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Positive motivation towards taking anticonvulsant drugs, which have side-effects, and which may need to be taken regularly for several years, is not automatic in patients with epilepsy It will be optimized by careful explanation about the drugs, and allowing time for the patient to express his feelings about the prospect of taking the pills regularly You need to help the patient to decide which drug has the best chance of controlling the seizures with the least risk of sideeffects that would be unacceptable from their point of view Patients will prioritize possible side-effects differently depending on their circumstances: sedation may be a major concern to an academic; teratogenic hazard may be the greatest worry to a woman who is planning a family Once you have chosen a drug, this should be introduced gradually with the aim of nding the smallest dose that completely suppresses the seizures.





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The normalized output voltage is simply: V Q Nk 2 L2 e X = e = E 8( L 2a)2 ( Rr + R ) (1.75)

If the patient builds the dose up to a level that is causing side-effects and is still having seizures, then you need to move on to another drug Serum anticonvulsant levels are not an important part of this titration process, but can be a way of making sure the patient is actually taking the pills Primary generalized epilepsy usually responds to drug treatment The rst-line drugs are sodium valproate and lamotrigine Myoclonus often responds to the addition of clonazepam, and absences may respond speci cally to ethosuximide There are several second-line options, including phenobarbitone, topiramate and levetiracetam The choice of drugs for focal epilepsy is even wider, but only 80% of patients achieve complete control The rst-line drugs are carbamazepine, sodium valproate and lamotrigine If none of these drugs work on their own, then the possibility of surgical treatment should be considered (see p.

80 70 90

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210) before moving on to a combination of a rst-line and a second-line drug (phenytoin, topiramate, levetiracetam, gabapentin, phenobarbitone, etc) If the patient responds to the combination, think about withdrawing the rst-line drug to see if control is maintained on the second-line drug alone In general, most patients prefer to take a single drug because this reduces the risk of side-effects; from the doctor s point of view, it also reduces the risk of interactions between the two drugs and, in the case of those anticonvulsants metabolized by the liver, interactions with other drugs such as the oral contraceptive and warfarin Most anticonvulsants have both idiosyncratic (occasional and unpredictable) side-effects and dose-dependent ones The most important side-effects of the rst-line drugs are shown in the table on the next page Teratogenicity (for example neural tube defects) is a serious concern when treating young women..

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his chapter provides the fundamentals of short-term planning and operations within a utility environment, assuming that each utility is responsible for operating the grid within its control area. Examining this in a utility setting is critical before moving to a market environment. The setting is simpler, allowing for a focus on operational requirements and objectives that any market design must also address. The layout of this chapter is congruent with the layout of the previous chapters. In Section 4.1, we begin with a preliminary discussion of operations that frames the rest of the material. We then move on to address day-ahead demand forecasting in Section 4.2. Sections 4.3 through 4.7 address the day-ahead scheduling of units to meet demand requirements. We layer the complexity of unit commitment scheduling section by section. A simple example starts the discussion. Then realistic operational supply-side assumptions from the previous chapters are introduced incrementally. Short-term planning requires that two issues be addressed, cost and reliability. The cost issue is addressed rst and is coupled with reliability as more realistic operational considerations are taken into account. Section 4.8 closes the chapter by addressing real-time operations and adjustments to the day-ahead schedule.

(closure(D))

(t) =

works to lower (heighten) the energy barrier for the forward process, while the fraction (1 a)DE works to heighten (lower) that for the backward process.

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