT WAS FUN TO TEST THE LIMITS!

A SOLID 8/10, GREAT GUY TO WORK WITH, POSSESSION EXPERIENCE COULD'VE BEEN BETTER THOUGH!

PINE TREE: BRAINWISE, LESS COMPLEXITY, MORE COMEDY, AT LEAST IN MY EYE! HE WAS A SMART KID, SURE, BUT MAN, RERUNS OF HIS LOWLIGHTS WILL KEEP ME ENTERTAINED FOR AGES. IMAGINE AN ACTUALLY FUNNY CRINGE COMPILATION THAT NEVER GETS OLD! THAAAAT'S PINE TREE!

AS FOR THE BODY, BETTER EYESIGHT, BETTER JOINTS, AND THE PAIN TOLERANCE WAS TERRIBLE, WHICH WAS GREAT FOR ME! IT WAS THE FIRST THING I NOTICED WHEN I TOOK THE STRINGS, HAHA! THOUGH BEING SWEATY, SMELLY, AND TICKLISH KINDA RUINED THE DELUXE SUITE FEEL. EH, WHEN DEALING WITH THE HUMAN BODY, THERE'S NO WAY TO HAVE IT ALL, EVER.

7/10, AT LEAST I'VE GOT A LOT TO LAUGH ABOUT.

HIRSCHEY: I THINK IT'S PRETTY OBVIOUS AT THIS POINT THAT I'VE BEEN PULLING THE STRINGS WITH FLANNELBRITCHES FOR A GOOD WHILE NOW. LONG BEFORE HE EVEN SECURED A ROLE WITH THE MOUSE, I'VE BEEN A SUBTLE INFLUENCE!

NOW LISTEN, I'D LOVE TO SPILL EVERYTHING, BUT THIS GUY HAS ALL THE RIGHT CONNECTIONS TO RUIN EVERYTHING IF I MAKE THE WRONG DECISIONS WHILE USING MY OTHER PUPPETS IN THIS REALITY. LET'S JUST SAY, HIS BODY IS MID, BUT HIS MIND ALONE ADDS EXTRA POINTS! I CAN'T EVEN BEGIN TO EXPLAIN, HAHA!

9/10, WHAT A GOOD FRIEND!

BURNSIDES: OH WAIT, I'M NOT SUPPOSED TO SAY ANYTHING ABOUT THIS YET! WINK! HAHA, COME BACK TO THIS POST FOR THE ANSWER ON SMOKEY'S BIGGEST FAN IN A FEW DAYS.

?/10, TO BE ANNOUNCED

EAS-Y: THE ONE I'M CURRENTLY USING! GONE BY SEVERAL DIFFERENT NAMES, BECAUSE THEIR MEAT SUIT IS LITERALLY STUFFED WITH SEVERAL DIFFERENT PEOPLE DUE TO CHILDHOOD TRAUMA, HAHA!! THE HUMAN MIND HAS SOME WEIRD COPING MECHANISMS. E.A.S STANDS FOR THE SILLY NAME FOR THEIR SYSTEM THEY PICKED ONE DAY ON A WHIM.

MY FAVORITE ONE HERE HAS TO BE ZILLARA, WHO I ONCE REFERRED TO AS "T" DURING AN APRIL FOOL'S EVENT ON THE SYSTEM'S ABANDONED ACCOUNT. (IT WAS SHORT FOR THE COLLECTIVE DEADNAME OF THIS VESSEL.) HE'S AN OLD HOST AND AN OLD PAL! Z'S BEEN SO... GENUINELY NICE TO ME FOR ALMOST TEN YEARS NOW. WHAT THE HELL IS WRONG WITH HIM?! HAHA!!! Ah... ENOUGH ABOUT JUST ONE GUY, THOUGH, THIS PLACE IS PACKED WITH EM! BUT THAT DOESN'T MEAN THEY DON'T HAVE WIGGLE ROOM. THIS MIND IS MORE SPACIOUS THAN PINE TREE AND SIXER'S COMBINED, BUT IT'S ALL BEING USED ON KEEPING FOLKS COMFORTABLE AND GUARDING HARMFUL MEMORIES. LISTEN, I'M NOT SALTY ABOUT THE MEMORY GUARDING. I TOOK A PEEK, AND JEEZ, IT'S DEFINITELY FOR THE BETTER.

ANYWAYS, THIS PLACE IS LAYED OUT LIKE A WHOLE SMALL TOWN! BEST VACATION HOME OUTTA ALL OF 'EM! AS AMAZING AS HIRSCHY'S IS, IT'S BUSY BUSY BUSY EVERYWHERE, ALL THE TIME. PARTIALLY MY FAULT FOR GETTING HIM INTO THE ANIMATION INDUSTRY. SORRY THERE, BUDDY!

THE DOWNSIDE TO IT ALL IS THAT EVEN THOUGH THERE ARE PLENTY WHO LIKE ME HERE, I'VE ALSO GOT A FAIR SHARE OF ENEMIES WHO CALL THEMSELVES "PROTECTORS" AND "GATEKEEPERS." NEVER UNDERESTIMATE THE POWER OF AN ANGRY SECRETARY LADY, LET ME TELL YOU!

BODY WISE, IT'S QUITE THE PAIN BUFFET! BAD JOINTS, MIGRAINES, LOW PAIN TOLERANCE, AND MAN, THE TICS AND SEIZURES! YOU'D THINK GIVEN MY EXPERIENCE WITH BODY SPASMS WHILE PUPPETING PINE TREE, I'D HATE THESE, BUT THIS IS DIFFERENT! IT'S SOME OF THE FUNNIEST PAIN, THE PUNCHLINE HITS YOU OUTTA NOWHERE, SEVERAL TIMES, IN SEVERAL DIFFERENT WAYS!

8.5/10, TALK TO YOUR PROTECTORS AND YOU MIGHT EARN THE FIRST 10, OR AT LEAST A 9.8!!!

IN SUMMARY:

- SIXER'S A DECENT PUPPET, BUT A BETTER ALLY. STILL A SHAME HE NEVER JOINED ME

- PINE TREE IS A PERSONAL COMEDY CLUB!

- HIRSCHEY IS A GREAT PUPPET, AND A POWERFUL ALLY WHO COULD EASILY BECOME MY WORST ENEMY

- I'M UNDER NDA ABOUT GUS UNTIL FURTHER NOTICE

- EASY HERE IS, WELL, THE EASIEST ONE!!

MAYBE I'LL RATE A FEW MORE SOMETIME, LIKE CHARLES GUITEAU, OR WITH LUCK, YOU!