martes, 25 de noviembre de 2008

Hepatitis B Virus Infection and Response to Antiretroviral Therapy (ART) in a South African ART Program
Christopher J Hoffmann, Salome Charalambous, Desmond J Martin, Craig Innes, et al. Clinical Infectious Diseases. Chicago: Dec 1, 2008. Vol. 47, Iss. 11; pg. 1479

Abstract (Summary)
Coinfection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in Africa; however, the impact of HBV infection on the outcomes of antiretroviral therapy programs is unclear. We evaluated the impact of chronic hepatitis B on HIV virologic response, changes in CD4 cell count, hepatotoxicity, and mortality among Africans receiving highly active antiretroviral therapy (HAART). We conducted a retrospective cohort study involving a workplace HAART program in South Africa. Participants received HAART according to a protocol and were followed up for up to 72 weeks. On the basis of pre-HAART serum assays, patients were classified as being hepatitis B surface antigen (HBsAg) negative, HBsAg positive with a low HBV DNA level (≤1 x 10... copies/mL), and HBsAg positive with a high HBV DNA level (>1 x 10... copies/mL). The relationships between HBV status and HIV RNA suppression, change in CD4 cell count, mortality, and hepatotoxicity were assessed with use of regression techniques. Five hundred thirty-seven individuals fulfilled the inclusion criteria; 431 (80.3%) of these patients were HBsAg negative, 60 (11.2%) were HBsAg positive with a low HBV DNA level, and 46 (8.6%) were HBsAg positive with a high HBV DNA level. All groups had similar rates of HIV RNA suppression (P = .61), CD4 cell count increases (P = .75), and mortality (17 total deaths; P = .11) for up to 72 weeks after the initiation of HAART. Baseline transaminase levels were highest in the group with high HBV DNA levels (P = .004). Hepatotoxicity was similar between the HBsAg-negative group and the group with low HBV DNA levels but was higher in the group with high HBV DNA levels (incidence rate ratio, 4.4). We revealed that HBV status does not affect HIV RNA suppression, CD4 cell count response, or mortality during the first 72 weeks of HAART in an African setting. The risk of HBV-associated hepatotoxicity, however, is associated with the baseline HBV DNA level. (ProQuest: ... denotes formulae/symbols omitted.)

Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations
James Pfeiffer, Wendy Johnson, Meredith Fort, Aaron Shakow, et al. American Journal of Public Health. Washington: Dec 2008. Vol. 98, Iss. 12; pg. 2134, 7 pgs

Abstract (Summary)
The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked "brain drain" from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems. [PUBLICATION ABSTRACT]

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Copyright American Public Health Association Dec 2008

The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked "brain drain" from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems. (Am J Public Health. 2008; 98:2134-2140. doi:10.2105/AJPH. 2007.125989)

AN ESTIMATED 20 MILLION people worldwide could still benefit from antiretroviral therapy (ART) for HIV/AIDS,1 yet the World Health Organization's "three by five" goal of placing 3 million HIV-infected people on treatment by 2005 has still not been met. Widespread deficiencies in public sector health infrastructure and workforce are at the root of failures to achieve treatment goals.2,3 According to one analysis, many new HIV treatment projects "are being implemented without adequate investment in strengthening the weak, and in some cases collapsing, health systems in sub-Saharan Africa."4(p18) Treatment expansion fueled by new large-scale funding from the President's Emergency Program for AIDS Relief; the Global Fund to Fight AIDS, TB, and Malaria; and the World Bank has been slowed by insufficient health infrastructure. 5 There is an emerging consensus among donors and local governments recognizing the urgency of strengthening the public sector through workforce expansion, infrastructure investment, and management capacity building.6-8 With sufficient support, national public sector systems can coordinate large-scale programs and bring integrated, quality services, such as HIV/AIDS treatment and care, to the greatest number of people most equitably.

However, much of the new HIV/AIDS funding is still channeled to international nongovernmental organizations (NGOs), whereas funding for public sector health systems remains constrained. Observers in developing countries with high HIV burdens have become convinced that the practices of NGOs may be causing permanent harm to public systems of care by fragmenting services, promoting internal "brain drain" from the public sector, and creating an excessive management burden for local health managers, who must monitor multiple projects.9 Paul Farmer, who pioneered the provision of ART in resource-poor settings in Haiti with the NGO Partners in Health, highlighted this problem in his 2006 American Public Health Association address:

The NGOs, which fight for the right to health care by serving the African poor directly, often do so at the expense of the public sector, creating a local brain drain by luring nurses, doctors, and other professionals from the public hospitals . . . to NGO-land where salaries are better and the tools of our trade more plentiful.10(p6)

Recently, notable exceptions including Partners in Health and Médecins Sans Frontie`res in the Khayelitsha township clinic in South Africa have recognized these challenges and worked to strengthen public services. Through our own experience in Mozambique with Health Alliance International, which supports increased ART through public sector strengthening, we have witnessed the pitfalls associated with the international NGO model. We believe that an international NGO code of conduct could help strengthen health systems by promoting a more constructive role for NGOs at this vital moment in the AIDS crisis.


The struggle to integrate NGOs into the health sector is part of a broader trend. Driven in some measure by donor preferences, the number of NGOs worldwide ballooned during the 1990s from 6000 to 26000.11 The number of international NGOs supported by the US Agency for International Development increased from 18 in 1970 to 195 in 2000.12 By 1996 the United States was directing almost one third of its African development assistance through NGOs, and overall aid funding to nonstate organizations from major donors such as the World Bank and European bilateral agencies grew 350% between 1990 and 1999.13 Civil society involvement (mostly NGOs) in World Bank operations rose from 21.5% of the total number of projects in 1990 to nearly 72% in 2003.12

These statistics, of course, depend on a clear consensus definition of NGO. This has often proven elusive. Influential typologies include the generational model of David Korten and the network analysis of Green and Matthias.14,15 Such questions are beyond the scope of this article. Rather than linger on definitional issues, we use the term pragmatically, in reference to any international, nonstate organization funded by external agencies to provide health services or technical assistance in developing countries. In addition to groups conventionally identified as NGOs, such as Save the Children, Cooperative for Assistance and Relief Everywhere, or Doctors Without Borders, our definition includes many faithbased organizations, foreign universities that register as NGOs in local settings, for-profit public health agencies, and some donors that occasionally act as service providers.

Many observers link this shift to NGOs, to structural adjustment programs promoted by the World Bank and International Monetary Fund in developing countries to limit public sector spending and privatize services to address the mounting foreign debt crises experienced by many poor countries since the early 1980s.16-18 Debtburdened countries were persuaded to impose public sector salary and hiring caps, cut construction, and reduce funding for training institutions to rectify balance of payment problems.19 As public services were cut back, some argued that NGOs had a "comparative advantage" in service delivery because they could presumably reach poor communities more effectively, efficiently, and compassionately. 20-31 In this view, state services are plagued by inefficiency, corruption, poor service quality, and unmotivated staff; by contrast, NGOs attract those eager to work with the poor and subsequently provide higher-quality services. Many donors celebrated the presumed virtues of the private sector in meeting market demand and allocating resourcesmore efficiently; the US Agency for International Development often refers to NGOs as Private Voluntary Organizations.32

However, many observers in Africa are now questioning this model as the proliferation of NGOs has led to management burden on local health managers, fragmentation of services, "brain drain" from public sector services to NGOs, and myriad projects that collapse when NGO grant funding ends.17,30,33,34 Driven by donor demands, NGOs often focus narrowly on vertical programs that serve limited populations in confined geographical settings for single health problems.35 As a result, NGOs frequently create showcase projects with questionable sustainability and perfunctory linkages to local health services; for instance, NGO-led HIV/AIDS testing and treatment projects are often not integrated into existing primary health care services. Some argue that NGOs can put more people on ART faster than could public sector systems in such projects by circumventing slow government bureaucracies-a claim that attracts donors eager to show dramatic results quickly.36 However, as stated by Loewenson and McCoy,

Vertical programs established to achieve rapid delivery against unrealistic targets can divert scarce resources from strained public health services and bring undesirable opportunity costs and inefficiencies through the creation of parallel management and administrative systems.37(p242)


With the challenges now confronting efforts to expand HIV/ AIDS treatment, many believe the comparative advantage actually lies with adequately funded national health systems. As implied in the Universal Declaration of Human Rights and clarified in subsequent covenants, governments must guarantee the right to quality health care that is available, accessible, and acceptable. 38-40 They can only meet this obligation through strong national health systems; nonstate actors and international agencies must commit to supporting this role to meet their own human rights obligations.

African governments can establish standards of care, ensure equity in service delivery, harmonize information systems, achieve geographic coverage, and carry out long-term planning based on local health priorities. Aid channeled into well-planned national health system strategies can prevent fragmentation of service delivery while efficiencies are gained by reducing the transaction costs from working across multiple vertical projects. Through economies of scale and coordination of funds, national health systems can reach the most people more efficiently and cost-effectively than could private sector commercial providers, charities, or NGOs. Their influence over all sectors of the health delivery system ensures decisions made at one level can intersect with those at another. Public sector health systems are also lasting institutions in which complex health programs can be sustained and improved over time. And, unlike NGOs, national health systems should, in principle, be accountable to those they serve because they are controlled through local mechanisms of governance. Although those mechanisms are frequently inadequate, public sectors are premised on their responsibility to serve their constituents.

Numerous empirical examples of this advantage in HIV care are now emerging. Brazil was among the first countries to implement a universal ART program and by 2003 was providing free medication to approximately 125000 people. According to the 2004 World Health Report, Brazil's success derived from aggressive drug price negotiation, a drugs logistic system, laboratory capacity, and drug delivery through a network of more than1000 public care and testing services.41 In Malawi, the public sector, with NGO help, has been able to deliver treatment to a large number of patients relatively quickly with good outcomes; the number of patients on ART rose from about 4000 in early 2004 to nearly 38000 by late 2005, nearly 47% of the national target.42 In Mozambique, NGOs provide critical support, but the national system created the framework through which treatment has been successfully expanded to nearly 80000 people in 3 years (more than 90% of its goal for the period),43 a feat impossible to achieve through an NGO-centered approach.

Donors are beginning to notice this advantage. The Paris Declaration on Aid Effectiveness, with more than100 signatory countries, affirms donor commitment to "increasing alignment of aid with partner countries' priorities, systems and procedures and helping to strengthen their capacities."44(p1) Curiously, however, this recognition has yet to translate into major shifts in funding. An analysis of 2004-2005 President's Emergency Program for AIDS Relief central awards grants (those managed by the US Agency for International Development and the Centers for Disease Control and Prevention directly out of the Washington, DC, headquarters) shows only16% of funds were paid to host governments and the remainder was paid to NGOs, universities, the World Health Organization, and private companies.45 In Mozambique, in 2008, only 26% of health sector foreign aid will be managed independently by the ministry of health, 26% will be jointly managed by the ministry of health with donors, and 48% will be channeled to NGOs.46 Recognizing that NGOs will continue to play key roles in many developing countries, especially for increasing ART, we believe the time is ideal to discuss a code of conduct for NGOs to strengthen public sector health systems.


Existing codes of conduct have typically been written by countryspecific NGO associations and national governments to address local concerns. As local circumstances vary widely, it may be challenging to develop a useful unifying international code. Nongovernmental organizations do not operate in isolation and any such code should acknowledge the varied possible relationships among international NGOs; local community, civic, and faith-based organizations; national and local governments; international institutions; and public and private donors. Although the challenges are daunting, we look to the success of the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations in Disaster Relief as a precedent for this movement.47 The International Committee of the Red Cross code, launched just after the Rwanda genocide of April 1994 with more than 300 signatories, has since been usefully invoked in humanitarian crises in Afghanistan, Iraq, Gujarat, and other areas.48 Other useful lessons are offered by the Code of Good Practice for NGOs Responding to HIV/AIDS, launched in 10 countries, with the endorsement of more than 160 NGOs.49 The specific urgent need now for national health system support leads us to propose an NGO Code of Conduct for Health System Strengthening to address 3 major concerns about NGO activity not included in other codes (Table 1 and the box on page 2137).

Management Burden

International NGOs often promote pet projects with idiosyncratic accounting systems, individual reporting systems, and objectives distinct from those of ministries of health. These create enormous management burdens for local health officials.50 Disruptive turf wars sometimes erupt between competing NGOs as they vie for access to specific geographic or health domains, requiring mediation by local authorities. Many ministry of health officials find it impossible to refuse desperately needed resources, even when they are channeled to NGO projects and away from national priorities.51,52

International NGOs should instead match their resources and projects to existing ministry of health priorities and management capabilities. To do this, they should engage in joint planning and implementation, support the strengthening of existing administrative and managerial structures, and strengthen management capacity of local and national governments. The NGOs should also share budgetary and financial information.

Fragmentation of the Health Sector

NGOs are normally pressured by donors to produce short-term gains quickly (within 1 to 2 years) in a limited population, creating conflict with longer-term system strengthening. Showcase projects by NGOs are frequently designed as vertical programs with no plans for expansion or sustainability, and little integration with local health systems. The result is fragmented and inequitable health care delivery, where, for example, viral load measurement may be available, but cesarean sections are not; where one district has a state-of-the-art hospital and the next district has a building serving as a makeshift health post.30,53

Nongovernmental organizations can minimize this fragmentation and help build a strong primary health care base by creatively integrating vertical donor-funded projects into the existing public sector health system. Donors should allow flexibility to NGOs in tailoring programs to existing conditions and systems. The code of conduct should include a commitment to help build local systems and use funding in ways that will most benefit comprehensive primary health care.

Brain Drain

Nongovernmental organizations often contribute to the human resources "brain drain" crisis in Africa when they lure government health workers away into highly paid NGO positions.10,30,33 In our experience in Mozambique, this internal "brain drain" has had a more severe impact on the local health system than has the more widely recognized international migration of health workers. The NGO salaries may be 5- to 20-times higher than are public-sector salaries while providing more comfortable working environments and benefits.27,30,33,54-56 Structural adjustment program-related public sector salary and hiring caps restrict the ability of governments to compete with NGO offers, or train sufficient numbers of new health workers. When NGOs provide a few lucky health workers with high salaries, they contribute to morale and management problems among those left behind. Instead, NGOs should strengthen local human resource capacity by working within existing salary structures and complementing local training capacity. Rather than hiring workers out of the public system to work in a parallel program, NGOs can integrate projects into local systems and fund additional workers in the public system in accordance with local pay structures. Nongovernmental organizations can also support other incentives to retain staff, such as payment for overtime or after-hours service expansion, or stipends for extra training and additional job responsibilities.

In limited cases where NGOs are faced with hiring workers from a ministry of health, local health authorities should approve and coordinate the process. We propose that in these rare situations, NGOs commit to replacing (via support for preservice training position and salary) each health worker they hire outof the public system. Planners for NGOsshould also commit to limiting pay inequities between NGO and ministry of health workers. Although market forces pressure NGOs to raise salaries, a collective effort within the NGO community could place ceilings on pay to keep pay ratios more reasonable.


International NGOs have unique standing and opportunity to influence donors, governments, and multilateral organizations to strengthen national health systems. 57 Policies that restrict investment in public sector health systems, such as structural adjustment programs, should be exposed and decried by NGOs who have firsthand experience of their destructive effects. Indeed, reversing these policies and freeing governments to invest in their beleaguered health care systems would provide more benefit than a legion of geographically constrained and time-limited NGO programs. The code should therefore explicitly compel signatories to advocate with donors, governments, and international financial institutions to remove constraints and increase aid directed to health systems strengthening.

martes, 4 de noviembre de 2008

Se realizo una investigación en el Hospital Universitario de Shaanb Kartum, Sudan en el cual los pacientes recibieron consejos sobre que es Asma y recibieron las respectivas consultas medicas y los obtuvieron resultados en el final de periodo las respectivas estadísticas comprobando ataques agudos con síntomas nocturnos de asma y con frecuencia el uso de inhaladores los hallazgos encontrados sugieren la intervención del farmacéutico que comprobarían su respectivo uso.

martes, 28 de octubre de 2008


La epilepsia es un trastorno cerebral que involucra convulsiones repetitivas de cualquier tipo.

*Causas, incidencia y factores de riesgo
Las convulsiones ("ataques") son episodios de alteración de la función cerebral que producen cambios en la atención o el comportamiento y son causadas por una excitación anormal en las señales eléctricas en el cerebro.
En algunas ocasiones, las convulsiones se relacionan con una condición temporal, como exposición a drogas, supresión de algunos medicamentos o niveles anormales de sodio o glucosa en la sangre. En estos casos, es posible que las convulsiones repetitivas no reaparezcan una vez que se corrija el problema subyacente.
En otros casos, la lesión cerebral (por ejemplo, accidente cerebrovascular o traumatismo craneal) hace que el tejido cerebral se agite de manera anormal. En algunas personas, una anomalía hereditaria afecta las neuronas del cerebro, lo que conduce a convulsiones.
Algunas convulsiones son idiopáticas, lo que quiere decir que no se puede identificar la causa. Estas convulsiones generalmente se dan entre las edades de 5 a 20 años, pero pueden ocurrir a cualquier edad. Las personas con esta condición no tienen otros problemas neurológicos, pero con frecuencia presentan antecedentes familiares de convulsiones o epilepsia.
Los trastornos que afectan los vasos sanguíneos , como un accidente cerebrovascular y AIT, son la causa más común de convulsiones después de los sesenta años de edad. Los trastornos degenerativos, como la demencia senil de tipo Alzheimer, también pueden llevar a que se presenten convulsiones.
Algunas de las causas más comunes de convulsiones abarcan:
Problemas de desarrollo, condiciones genéticas presentes al nacer o lesiones perinatales (las convulsiones generalmente comienzan en la lactancia o en la primera infancia)
Anomalías metabólicas que pueden afectar a personas de cualquier edad y pueden ser el resultado de:
complicaciones de diabetes
desequilibrios electrolíticos
insuficiencia renal, uremia (acumulación tóxica de residuos)
deficiencias nutricionales
fenilcetonuria (PKU) que puede causar convulsiones en bebés
otras enfermedades metabólicas tales como la metabolopatía congénita
consumo de cocaína, anfetaminas, alcohol u otras drogas psicoactivas
síndrome de abstinencia de alcohol
síndrome de abstinencia de drogas, particularmente barbitúricos y benzodiazepinas
Lesión cerebral
más común en adultos jóvenes
las convulsiones generalmente comienzan dentro de los dos años después de la lesión
convulsiones tempranas (dentro de las dos semanas después de la lesión), que no necesariamente indican que se desarrollarán convulsiones crónicas (epilepsia)
Tumores y lesiones cerebrales (como hematomas)
pueden afectar a cualquier edad, pero es más común después de los 30 años
inicialmente son más comunes las convulsiones parciales (focales)
puede evolucionar a convulsiones tonicoclónicas generalizadas

pueden afectar a personas de todas las edades
pueden ser una causa reversible de las convulsiones
las infecciones cerebrales como meningitis y encefalitis pueden producir convulsiones
absceso cerebral
infecciones severas agudas de cualquier parte del cuerpo
infecciones crónicas (como la neurosífilis)
complicaciones del SIDA u otros trastornos inmunitarios
Los trastornos convulsivos afectan a cerca del 0,5% de la población y aproximadamente del 1,5 al 5,0% de la población puede presentar una convulsión en su vida. La epilepsia puede afectar a personas de cualquier edad.
Entre los factores de riesgo se encuentran antecedentes familiares de epilepsia, traumatismo craneal u otra condición que produzca daño cerebral.
Los siguientes factores pueden presentar un riesgo de empeorar las convulsiones en una persona con un trastorno convulsivo bien controlado con anterioridad:
Falta de sueño
Pasar por alto dosis de los medicamentos para la epilepsia
Consumo de alcohol u otras drogas psicoactivas
Ciertos medicamentos de prescripción
La gravedad de los síntomas puede variar enormemente, desde simples episodios de ausencias hasta pérdida del conocimiento y convulsiones violentas. Para muchos pacientes, el evento es la misma situación una y otra vez, mientras que algunos pacientes tienen muchos tipos diferentes de convulsiones que producen síntomas diferentes cada vez. El tipo de convulsión que una persona experimenta depende de una variedad de muchas cosas, como la parte del cerebro que se encuentra afectada y la causa subyacente de dicha convulsión.
En algunas personas, se presenta un aura, que consiste en una sensación extraña (como hormigueo, olor o cambios emocionales), antes de cada convulsión. Las convulsiones se pueden presentar de manera repetitiva sin explicación.
Nota: los trastornos que pueden causar síntomas similares a las convulsiones comprenden accidente isquémico transitorio (AIT), ataques de ira o pánico y otros trastornos que causan pérdida del conocimiento.
Las convulsiones generalizadas afectan todo o la mayor parte del cerebro. Entre ellas se encuentran las ausencias y las convulsiones tonicoclónicas generalizadas.
Movimientos mínimos o inmovilidad (por lo general, a excepción del "parpadeo") que puede parecer una mirada en blanco
Pérdida repentina y breve del conocimiento o la actividad consciente que puede durar sólo unos segundos
Se repite muchas veces
Ocurre más a menudo en la niñez
Disminución del aprendizaje (con frecuencia se cree que el niño sueña despierto)
Convulsiones tonicoclónicas generalizadas :
Contracciones musculares violentas en todo el cuerpo
Rígido y tenso
Afecta una parte importante del cuerpo
Pérdida del conocimiento
La respiración se suspende temporalmente, seguida de un suspiro
Incontinencia urinaria
Mordeduras en la lengua o las mejillas
Confusión después de la convulsión
Debilidad después de la convulsión (parálisis de Todd)
Las convulsiones parciales pueden ser simples o complejas y afectan sólo una porción del cerebro.
Los síntomas de las convulsiones parciales simples (focales) pueden ser:
Contracciones musculares de una parte específica del cuerpo
Sensaciones anormales
Enrojecimiento de la piel
Pupilas dilatadas
Los síntomas de las convulsiones parciales complejas pueden ser:
Automatismo (ejecución automática de conductas complejas sin percepción consciente)
Sensaciones anormales
Enrojecimiento de la piel
Pupilas dilatadas
Emociones recordadas o inapropiadas
Cambios en la personalidad o lucidez mental
Se puede perder o no el conocimiento
Problemas con los sentidos del olfato y el gusto si la epilepsia está focalizada en el lóbulo temporal del cerebro
*Signos y exámenes

El diagnóstico de la epilepsia y de los trastornos convulsivos requiere antecedentes de convulsiones recurrentes de cualquier tipo. Un examen físico (que comprende una revisión neuromuscular detallada) puede ser normal o puede mostrar funcionamiento cerebral anormal en relación con áreas específicas del cerebro.
Un electroencefalograma (EEG), una lectura de la actividad eléctrica del cerebro, puede confirmar la presencia de varios tipos de convulsiones. Éste puede, en algunos casos, indicar la ubicación de la lesión que está causando la convulsión. El EEG a menudo puede ser normal entre convulsiones, por lo que puede ser necesario efectuar un monitoreo prolongado con este procedimiento.
Los exámenes pueden abarcar diversas pruebas de sangre para descartar otras causas temporales y reversibles de las convulsiones, incluyendo:
Análisis bioquímico de la sangre
Glucosa en sangre
Pruebas de la función hepática
Pruebas de la función renal
Pruebas para enfermedades infecciosas
Análisis del LCR (líquido cefalorraquídeo)
Los exámenes para determinar la causa y localización del problema pueden incluir procedimientos tales como:
IRM o TC de cabeza
Punción lumbar (punción de la columna)
Para el tratamiento de las convulsiones, por favor ver primeros auxilios en caso de convulsiones.
Si se ha identificado y tratado una causa subyacente de las convulsiones recurrentes, como una infección, dichas convulsiones deben cesar. El tratamiento puede incluir la reparación quirúrgica de tumores o lesiones cerebrales.
Los anticonvulsivos por vía oral pueden reducir el número de convulsiones futuras. La eficacia del medicamento depende de la respuesta de cada individuo a la droga. El tipo de medicamento que se utiliza depende del tipo de convulsión y es posible que se tenga que ajustar la dosis de vez en cuando. Algunos tipos de convulsiones responden bien a un medicamento y pueden responder muy poco (e incluso hacer empeorar) con otros. Es necesario vigilar algunos medicamentos con relación a sus efectos secundarios y niveles en la sangre.
La epilepsia que no responde al uso de algunos medicamentos se denomina epilepsia resistente al tratamiento. Ciertas personas con este tipo de epilepsia se podrían beneficiar de la cirugía cerebral para extirpar las células cerebrales anómalas que están provocando las convulsiones. A otras les puede ayudar el uso de un estimulador del nervio vago, que se implanta en el pecho y que puede ayudar a reducir el número de convulsiones.
Algunas veces, a los niños se les somete a una dieta especial, como la dieta cetógena, para ayudarles a prevenir las convulsiones.
Los pacientes deben portar placas de alerta médica para que se pueda obtener el tratamiento médico oportuno si se presenta una convulsión.
*Grupos de apoyo
El estrés causado por la presencia de las convulsiones (o ser responsable de alguien con convulsiones) se puede aliviar mediante la vinculación a un grupo de apoyo, en el que los miembros comparten experiencias y problemas en común.

*Expectativas (pronóstico)
La epilepsia puede ser una condición crónica, de por vida. En algunos casos, sin embargo, la necesidad de medicamentos se puede reducir e incluso eliminar con el tiempo. Algunos tipos de epilepsia infantil se resuelven o mejoran con la edad. Un período de cuatro años sin convulsiones puede indicar la posibilidad de reducir o suspender los medicamentos.
La muerte o daño cerebral permanente a causa de las convulsiones es poco común pero puede ocurrir si la convulsión es prolongada o si se presentan dos o más convulsiones en un período corto (estado epiléptico). La muerte o el daño cerebral son, más a menudo, causados por la falta prolongada de respiración y la resultante muerte del tejido cerebral por falta de oxígeno. Existen algunos casos de muerte súbita e inexplicable en pacientes con epilepsia.
Si la convulsión ocurre mientras la persona está conduciendo u operando equipo peligroso, se pueden presentar lesiones serias, por lo cual estas actividades se deben restringir en personas con trastornos convulsivos mal controlados.
Es posible que las convulsiones poco frecuentes no restrinjan significativamente el estilo de vida de la persona, por lo que el trabajo, el estudio y la recreación no necesariamente se deben limitar.
Convulsiones prolongadas o numerosas sin recuperación completa entre ellas (estado epiléptico)
Lesiones causadas por caídas, golpes o mordida autoinfligida
Lesiones durante una convulsión mientras se está conduciendo u operando maquinaria
Inhalación de líquido a los pulmones y consecuente neumonía por aspiración
Daño cerebral permanente (accidente cerebrovascular u otro daño)
Dificultad de aprendizaje
Efectos secundarios de los medicamentos
Muchos medicamentos antiepilépticos producen defectos congénitos, por lo que las mujeres que desean quedar embarazadas deben informar a su médico con anterioridad para ajustarlos
*Situaciones que requieren asistencia médica

Se debe llamar al número local de emergencia (como el 911 en Estados Unidos) si es la primera vez que una persona tiene una convulsión o si se presenta una convulsión en una persona sin una placa o brazalete de identificación médica (con instrucciones que expliquen qué se debe hacer). En el caso de alguien que haya presentado convulsiones con anterioridad, se debe llamar una ambulancia para cualquiera de las siguientes situaciones de emergencia:
Es una convulsión más larga de las que la persona presenta normalmente o es un número inusual de convulsiones para la persona
Se repiten las convulsiones en pocos minutos
Se repiten las convulsiones cuando no se ha recuperado el conocimiento o comportamiento normal entre ellas (estado epiléptico)
Se debe buscar asistencia médica si aparecen nuevos síntomas, incluyendo posibles efectos secundarios de los medicamentos (somnolencia, inquietud, confusión, sedación, etc), náuseas y vómito, erupción cutánea, pérdida del cabello, temblores o movimientos anormales, o problemas de coordinación.
*Prevención En general, no existe una prevención conocida para la epilepsia. Sin embargo, con una dieta y reposo adecuados, la abstinencia de drogas y alcohol se puede disminuir la probabilidad de precipitar una convulsión en una persona con epilepsia.
Se debe reducir el riesgo de traumatismo craneal mediante el uso de cascos durante actividades de riesgo, lo cual puede ayudar a disminuir la posibilidad de desarrollar epilepsia.