Special Interest Groups
Guidelines
Join ongoing discussions on these topic areas at the Message Board (members-only).
Basic Mechanisms Roundtable
Claude Wasterlain, M.D.
Raman Sankar, M.D., Ph.D.
Topic for 2010 Annual Meeting to be announced.
Basic Neuroscience
Brenda E. Porter, M.D., Ph.D.
Celine Dube, M.D.
Michael Wong, M.D.
Depolarizing GABAergic signaling and seizures
The SIG will discuss the contribution of the depolarizing action of GABA to increased susceptibility to seizures in neonates and to epileptogenesis in adults. Dr. Kevin Staley will discuss the role of the bumetanide-sensitive Na-K-2Cl cotransporter NKCC1 in depolarizing GABA actions and its potential therapeutic anticonvulsant effects in neonates. Dr. Aristea Galanopoulou will talk about the importance of GABAA-receptor signaling for age and sex-specific effects of seizures. Dr. John F. Kerrigan will discuss the depolarizing GABAergic response in human hypothalamic hamartomas.
Botanicals & Alternative Treatments for Epilepsy
Botanicals and Natural Products: Open Mic Night
Are you working with botanicals or natural products? Do you want to share your findings with the epilepsy botanical community and meet potential collaborators? Then come join us for an “open microphone” at this year’s Botanical SIG for 5-minute presentations followed by 5-minute discussions. Space is limited, so presenters will be scheduled on a first come, first served basis. To reserve your place on the program, contact Steve Schachter at sschacht@bidmc.harvard.edu as soon as possible.
Children's Hour
Marcio A. Sotero de Menezes, M.D.
Lionel Carmant
New Developments in Infantile Spasms
The Children’s Hour this year will give an overview of the new developments in the understanding of Infantile Spasms. We will include discussions on basic mechanisms including the role of hypothalamic/pituitary axis/adrenal and its role in stress as well as the new animal models of Infantile Spasms. Last but no least Dr. Carmant we will lead a discussion the results of the latest trials aiming at improving cognitive dysfunction due to infantile spasms.
Clinical Nursing
Sarah Kiel, MSN, CPNP
Madona Plueger, MSN, RN, CNRN
Paving the way to Epilepsy Specialty in Nursing Certification
Objectives:
1. Discuss the American Board of Nursing Specialties requirements for application of Speciality Certification.
2. Define the process that is needed to create a formal method of creating an Epilepsy Nurse Specialty Certification.
3. Demonstrate the skills, knowledge and experience desired for nurses seeking Epilepsy Nurse Specialty Certification.
4. Demonstrate ways that could improve patient outcomes in facilities in which there would be certified Epilepsy Nurses.
Clinical Roundtable
Neonatal seizures are a common and ominous sign of neurologic injury that can arise from a variety of etiologies. The immature brain presents particular challenges regarding semiology and response to treatment compared to adults. This discussion will bring together experts in the field of neonatal seizures to discuss their approach to patients in terms of practical issues and future directions. Audience participation is encouraged.
Controversies in Epilepsy
Topic for 2010 to be announced.
EEG
What are clinical seizures, electrographic seizures (is there such a thing?), the minimum duration of a seizure? What is a seizure in an experimental animal, when does a seizure become an interictal discharge and an interictal discharge has clinical accompaniment and becomes a seizure? Should we try to define seizures, are there different definitions for different purposes? What should an automatic seizure detection system detect?
Engineering and Epilepsy
Piotr J. Franaszczuk, Ph.D.
Gregory K. Bergey, M.D.
The recent advances in recording from intact biological systems (e.g. increased sampling, special recording wires for recording high frequency activity) have further increased the value of neural network modeling of seizure dynamics. Improved computational power and the use of parallel processors (clusters) have facilitated computationally intensive modeling studies. The advantage of neural network modeling is the ability to “record” and modify variables simultaneously on different levels of the modeled system. This may include investigating and/or modifying synaptic weights, concentrations of ions, neurotransmitters, changes in neural membrane potentials, as well as simulations of local field potentials, and the effects of external stimulation. These studies can be done for single neurons, small networks of neurons as well as the larger networks and whole brain structures. This allows for systematic testing of influences on seizure dynamics that then can be compared with biological systems. This SIG will have presentations by experts in neural modeling who will address the various considerations important in implementing these models and considerations of the different approaches currently available.
Epidemiology
The CDC is funding several epidemiological studies of epilepsy to improve surveillance methods, to better define the impact of epilepsy, and to evaluate differences in incidence and prevalence by race/ethnicity and socioeconomic status. This SIG group will be a forum for presentation of the results of several of these projects.
Frontal Lobe Epilepsy
Matthias J. Koepp, M.D., Ph.D.
This SIG will address the added yield of new neurophysiological (ESI, MEG/MSI) and imaging (fMRI/DTI, PET/SPECT) techniques in the assessment and evaluation of patients with frontal lobe epilepsy. Speakers will present the methodological advances and limitations, challenges and opportunities for each of these techniques, and then discuss illustrative cases, which include head-to-head comparisons, illustrating which patients stand to benefit the most from which technique.
Genetics
Jennifer Kearney, Ph.D.
Andrew Escayg, Ph.D.
Genetic Modifiers in Epilepsy: Of Mice and Men
This year’s topic for the genetics SIG is Genetic Modifiers. The role of genetic modifiers in influencing clinical severity is becoming increasingly important for understanding the pathophysiology of disease. We will discuss recent progress identifying genetic modifiers that influence epilepsy susceptibility and disease progression in animal models and patient populations. We will also consider how these discoveries might be translated into improved treatment for patients.
Issues of Concern for Women with Epilepsy
Lisa Bateman, M.D.
Mary Zupanc, M.D.
Women with Epilepsy and Special Disabilities
This group of women poses special challenges to the adult/pediatric epileptologist. The issues include contraception and pregnancy related issues, guardianship, transition to appropriate adult health care, and transition from school to adult work/sheltered workshops. There are many other issues as well, similar to all adolescent/adult women with epilepsy, such as bone mineral health, folate supplementation, catamenial epilepsy, etc
Junior Investigator Workshop
Audrey S. Yee, M.D.
Brandy Fureman, Ph.D.
Mentoring as an essential part of Career Advancement. Join us for an exciting Junior Investigator workshop on Mentoring with pioneers in Epilepsy research: Scott Baraban, Amy Brooks-Kayal, Robert MacDonald and Helen Scharfman. This will be an interactive session where our panelists will share their pearls of wisdom and then we will open the floor for discussion. Join us for this lively interchange!
MEG/MSI (Magnetoencephalography)
MEG/MSI Data Highlights: An International Perspective
Despite the seamless flow of the literature across borders, regional differences exist in the type of research questions addressed. A panel from Europe, Asia and North America will select and present the most important discoveries in the past 2 years from their own geographical region and assess their impact on clinical practice. The session will conclude with a 10-minute discussion on MEG reimbursement worldwide. Audience participation is strongly encouraged in what should be a lively Q/A session.
Military Epileptologists
Details of 2010 session to come.
Neuroendocrinology
D. Samba Reddy, Ph.D., R.Ph.
Jana Veliskova, M.D., Ph.D.
Hormonal issues in men with epilepsy: The impact of seizures, AEDs and aging
This SIG will discuss hormonal issues in men with epilepsy during their lifespan. Discussion will focus on the effects of epilepsy on hormones, which AEDs do and do not affect the hormonal levels, on the impact of these changes on sexual function and fertility, on the aging component, and the importance of counseling available for the male patients.
Neuroimaging
Imaging in focal cortical dysplasia (FCD): What’s new in the diagnosis and classification?
FCDs are highly epileptogenic lesions which present a wide spectrum of imaging abnormalities: They can be either small or invisible to standard imaging techniques in one end of this spectrum, or they can be easily detected by MRI and sometimes affect multiple lobes in the other end of the spectrum. FCDs may occur also in combination with other types of lesion such as low grade tumors and hippocampal sclerosis.
In this SIG section we propose to discuss the imaging and histopathological spectrum of FCDs in the light of recent clinical and experimental evidence.
Neuropathology of Epilepsy
Harvey B. Sarnat, M.S., M.D., FRCPC
The 2010 SIG in Neuropathology of Epilepsy will include three didactic themes, each with new advances in the neuropathology of surgical resections and autopsy brain tissue in epilepsy:
1) Columnar cortical architecture as a developmental delay or arrest and also as a newly recognized form of focal cortical dysgenesis that may be epileptogenic. Radial columnar architecture precedes laminar architecture in the human fetus in the first half of gestation and may persist in acquired lesions of the fetal brain (e.g. infarcts), in some genetically-programmed malformations and also in some focal cortical dysplasias resected for epilepsy. The ontogenesis and synaptic organization of such architecture will be reviewed and compared with other forms of cortical dysplasia.
2) Maturation of the cortical tuber will be traced from fetuses with tuberous sclerosis to infants and children with surgical resection of highly epileptogenic tubers. The histopathology, including immunocytochemical markers for neuronal and glial cellular lineages, will be shown at various ages to demonstrate the evolution of the tuber over time.
3) Satellitosis as a phenomenon of glial cell adhesion to the neuronal soma, almost universal in chronically epileptogenic cortex and Ammon’s horn of the hippocampus, will be examined in the context of two opposing theories: neuroprotection and contributing to epileptogenic neurons and later to neuronal death. Evidence will be presented mainly from ultrastructural (EM) studies of surgically resected epileptic foci.
Finally, time will be provided for participants in the course to bring brief cases of unusual or problematic neuropathological findings in the resected tissue for open discussion.
Neuropharmacology
Gail Anderson, Ph.D.
Eugene Ramsay, M.D.
Jacci Bainbridge, Pharm.D.
This SIG will present “Experimental Methods to Guide the use of Combination Antiepileptic Drug Therapy”. This session will discuss the rationale and controversies of using pre-clinical and clinical data to guide practitioners in the use of combination antiepileptic drug therapy. Dr. Rho will discuss antiepileptic drug Polypharmacy, the rationale, definitions and controversies. Dr. Rogawski will review experimental studies of AED combinations and whether they provide useful guidance for the clinician. Lastly, Dr. Poolos will discuss the comparative efficacy of combination AED therapy in refractory epilepsy.
Neuropsychology
The changing role of neuropsychology in epilepsy: Future directions
With decades of research behind us and advances in neuroimaging, the role of neuropsychology in epilepsy is changing. The nature of these changes and their implications for both clinical practice and future research will be discussed from adult and pediatric perspectives.
Neurostimulation
Christopher DeGiorgio, M.D.
James W. Wheless, M.D.
This year's session will focus on breaking developments in neurostimulation for epilepsy.
1. Controversies in Epilepsy: The Pivotal Studies of DBS and RNS: Are DBS and RNS Truly Safe and Effective for Epilepsy
2. Trigeminal Nerve Stimulation for Epilepsy: An emerging therapy for epilepsy and depression
NIH Grants System
During the Annual Meeting, this group meets to discuss the NIH grant process. Guest speakers share tips, "how-tos" and "Hot" research topic areas. Designed to encourage young investigators and other professionals to submit applications. Successful investigators will provide tips and strategies for writing comeptitive clinical research applications. Information about NINDS funding opportnities can be found at http://www.ninds.nih.gov.
Nursing Research
Gigi Smith, MSN, APRN, CPNP
Rebecca Schultz, RN, M.S.N., CPNP
The Nursing Research SIG will focus on nursing research related to osteoporosis. Osteoporosis is a concern for people who take antiepileptic medications. The purpose of this SIG is raise awareness about the nursing research currently being conducted. A second aim is to generate discussion about gaps in the research examining the link between osteoporosis and antiepileptic medications and research needed to support nursing practice to foster prevention of osteoporosis.
Patient-Reported Outcomes
Rosemarie Kobau, MPH
Erik K. St. Louis, M.D.
Improving Mental Health Outcomes in People with Epilepsy through the CDC Managing Epilepsy Well Network--PEARLS and UPLIFT
Two interventions supported by the CDC Managing Epilepsy Well (MEW) Network are designed to meet the gap in mental health treatment for people with epilepsy. PEARLS (Program to Encourage Active, Rewarding Lives) is a community-integrated, home-based treatment for depression previously shown to be effective at reducing depression symptoms and improving quality of life for individuals with acute and chronic depression (Ciechanowski, et al., 2004). PEARLS consists of problem solving treatment, behavioral activation, and psychiatric consultation. Adults with epilepsy and comorbid depression receiving PEARLS were more likely to have reductions in depression and improvements in quality of life, as compared to usual care. UPLIFT (Using Practice and Learning to Increase Favorable Thoughts), another home-based treatment for depression in people with epilepsy, was developed to provide group delivery of depression treatment by telephone or Web. UPLIFT materials include 8 modules that incorporate mindfulness-based cognitive therapy for depression. With support from the National Center for Minority Health and Health Disparities, UPLIFT has expanded its scope to include prevention of depression in people with epilepsy. UPLIFT participants will be recruited from all MEW sites in Georgia, Michigan, Texas and Washington State. MEW Network members work together to promote epilepsy self-management research and improve the quality of life for people with epilepsy.
PEC Practice Resources
Peggy Clark, RN, M.S.N
Sandra Cushner-Weinstein, RPT, LSCW
A show and tell opportunity for professionals in Epilepsy care wil be available in the Exhibit Hall in the Epilepsy Resource Center.
Pediatric Roundtable
Elaine Wyllie, M.D.
Douglas Nordli, M.D.
Advances in diagnosis and medical and surgical treatment of children with epilepsy
Six dynamic faculty will each present an exciting case from his or her clinical experience that teaches an important clinical point and advances our field of pediatric epilepsy. Topics will be diverse and touch on aspects of EEG, seizure semiology, genetics, neuroimaging, antiepileptic drug therapy, epilepsy surgery, and psychosocial co-morbidity. We encourage audience interaction!
Pregnancy Registry Outcomes
Cynthia Harden, M.D.
Georgia Montouris, M.D.
The Pregnancy Registry Outcomes Special Interest Group was started in 2004 by Drs Page Pennell and Kim Meador to provide an annual update on the recent findings of international pregnancy registries in which outcomes of the offspring born to women with epilepsy were collected. This SIG has continued to provide this update every year, but has also evolved and expanded to include the South India Pregnancy Registry and late breaking information from the European Pregnancy Registry. In addition to structural teratogenesis, cognitive teratogenesis from the NEADs study is presented. Registry information is becoming more and more detailed and refined, and now specific dose effects of AEDs, longer term effects on cognition and fertility are being put forth. This SIG continues to represent the best efforts of the American Epilepsy Society, which are to provide timely and scientifically valid epilepsy education. This year we will strive to have presentations from all global registries including Australian, European, South Indian, United Kingdom, North American, and the NEADs group. The focus will be on teratogenic outcomes from exposure to newer AEDs and to present teratogenic dose effects of AEDs.
Psychiatry in Epilepsy
Andres M. Kanner, M.D.
Anxiety Disorders in Epilepsy: The forgotten psychiatric comorbidity
The last decade has been pivotal in the recognition of the importance of early identification and treatment of psychiatric comorbidities. While most of the interest has been focused on mood disorders, little attention has been paid to anxiety disorders. And yet, the prevalence of symptoms of anxiety and anxiety disorders in patients with epilepsy is comparable to that of mood disorders. Furthermore, mood and anxiety disorders tend to occur together in a very high percentage of patients. Also, the presence of anxiety disorders is associated with a worse quality of life, more frequent complaints of adverse events to antiepileptic drugs and increases the suicidal risk in depressed patients. Finally, in patients with mood disorders, untreated comorbid symptoms (and/or episodes) of anxiety increase the recurrence risk of major depressive episodes. Despite all of the above, anxiety disorders remain undetected and untreated in a very large percentage of patients with epilepsy. The 2010 Psychiatry SIG will be devoted to a discussion on the screening, diagnosis and treatment of anxiety disorders in patients with epilepsy.
Psychogenic Non-epileptic Seizures
The first part will feature an enthusiastic debate on terminology between Selim Benbadis and W. Curt LaFrance Jr. The second part will have Markus Reuber presenting the use of Conversation Analysis in the diagnosis of NES.
Quality and Value Indicators
Practice, Research and Education of Epilepsy Using the 8 Epilepsy Quality metrics
There are 8 Epilepsy Quality metrics which will need to be addressed in each and every visit with patients with epilepsy in order to assure quality care. Moreover, all recent board certified neurologists must have some quality metrics demonstrated in order to maintain board certification. The logical question that follows is how do we best use these metrics to inform and guide research, education and practice. The 2010 SIG will address the following topics in order to answer that question:
1. How do we best alter or transform the health care delivery system at your institution to best deliver quality care for patients with epilepsy?
2. What are potential research questions and examples of current research projects that can be done using the 8 quality metrics?
3. An Introduction to the American Academy of Neurology Epilepsy Performance in Practice Module for Maintenance of Certification
Sleep and Epilepsy
Carl Bazil, M.D., Ph.D.
Mark Quigg, M.D.
Memory and cognitive dysfunction related to subclinical/interictal epileptiform activity during sleep.
This year’s SIG will continue last year’s discussion of memory relating to sleep with a presentations regarding electrical status epilepticus of sleep and potential impact on cognitive development. This will lead into discussion regarding the broader question of the potential impact of impact of interictal epileptiform discharges on memory. We will also discuss data regarding EEG changes during apnea in children and impact on cognition.
Status Epilepticus - NEW
Tobias Loddenkemper, M.D.
Susan Herman, M.D.
Status epilepticus (SE) is a life-threatening condition, frequently necessitating immediate medical attention and treatment. Surviving patients may suffer from cognitive and neurodevelopmental deterioration. Identification and treatment of patients in status epilepticus is difficult depending on the clinical presentation and etiology. This special interest group will review the pathogenesis, discuss clinical workup, identification, and monitoring, and outline treatment options of SE.
SUDEP
Lawrence J. Hirsch, M.D.
Elizabeth Donner, M.D.
George Richerson, M.D.
Mechanisms and Models
Presentation will include an invited data blitz w/ several brief presentations, partly based on abstracts being presented at that meeting, and maybe a brief synthesis by the chair(s).
Surgery
Michael M. Haglund, M.D., Ph.D
This year we will discuss the approaches different groups take in the work up and surgical treatment of "non-lesional epilepsy". Last year we had a great discourse on approaches to specific cases and as usual the audience participation was active and made for great debate. I look forward to moderating another exciting session, especially with the topic of "non-lesional epilepsy". Please send your willingness to present by sending cases to Michael Haglund MD, PhD, Duke University Medical Center at haglu001@mc.duke.edu. The success of this session is dependant upon the great and lively audience participation.
Temporal Lobe Club
Jerome Engel Jr., M.D., Ph.D.
Kimford Meador, M.D.
The pre-operative localization of cerebral dysfunction allows reduction or avoidance of impaired cognitive function from epilepsy surgery. Further, it is complimentary to the localization of seizure onset by providing additional confidence in delineation of the epileptogenic region. The Wada test was first introduced over 60 years ago as a method of cerebral inactivation to determine language lateralization and shortly thereafter modified to assess hemispheric contribution to memory function. The Wada test has been a mainstay in the preoperative evaluation for epilepsy surgery, but not without problems, controversies and new challenges. The intracarotid amobarbital procedure is not a single test, and methodological differences in the Wada test can lead to quite variable results. Recent shortages in amobarbital have led to the need to employ alternative medications for the amobarbital, but there is some uncertainty as to the methodology and comparability of these alternatives. Emerging techniques (e.g., fMRI) provide potentially new alternatives for pre-operative functional assessment, but the data on post-operative outcomes is less than the Wada test.
The Ketogenic Diet
Glucose Restriction Revisited
This year's SIG will revisit the topic of reduced glucose as an interventional strategy and potential mechanistic underpinning of ketogenic diet (KD) action. There are emerging data indicating that reduced glucose may have profound effects on neuronal excitability through novel mechanisms, including purinergic modulation. Additionally, low serum glucose levels are not always seen in patients successfully treated with the KD, suggesting more complex metabolic interactions.
Translational Research
Thomas P. Sutula, M.D., Ph.D.
Warren Lammert
Epilepsy Models, Clinical Syndromes, and “Personalized” Medicine: are preclinical and pipeline pathways aligned for successful translational and commercial development?
Tuberous Sclerosis
Gregory L. Holmes, M.D.
Vicky Whittemore, Ph.D
How does genotype matter?
A disease causing mutation in the TSC1 or TSC2 gene is found in 85% of individuals with TSC. Speakers will discuss the current understanding of the genetics of TSC, including the value of testing, and interpretation of the results. Possible genotype/phenotype correlations with regard to epilepsy and other neurologic symptoms will also be addressed, as well as possible mechanisms explaining those with “no mutation identified”