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Improved accuracy in diagnosis for epilepsy with new clinical definition

Medical News Today - 12 hours 2 min ago
An expert task force has created a new definition for epilepsy that refines the scope of patients diagnosed with this brain disease.
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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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Epilepsy diagnosis may be improved by new clinical definition

Medical News Today - Mon, 04/14/2014 - 03:00
Nine years after redefining the diagnosis criteria for epilepsy, the International League Against Epilepsy have published a new, updated version of their clinical definition.
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Clinical definition of epilepsy broadened by new criteria

Clinical Neurology News - Mon, 04/14/2014 - 00:01

The International League Against Epilepsy has revised its definition of epilepsy to include additional criteria for clinical diagnosis, according to a report from the organization published April 14....

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Adjunctive use of ezogabine/retigabine with either traditional sodium channel blocking antiepileptic drugs (AEDs) or AEDs with other mechanisms of action: Evaluation of efficacy and tolerability - Corrected Proof

Epilepsy Research Journal - Mon, 04/14/2014 - 00:00
Highlights: Summary: Integrated data from three double-blind, randomized, placebo-controlled trials were analyzed to evaluate the efficacy and tolerability of ezogabine (EZG; US adopted name)/retigabine (RTG; international non-proprietary name) when used in combination with ≥1 sodium channel blocking antiepileptic drug (AED), ≥1 non-sodium channel blocking AED, or ≥1 AED from both the sodium channel and non-sodium channel mechanistic groups. Efficacy and tolerability appeared to be similar across all three groups of patients.
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New study highlights factors behind anxiety and depression in epilepsy patients

Epilepsy Research - Fri, 04/11/2014 - 13:12

Healthcare professionals need to adopt a wider outlook on the factors underpinning anxiety and depression in epilepsy patients, according to new Australian research.

Carried out by La Trobe University in Victoria, the study looked at data from the 2010 Australian Epilepsy Longitudinal Survey in order to better understand the mechanisms causing mental problems in this group.

Key influencing factors for both anxiety and depression included social aspects of stigma, effectiveness of seizure control and employment status, while the number of different epilepsy drugs also caused anxiety in some cases.

According to the researchers, doctors and caregivers look to be more considerate of factors such as these when looking for the best way to treat and support epilepsy patients affected by mental issues.

The paper observed: “Without this fuller social context, there are limitations on understanding factors that influence anxiety and depression and how to deal with the outcomes.”

Epilepsy patients experiencing signs of depression, meanwhile, are advised that taking regular exercise and improving the quality of their diet could help to alleviate the problem.

Posted by Anne Brown

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Caregivers for children with epilepsy ‘need greater support’

Epilepsy Research - Fri, 04/11/2014 - 13:12

The importance of offering proper support to those tasked with looking after young epilepsy patients has been underlined by a new study.

Conducted by a team at the Medical University of South Carolina, the research involved conversations with four focus groups of caregivers of young people with epilepsy, in order to better understand their experience of looking after the children.

According to those questioned, caregivers generally have most difficulties with the unpredictability of looking after children with epilepsy, the need for constant vigilance and the lack of a perceived relationship between certain actions and outcomes.

This comes in addition to previous research showing these people often experience greater parenting stress and unanticipated caregiving responsibilities. The study therefore highlighted the need for greater professional support for caregivers.

The researchers said: “Epilepsy healthcare professionals are encouraged to promote patient and family centeredness, provide information on how to access community resources, and work with caregivers to enhance epilepsy self-management skills.”

It is estimated that around one in 240 children under 16 in the UK has epilepsy.

Posted by Steve Long

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Immunotherapy trials ‘can benefit suspected autoimmune epilepsy patients’

Epilepsy Research - Fri, 04/11/2014 - 07:12

New research has underlined the potential benefits that a trial of immunotherapy can have in the diagnosis and treatment of patients with suspected autoimmune epilepsy.

Conducted by the College of Medicine at the Mayo Clinic in Rochester, Minnesota, the study saw a team of scientists review the charts of 110 patients seen at the institution’s autoimmune neurology clinic with seizures as a chief complaint.

Out of these, a total of 29 patients with frequent or medically intractable seizures were selected after meeting a number of key inclusion criteria, including the suspicion of autoimmune epilepsy based on the presence of neural autoantibodies, a personal or family history or physical signs of autoimmunity.

The selected patients had also initiated a six to 12-week trial of intravenous methylprednisolone, immune globulin or both. Subjects were defined as having responded to treatment if a 50 per cent or greater reduction in seizure frequency was observed.

According to results published in the journal Neurology, a total of 18 patients, or 62 per cent of the group, responded to therapy, with ten of these becoming seizure-free.

Just over half of this group improved with the first agent, while 43 per cent of those receiving a second agent after not responding to the first subsequently saw improvement.

A favourable response tended to correlate with a shorter interval between symptom onset and treatment initiation. Moreover, of the 13 responders followed for more than six months after initiating long-term oral immunosuppressant therapy, the positive response was sustained in 11 of them, equating to an 85 per cent success rate.

“These retrospective findings justify consideration of a trial of immunotherapy in patients with suspected autoimmune epilepsy,” said the researchers.

This could be an important discovery as it has been noted previously that epilepsy patients are often also affected by autoimmune disorders. A recent JAMA Neurology study analysing US insurance claims data on around 2.5 million people revealed that a diagnosis of epilepsy was nearly four times as common among those with some form of autoimmune disease.

Posted by Anne Brown

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Cognitive impairments in idiopathic generalised epilepsy ‘a shared family trait’

Epilepsy Research - Fri, 04/11/2014 - 07:12

Patients affected by a certain type of epilepsy are likely to experience cognitive impairments that are shared by other members of their family, a new study has revealed.

The King’s College London study has investigated the strong genetic component of idiopathic generalised epilepsy (IGE) in order to better understand why patients with this condition often show deficits in a range of frontal lobe functions.

IGE is the term used to describe forms of epilepsy that do not have any readily apparent causes and are not associated with structural brain abnormalities, meaning that a better understanding of their underlying genetic foundations is essential.

For this new study, 36 patients with IGE were examined using a series of neuropsychological tests sensitive to frontal lobe dysfunction, including assessments of executive function, nonverbal reasoning, verbal generativity, response inhibition, attention and working memory. 38 of their first-degree relatives and 40 healthy controls also underwent these tests.

Previous studies have hinted that unaffected siblings of people with IGE may share some of their cognitive deficits, suggesting these may be genetically determined endophenotypes – a discovery that would increase general understanding of the pathophysiology of these types of epilepsy.

Results published in the journal Epilepsia revealed not only that patients with IGE tended to experience deficits in nonverbal reasoning, verbal generativity, attention, and working memory, but also that their relatives exhibited a parallel profile, with significant impairments in these tasks.

Though the IGE patients tended to show greater deficits in these tasks than their relatives, this nevertheless indicates that these problems stem from the same underlying genetic cause.

The paper concluded: “This study shows that measures of nonverbal reasoning, verbal generativity, sustained attention and working memory are endophenotypes of IGE and offer the potential for aiding molecular genetic studies and elucidating the pathophysiology of IGE.

“Patients tended to demonstrate greater impairment in these tasks, possibly because of a greater genetic contribution and/or disease-related factors.”

Posted by Anne Brown

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Structural changes in the temporal lobe and piriform cortex in frontal lobe epilepsy - Corrected Proof

Epilepsy Research Journal - Fri, 04/11/2014 - 00:00
Highlights: Summary: Background: Neuronal networks involved in seizure generation, maintenance and spread of epileptic activity comprise cortico-subcortical circuits. Although epileptic foci vary in location across focal epilepsy syndromes, there is evidence for common structures in the epileptogenic networks. We recently reported evidence from functional neuroimaging for a unique area in the piriform cortex, common to focal epilepsies in humans, which might play a role in modulating seizure activity.In this study, we aimed to identify common areas of structural abnormalities in patients with frontal lobe epilepsy (FLE).Methods: T1-weighted MRI scans of 43 FLE patients and 25 healthy controls were analysed using voxel based morphometry. Differences in regional grey matter volume were examined across the whole brain, and correlated with age at epilepsy onset, duration and frequency of seizures.Results: We detected areas of increased grey matter volume in the piriform cortex, amygdala and parahippocampal gyrus bilaterally, as well as left mid temporal gyrus of patients relative to controls, which did not correlate with any of the clinical variables tested. No common areas of atrophy were detected across the FLE group.Conclusions: Structural abnormalities within the piriform cortex and adjacent structures of patients with FLE provide further evidence for the involvement of this area in the epileptogenic network of focal epilepsies. Lack of correlation with duration or age of onset of epilepsy suggests that this area of abnormality is not a consequence of seizure activity.
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Tractography of Meyer's Loop asymmetries - Corrected Proof

Epilepsy Research Journal - Fri, 04/11/2014 - 00:00
Highlights: Summary: Purpose: The purpose of the current study was to use diffusion tensor imaging (DTI) to conduct tractography of the optic radiations (OR) and its component bundles and to assess both the degree of hemispheric asymmetry and the inter-subject variability of Meyer's Loop (ML). We hypothesized that there are significant left versus right differences in the anterior extent of ML to the temporal pole (TP) in healthy subjects.Materials and methods: DTI data were acquired on a 3T Siemens MRI system using a single-shot Spin Echo EPI sequence. The dorsal, central and ML bundles of the OR were tracked and visualized in forty hemispheres of twenty healthy volunteers. The uncinate fasciculus (UF) was also tracked in these subjects so that it could be used as a distinct anatomical reference. Measurements were derived for the distance between ML-TP, ML and the temporal horn (ML-TH) and ML and the uncinate fasciculus (ML-UF). Paired difference t-tests were carried out with SPSS 14.0.Results: ML and the UF were successfully tracked and visualized in all 20 volunteers. Significant hemispheric asymmetries were found for all measurements with left distances shorter than the right (P<0.005). In 50% of the subjects the left ML-UF distance was ≤1.9mm.Conclusion: The results support our hypothesis and demonstrate that left ML-TP distances are significantly shorter than right ML-TP distances. These asymmetries are also reflected in shorter left distances between ML-TH and ML-UF. Moreover, these results are of interest to left-sided temporal lobe epilepsy surgery because it is not only more likely to disturb the anterior extent of ML but also renders the often closely located posterior aspect of the left UF more vulnerable to potential surgical impact
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Reassessment of stiripentol pharmacokinetics in healthy adult volunteers - Corrected Proof

Epilepsy Research Journal - Fri, 04/11/2014 - 00:00
Highlights: Summary: Because children who have been receiving stiripentol for the treatment of Dravet syndrome for more than 10 years are now becoming young adults, it is important to accurately characterize stiripentol pharmacokinetics in this age range. A double-blind placebo-controlled dose ranging study was therefore conducted to investigate the pharmacokinetics and tolerability of stiripentol in 12 healthy volunteers. Each subject received 3 single doses of stiripentol (500, 1000, and 2000mg) separated by a wash-out period of 1 week. Pharmacokinetics of stiripentol was analyzed for each dose by non-compartmental analysis. Median area under the curve (AUC), terminal elimination half-life (t1/2,z) and maximal concentration (Cmax) were calculated for between-dose comparison. Safety was evaluated based on both clinical and biological criteria. Oppositely to previous results, there was no concentration rebounds in the elimination phase, which could be the consequence of the food intake. A more than proportional increase in the AUC was observed, associated with a significant increase in the t1/2,z, for increasing doses (median AUC of 8.3, 31 and 88mgh/L, and median t1/2,z of 2, 7.7 and 10h for the 500, 1000, and 2000mg doses respectively), which confirmed the Michaelis–Menten pharmacokinetics of Stiripentol. However, dose-normalized Cmax did not significantly vary between doses. Median Michaelis–Menten parameters were 117mg/h for Vmax and 1.9mg/L for Km. No safety concern was observed during the study. The present study allowed a better characterization of the disposition phase of stiripentol and confirmed its non-linear pharmacokinetic behaviour. Further pharmacokinetic/pharmacodynamic studies would be useful to determine the optimal dose of stiripentol for the treatment of Dravet patients in adulthood.
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Outcome of intracranial electroencephalography monitoring and surgery in magnetic resonance imaging-negative temporal lobe epilepsy - Corrected Proof

Epilepsy Research Journal - Fri, 04/11/2014 - 00:00
Highlights: Summary: We evaluated the outcomes of intracranial electroencephalography (iEEG) recording and subsequent resective surgery in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE). Thirty-two patients were identified from the Mayo Clinic Epilepsy Surgery Database (Arizona, Florida, and Minnesota). Eight (25.0%) had chronic iEEG monitoring that recorded neocortical temporal seizure onsets; 12 (37.5%) had mesial temporal seizure onsets; 5 (15.6%) had independent neocortical and mesial temporal seizure onsets; and 7 (21.9%) had simultaneous neocortical and mesial seizure onsets. Neocortical temporal lobe seizure semiology was the only factor significantly associated with neocortical temporal seizure onsets on iEEG. Only 33.3% of patients who underwent lateral temporal neocorticectomy had an Engel class 1 outcome, whereas 76.5% of patients with iEEG-guided anterior temporal lobectomy that included the amygdala and the hippocampus had an Engel class 1 outcome. Limitations in cohort size precluded statistical analysis of neuropsychological test data.
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Start rapid status epilepticus protocol when convulsions go past 2 minutes

Clinical Neurology News - Thu, 04/10/2014 - 09:30

LAS VEGAS – The treatment window for generalized, convulsive status epilepticus has been compressed in recent years, something that’s important for hospitalists to know, according to Dr. Andrew...

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New treatment shows benefits for children with epilepsy

Epilepsy Research - Thu, 04/10/2014 - 07:07

Parents of children with epilepsy and pervasive developmental disorders (PDDs) could soon see a new treatment option become available.

A new study from Japan’s University of Yamanashi has demonstrated the potential benefits that treatment with the drug levetiracetam can deliver for younger patients affected by these conditions.

Published in the European Journal of Paediatric Neurology, the study investigated the relationship between behavioural problems, the location of electroencephalogram (EEG) paroxysmal abnormalities and levetiracetam therapy among this patient group.

A total of 12 children were involved in the trial, which saw the subjects receive levetiracetam with an initial dose of ten mg/kg/day for the first week, followed by increments of five mg/kg/day every week. The dosage was then adjusted up to a maximum of 60 mg/kg/day.

EEG recordings were performed every three months, with the researchers counting the frequency of seizures and EEG paroxysmal abnormalities, while instances of panic/aggressive behaviours were scored.

It was found that 66.7 per cent of the patients saw reductions in the number of seizures and paroxysmal abnormalities they experienced during the trial period, while 75 per cent of them saw an easing of their behavioural problems.

The researchers concluded: “The present data indicated the usefulness of LEV in reducing behavioural problems related to the reduction of seizures and frontal spikes in PDD for some, but not all, of the patients.

“Thus, levetiracetam represents an important addition to treatment for PDD children with epilepsy presenting with frontal EEG paroxysms.”

Epilepsy is particularly common in youngsters who have developmental disabilities, with approximately 30 per cent of children with epilepsy having another form of development disorder. The presence of both conditions presents its own unique challenges in terms of treatment and symptom management, meaning research into new therapy options represents an important area of scientific understanding.

Posted by Steve Long

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Magnetic stimulation shows epilepsy treatment potential

Epilepsy Research - Thu, 04/10/2014 - 07:07

A new study has demonstrated the potential benefits of a technique called transcranial magnetic stimulation (TMS) in the treatment and diagnosis of epilepsy.

The Aristotle University of Thessaloniki-led research reviewed a number of recent papers showing how TMS can be used to track distinct changes in brain activity patterns associated with the condition.

TMS involves the use of magnetic fields to stimulate nerve cells in the brain, an approach that is sometimes applied to improve symptoms of depression. However, these recent studies have suggested it could be utilised to monitor the effect that traditional and new epilepsy medicines have on the brain, in order to gauge their efficacy.

Moreover, it has also shown promise in predicting patients response to therapy and to treat the disease itself, with the newer technique of TMS-electroencephalography demonstrating particularly strong promise.

The study concluded: “TMS has provided important insight into the pathophysiological substrate of human epilepsies and emerges as a valuable tool with diagnostic, prognostic and therapeutic potential.”

Posted by Bob Jones

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