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A TCA should not be prescribed to any patient with a history of epilepsy since it may provoke a seizure. Other medications that may decrease the frequency of tension-type headaches include gabapentin, cyproheptadine, valproate, and topiramate (12,13) (see migraine prophylaxis). If the patient’s headaches become less frequent (at least 70% improvement) as a result of taking a preventive drug, the patient should continue to take the drug for 3 to 6 months, at which point it may be tapered off. In many cases, the headaches will remain infrequent.

Qxd 9/26/06 1:12 PM Page 33 Chapter 1 • Suggestions for History and Physical Examination Brain region(s) Primary functions Most common result of lesion Thalamus Relay station for ascending, descending, and intracerebral pathways; involved in maintenance of alertness Variable depending on part affected; large lesions often cause obtundation or coma; seizures do not occur Cerebellum Coordination of movements and gait Gait and limb ataxia; nystagmus; seizures do not occur 33 The brainstem also contains the reticular formation, which is important for maintaining general alertness, and nuclei that secrete the neurotransmitter serotonin (raphe nucleus) and norepinephrine (locus ceruleus).

Paralysis Monoparesis/monoplegia Weakness/paralysis of one extremity; brain lesion, spinal cord lesion, peripheral nerve injury Hemiparesis/hemiplegia Weakness/paralysis of both extremities on one side of the body; brain or cervical spinal lesion Diparesis/diplegia Weakness/paralysis of both legs (usually) or both arms (rare); spastic diplegia from infancy is usually caused by bilateral cerebral white matter injury (see Chapter 10); acquired diplegia is usually a sign of spinal cord disease Apraxia/dyspraxia Difficulty planning/conceptualizing movements or speech; usually developmental in young children and often improves over time Dysarthria Incoordinated or slurred speech, usually acquired; cerebellar disease Aphasia Acquired speech disorder; cerebral cortex lesion; rare in children Ataxia Motor incoordination; cerebellar or spinal cord lesion, peripheral nerve disease, drug intoxication, or medication overdose a Most common causes are italicized.

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