online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	$34.77 - Dilantin 100 mg 60 pills	$40.07 - Dilantin 100 mg 90 pills	14/free		most countries
Tl-Pharmacy	$49.20 - 100mg × 30 pills	$128.40 - 100mg × 360 pills	10-21 days/free		every country
MedRx-One	$59.20 - 100mg × 30 pills	$138.40 - 100mg × 360 pills	10 days/free		most countries
LeadMedic	$49.67 - 60 pills x 100 mg	$57.24 - 90 pills x 100 mg (+$7.57)	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	$27.00 - Dilantin (generic) 100mg * 90 pills	$38.87 - Dilantin (generic) 100mg * 180 pills	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	$12.90 - 30 pills x 100 mg	$28.80 - 90 pills x 100 mg	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

Other names: Phenytek Er

TYPES OF EPOLEPTIC SEIZURE: SIMPLE PARTIAL (OR FOCAL) SEIZURES
Partial seizures are always caused by damage to some part of the brain, and always begin in that area of the brain, though they may later spread. If you have partial seizures you will nearly always have some kind of ‘aura’, a feeling or sensation that you will come to recognize at the beginning of your seizure and that acts as a warning to you that the seizure has begun. The aura is caused by the start and early spread of the electrical discharge within the brain.
The characteristics of the aura will depend on the part of the brain involved. That is why when your doctor is making the diagnosis he or she will want to know in as much detail as possible the feelings or symptoms you experience at the start of the seizure. If your seizure starts in the motor cortex (the part of the brain that controls movement), your aura will probably consist of a movement of part of the body, usually a thumb or the face, perhaps an arm, hand or foot.
A common form of motor epilepsy is Jacksonian epilepsy, named after the English neurologist Hughlings Jackson, who lived at the turn of the century. His wife had motor seizures and so Professor Jackson had plenty of opportunity to study them. The seizures often start in the face region of the cortex and then the abnormal activity spreads out along the motor area progressively involving different areas of the body. It spreads from the face area to the thumb and hand and then through the arm down into the rest of the body. This spread is often called a ‘march’. Some people may have weakness in the affected limb after a motor seizure for a number of hours, or even occasionally days. This weakness is called a Todd’s paralysis, after the Dr Todd whose statue can be seen in the forecourt of Kings College Hospital in South London.
A partial seizure which arises in the sensory cortex (the part of the brain concerned with sensation) will produce an aura which may be a definite feeling such as itching or tingling, or some sensation that is quite indescribable, though instantly recognizable to you. Auras that take the form of simple flashes or speckles of light arise in the occipital cortex.
Sometimes a partial seizure is minor and very brief, and consists only of the aura. On other occasions, if the seizure spreads further throughout the brain, it may cause longer and more disturbance, perhaps being followed by transient weakness of a limb (Todd’s paralysis, see above) or a temporary inability to find words (dysphasia). But usually there is no loss of consciousness during the seizure.
Complex Partial Seizures
Complex partial seizures, like simple partial seizures, always begin with an aura but, unlike simple partial seizures, they always produce some disturbance of consciousness. Many complex partial seizures originate in the temporal lobe of the brain, the part of the brain that is involved in emotions, feelings and memory.
Seizures that start in the temporal lobe often begin with a feeling arising in the stomach and moving up to the throat, called an epigastric aura. This is usually accompanied by a sensation of fear which can be so intense that the person fears they are going to die. Less often there may be an aura of taste or smell, usually unpleasant, or of some simple sound such as hummings or clicks. There may be feelings of deja vu, that is, an intense feeling of recognition or a feeling that you know what is going to happen. Some people describe it as a feeling of reincarnation. There may even be a sensation that the world is quite unrecognizable (jamais vu). Memories may be triggered off as part of the aura and, very rarely, intensely pleasant mystical, or even sexual feelings can arise.
EpilepsySometimes a partial seizure may spread so rapidly through a wide area of the brain that it becomes generalized and there is a tonic clonic convulsion. This is called a secondarily generalized seizure.
People who have simple partial or complex partial seizures have one great advantage over those with generalized tonic clonic (grand mal) seizures; because of the warning aura they know that a seizure is beginning. So they have time to manoeuvre themselves out of danger Ђ” maybe sit down somewhere safe, or put down anything hot or breakable that they are carrying. Many people even manage to develop various techniques to abort their seizures at this stage so that they do not spread any further, and there is no loss of consciousness.
*6/193/2*

online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	$37.37 - Lamictal 25 mg 30 pills	$126.88 - Lamictal 50 mg 90 pills	14/free		most countries
Tl-Pharmacy	$74.99 - 100mg × 30 pills	$275.00 - 100mg × 120 pills	10-21 days/free		every country
MedRx-One	$84.99 - 100mg × 30 pills	$315.00 - 25mg × 180 pills	10 days/free		most countries
LeadMedic	$53.39 - 30 pills x 25 mg	$119.25 - 90 pills x 25 mg (+$65.86)	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	- - -	- -	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	$93.00 - 30 pills x 25 mg	$208.80 - 90 pills x 25 mg	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

TYPES OF EPILEPTIC SEIZURES: TEMPORAL LOBE SEIZURES (COMPLEX PARTIAL SEIZURES)
EpilepsyThere are three main groups of causes of temporal lobe seizures. The first includes people who have known brain damage from birth, and those who have meningitis, head injuries or other reasons. The second group includes people who have had status epilepticus, possibly associated with febrile convulsions, earlier in their lives. Frequently no cause can be identified (idiopathic).
The temporal lobe contains an area known as the limbic system in which the heart, blood vessels, respiration and gastrointestinal systems are represented in terms of function. This area also deals with memory and smell. When one considers that all these functions are represented in the temporal lobe, it is hardly surprising that the symptoms of temporal lobe epilepsy can be very varied and difficult to diagnose. Hence the term complex partial seizures. Often there are distortions of sensation which may include strange feelings in the stomach, odd smells, hearing voices or music and sometimes there may be visual hallucinations. One of the better known distortions which occurs in temporal lobe seizures is a sensation of familiarity, of having been there before, which is called the deja vu phenomenon. The person will have an abnormal sense of familiarity with a real situation. There may also be disturbances of speech Ђ” not only does the person have difficulty in talking but may make remarks which are quite inappropriate at the time. Certain emotional features such as fear or strangeness may occur, and occasionally giddiness. Other features may occur if the electrical activity spreads from being a partial seizure and becomes secondarily generalised. The person may have a grand mal convulsion. A further complicating feature is that unresponsive staring may occur in temporal lobe epilepsy and this may be confused with true absences (petit mal). In temporal lobe seizures the attacks are more prolonged and may last some minutes; the person may perform familiar actions but in an unusual and repetitive way. This can sometimes be associated with difficult behaviour or confused speech. These repetitive activities are called ‘automatisms’. Such automatisms may also occur in association with absences.
*7/192/2*

online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	$26.16 - Trileptal 150 mg (Extra Low Dosage) 30 pills	$183.65 - Trileptal 600 mg (Normal Dosage) 90 pills	14/free		most countries
Tl-Pharmacy	$58.20 - 150mg × 30 pills	$355.20 - 600mg × 180 pills	10-21 days/free		every country
MedRx-One	$68.20 - 150mg × 30 pills	$246.40 - 150mg × 360 pills	10 days/free		most countries
LeadMedic	$37.37 - 30 pills x 150 mg	$85.85 - 90 pills x 150 mg (+$48.48)	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	- - -	- -	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	- - -	- -	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

TYPES OF EPILEPTIC SEIZURES: FOCAL SEIZURES (SIMPLE PARTIAL SEIZURES) AND MYOCLONIC SEIZURES
Partial seizures which are focal (involve one part or one side of the body) are quite common in the newborn, young infants and in adults.
The part of the body affected depends on where the brain abnormality is situated. The body is somewhat strangely represented on the surface of the brain. The areas which seem to be the most sensitive to stimulation are those which represent the index finger, the thumb, the corner of the mouth and the big toe. Thus it is not uncommon for a focal seizure to start in one of these areas. It may then spread around that area and involve that side of the body. This sort of fit is sometimes called a Jacksonian seizure after the great English neurologist, Hughlings Jackson, who first described it in detail. Consciousness will be retained unless secondary generalisation occurs.
EpilepsyThese are brief, involuntary (carried out subconsciously) contractions of the muscles. Quite often the contractions are symmetrical, most often involving the muscles of the head and upper limbs. The jerks may be rhythmic or sporadic. Sometimes myoclonic seizures may be followed by grand mal seizures.
Other seizure types exist. The main ones have been described above and further information can be obtained from your doctor.
*8/192/2*

online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	$67.27 - Topamax 100 mg (Low Dosage) 30 pills	$267.12 - Topamax 200 mg (Normal Dosage) 90 pills	14/free		most countries
Tl-Pharmacy	$52.94 - 25mg × 100 pills	$480.71 - 100mg × 300 pills	10-21 days/free		every country
MedRx-One	$62.94 - 25mg × 100 pills	$102.67 - 25mg × 200 pills	10 days/free		most countries
LeadMedic	$96.10 - 30 pills x 100 mg	$221.73 - 90 pills x 100 mg (+$125.63)	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	$28.80 - Topamax (generic) 25mg * 30 pills	$489.64 - Topamax (generic) 100mg * 240 pills	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	$102.00 - 60 pills x 25 mg	$314.40 - 240 pills x 25 mg	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

WHO HAS EPILEPSY?
At least one person in 200 (about 300,000 in the UK) suffers from epilepsy, and this is probably a conservative estimate. The figure may be nearly as high as one person in 100.
Epilepsy is very much a disease of the young, partly because the brain is always more excitable in children than it is in adults. If you are going to develop epilepsy, you are most likely to do so in childhood or adolescence. About one quarter of people with epilepsy will have developed the condition by the time they start primary school at the age of five; half will have done so by the time they move on to secondary school at 11. By the age of 18, three-quarters of those who are going to develop the condition will have done so, and, by the age of 20, 90 per cent. There is a further and final peak in middle to old age, this time because of damage to the brain by degenerative disease.
EPILEPSY AND INHERITANCE
EpilepsyThe genes which determine brain excitability, and which are inherited, have their strongest effect in childhood. That is why most people who develop epilepsy do so then. Excitability ‘peaks’ at the age of about 16, and thereafter the brain becomes progressively less excitable. This kind of inherited epilepsy used to be called ‘idiopathic epilepsy’, meaning simply that no one knew what caused it.
Other developmental changes are now thought to be important causes of epilepsy. During the second three months of pregnancy, as the brain develops, cells migrate from one position in the brain to another. Sometimes this migration goes wrong and leads to a condition known as heterotopia. In some people these areas of heterotopia are intensely epileptogenic (that is, very likely to give rise to seizures). Another common congenital (developmental) cause of epilepsy is the dysembryoplastic neuroepithelial tumour, or DNT, a lesion which is found most frequently in the temporal lobe though it can occur elsewhere in the brain.
*7/193/2*

online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	$27.96 - Depakote 250 mg (Low Dosage) 30 pills	$105.18 - Depakote 500 mg (Normal Dosage) 90 pills	14/free		most countries
Tl-Pharmacy	$87.42 - 300mg × 50 pills	$244.72 - 300mg × 150 pills	10-21 days/free		every country
MedRx-One	$97.42 - 300mg × 50 pills	$254.72 - 300mg × 150 pills	10 days/free		most countries
LeadMedic	$39.94 - 30 pills x 250 mg	$92.15 - 90 pills x 250 mg (+$52.21)	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	$33.00 - Depakote (generic) 300mg * 10 pills	$170.10 - Depakote (generic) 300mg * 90 pills	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	$25.00 - 10 pills x 300 mg	$192.00 - 120 pills x 250 mg	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

STRESS BREAKDOWN: LEARNING/UNLEARNING NEURONES AND INHIBITION
I didn’t have to learn how to sneeze, breathe, cry, swallow, blink or smile at my mother when I was a newborn baby. I didn’t have to learn how to do these things and I am not really able to forget how to do them. I can choose to inhibit or try to inhibit these reflexes, but I can’t really forget them.
On the other hand, I did have to learn how to write my name, how to speak English, and how to tie my shoelaces. These things I can forget if I neglect to practice them daily.
The nerve cells involved in learning must also have the capacity for forgetting, otherwise real learning would not be possible. If it were otherwise, we would never be able to learn from our experiences, forgetting the wrong and remembering the right way of doing something.
Built-in knowledge, such as knowing how to blink in response to sudden movement in front of the eyes, is not able to be forgotten in the same way as we forget algebra we learned at school. Usually, this built-in knowledge is handled by brain-cell networks in different areas of the brain from those that contain the learning /unlearning brain cells, which have the capacity to learn and forget as well.
It is the learning / unlearning brain cells which have their function disturbed by excessive stress.
These learning/unlearning cells are usually situated in the cerebral cortex, the folded outer layer that we call the outer grey matter of the brain; these cells are able to be stimulated or inhibited by the reticular activating system as being responsible for the willpower, and which is also responsible for the selective attention mechanism.
It is important to know that these learning/unlearning brain cells can be either stimulated or inhibited by the reticular activating system, because it is often the over-stimulation of the learning/unlearning cells by the reticular activating system that provokes the switching off phenomena responsible for third stage stress breakdown symptoms.
I hope my explanations have made it possible for the reader to see how a person experiencing excessive stress, and who attempts to ignore the warning signals of persistent anxiety and loss of emotional control, could so over-stimulate the cells of the brain cortex as to require the brain cortex to protect itself by switching off overloaded circuits. It is this switching off in response to excessive stress that causes the symptoms of third stage stress breakdown.
*29/129/5*

online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	$39.84 - Neurontin 100 mg 60 pills	$183.65 - Neurontin 600 mg 90 pills	14/free		most countries
Tl-Pharmacy	$28.92 - 300mg × 30 pills	$109.13 - 400mg × 90 pills	10-21 days/free		every country
MedRx-One	$38.92 - 300mg × 30 pills	$99.49 - 300mg × 120 pills	10 days/free		most countries
LeadMedic	$56.91 - 60 pills x 100 mg	$71.55 - 90 pills x 100 mg (+$14.64)	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	$52.65 - Neurontin (generic) 300mg * 30 pills	$178.21 - Neurontin (generic) 300mg * 120 pills	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	$48.00 - 30 pills x 300 mg	$90.90 - 90 pills x 300 mg	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

PSYCHIATRIC DIMENSIONS OF MEDICAL PRACTICE: CLINICAL
ASSESSMENT-HALLUCINATIONS AND DELUSIONS AND INSTRUCTIONS FOR ADMINISTRATION OF MINI-MENTAL STATE EXAMINATION
Medical and surgical patients who develop hallucinations or delusions are almost always delirious. A hallucination is a perception without a stimulus (e.g., the patient sees people in the room when no one is there). Hallucinations are distinguished from illusions, in which stimuli are present, but misidentified (e.g., the patient sees an intravenous line as a snake). A delusion is a fixed, false, idiosyncratic belief (e.g., the patient is convinced, despite reassurance from family members and staff, that her physicians are trying to kill her).
Orientation:
(1) Ask for the date. Then ask specifically for parts omitted, for example, “Can you also tell me what season it is?” One point for each correct.
(2) Ask in turn “Can you tell me the name of this hospital?” (town, county, etc.). One point for each correct.
Registration-Ask the patient if you may test his memory. Then say the names of 3 unrelated objects, clearly and slowly, about one second for each. After you have said all 3, ask him to repeat them. This first repetition determines his score (0-3), but keep saying them until he can repeat all 3, up to 6 trials. If he does not eventually learn all 3, recall cannot be meaningfully tested.
Attention and calculation-Ask the patient to begin with 100 and count backwards by 7. Stop after 5 subtractions (93, 86, 79, 72, 65). Score the total number of correct answers.
If the patient cannot or will not perform this task, ask him to spell the word “world” backwards. The score is the number of letters in correct order. E.g. dlrow = 5, dlorw = 3.
RECALL-Ask the patient if he can recall the 3 words you previously asked him to remember. Score 0-3.
Language-Naming: Show the patient a wrist watch and ask him what it is. Repeat for a pencil. Score 0-2.
Repetition: Ask the patient to repeat the sentence after you. Allow only one trial. Score 0 or 1.
3-Stage command: Give the patient a piece of plain blank paper and repeat the command. Score 1 point for each part correctly executed.
Reading: On a blank piece of paper, print the sentence “Close your eyes”, in letters large enough for the patient to see clearly. Ask him to read it and do what it says. Score 1 point only if he actually closes his eyes.
Mental Disorders
Epilepsy Copying: On a clean piece of paper, draw intersecting pentagons, each side about 1 in and ask him to copy it exactly as it is. All 10 angles must be present and 2 must intersect to score 1 point. Tremor and rotation are ignored.
Estimate the patient’s level of sensorium along a continuum, from alert on the left to coma on the right.
*7/172/2*

online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
Qblh	- - -	- - -	14/free		most countries
Tl-Pharmacy	- - -	- - -	10-21 days/free		every country
MedRx-One	- - -	- -	10 days/free		most countries
LeadMedic	- - -	- -	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	- - -	- -	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	- - -	- -	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

COMMON CAUSES OF EPILEPSY
Even if you have inherited a tendency to seizures, you will not necessarily develop epilepsy. Nearly always there has to be some other ‘insult’ to the brain, usually in the form of damage through head injury or an infection such as encephalitis or lack of oxygen. This kind of damage to the brain can leave a small ’scar’, which later acts as a focus for seizures Ђ” an area from which seizures can arise. Where the damage is makes a difference to your chances of developing epilepsy: an injury to the frontal and temporal lobes is more likely to cause seizures than damage to the occipital and parietal lobes at the back of the brain.
Childhood epilepsy
When epilepsy develops in infancy or very early in childhood, it is often because there has been some damage to the brain during pregnancy or birth. The damage is usually caused because the baby has been deprived of oxygen, most frequently during the pregnancy, but sometimes during the delivery of the baby. More rarely, damage is due to some developmental defect in the brain.
Seizures due to head injury
Head injury can lead to epilepsy at any age, and is one of the most common causes in young adults. There is usually some loss of memory immediately after a head injury (called posttraumatic amnesia), and one way of measuring the severity of a head injury is by the length of this post-traumatic amnesia. About five per cent of people who have a head injury severe enough to cause loss of memory for half an hour after the injury eventually develop epilepsy. More than half of these have their first fit within one year of the injury, and three-quarters within three years. Seizures can make their first appearance even later than this. If the injury has penetrated the skull the chances of epilepsy developing are much greater.
Epilepsy is less likely to develop, however, when seizures occur soon after the injury (within a week). These early seizures are much less likely to recur, and much more likely to be simple partial seizures, often limited to a twitching in the hand or face.
Seizures due to febrile convulsions
A few people develop complex partial seizures, usually in childhood and less frequently in adolescence, as a result of febrile convulsions in childhood. Febrile convulsions run in families: they are grand mal convulsions which sometimes occur in a few young children when they are running a high temperature. They are nearly always harmless, and most children outgrow them by the time they are three or four years old. But a few children who have very severe or prolonged febrile convulsions do develop epilepsy later in life. This is because during prolonged convulsions the brain may have been temporarily starved of oxygen when the child had difficulty in breathing during a seizure. Such oxygen deprivation can cause brain damage, nearly always in the temporal lobe, which is the part of the brain most easily injured by lack of oxygen. There is some debate as to whether this damage is due entirely to the shortage of oxygen, or whether it actually occurs because there is already some developmental abnormality present in this part of the brain beforehand. In either case the outcome is the same: after a prolonged febrile convulsion this area of the brain is damaged, and from this damage complex partial seizures later arise.
Seizures in adulthood
EpilepsyWhat triggers off a seizure?
Some things are especially likely to trigger off a seizure. Drowsiness, low blood sugar, even boredom may do it for example. So too may sleep (some people have convulsions only when they are asleep). But many people who have epilepsy discover that a convulsion is often sparked off by some specific and trivial trigger. It may be a particular movement, something they see or hear, or even a mental image or thought or feeling. Once you have discovered what it is that is most likely to trigger off your own seizures you will probably be able to avoid these triggers much of the time and so cut down your seizure frequency.
*8/193/2*