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Medical Rounds

An Electrifying Approach to Epilepsy

About one-half of patients with epilepsy can control their seizures with medication, but when that doesn’t prove successful, surgery to remove the seizure focus—the brain region triggering the episodes—can often render patients seizure-free. For some, however, surgery isn’t a viable option. Those who have more than one seizure focus or more than one in locations where removal would lead to neurological deficits, for example, aren’t candidates for the procedure.

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Unraveling Sjogren’s Mystery

Sjogren’s syndrome is one of medicine’s most puzzling enigmas. Recognized as an autoimmune disorder, its constellation of symptoms can seem bafflingly unrelated, causing problems as diverse as multiple dental carries, chronic dry eye, painful intercourse and digestive problems. Though researchers have tied many of these issues to an attack on the body’s exocrine glands, including salivary and lacrimal, its cause and exactly how it exerts its effects remain a mystery.

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Aggressive Treatment Persists

While more people appear to be designating power of attorney privileges to a loved one, a new study has found no corresponding impact on their rates of aggressive medical care received in the last weeks of life.

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Beyond Milan

Amy Kim believes that the Milan criteria—the formula adopted around the world in 1996 to determine the need and suitability for a liver transplant in patients with hepatocellular carcinoma (HCC) or cirrhosis—might be due for an update.

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Comfort: On the Menu in the ICU

During the long hours they spend at the bedside of loved ones in the surgical intensive care unit (ICU), family members can feel helpless—frustrated that they can’t do more to provide comfort and care.

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A Blood Test for Traumatic Brain Injuries

After a hit to the head or rapid whiplash, millions of Americans develop traumatic brain injuries (TBIs) each year. TBIs can range from mild concussions, causing only a headache or temporary blurred vision, to much more severe injuries—causing seizures or even coma. These symptoms, whether mild or more severe, are generally caused by damaged brain cells.

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High-Normal Blood Pressure

"A number of patients in our study had ‘high-normal’ blood pressure in their 20s and 30s, but by the time they were 45, they had the heart function of a 75-year-old—even if they never met the clinical definition of hypertension.” 

—João Lima, director of cardiovascular imaging at Johns Hopkins’ Heart and Vascular Institute. Lima led a recent study showing that mild elevations in blood pressure considered to be in the upper range of normal during young adulthood can lead to subclinical heart damage by middle age—a condition that sets the stage for full-blown heart failure.

“Our results suggest the heart muscle may be more exquisitely sensitive to the effects of even subtle elevations in blood pressure than we thought,” says Lima, who emphasizes the importance “of regular blood pressure checks that begin early in life.” The study was published online June 22 in the Journal of the American College of Cardiology.

Graham Redgrave

"We were able to get patients with anorexia to safely gain around 4 pounds a week. That’s twice the national average.”

—Johns Hopkins psychiatrist Graham Redgrave, first author on a study showing that a faster weight gain during inpatient treatment for anorexia—well beyond what national standards recommend—is safe and effective. “The higher rate is important, because it means that most patients left the hospital at a normal weight. Studies show that patients who gain more weight in treatment are less likely to relapse in the first two years after treatment, when they’re most vulnerable,” he says. The study was recently published online in the International Journal of Eating Disorders.

View a video about eating disorders treatment at Johns Hopkins.