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.
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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

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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

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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...
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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.
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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.
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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...

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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.
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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
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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.
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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.
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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.
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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...

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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.
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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.
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Young people with epilepsy at significantly more risk of injury

Science Daily - Mon, 04/14/2014 - 09:19
Children and young adults with epilepsy are more likely to suffer broken bones, burns and poisonings compared to those without the neurological disorder, new research has found. The results, taken in tandem with previous research findings, highlight the need for further research into whether young people with the condition are at greater risk from an overdose, accidental or intentional, of their epilepsy drugs or other medication.
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Young people with epilepsy significantly more at risk of injury

Medical News Today - Mon, 04/14/2014 - 03:00
Children and young adults with epilepsy are more likely to suffer broken bones, burns and poisonings compared to those without the neurological disorder, new research has found.
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