What's Current?

New study shows long-term benefits of paediatric epilepsy treatment

Epilepsy Research - 14 hours 51 min ago

Children with partial epilepsy could benefit from long-term treatment with the drug zonisamide, according to a newly-published study.

The open-label extension of a randomised phase III placebo-controlled trial has demonstrated how the drug – which is sold under the brand name Zonegran – was well-tolerated and efficacious when used as an add-on treatment for partial epilepsy among children aged between six and 17 years for at least 12 months.

Enrolling patients from ten European countries, the study involved 144 patients and revealed that 56.3 per cent of subjects were classified as responders to treatment, while 11.1 per cent achieved seizure freedom. Meanwhile, there was a low incidence of serious treatment-emergent adverse events leading to discontinuation of therapy.

The results, which were published in the medical journal Epilepsia, have further underlined the potential benefits offered by zonisamide, which was approved in Europe in 2005 as an adjunctive therapy in the treatment of partial seizures in adults, before receiving the greenlight for use among children over the age of six in October 2013.

Previous clinical studies have shown that significantly more paediatric patients responded positively to treatment with zonisamide versus therapy with placebo.

Currently, there are approximately 0.9 million children and adolescents living with active epilepsy in Europe, many of whom are unable to benefit from currently-available therapies.

Professor Renzo Guerrini from the Children’s Hospital Anna Meyer-University of Florence said: “Unfortunately, more than one-quarter of children with epilepsy remain refractory to treatment. There is still a need for additional treatment options.

“The results of this one-year open-label extension of a randomised-controlled study of zonisamide are therefore particularly welcomed and zonisamide could be a valuable treatment option for children with partial epilepsy.”

Zonisamide is a second-generation anti-epileptic drug with multiple mechanisms of action and a chemical structure that is unlike other treatments for the same condition. It is manufactured by Eisai, which also produces the epilepsy therapies Fycompa, Inovelon and Zebinix.

Posted by Anne Brown

Categories: What's Current?

Epileptic and non-epileptic seizures ‘hard to tell apart for patients’

Epilepsy Research - 15 hours 59 min ago

A new study has highlighted some of the difficulties that patients and caregivers are having in determining the difference between seizures that are related to epilepsy and those that are not.

Conducted at the Universidade de Sao Paulo, the study assessed 24 adult patients with comorbid epilepsy and psychogenic nonepileptic seizures (PNES) in order to gauge whether they and their caregivers were able to distinguish between these two events at least one year after initial diagnosis.

Patients and a caregiver of their choice were interviewed and shown videos containing the patients’ epileptic and PNES events, with variables associated with correct identification of events evaluated by the scientists.

It was revealed that only six of the patients were able to correctly distinguish between the two events. They were able to tell the difference by noticing factors such as the absence of intellectual disability and a degree of preserved awareness during the PNES event.

Meanwhile, 12 caregivers were able to correctly tell the events apart by assessing criteria such as the presentation of only one epileptic seizure type in the patient and the communication of PNES diagnosis to the patient.

The researchers said: “These findings have implications for both clinical follow-up and research involving this population. Future research should further investigate methods that would allow patients and their caregivers to better distinguish between these two events.”

Epileptic and non-epileptic seizures can often look the same and result in similar symptoms, with the main differences coming from their causes. Whereas epileptic seizures are always caused by disturbances in the electrical activity of the brain, non-epileptic events can be triggered by a variety of factors.

The term PNES describes any seizures that have a psychological cause, often occurring as a result of a change in the mood or emotional state of the patient. They can include seizures induced by panic attacks and dissociative seizures that occur involuntarily.

Posted by Anne Brown

Categories: What's Current?

Brain stimulator reduces seizures in patients with drug-resistant epilepsy

Medical News Today - Wed, 04/23/2014 - 11:00
An FDA-approved brain stimulator with a novel electrode placement system has resulted in nearly half of patients with epilepsy in a trial experiencing total seizure cessation.
Categories: What's Current?

Young people with epilepsy ‘at elevated risk of injury’

Epilepsy Research - Wed, 04/23/2014 - 10:32

A new UK study has shed light on the elevated risk of injury experienced by children and young adults with epilepsy.

Led by the University of Nottingham and funded by the National Institute for Health Research, the research revealed that those affected by the condition are more likely to suffer broken bones, burns and poisonings than those who do not.

Published in the latest edition of the journal Pediatrics, the study showed that young people with epilepsy were more than twice as likely to be poisoned by medication, increasing to four times the risk in patients aged between 19 and 24 years old.

These patients were also revealed to be almost one-and-a-half times more likely to suffer a burn-related injury and at an almost 25 per cent greater risk of breaking an arm or leg.

Previous research into this topic has suggested that epileptic seizures can explain this increased risk, but many of these past studies may have overestimated this association, due to the fact they focused primarily on patients with more severe forms of epilepsy.

By contrast, this new study had a broader focus, drawing data from GP records from almost 12,000 patients with epilepsy over an average of two-and-a-half years before comparing it with the records of around 47,000 non-epileptic people.

Dr Vibhore Prasad of the university’s division of primary care said: “More research is needed to understand why people with epilepsy have a greater number of medicine-related poisonings and whether the poisonings are intentional or accidental.

“This is the first study in the UK population to estimate the risk of fractures, burns and poisonings.”

The authors concluded that the findings should be used by medical professionals to make epilepsy patients and their families more aware of the risk of injury, as well as to inform existing guidelines on treatment. It could also mean that more information relating to the safe storage of medicines and the supervision of children could be given by doctors.

Currently, it estimated that around one in 240 children under 16 in the UK is affected by epilepsy.

Posted by Steve Long

Categories: What's Current?

New clinical definition for epilepsy promises to improve treatment

Epilepsy Research - Wed, 04/23/2014 - 10:23

A new clinical definition for epilepsy has been devised by an expert task force with the aim of making the condition easier to diagnose and treat.

Published in the medical journal Epilepsia on behalf of the International League Against Epilepsy, the new definition provides a greater level of detail to diagnose epilepsy than the previous guidelines, which were laid down in 2005.

It suggests that epilepsy is a disease of the brain defined as at least two unprovoked or reflex seizures occurring more than 24 hours apart, or one seizure and a probability of further seizures similar to the general recurrence risk of at least 60 per cent after two unprovoked seizures occurring over the next ten years.

The task force’s new definition – which also encompasses patients who have been diagnosed with an epilepsy syndrome – improves upon the older designation of epilepsy as an enduring predisposition to generate epileptic seizures, with accompanying neurobiologic, cognitive, psychological and social consequences. This previous definition of epilepsy required the occurrence of at least one epileptic seizure.

Task force lead author Dr Robert Fisher from Stanford University School of Medicine explained: “The 2005 definition does not allow a patient to outgrow epilepsy, nor does it take into account some clinicians’ views that epilepsy is present after a first unprovoked seizure when there is a high risk for another. The task force recommendation resolves these issues with the new, more practical, definition of epilepsy that is aimed at clinicians.”

It was also noted that some researchers might choose to use criteria similar to the older definition to facilitate comparison with prior studies, while the 2005 outline might also be preferred if information is not available on recurrence risk after a first seizure.

The International League Against Epilepsy is the world’s most prominent association of physicians and health professionals dedicated to the treatment of epilepsy and has been providing educational and research resources on the subject since 1909.

Posted by Bob Jones

Categories: What's Current?

Study examines effectiveness of two medications for treating epileptic seizures in children

Medical News Today - Wed, 04/23/2014 - 05:00
Although some studies have suggested that the drug lorazepam may be more effective or safer than the drug diazepam in treating a type of epileptic seizures among children, a randomized trial finds...
Categories: What's Current?

Anti-seizure drug may reduce alcohol consumption

Medical News Today - Wed, 04/23/2014 - 03:00
Researchers from Boston University School of Medicine (BUSM) have discovered that the anti-seizure drug ezogabine, reduced alcohol consumption in an experimental model.
Categories: What's Current?

Newly-approved brain stimulator offers hope for individuals with uncontrolled epilepsy

Science Daily - Tue, 04/22/2014 - 16:20
A recently FDA-approved device has been shown to reduce seizures in patients with medication-resistant epilepsy by as much as 50 percent. When coupled with an innovative electrode placement planning system, the device facilitated the complete elimination of seizures in nearly half of the implanted patients enrolled in the decade-long clinical trials.
Categories: What's Current?

Lorazepam not superior to diazepam in pediatric status epilepticus

Clinical Neurology News - Tue, 04/22/2014 - 16:00

The efficacy and safety of lorazepam were not superior to diazepam in a clinical trial of pediatric status epilepticus, investigators reported online April 22 in JAMA.

Both drugs effectively halted...

Categories: What's Current?

Commonly available blood-pressure medication prevents epilepsy after severe brain injury

Science Daily - Tue, 04/22/2014 - 10:01
A team of neuroscientists has shown in rats that a drug commonly prescribed for hypertension can nearly eliminate the epilepsy that often follows severe head injury. The drug blocks a receptor on astrocytes, preventing a cascade of signals that lead to inflammation and neuron damage. The experiments also prove that epilepsy results from temporary breaks in the blood-brain barrier following head trauma.
Categories: What's Current?

An Ingredient of Pot May Help People with Epilepsy

Scientific American: Epilepsy - Tue, 04/22/2014 - 07:30
A new marijuana-derived drug may treat epileptic children, without the high

-- Read more on ScientificAmerican.com
Categories: What's Current?

Discovery may lead to improvements in drugs that act on the sodium channel to treat a range of cardiac and pain conditions

Medical News Today - Tue, 04/22/2014 - 03:00
Sodium channels are implicated in many serious conditions such as heart disease, epilepsy and pain, making them an important potential target for drug therapies.
Categories: What's Current?

Hemodynamic changes during posterior epilepsies: An EEG-fNIRS study - Corrected Proof

Epilepsy Research Journal - Mon, 04/21/2014 - 00:00
Highlights: Summary: Posterior epilepsies are mainly characterized clinically by visual symptoms. Functional near-infrared spectroscopy (fNIRS) is an emerging non-invasive imaging technique that has the potential to monitor hemodynamic changes during epileptic activity. Combined with electroencephalography (EEG), 9 patients with posterior epilepsies were recorded using EEG-fNIRS with large sampling (19 EEG electrodes and over 100 fNIRS channels). Spikes and seizures were carefully marked on EEG traces, and convolved with a standard hemodynamic response function for general linear model (GLM) analysis. GLM results for seizures (in 3 patients) and spikes (7 patients) were broadly sensitive to the epileptic focus in 7/9 patients, and specific in 5/9 patients with fNIRS deoxyhemoglobin responses lateralized to the correct lobe, and to plausible locations within the occipital or parietal lobes. This work provides evidence that EEG-fNIRS is a sensitive technique for monitoring posterior epileptic activity.
Categories: What's Current?

Default mode network hypometabolism in epileptic encephalopathies with CSWS - Corrected Proof

Epilepsy Research Journal - Mon, 04/21/2014 - 00:00
Highlights: Summary: Previous studies investigating cerebral metabolic changes associated with continuous spike-waves during sleep (CSWS) compared the metabolism of children with CSWS with that of healthy adults, precluding any assessment in brain areas showing physiologic age-related metabolic changes. Here, we investigated the metabolic and connectivity changes characterizing the acute phase of CSWS activity by comparing awake brain metabolism of children with CSWS with that of pediatric pseudo-controls.Positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET) was performed in 17 awake children with cryptogenic CSWS (5 girls, age: 5–11 years). Voxel-based analyses identified significant metabolic changes in CSWS patients compared with 18 pediatric pseudo-controls (12 girls, age: 6–11 years, non-CSWS focal cryptogenic epilepsy with normal FDG-PET). CSWS-induced changes in the contribution of brain areas displaying metabolic changes to the level of metabolic activity in other brain areas were investigated using pathophysiological interaction.Hypermetabolism in perisylvian regions bilaterally and hypometabolism in lateral and mesial prefrontal cortex, precuneus, posterior cingulate cortex and parahippocampal gyri characterized the acute phase of CSWS (p<0.05 FWE). No change in thalamic metabolism was disclosed. Altered functional connectivity was found between hyper- and hypometabolic regions in CSWS patients compared with pediatric pseudo-controls.This study demonstrates hypometabolism in key nodes of the default mode network (DMN) in awake patients with CSWS, in relation with a possible phenomenon of sustained remote inhibition from the epileptic foci. This hypometabolism might account for some of the acquired cognitive or behavioral features of CSWS epileptic encephalopathies. This study failed to find any evidence of thalamic metabolic changes, which supports the primary involvement of the cortex in CSWS genesis.
Categories: What's Current?

Antiepileptic drugs ‘can be safely discontinued following successful surgery’

Epilepsy Research - Thu, 04/17/2014 - 13:23

New research has underlined the safety of discontinuing treatment with antiepileptic drugs (AEDs) among patients who have successfully undergone epilepsy surgery.

Carried out by researchers at the University of Saskatchewan in Canada, the meta-analysis aimed to establish a consensus regarding the management of AEDs after successful epilepsy surgery, as none previously existed.

Collating the most relevant evidence in this topic, the team identified 257 abstracts and eventually selected 16 papers for consideration, describing outcomes in 1,456 patients who discontinued AEDs and 685 patients who did not.

Results published in the medical journal Epilepsy Research revealed that the odds of experiencing seizure recurrence after AED discontinuation was 0.39 times lower in patients who ceased treatment after undergoing surgery.

A minority of patients who were seizure-free after surgery had recurrence after discontinuation, but recurrence tended to be higher for those without AED withdrawal.

It was also noted that patients who did experience seizure recurrence after discontinuation found the problem relatively easy to bring back under control after restarting their programme of medication.

Differences in the success of this strategy were attributed to specific attributes of the selected population where discontinuation was attempted, with young patients with lesional temporal epilepsy shown to be good candidates. This suggests that doctors need to be selective when choosing when to apply this principle.

The researchers concluded: “The discontinuation of medications should be done in good candidates and the decision should be individualised taking into account clinical, electrographical, imaging and histopathological variables.”

Around two thirds of epileptic seizures can be successfully treated and controlled through the appropriate use of AEDs, though they do not help every patient in the long term. For those who are unable to benefit from drug therapy, surgery can be a preferable option.

Surgical interventions can be performed on both adults and children and are utilised when a physical cause for the epilepsy can be found in a specific area of the brain.

Posted by Bob Jones

Categories: What's Current?

Antiepileptic drugs ‘can be safely discontinued following successful surgery’

Epilepsy Research - Thu, 04/17/2014 - 13:23

New research has underlined the safety of discontinuing treatment with antiepileptic drugs (AEDs) among patients who have successfully undergone epilepsy surgery.

Carried out by researchers at the University of Saskatchewan in Canada, the meta-analysis aimed to establish a consensus regarding the management of AEDs after successful epilepsy surgery, as none previously existed.

Collating the most relevant evidence in this topic, the team identified 257 abstracts and eventually selected 16 papers for consideration, describing outcomes in 1,456 patients who discontinued AEDs and 685 patients who did not.

Results published in the medical journal Epilepsy Research revealed that the odds of experiencing seizure recurrence after AED discontinuation was 0.39 times lower in patients who ceased treatment after undergoing surgery.

A minority of patients who were seizure-free after surgery had recurrence after discontinuation, but recurrence tended to be higher for those without AED withdrawal.

It was also noted that patients who did experience seizure recurrence after discontinuation found the problem relatively easy to bring back under control after restarting their programme of medication.

Differences in the success of this strategy were attributed to specific attributes of the selected population where discontinuation was attempted, with young patients with lesional temporal epilepsy shown to be good candidates. This suggests that doctors need to be selective when choosing when to apply this principle.

The researchers concluded: "The discontinuation of medications should be done in good candidates and the decision should be individualised taking into account clinical, electrographical, imaging and histopathological variables."

Around two thirds of epileptic seizures can be successfully treated and controlled through the appropriate use of AEDs, though they do not help every patient in the long term. For those who are unable to benefit from drug therapy, surgery can be a preferable option.

Surgical interventions can be performed on both adults and children and are utilised when a physical cause for the epilepsy can be found in a specific area of the brain.

Posted by Bob Jones

Categories: What's Current?

Improved accuracy in diagnosis for epilepsy with new clinical definition

Medical News Today - Wed, 04/16/2014 - 03:00
An expert task force has created a new definition for epilepsy that refines the scope of patients diagnosed with this brain disease.
Categories: What's Current?

Evidence-Based Apps: Is it possible to diagnose epileptic seizure digitally?

Clinical Neurology News - Tue, 04/15/2014 - 14:00

A new app seems to help nonneurologist health care workers diagnose seizures as epileptic or nonepileptic, findings from a small study to be presented at the American Academy of Neurology meeting...

Categories: What's Current?

The effect of phenobarbitone on cognition in adult patients with new onset epilepsy: A multi-centric prospective study from India - Corrected Proof

Epilepsy Research Journal - Tue, 04/15/2014 - 00:00
Highlights: Summary: Objective: In view of the conflicting results of cognitive and behavioral consequences of PB, the present study was planned to analyze its efficacy, serial neuropsychological functions and its impact on psychosocial functioning in adults with epilepsy while on phenobarbitone (PB).Methodology: This prospective multi-centric study carried out across 4 centers in India included 75 adult patients of ≥18 years (M:F=52:23; age: 27.3±8.5 years) with epilepsy who were prescribed phenobarbitone and underwent serial standardized neuropsychological assessment (NIMHANS battery for adults) at baseline, 1 month, 3 months, 6 months and 12 months. The demographic, seizure details and outcome measures were recorded.Results: Of the 75 patients, 63 had completed clinical and neuropsychological assessment, i.e. visit 1 (baseline), visit 4 (6 months) and visit 5 (12 months). There was no deterioration rather an improvement during the follow visits in all the neuropsychological functions. The results indicate that 16 neuropsychological variables changed significantly, viz. mental speed (p<0.001), sustained attention (p<0.001), focused attention (p<0.002), planning (p<0.001), concept formation (p<0.05), set shifting (p<0.001), verbal learning (p<0.0001), verbal memory (p<0.0001), visual memory (p<0.0001) and intelligence (p<0.001). The scales measuring the outcome of psychosocial functioning significantly changed during follow up included happiness (p<0.002), Impact of Epilepsy on patient's life (p<0.02), A–B Neuropsychological Assessment (p<0.015), HADS anxiety (p<0.001) and emotional disorder (p<0.006). There was a significant reduction in seizure severity as measured by Liverpool Seizure Severity Scale (p<0.002) and seizure freedom was maintained.Conclusions: This study demonstrated that phenobarbitone is effective, well tolerated AED and do not have cognitive impairment over one year. There was variable but distinct improvement in cognition and psychosocial functioning, and effective seizure control could be one of the factor for it.
Categories: What's Current?

New clinical definition for epilepsy improves diagnosis accuracy

Science Daily - Mon, 04/14/2014 - 09:19
An expert task force has created a new definition for epilepsy that refines the scope of patients diagnosed with this brain disease. The study provides a greater level of detail to diagnose epilepsy by including individuals with two unprovoked seizures, and those with one unprovoked seizure and other factors that increase risk of seizure recurrence.
Categories: What's Current?

Pages