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 2009 Annual Meeting to be announced.

Basic Neuroscience

Brenda E. Porter, M.D., Ph.D.
Karen S. Wilcox, M.D.

The 2008 SIG focused on a discussion of technology advances, such as Genome Wide Association array, laser scanning photostimulation and voltage sensitive dye and calcium imaging.  Dr. J.A. Kearney from Vanderbilt University presented an overview of several genome wide association studies in epilepsy and discussed the technical progress made in this field: higher resolution single and/or multiple nucleotide polymorphisms detection methods, and faster sequencing. Additional methodological aspects such as the importance of the phenotype, the sample size, the replication of the studies and finally the cost of these techniques, were also discussed.  Dr. S. Kumar, from Florida State University reviewed his work involving laser scanning photostimulation/glutamate uncaging coupled with electrophysiology recording techniques. This can be used to evaluate the interconnection of a cell population and compare the responses of this cell population between animals with different treatments. He emphasized the technique’s ability to stimulate several points of a same region with a low interval stimulus.  Finally, Dr. D. Coulter, from the University of Pennsylvania presented an overview of voltage sensitive dye and calcium imaging techniques. Voltage-sensitive dye and calcium imaging combined with electrophysiology permits the monitoring of activity in individual neurons, as well in neuronal networks.  He raised important practical aspects such as cost issues. An active discussion followed each presentation. Topics for 2009 are under consideration; please contact Celine Dubé at cdube@uci.edu to submit suggestions.

Botanicals & Alternative Treatments for Epilepsy

Siegward M. Elsas, M.D.

In the 2009 session, we will discuss the possible role of EEG biofeedback as an aid to improve seizure control in epilepsy patients, by considering the experience of several centers which use widely differing methods to accomplish similar goals.

Children's Hour

Marcio A. Sotero de Menezes, M.D. 
Lionel Carmant     

The 2008 Children’s Hour focused on Metabolic Diseases and Epilepsy with over 150 particpants. To help us improve the diagnosis, treatment and outcome of children with metabolic disorders, Program Chair, Dr. Marcio Sotero de Menezes, gathered a group of specialists in the field to discuss diagnosis and two under-recognized causes of seizures: vitamin B6 deficiencies and mitochondrial disorders. 

The first subject was the clinical and electroencephalographic presentation of metabolic disorders in childhood. Dr. Douglas Nordli Jr. discussed the differential diagnosis of seizures associated with common and less common metabolic disorders based on clinical presentation and EEG patterns. He showed that a specific pattern is rarely observed and that other clinical signs and symptoms should raise our degree of clinical suspicion.  Dr. Sid Gospe provided us with an update on the clinical presentation of vitamin B6 deficiency and dependency. He discussed clinical presentation, diagnosis, treatment and outcome and shared his large clinical experience on the subject. He shared new data on mutations of the antiquitin gene (ALDH7A1) as the molecular basis of neonatal-onset PDS and for some but not all later-onset cases. Also of note is the fact that children with infantile spasms with good outcomes lacked evidence for antiquitin dysfunction, suggesting that this phenotype is less compelling for PDS. The final speaker, Dr. Rusell P. Saneto, discussed the topic of seizures in mitochondrial disorders. He reviewed his experience with under diagnosed electron transport chain disorders. He stressed that they can often present with infantile spasms and a normal diagnosis leading to a false classification of cryptogenic infantile spasms.

 

The topic for 2009 will be Treatment of Infantile Spasms 2009:  A turning point in the USA? 

Clinical Nursing 

Sarah Kiel, MSN, CPNP 
Irene Dustin, M.S.N., CRNP

This year's topic will be annouced shortly.

Clinical Roundtable

Kevin E. Chapman, M.D.

Topic for 2009:  With the expectant approval of vigabatrin in the US, another weapon will be available for combating infantile spasms. Debate continues about which treatment is “best,” and where vigabatrin fits in the armamentarium of the pediatric epileptologist. The goal of this session is to debate the merits of different treatments, including vigabatrin, ACTH/Steroids, and ketogenic diet. Case discussions are encouraged from the audience.

Controversies in Epilepsy

Hans O. Luders, M.D., Ph.D.

Topic for 2009 to be announced.

EEG

Jean Gotman, M.D.

Topic for 2009 to be announced.

Engineering and Epilepsy

Piotr J. Franaszczuk, Ph.D. 
Gregory K. Bergey, M.D.                                                   

Progress reports at the 2008 Annual Meeting on the clinical trials of anterior thalamic stimulation and responsive neurostimulation helped fuel interest in this SIG. Over 300 attended the session which focused on “Neurostimulation of the Brain in the Treatment of Epilepsy: What We Need to Know Before We Start.” 

Stan Anderson of Harvard Medical School started the program with a discussion of neural network models and how they could provide potential insights into which stimulus parameters might be most effective in producing seizure termination.  He was followed by Brett Wingeier of Neuropace, Inc. who discussed the various important considerations in the brain-electrode interface.  While intracranial targets are chosen for stimulation (either chronic or responsive) it is not known how close to the seizure focus stimulation needs to be for the optimal response.  Stimulation typically is of low intensity (several mA) and what tissue is actually stimulated depends upon electrical field considerations.  These issues were addressed by Bruce Gluckman of Penn State University who discussed many of the biophysical considerations that need to be taken into account.  The concluding presentation by Ryder Gwinn of Swedish Neuroscience Institute summarized what we currently understand about stimulus parameters.  The SIG addressed important areas, but it is acknowledged that the ideal stimulus parameters may not yet be known and may differ for different patients or for seizures from different brain regions.  These considerations become even more important as additional methods of neurostimulation (in addition to VNS) may become approved therapy for epilepsy in the near future.

Epidemiology

Dale Hesdorffer, Ph.D.

The 2008 Epidemiology SIG focused upon the comorbidity of epilepsy with cognitive deficits (Dr. Berg), psychiatric disorders (Dr. Kanner), migraine (Dr. Ludvigsson) and somatic disorders (Dr. Hesdorffer).  Cognitive dysfunction is associated with childhood-onset epilepsy with lower scores on neuropsychological tests observed even among children with idiopathic epilepsy. Such cognitive comobidity may occur due to underlying “symptomatic” causes of epilepsy, transient or episodic effects of seizures, progressive effects of seizures, mechanisms underlying both seizures and deficits, and effects of AEDs. Dr. Berg concluded that the most plausible model was a common underlying etiology with ongoing seizures exerting further adverse effects on cognition. She further speculated that cognitive deficits present before epilepsy onset may be a consequence of subclinical seizure activity.  ADHD and depression are more common in prevalent epilepsy than in the general population, but such cross-sectional studies are unable to assess time order. When time order is examined, both ADHD and depression are associated with an increased risk for developing epilepsy. Based upon these data and studies showing that depression is associated with more severe epilepsy and with greater likelihood of continued seizures after epilepsy surgery, Dr. Kanner hypothesized that depression may be a marker for more severe epilepsy and that serotonergic dysfunction may underlie the co-occurrence of depression and epilepsy.  Dr. Ludvigsson described the bidirectional relationship between epilepsy and migraine, where migraine with aura is associated with an increased risk for developing epilepsy and epilepsy is associated with an increased risk for developing migraine. Additionally, migraine is associated with a worse prognosis for epilepsy.   A wide range of somatic disorders are associated with prevalent epilepsy, but Dr. Hesdorffer indicated that more work is needed as several biases may explain the findings. Additionally, several of the somatic disorders are associated with stroke, a known epilepsy risk factor.

Topic for 2009: Clinical definitions of prolonged seizures/status epilepticus have slowly moved from a duration of 30 minutes or more to one of at least 5 or 10 minutes.  The reasons for these changes in clinical practice are different from the processes that guide construction of meaningful epidemiological definitions. We will explore the impact of definitions of  prolonged seizurs on prognosis (e.g., mortality) and discuss characteristic of an epidemiologically meaningful definition. 

Frontal Lobe Epilepsy

Matthias J. Koepp, M.D., Ph.D.  

Topic for 2009 to be announced.

Genetics

Jennifer Kearney, Ph.D.
Andrew Escayg, Ph.D.

This year’s Genetics SIG topic is Mutation Identification State of the Art. We will discuss current and emerging technologies for mutation identification in epilepsy patient populations. The topics will include detection of sequence variants, copy number variants, and cytogenetic abnormalities. In addition we will discuss issues related to sample collection efforts.

Issues of Concern for Women with Epilepsy

Romila Mushtaq, M.D.    
Katherine Noe, M.D., Ph.D.  

The 2008 program focused on concerns of the peri-menopausal and menopausal years.  The coordinators presented the current state of the evidence on impact of the menopausal transition and hormone replacement therapy on seizure control, as well as data relevant to the risk of premature menopause in women with epilepsy.  Around a quarter of participants noted anecdotal experience with peri-menopause as a potential trigger for development of new onset idiopathic epilepsy.   Osteoporosis and fracture are a particular concern of the postmenopausal woman.  Dr. Allison Pack discussed the latest information on bone health, including the role of AED exposure and impact of epilepsy on bone, as well as recommendations for screening and prevention.  The overwhelming majority of participants volunteered that they are routinely prescribing prophylactic calcium and vitamin D supplementation, and more than half were routinely screening for vitamin D deficiency.  Dr. Jim McAuley once again provided a bibliography of articles relevant to women with epilepsy published in the last year. 

Thanks to everyone who was able to stay for the final hour of the annual meeting to participate in this SIG. We are currently exploring topics for next year's program, with a potential focus on the adolescent female.  Past years’ topics have included management of pregnancy, breastfeeding, and sexual dysfunction in women with epilepsy.   Please contact the coordinators, Dr. Katherine Noe (noe.katherine@mayo.edu) or Dr. Romila Mushtaq (mushtaq@mcw.edu), or utilize the SIG message board on the AES website, with any feedback or suggestions for the 2009 program.

The 2009 SIG will focus on issues specific to the adolescent female with epilepsy.  The biologic and psychosocial impact of seizures and antiepileptic therapy in this age group will be discussed, with a focus on menstrual cycle disorders, contraception, and bone development. 

Junior Investigator Workshop

Audrey S. Yee, M.D.  
Brandy Fureman, Ph.D.

2009 Topic:  Starting Out: Your First Lab and Faculty Position

MEG/MSI (Magnetoencephalography)

Jerry J. Shih, M.D.

There were more than 200 attendees at the 2008 program. Four MEG/MSI experts shared their experiences. Dr. Robert Knowlton delineated the role of MSI in epilepsy surgery as compared with other neuroimaging tools and cortical mapping. He concluded that MSI plays an important role in patient selection, improving ICEEG localization yield and accuracy, and may increase the proportion of patients that can avoid ICEEG. Dr. Gregory Barkley described the coherence analysis of MSI data in epilepsy patients to identify the epileptogenic zone. He demonstrated the advantage of coherence analysis. Dr Marta Santiuste reported the simultaneous recording of MEG and intra-cranial depth EEG and compared to findings with SISCOM. She claimed that epileptiform activity from deep sources (amygdala, hippocampus) is still detectable in MEG measurements with magnetometers. Dr Jing Xiang shared his experience in localization of high-frequency brain signals (HFBS). He was able to identify and localize HFBS corresponding to epileptic and cognitive activity. He also demonstrated the integration of MEG data and other neuroimaging tools, such as SICOM, PET and DTI in his practice. Given the abundant data published before and during 2008, MEG/MSI consolidated its position as a clinical tool in pre-surgical mapping and epileptogenic localization. More localization algorithms such as coherence analysis and high frequency analysis may become more mature and widely used clinically in the near future.  Dr. Jerry Shih will be coordinating this SIG starting in 2009.

2009 Topic:  A panel of investigators in adult epilepsy, pediatric epilepsy, and cognitive neurosciences will select and present the most important scientific discoveries in the MEG field in the past 5 years and their impact on clinical practice.  Presenters will be asked to hypothesize what MEG studies will show us in the 5 years.  Audience participation is strongly encouraged in what should be a lively Q/A session. 

Military Epileptologists 

Jose E. Cavazos, M.D., Ph.D.

Issues of concern to military epileptologists include: 1) access of care to video EEG monitoring and Epileptologist within the VA, 2) Implementation of VA Epilepsy Centers of Excellence, and 3) National VA Formulary and Generics.

Neuroendocrinology

D. Samba Reddy, Ph.D., R.Ph.
Jana Veliskova, M.D., Ph.D.

The Neuroendocrine SIG covered the effects of neurosteroids on neuronal excitability and modulation of seizures. Both clinicians and basic scientists showed great interest in this topic. Dr. Doodipala Reddy and Dr. Michael A. Rogawski described physiological and pharmacological importance of neurosteroids in modulation of neuronal excitability, seizures and their potential important role in catamenial epilepsy. Neurosteroids are synthesized from sterol precursors by the nervous system independently on the endocrine sources (ovarian or adrenal).  The GABA-A receptors are one of the main targets of neurosteroids. Dr. Reddy provided an overview of neurosteroid synthesis, regulation and their anticonvulsant profiles including their clinical implications. A rat model of catamenial epilepsy was presented based on the neurosteroid-withdrawal approach, where the protective activity of neurosteroids seems to be enhanced in animals undergoing withdrawal. Dr. Rogawski presented molecular mechanisms of neurosteroids in the CNS with an emphasis on extrasynaptic/perisynaptic (d subunit) GABA-A receptors as main target for neurosteroid action. A neurosteroid replacement therapy was proposed as an experimental treatment for catamenial epilepsy. This strategy was based on extensive data from recent clinical observations that women with catamenial epilepsy exhibit deficiency or reduced levels of certain neurosteroids, and synthetic neurosteroid analog enhances tonic GABAergic inhibition that could effectively control seizure exacerbation around menstrual periods. Overall, there is clearly emerging importance for the role of neurosteroids in pathophysiology and treatment of catamenial epilepsy.  Our 2009 SIG will focus on d subunit-containing GABA-A receptors as novel target for neurosteroids and its relation to neuronal excitability and epilepsy.

2009 Topic:  The delta-subunit containing GABAA receptors, located perisynaptically/extrasynaptically, mediate “tonic” current activated by ambient GABA levels, thus “setting” the baseline excitability of neurons. Neurosteroids potentiate most GABAA receptor isoforms, but the delta-subunit containing receptors are more sensitive to neurosteroids making them the prime targets. The delta-subunit undergoes dynamic plasticity in epilepsy and during ovarian cycle. This SIG will focus on delta-subunit as a novel target for seizure disorders.

Neuroimaging

Fernando Cendes, M.D., Ph.D. 

This year’s Neuroimaging SIG featured two speakers, Dr. Olli Grohn, University of Kuopio and Dr. Theodore Schwartz, Cornell University. Dr. Grohn’s presentation focused on novel MR methods for detecting axonal plasticity. Non-invasive imaging measures of axonal plasticity can potentially provide surrogate markers for disease progression or recovery in both basic science and clinical investigations of epilepsy. Dr Grohn demonstrated that axonal plasticity can be detected in vivo using manganese-enhanced magnetic resonance imaging (MEMRI) after kainic acid induced status epilepticus. Although MEMRI may become an important tool to study mossy fiber sprouting in experimental settings, its use clinically is limited due to its toxicity. For possible clinical application, Dr Grohn demonstrated that increases in fractional anisotropy in the dentate gyrus in pilocarpine and kainate models are correlated with the amount of mossy fiber sprouting. These results suggest that detection of mossy fiber sprouting in patients at risk for epilepsy may be possible using DTI. 

Dr. Schwartz presented work using optical imaging spectroscopy during interictal spikes and seizures in animals and humans. Several new findings that bear on our understanding of the BOLD signal were discussed. First, Dr. Schwartz showed that both types of epileptiform events cause a focal decrease in tissue and hemoglobin oxygenation lasting anywhere from a few seconds to a minute. Such a negative BOLD signal is generally not described in the fMRI literature.  This signal was also much more focal than the traditional positive BOLD signal, which was poorly localized with the focus until tens of seconds after the offset of the seizure. However, this late positive BOLD signal may be a useful signal for fMRI. Finally, data was presented that indicated the intriguing possibility that changes in hemoglobin oxygenation may actually precede electrographic onset of the seizure and be a useful method for seizure prediction.

Neuropathology of Epilepsy 

Harvey B. Sarnat, M.S., M.D., FRCPC

2009 Topic:  Varieties of Focal Cortical Displasia.  Will invite cases from medical centers.

Neuropharmacology

Gail Anderson, Ph.D.
Eugene Ramsay, M.D.

Topic for 2009 to be announced.

Neuropsychology

Marla Hamberger, Ph.D.

2009  Topic:  Compared to an overabundance of discussions on Wada testing in the 1990’s, the topic has received little attention during the past decade.  Three speakers will each take one of the following positions 1) retain the procedure, 2) modify the procedure with regard to patient selection and choice of anesthesia and 3) replace the Wada with noninvasive imaging techniques.

Neurostimulation

Douglas R. Labar, M.D., Ph.D
James W. Wheless, M.D.

The 2008 program attracted 350 people to hear three talks on recent developments.  Dr. Anna Velasco, head of the epilepsy clinic, General Hospital of Mexico, discussed her group’s results using motor cortex stimulation for the treatment of epilepsy. She discussed her center’s experience in centromedian nucleus of the thalamus stimulation in Lennox-Gastaut syndrome as a treatment for generalized tonic clonic seizures.  Dr. Velasco then reviewed her experience with hippocampal stimulation for temporal lobe epilepsy, comparing the outcome for those patients with a normal MRI to those with hippocampal sclerosis.   She noted that the group with the normal MRI had a better response to hippocampal stimulation and the response was typically seen in the first couple of weeks of therapy.  She noted the stimulation of the primary motor and supplemental motor areas showed a reduction in seizure frequency that were seen early, often in the first week.  In summary, she noted that picking the exact target was critical for central nervous stimulation therapy to work, along with understanding of stimulation parameters.  Different targets have different time to clinical response and she felt that follow up neuropsychology was helpful in assessing this treatment modality. Dr. Robrecht Raedt, from the neurology group at the University Hospital in Ghent, Belgium, presented the results of his group’s use of hippocampal and amygdala stimulation for the treatment of temporal lobe epilepsy.  He began by discussing the rationale and the need for another treatment strategy and then reviewed the results in 12 patients, nine of which had a normal MRI, all of who were adults with partial onset seizures for over 16 years.  They were implanted with deep brain stimulation electrodes and then an enhanced study design was used. If they had over 50% reduction in interictal spikes they continued with chronic stimulation. They have had a follow up of 12 to 52 months.  Ten of the eleven had chronic stimulation performed unilaterally and one had this performed bilaterally.  They noted improvement in seizure control by more than 50% in both patients with normal MRI and in patients with lesions.  Overall, 70% of their patients had their seizures decrease by 50% or more using this therapy, which was well tolerated.  As a result of the preliminary results, they are currently entering a multi-center study that involves the hospital in Ghent and two facilities in Germany, as part of the CoRaStiR study.  This study will compare the results of amygdala hippocampectomy to immediate vs. delayed hippocampal neurostimulation in the treatment of temporal lobe epilepsy.   Finally, Dr. Walter Besio from the Electrical, Computer, and Biomedical Engineering Department of the University of Rhode Island presented his data using transcutaneous electrical stimulation with concentric ring electrodes in rats.  He presented design differences between a concentric ring electrode and disc electrode as it relates to transcutaneous stimulation.  He showed videos demonstrating the different clinical effect.  He then reviewed the various models he used to induce seizures in the rat and  the effects of transcutaneous stimulation.  Four of seventeen rats had seizure freedom when transcutaneous stimulation was used in the penicillin induced seizure model.   All three speakers kept the audience actively engaged when reviewing recent developments in neurostimulation therapy.  There was a lively exchange between the audience and the speakers after the presentations.  We look forward to the 2009 event in Boston and hope you will plan on being there.

Topic for 2009:  Programming Neurostimulation Devices: The Nuts and Bolts

NIH Grants System

Randall Stewart, M.D. Ph.D.

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

Colleen DiIorio, Ph.D, RN
Rebecca Schultz, RN, M.S.N., CPNP      

The SIG was well attended this year with 42 individuals present. The theme was “Conducting Clinical Trials—Success and Barriers”. Two groups of researchers presented their experiences. Laura Jarasek, RN, PNP, MN, Stollery Children’s Hospital, Edmonton, Alberta, and Daphne Quigley, BScN, RN, University of Alberta Hospital, Edmonton, Alberta, presented their experiences in the development, implementation, and evaluation of an adolescent transition clinic. Successful development and implementation of the adolescent transition clinic was attained through identifying the gaps in service/knowledge, collaboration with staff—nurses and physicians, and awareness of the differences and similarities in needs of the adolescents/families during the transition process. Kristen Schardein, RN, MS, University of California, San Francisco, Ariele Edwards, MSPH, CHES, Emory University, and Peggy Clark, RN, MSN, PNP, Cincinnati Children’s Hospital Medical Center discussed recruitment issues in clinical research. A brief review of the literature on effective methods to increase the enrollment of underrepresented racial and ethnic minorities in clinical research and barriers to successful enrollment of minorities was presented. Finally, the Childhood Absence Epilepsy study, a multi-site study of children with Childhood Absence Epilepsy, was discussed as a model illustrating some of the strategies for successful enrollment of minority and ethnic populations. Following these presentations, the floor was opened to audience participation and group discussion. Suggestions for topics for next year are welcome.

The 2009 Nursing Research SIG will provide a forum for those nurses who are involved in clinical work and interested in research. The group will provide support and networking as we work together to answer critical questions. Individual nurse researchers will present their experience in conducting clinical trials. Discussion will include recruitment, documentation, successes and barriers to nurses in conducting clinical trials.

Patient-Reported Outcomes

Rosemarie Kobau, MPH
Erik K. St. Louis, M.D.

Epilepsy care involves a constant balancing act between reducing seizure burden and limiting adverse effects.  The 2008 program centered on the practically important theme “Quality of Life in Epilepsy (QOLie): Does Seizure Frequency Matter?” Opposing views on the relevancy of seizure frequency to QOLie were delineated by two “point-counterpoint” presentations, followed by general discussion among the 30 participants. SIG Coordinator David Ficker, M.D. provided relevant QOLie background and represented the “Con” view that seizure frequency is not an important factor in QOLie through review of relevant supportive literature establishing mood state and antiepileptic drug adverse effects as key QOLie determinants.  Erik St. Louis, M.D. presented the “Pro” view and discussed several potential reasons for conflicting data on the bearing of seizure frequency on QOLie.  The impact of seizure frequency impact on QOLie may be an all or none phenomena, since substantial evidence demonstrates that seizure free outcome (i.e., seizure frequency=0!) is critical to optimal QOLie.  However, in refractory epilepsy, seizure frequency carries less overall impact than mood state and medication adverse effects.  Recent studies by Kobau and coworkers and Cramer and colleagues additionally highlight the importance of seizure recency (i.e., whether a seizure has occurred within the past three months) as an even more important determinant of QOLie than seizure frequency per se. During subsequent discussion, it was agreed that both ictal and interictal state factors remain important influences on patient QOLie.  The potential impact of each state should be carefully considered when designing and interpreting QOLie studies.  Potential influences of several other interictal and ictal factors on QOLie offer fertile future ground to explore, including individual illness trajectory in epilepsy and novel ictal state variables such as seizure recency, pattern, periodicity, and predictability.

2009 Topic:  An overview of the NIH Toolbox and Neuro-QOL Projects for Assessing HRQOL in Epilepsy

NIH Toolbox and Neuro-QOL are part of a multi-site effort supported by NIH to develop publicly available health-related quality of life (HRQL) assessment tools (generic item banks and short forms and targeted scales) for adults and children with common neurological disorders including epilepsy. These tools are intended to be responsive to the needs of clinical researchers and will facilitate comparison of results across studies in different diseases. Dr. Cindy Nowinski, Center on Outcomes Research and Education, Northshore University Healthsystem, Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine will present an overview of NIH Toolbox and NeuroQOL.

PEC Practice Resources

Peggy Clark, RN, M.S.N
Sandra Cushner-Weinstein, RPT, LSCW

A show and tell opportunity for professionals in Epilepsy care.

Pediatric Roundtable

Elaine Wyllie, M.D.
Douglas Nordli, M.D.

Our 2008 Pediatric Epilepsy SIG in Seattle featured terrific case presentations from a panel of seasoned clinicians as well as rising stars!  The session was notable for fascinating cases and vibrant audience interaction.  This year’s wide-ranging discussion included: (1) approach to the presurgical evaluation in the child with normal MRI (Dennis Dlugos, MD); (2) diagnosis and treatment of an unusual form of benign reflex epilepsy (Renee Shellhaus, MD); (3) considerations for and against epilepsy surgery in different scenarios, when EEG findings include benign focal epileptiform discharges of childhood (Deepak Lachhwani, MBBS, MD, and Tobias Loddenkemper, MD); (4) recognition of a potentially fatal non-neurological complication of MELAS: aortic rupture due to microangiopathy (Douglas Nordli, MD); and (5) appreciation of surgical possibilities in the child with an early-acquired focal epileptogenic lesion and generalized ictal and interictal EEG (Elaine Wyllie, MD). The Pediatric Epilepsy SIG provided a wonderful opportunity for adult and pediatric epileptologists and other professionals to gather for open discussion about challenging cases from our clinical practice!

2009 Topic:  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

Page Pennell, M.D.
Kimford J. Meador, M.D.

The Pregnancy Outcomes SIG is designed to be a resource for information regarding pregnancy-related outcomes in women with epilepsy. It will provide presentations and discussion of the most up-to-date information from the major antiepileptic drug (AED) pregnancy registries and other data regarding pregnancy outcomes. The goal is to improve the ability to make evidence-based decisions in treating women of childbearing age who have epilepsy.

Psychiatric Aspects of Epilepsy

Andres M. Kanner, M.D.

2009 Topic:  The FDA has instructed all manufacturers of AEDs to include a warning in their package inserts indicating a potential increased risk of suicidal ideation and behavior associated with the use of any of these drugs. This SIG will be devoted to discuss the legal implications of such alert for the practice of any physician that prescribes AEDs.

Psychogenic Non-epileptic Seizures

Selim R. Benbadis, M.D.
John J. Barry, M.D.

Psychogenic Non-Epileptic Seizures (PNES) are a common and often difficult problem for neurologists and epileptologists. This year we will focus on:

1.  A diagnosis and misreading of EEGs resulting in mis-diagnosis

2.  Treatment

Quality and Value Indicators

Joseph I. Sirven, M.D.

This initial meeting had excellent attendance (55) given the fact that it was scheduled last on the conference agenda.  The program covered the various facets of quality indicators in the care of patients with seizures.  The first of four speakers was Dr. Richard Zimmerman who presented an overall evaluation of quality indicators and how they are utilized by both hospital and government payers.  He was followed by Dr. William Tatum from Tampa, Florida with presentation of the Pugh et al guidelines for potential quality indicators for adult patients with epilepsy.  Christine O’ Dell, Chair of the Practice Committee of the AES, presented on quality in the Epilepsy Monitoring Unit and summarized some of the salient findings with regards to potential quality measures that could be addressed in the EMU.  Lastly, Dr. Nathan Fountain presented the eight candidate quality measures that would be required as documentation for the care of patients with seizures and epilepsy.  Dr. Fountain and Dr. Paul  Van Ness are currently co-chairing the Epilepsy Quality Measure Development Group for the American Academy of Neurology which is in the process of obtaining public comment on the selected quality measurements for epilepsy.  We are looking forward to further discussion and refinement of these issues over the course of this year via the AES online Message Board in addition to capturing some of the new movements and issues for the 2009 SIG on this issue.

Topic for 2009:  There are Eight proposed Epilepsy Quality metrics which will need to be addressed in each and every visit with patients with epilepsy in order to assure quality care.Topics to be covered include:  Which epilepsy care metrics will serve as the Quality metrics for epilepsy care in the USA? What are the thoughts from government and other experts with experience in the measurement and reporting of quality metrics?  What are the implications for not recording or meeting quality measurements?  Potential future studies involving quality metrics will be reviewed.

Sleep and Epilepsy

Carl Bazil, M.D., Ph.D.
Mark Quigg, M.D.

The 2008 program focused on sleep complaints in people with epilepsy, and how these should be addressed. Al deWeerd, M.D., Head of the Department of Clinical Neurophysiology and Sleep Center, SEIN, Zwolle, The Netherlands has written many papers on the subject.  He discussed the prevalence of various sleep problems in epilepsy, particularly insomnia and obstructive sleep apnea.  Most sleep disorders occur more frequently in people with epilepsy than in the general population, and the effects on various measures of quality of life are significant.   Jennifer DeWolfe, D.O., Director, VA Sleep Center, Birmingham Veterans Affairs Medical Center and Assistant Professor of Neurology, University of Alabama at Birmingham then discussed indications for sleep testing in patients with epilepsy.  She showed a number of case histories, illustrating the importance of vigilance for coexisting sleep disorders in an epilepsy practice (including probably the best video of REM behavior disorder I’ve ever seen).  Treating the sleep disorder can make a real difference not only in alertness, but also in seizure control.  As sleep disorders and epilepsy are both rarely witnessed by the physician, sleep disorders should fall into the differential of many unexplained nocturnal episodes that could be mistaken for seizures.

Topic for 2009:  Memory loss and cognitive dysfunction are nearly universal concerns in people with epilepsy, however the potential causes are many.  This year’s SIG will focus on the role sleep plays in memory consolidation and cognitive processing – an exciting, rapidly changing field.  Relevance of recent findings specifically to patients with epilepsy will also be discussed.

SUDEP

Jeffrey Buchhalter, M.D., Ph.D.  
Tess L. Sierzant, RN, M.S.  

The bulk of the program was a discussion of the results of the NINDS Workshop on SUDEP that was held in November of 2008.  Margaret Jacobs explained the objectives and the format of the Workshop.  Lawrence Hirsch presented the following key recommendations of the Research Session: assess family history for sudden death and conduct EKG in all epilepsy patients; explore relevance of risk factors of other types of sudden death, including genetics; explore respiratory, autonomic and serotonin-related mechanisms in animal models and high-risk patients; establish a SUDEP registry and central tissue bank.  The recommendation that EKG be obtained in all epilepsy patients was actively discussed.  An opinion was expressed from the floor that its yield would be low.  However, others pointed out the safety and relative inexpensiveness of EKG for the potential of identifying patients with cardiac disorders that may put them at risk for sudden death.  Georgia Montouris presented the key recommendations of the Education Session: determine the best method to educate patients, families, and medical professionals; develop an instrument to assess the level of interest of the patient and family to learn about SUDEP; develop guidelines on when and how to counsel patients and families; develop educational materials in different formats for different patient populations.

For the last part of the SIG, Philippe Ryvlin of France shared with us the Mortemus project, which consists of a consortium of European centers that are retrospectively identifying SUDEP and near-SUDEP cases that had occurred in epilepsy monitoring units.  The possibility of participation by U.S. centers is being pursued by Stephan Schuele and Jeff Britton.

2009 Topic:  As a result of the 2007 AES-EF SUDEP Task Force and the 2008 NINDS SUDEP Workshop, a SUDEP Coalition has been formed to advance research and education in SUDEP.  The on-going work of the Coalition will be presented, and input and participation will be sought from the SIG audience.

Surgery

Michael M. Haglund, M.D., Ph.D

We plan to again have exciting presentation and discussion of difficult cases that involve surgery. We hope to add a neuropathology component this year to incorporate this critical feature of the surgical resections being discussed. Topic for 2009:  Epilepsy Surgery: Difficult Cases with Focus on Epilepsy and Lesions.

Temporal Lobe Club

Jerome Engel Jr., M.D., Ph.D.
Susan Spencer, M.D.

The topic for 2009 will be:  Has the referral pattern for epilepsy surgery changed since the 2001 RCT and the 2003 Practice Parameter.

The Ketogenic Diet

Eric Kossoff, M.D.

The ketogenic diet creates a ketotic state, but is that why it works? Does ketosis really matter? Most researchers agree that therapeutic diets are more complicated and probably work via multiple mechanisms for epilepsy, let alone for other possible neurologic indications such as brain tumors and autism. In this year's ketogenic diet SIG, we will have 2 debates, following the success of the 2007 AES ketogenic diet SIG.  The first debate will be regarding whether the ketogenic diet can be successfully implemented as a first-line therapy.  The second debate will discuss whether the ketogenic diet is effective due to carbohydrate restriction or providing extra fats.

Translational Research

Thomas P. Sutula, M.D., Ph.D.
Warren Lammert

This Special Interest Group seeks interested members from basic and clinical science corporations (especially research & development), and lay groups. The goal is to create a forum for a dialogue between different interest, solicit new ideas, and promote collaboration that move the epilepsy community towards translational research projects that advances new therapies. 

2009 topic to be announced.

Tuberous Sclerosis

Gregory L. Holmes, M.D.
Vicky Whittemore, Ph.D

2009 topic:  Controversies in Epilepsy Surgery for TSCTwo groups will present different strategies for the pre-surgical workup and surgical approaches in epilepsy surgery for individuals with TSC.