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When I talk with patients and families about a new diagnosis of epilepsy, part of that discussion almost always involves the future. How long will medications be needed? How will we know if or when it is safe to stop medications? Will epilepsy be a life-time condition or concern? Epilepsy can have a spectrum of severity. Some people with epilepsy have only a couple of seizures in a lifetime, whereas others may have multiple seizures every day. Overall, though, the outlook is bright.

Epilepsy most commonly develops during childhood, but can start at any age. Seizures can happen to newborns, or even in rare cases, prior to birth. The good news is that if your child is diagnosed with epilepsy, his or her chances of gaining good seizure control is excellent. 

About two thirds of children with epilepsy will have their seizures well-controlled on either the first or second medication they are prescribed. For kids, there is about a 75 percent likelihood of becoming seizure-free within two years. The chance of becoming seizure-free is best in children who do not have a known cause of epilepsy, do not have a family history of epilepsy and are developmentally normal with a normal neurological exam and EEG.

Once a child becomes seizure-free, sometimes the medication can be stopped. In fact, about half of children diagnosed with epilepsy are eventually able to come off of seizure medications. Once medication is stopped, many kids do very well in the long term. However, sometimes seizures do come back days, months or even several years later. Neurologists can provide some statistical information about the outlook for remaining seizure free off of medication, and will typically do an EEG to help inform that conversation. 

A new diagnosis of epilepsy for your child can be very distressing, but it is important to remember that life will eventually get back to normal. It may not be the same normal you or your family experienced prior to the epilepsy diagnosis, but with enough time, education and support from your physician and your loved ones, it will get better.

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Japanese flu – or Yamagata – is a particular strain of influenza B.

The bug is said to be less serious than Aussie flu – or H3N2 which is also sweeping the country – but more contagious.

The flu, which originated in Yamagata, Japan, has already made its presence known in Ireland and Greater Manchester, and doctors are urging parents to have their kids vaccinated.

Children are especially susceptible to this type of flu as they are “super spreaders” – meaning they transfer the virus to a greater number of people than the average infected host.

They are also deemed by experts to be “super shredders” – meaning that their immune systems can’t distinguish between what makes them ill and what will kill them – causing their body to excrete more of the virus.

The bug has already overtaken Aussie flu in Ireland – and reportedly accounts for around 60-70% of confirmed flu cases. 

What are the symptoms of Yamagata?

Symptoms of Yamagata flu are similar to those of an ordinary flu, but can be more severe.

Those who have Yamagata may experience extreme fatigue, and most people will experience headaches and muscle soreness.

Nasal congestion, runny noses and sore throats are also common.

Some may experience a dry cough as well. Other symptoms include fever, vomiting and/or diarrhoea.

According to the Medical University of South Carolina symptoms of Yamagata are more severe and sudden than other respiratory diseases.

Symptoms will generally start to disappear within a week. If symptoms persist, or worsen, you should contact your GP. 

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Parasitic Infections

I. Problem/Condition

Medical parasitology is primarily concerned with organisms that infect the human host and may cause symptomatic or asymptomatic diseases. Three main classes of parasites cause disease in humans: protozoa - microscopic organisms that live in the blood or stool, helminths-multi-cellular organisms that can either cause systemic tissue invasive infection or establish infection in the gut, and ectoparasites that burrow in the skin causing prolonged infections (weeks to months).

Although the prevalence of parasitic infections in the US is not as widespread of a problem as the rest of the world, there are pockets of infection in the Mississippi Delta, disadvantaged urban areas, near the US-Mexico borderlands, and Appalachia where these infections cluster with poverty and presumably poor sanitation. Moreover, these infections can remain underdiagnosed if the clinician does not think of parasitic diseases in immigrants/travellers from areas of the world which are endemic for these infections.

US health professionals should be aware of the five "neglected parasitic infections" - Chagas disease, toxocariasis, cysticercosis, toxoplasmosis, and trichomoniasis that have been targeted by as public health priorities based on the large number of people affected, the severe morbidity caused and the availability of treatment and prevention.

Lastly, physicians should be cognizant of "delusional parasitosis" characterized by the fixed belief of being infested with parasites against all medical evidence to prevent unnecessary medical work-up for parasitic infection. Details of this disorder are beyond the scope of this chapter, but have been summarized in several excellent reviews.

II. Diagnostic Approach

Consideration of parasitic infection and further work-up is determined primarily by whether the patient is an immigrant from, or has recently travelled to a region endemic for parasites. The differential diagnosis in these patients vs. someone who has never travelled outside the US is broader. A good clinical history and focused physical examination can narrow the diagnosis and prevent unnecessary testing.

Common symptoms warranting consideration of specific parasitic infections in the immigrant/returning traveller are presented first. A distinction should be made between parasitic infections that can present as severe acute illness and those that cause more chronic disease. Important geographical considerations to keep in mind are:

• Chloroquine resistant falciparum malaria should be assumed in a patient suspected of having malaria unless the patient is from Central America west of the Panama Canal, Haiti, the Dominican Republic, and most of the Middle East.
• Chagas disease has not been reported to occur in Africa or Asia.
• Of the filarial infections, onchocerciasis has been eliminated in most of Latin America except Venezuela and Brazil.
• Loasis (eye worm infection) is not reported in Latin America.

Symptomatic presentations of diseases endemic to the US are presented separately.

a. The immigrant/traveller with exposure to a parasite endemic region

Fever

Fever is probably the most common nonspecific complaint and the most important infection to assess and rule out in this population is malaria. Since malaria caused by Plasmodium falciparum can be severe and cause complications, prompt workup and assessment of parasite burden in the blood is warranted. Important information is patient's country of origin/travel, duration of symptoms (Plasmodium vivax and Plasmodium ovale can relapse after months to years if not treated with radical cure).

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What is Parkinson’s disease?

Parkinson’s disease is a chronic (long-term) neurological condition. It is progressive and symptoms worsen over time. It is named after Dr James Parkinson who first described the condition in 1817.

People with Parkinson’s disease experience a loss of nerve cells in the part of their brains responsible for controlling voluntary movements. This part of the brain is called the substantia nigra (a small cluster of cells deep in the centre of the brain within an area called the basal ganglia). The nerve cells in the substantia nigra usually produce a chemical called dopamine which helps transmit messages from the brain to the rest of the body via the central nervous system (the brain and spinal cord). As these cells are lost, people with Parkinson’s disease experience a loss of dopamine and the messages controlling movement stop being transmitted efficiently.

Parkinson’s disease is more common as people get older but it can affect younger adults. Men tend to be affected in slightly higher numbers than women.

What causes Parkinson’s disease?

We do not know what causes Parkinson’s disease. There is some evidence to suggest that there is a genetic factor which increases the risk of Parkinson’s disease within some families. Also, there might be an increased risk if people have come into contact with a particular toxin (poison) or toxins found in the environment via pesticides and other chemicals used in agriculture. The specific toxin or toxins have not yet been identified but there is ongoing research into this possible cause.

What are the symptoms?

Each person is affected differently by Parkinson’s disease and no two people will experience exactly the same symptoms. The impact of Parkinson’s disease can be unpredictable and it is common for people to have good days and bad days.

The main symptoms of Parkinson’s disease are:

• tremor (involuntary trembling or shaking movements; the most common symptom)
• rigidity (stiffness)
• slowness of movement (bradykinesia)
• balance problems
• problems with posture (particularly a tendency to stoop forwards)

Other possible symptoms include difficulty initiating movement (for example, when getting up from a chair), a shuffling gait when walking, and freezing when trying to move (especially in confined spaces such as doorways). People might experience a loss of facial expression, speech problems (softened voice, slurred speech), swallowing problems, bowel and bladder problems, difficulties at night (discomfort in bed, cramps, disturbed sleep pattern) and tiredness during the day. Skin can become greasy and people might experience excessive sweating. Sexual problems are common. People often experience depression and anxiety. Another common symptom is small handwriting (micrographia).

Other less common symptoms can include pain and memory problems.

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A woman who was sexually assaulted by a hospital cleaner as she lay helpless in bed on morphine says the ordeal left her scared to leave her own home. The victim, now 27, was an in-patient at Wythenshawe Hospital in Manchester when Ahmed Ismail, now 44, groped her as she lay drowsy in bed.

Ismail, who was working as a cleaner at the time, carried out a second sex assault the following day.

The woman, speaking this week after a compensation payout settlement, said she is still scared to leave her home four years after the assaults in 2014.

She said: 'I'm so nervous. I am scared to go out and will only do things like go to the supermarket when somebody can come with me.

'I used to be really bubbly and, as I come from a very large family, I'd always wanted that myself. There's no way I can imagine that happening now.

'I used to be admitted to Wythenshawe Hospital regularly for an ongoing problem. Now I just take oral antibiotics because I'm too scared to go in hospital as an in-patient.'

Ismail was employed at the time by Sodexo as an agency worker.

Law firm Slater and Gordon, which represented the woman in a civil case against both the hospital trust and Sodexo, said she had been 'failed at so many levels'. She has now secured a five-figure sum in compensation. The hospital trust have now apologised and say that safety of patients 'is our utmost priority'.

Lawyer Kim Harrison said the victim, from south Manchester, had reported a previous incident involving Ismail to the hospital a month before she was assaulted. 

She cannot be named for legal reasons. Ismail, from Hulme, was convicted of two counts of sexual assault in June 2015.

He denied the offences but was found guilty after a trial at Manchester Magistrates' Court and jailed for 18 months at Manchester Crown Court in April, 2016, after an appeal against his conviction was dismissed, the Crown Prosecution Service said.

He was ordered to sign the sex offenders' register for ten years and a Sexual Harm Prevention Order was also issued, banning him from working in any hospital or establishment where in-patients reside.

The woman, who cannot be named for legal reasons, said she decided to speak out about the attacks as a warning. She said: 'My client was failed at so many levels. As well as the man who attacked her, by the people she reported concerns to who failed to take adequate measures to protect her until after she had been assaulted on more than one occasion.

'If her original concerns had been treated more seriously, than perhaps the further assaults could have been prevented.

'It's crucial that lessons are learnt by the trust about how to handle reports of inappropriate behaviour at a much earlier stage.'

A spokesman for Manchester University NHS Foundation Trust (MFT), which runs Wythenshawe Hospital, said; 'We wish to again extend our sincere apologies to the patient involved.

'The safety and care of our patients is our utmost priority and we are deeply sorry that this incident took place on one of our hospital wards.

Ahmed Ismail was ordered to sign the sex offenders' register for ten years and a Sexual Harm Prevention Order was also issued

'Behaviour of this kind is completely unacceptable and is not tolerated. Following this incident, the Trust immediately launched an investigation to learn lessons that would prevent any further incidents of this nature.

'The learning from this investigation has been shared appropriately and we wish to reassure our patients, the public and our staff that any allegations of unlawful or inappropriate conduct are immediately and thoroughly investigated and the necessary action is taken accordingly.' 

A Sodexo spokesman has been contacted for comment by MailOnline. 

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A measles outbreak has spread to five regions in England, infecting 122 confirmed cases. West Yorkshire has the most sufferers with 34 people being struck down with the life-threatening infection, followed by 32 in the West Midlands, 29 in Liverpool and Cheshire, 20 in Surrey and Sussex, and seven in Greater Manchester.

Dr Mary Ramsey, head of immunisation at Public Health England, believes the measles outbreak in England has come from Europe as people travel to regions experiencing epidemics, such as Italy, Germany,  and Romania.

She adds that in order to avoid an epidemic in the UK, parents should vaccinate their children against measles, mumps and rubella (MMR). 

To prevent a measles outbreak, it is recommended that 95 per cent of the population is immunised against the infection.

Only 91.9 per cent of children were vaccinated against measles between 2015 and 2016 compared to 94.2 per cent in 2014 to 2015 and 94.3 per cent in 2013 to 2014, according to NHS immunisation statistics. 

The World Health Organization (WHO) claims people's fear of vaccines, along with complacency, means many, particularly young children, are unprotected. 

The decision by parents not to vaccinate their children could be attributed to disgraced gastroenterologist Andrew Wakefield's theory in 1995 that the MMR vaccine is linked to bowel disease and autism. His controversial views have since been widely discredited. Epidemics in Europe  

Earlier this year, the WHO warned measles was spreading across Europe in regions where vaccination rates are low, namely France, Germany, Italy, Poland, Romania, Switzerland and Ukraine. 

Data published in November last year by the European Centre for Disease Prevention and Control in the Communicable Disease Threat Report show that from January 2016 to November 2017, more than 19,000 measles cases were reported in the European Union, including 46 deaths.

The highest number of cases in 2017 were reported in Romania, where 7,759 people suffered, followed by Italy with 4,775 cases and Germany with 898 sufferers. Greece also experienced a measles outbreak, with at least 368 cases, and one death, since May 2017.

These outbreaks occurred due to insufficient vaccination levels. 

Dr Ramsay said: 'Due to ongoing measles outbreaks within Europe, we will continue to see imported measles cases in the UK in unimmunised individuals.

'This serves as an important reminder for parents to take up the offer of MMR vaccination for their children when offered at one year of age and as a pre-school booster at three years, four months of age.'

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Anaplasmosis is a tick-borne illness caused by the bacterium Anaplasma phagocytophilum. The disease was previously classified as Human Granulocytic Ehrlichiosis (HGE), but the name has recently been changed to Human Granulocytic Anaplasmosis (HGA).

The tick that spreads anaplasmosis is commonly found in the northeast, upper Midwest, and northwestern parts of the United States. The first symptoms of anaplasmosis begin within 1-2 weeks after the bite of an infected tick. Symptoms of anaplasmosis can vary person to person and some people can become ill with all the symptoms. Rash is rarely reported with anaplasmosis infections, and if patients have a rash, it may indicate coinfection with another tick-borne illness.

Symptoms of anaplasmosis include:

• Fever
• Headache
• Muscle pain
• Malaise
• Chills
• Nausea / Abdominal pain
• Cough
• Confusion
• Rash (rare)

Anaplasmosis can be a serious disease, even in previously healthy people, if not treated correctly.

Arizona will typically see 2-5 cases of anaplasmosis reported each year. 

Transmission
Anaplasmosis is spread by the bite of an infected tick.

Blood transfusions and organ transplantation are also possible modes of transmission.

The incubation period is 1-2 weeks.

Lab Tests & Specimen Info

Test*	Specimen
PCR (this test should be used during the acute phase of the disease)	Whole Blood
Serology (Acute and convalescent specimens should be sent and the convalescent should be collected 2-4 weeks after the acute)	Serum
Microscopic examination (this test should be used during the first week of illness)

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The annual flu epidemic has suddenly become serious. Few could have missed the alarming headlines last week about the dramatic rise in cases — GP consultations for ‘flu’ up by 78 per cent, hospital admissions up by 50 per cent and intensive care admissions up by 65 per cent compared with the week before. Nearly 2,000 people have now been hospitalised because of complications owing to this year’s flu outbreak, according to Public Health England — and 85 have died as a result.

Worryingly, the danger is far from over, with the flu season set to last at least to the end of February, and possibly as late as May, according to the Department of Health’s Communicable Disease Centre.

It’s not the flu virus itself that claims lives, but ‘almost always flu-related pneumonia, the most common cause of death from flu’, explains Dr Ben Marshall, a consultant respiratory physician at Southampton General Hospital. It’s been reported that the tragic death this month of Bethany Walker, 18, from Applecross in Wester Ross, Scotland, was due to flu-related pneumonia.

What many people may not realise is that there is a pneumonia vaccine that can help protect against the bacteria most commonly responsible for the disease, Streptococcus pneumoniae (also known as pneumococcus). This one-off vaccine can last for up to 20 years.

But while it’s been available for 17 years and is offered for free on the NHS to at-risk groups, uptake remains low — this includes the over-65s, with around a third (four million people) declining the free jab.

Uptake is even lower among people with conditions that raise the risk of pneumonia, including long- term kidney, liver and heart problems such as congenital heart disease, anyone with COPD (chronic obstructive pulmonary disease), diabetes and those having chemotherapy for cancer or on long-term steroids for severe asthma or arthritis — with just four in ten having the jab.

This is deeply worrying, says Dr Marshall. ‘We know the vaccine protects around 45 per cent of people over 65 and those with chronic illness, compared to around 70-75 per cent of those with healthy immune systems.

‘But this is still very worthwhile. For people of any age, I would recommend consideration of vaccination for pneumonia if there’s an underlying medical condition that might increase the risk of serious complications.’

Experts suspect that one reason people don’t have the jab is simply because most don’t know about it. The rate of vaccination among the general population — who have to pay a £70 fee to a pharmacy to have the jab privately — is perhaps, not surprisingly, even lower than among at-risk groups. And if they do know about the jab, many people think pneumonia is a serious concern only for people at the end of their lives.

Smileband general news

Two parents have been arrested after 12 of their children were found shackled to beds inside their home in California. The victims, all siblings aged between two and 29 years old, were being held captive at the home of David Allen Turpin, 57, and Louise Anna Turpin, 49, in Perris, California, police said.

Riverside County Sheriff's Department began investigating after a 17-year-old girl managed to free herself, call police on a cell phone and escape the home, cops said. The teenager, who was so emaciated police thought she was just 10 years old, told cops her 12 siblings were being held inside the home on the 100 Block of Muir Woods Road.

Officers then arrived at the home and found several children and adults chained and padlocked to to beds in a foul-smelling room.   

They were malnourished, dirty and all of them have been hospitalized, police said.

The victims were given food and drinks and Child Protective Services and Adult Protective Services will care for them once they are well enough to be released from hospital.

Police originally thought all of the victims were children but soon discovered seven were adults. 

Mr and Mrs Turpin were arrested and charged with torture and child endangerment. They will appear in court on Thursday. The couple are being held at Robert Presley Detention Center east of Los Angeles and their bail has been set at $9million. 

Pictures on Facebook show the Turpins getting married by an Elvis impersonator in Las Vegas, with 13 children posing for photos in matching outfits for the boys and the girls.

The 10 girls are all dressed in pink dresses with white tights and white shoes, while the boys are seen in suits with purple ties - and bowl haircuts like their father.

Other pictures show the family smiling on a trip to Disneyland, while another shows them wearing Dr Seuss-style shirts, with each child's top emblazoned with 'Thing 1' to 'Thing 13'.

Smileband health topics

Histoplasmosis is an infection caused by a fungus called Histoplasma. The fungus lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. Endemic areas include central and eastern United States, particularly areas around the Ohio and Mississippi River Valleys, as well as parts of Central and South America, Africa, Asia, and Australia.

Symptoms include:

• Fever
• Cough
• Fatigue
• Chills
• Headache
• Chest pain
• Body aches

Transmission

People can get histoplasmosis after breathing in the microscopic fungal spores from the air. Histoplasmosis can’t spread from the lungs between people or between people and animals.

Lab Tests & Specimen Info

Test*	Specimen
Immunodiffusion antibody	Serum

 Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
In areas where Histoplasma is known to live, people who have weakened immune systems should avoid doing activities that are known to be associated with getting histoplasmosis, including:

• Disturbing material (for example, digging in soil or chopping wood) where there are bird or bat droppings
• Cleaning chicken coops
• Exploring caves
• Cleaning, remodeling, or tearing down old buildings

Large amounts of bird or bat droppings should be cleaned up by professional companies that specialize in the removal of hazardous waste.