What's Current?

Even seizure-free, children with epilepsy can face social problems as adults

Science Daily - Wed, 03/30/2016 - 13:54
Learning difficulties and behavioral problems during childhood can lead to suboptimal social and educational outcomes among young adults with childhood epilepsy even when their seizures are well under control and their disease in remission, according to findings from a study.
Categories: What's Current?

Birth control pills may increase risk of seizures

Science Daily - Wed, 03/30/2016 - 12:45
Could certain types of hormonal contraceptives cause an increase in seizures in women with epilepsy? A recent study suggests that ethinyl estradiol, the primary component of oral contraceptives, could be detrimental to the epileptic brain.
Categories: What's Current?

Pitt team redesigns epilepsy drug to increase potency and specificity, reduce side effects

Medical News Today - Wed, 03/30/2016 - 12:00
Researchers at the University of Pittsburgh School of Medicine and Arts & Sciences have designed a more effective version of an FDA-approved epilepsy drug with the potential for fewer side effects...
Categories: What's Current?

Team redesigns epilepsy drug to increase potency, specificity, reduce side effects

Science Daily - Wed, 03/30/2016 - 10:28
A more effective version of an FDA-approved epilepsy drug has been designed with the potential for fewer side effects, according to a study. The experimental agent could also prove to be a treatment for tinnitus and other disorders caused by volatile neural signaling.
Categories: What's Current?

Small temporal pole encephalocele: A hidden cause of “normal” MRI temporal lobe epilepsy

Epilepsia - Tue, 03/29/2016 - 00:46
Summary Objective

Small temporal pole encephalocele (STPE) can be the pathologic substrate of epilepsy in a subgroup of patients with noninformative magnetic resonance imaging (MRI). Herein, we analyzed the clinical, neurophysiologic, and radiologic features of the epilepsy found in 22 patients with STPE, and the frequency of STPE in patients with refractory focal epilepsy (RFE).

Methods

We performed an observational study of all patients with STPE identified at our epilepsy unit from January 2007 to December 2014. Cases were detected through a systematic search of our database of RFE patients evaluated for surgery, and a prospective collection of patients identified at the outpatient clinic. The RFE database was also employed to analyze the frequency of STPE among the different clinical subgroups.

Results

We identified 22 patients with STPE (11 women), including 12 (4.0%) of 303 patients from the RFE database, and 10 from the outpatient clinic. The median age was 51.5 years (range 29–75) and the median age at seizure onset was 38.5 years (range 15–73). Typically, 12 (80%) of 15 patients with left STPE reported seizures with impairment of language. Among the RFE cases, STPE were found in 9.6% of patients with temporal lobe epilepsy (TLE), and in 0.5% of those with extra-TLE (p = 0.0001). STPEs were more frequent in TLE patients with an initial MRI study reported as normal (23.3%) than in those with MRI-visible lesions (1.4%; p = 0.0002). Stereo-electroencephalography was performed in four patients, confirming the localization of the epileptogenic zone at the temporal pole with late participation of the hippocampus. Long-term seizure control was achieved in four of five operated patients.

Significance

STPE can be a hidden cause of TLE in a subgroup of patients with an initial report of “normal” MRI. Early identification of this lesion may help to select patients for presurgical evaluation and tailored resection.

Categories: What's Current?

Experimental febrile seizures increase dendritic complexity of newborn dentate granule cells

Epilepsia - Tue, 03/29/2016 - 00:40
Summary Objective

Febrile seizures (FS) are fever-associated convulsions, being the most common seizure disorder in early childhood. A subgroup of these children later develops epilepsy characterized by a hyperexcitable neuronal network in the hippocampus. Hippocampal excitability is regulated by the hippocampal dentate gyrus (DG) where postnatal neurogenesis occurs. Experimental FS increase the survival of newborn hippocampal dentate granule cells (DGCs), yet the significance of this neuronal subpopulation to the hippocampal network remains unclear. In the current study, we characterized the temporal maturation and structural integration of these post-FS born DGCs in the DG.

Methods

Experimental FS were induced in 10-day-old rat pups. The next day, retroviral particles coding for enhanced green fluorescent protein (eGFP) were stereotactically injected in the DG to label newborn cells. Histochemical analyses of eGFP expressing DGCs were performed one, 4, and 8 weeks later and consisted of the following: (1) colocalization with neurodevelopmental markers doublecortin, calretinin, and the mature neuronal marker NeuN; (2) quantification of dendritic complexity; and (3) quantification of spine density and morphology.

Results

At neither time point were neurodevelopmental markers differently expressed between FS animals and normothermia (NT) controls. One week after treatment, DGCs from FS animals showed dendrites that were 66% longer than those from NT controls. At 4 and 8 weeks, Sholl analysis of the outer 83% of the molecular layer showed 20–25% more intersections in FS animals than in NT controls (p < 0.01). Although overall spine density was not affected, an increase in mushroom-type spines was observed after 8 weeks.

Significance

Experimental FS increase dendritic complexity and the number of mushroom-type spines in post-FS born DGCs, demonstrating a more mature phenotype and suggesting increased incoming excitatory information. The consequences of this hyperconnectivity to signal processing in the DG and the output of the hippocampus remain to be studied.

Categories: What's Current?

Neuron type-specific gene loss linked to Angelman syndrome seizures

Medical News Today - Mon, 03/28/2016 - 03:00
The gene UBE3A plays a critical role in early neurological development. If UBE3A is overexpressed - or if the enzymatic function of UBE3A protein is hyperactive - autism ensues.
Categories: What's Current?

Cannabinoids for seizures: Frankness, comfort, and follow-up are key to gathering data

Clinical Neurology News - Fri, 03/25/2016 - 12:34

Since Colorado is “ground zero” for medical marijuana use, the rest of the nation can learn from how pediatric neurologists there are taking care of children with seizures who use cannabinoids.

<a...

Categories: What's Current?

Validation of rapid suicidality screening in epilepsy using the NDDIE

Epilepsia - Fri, 03/25/2016 - 03:10
Summary Objective

Standard mortality ratio for suicide in patients with epilepsy is three times higher than in the general population, and such a risk remains high even after adjusting for clinical and socioeconomic factors. It is thus important to have suitable screening instruments and to implement care pathways for suicide prevention in every epilepsy center. The aim of this study is to validate the use of the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) as a suicidality-screening instrument.

Methods

The study sample included adult patients with epilepsy assessed with the Mini International Neuropsychiatric Interview (MINI) and the NDDIE. A high suicidality risk according to the Suicidality Module of the MINI was considered the gold standard. Receiver operating characteristic analyses for NDDIE total and individual item scores were computed and subsequently compared using a nonparametric approach. The best possible cutoff was identified with the highest Youden index (J). Likelihood ratios were then computed, and specificity, sensitivity, positive, and negative predictive values calculated.

Results

The study sample consisted of 380 adult patients with epilepsy: 46.3% male; mean age was 39.4 ± 14.6; 76.7% had a diagnosis of focal epilepsy; mean age at onset of the epilepsy was 23.3 ± 17.5. According to the MINI, 74 patients (19.5%) fulfilled criteria for a major depressive episode and 19 (5%) presented a high suicidality risk. A score >2 (J = 0.751) for item 4 “I'd be better off dead” of the NDDIE displayed excellent psychometric properties with a good to excellent validity (area under the curve [AUC] 0.906; 95% confidence interval [CI] 0.820–0.992; p < 0.001), sensitivity 84.21% (95% CI 60.4–96.6), specificity 90.86% (95% CI 87.4–93.6), likelihood ratio+ 9.21 (95% CI 6.3–13.5), likelihood ratio– 0.17 (95% CI 0.06–0.50).

Significance

Item 4 of the NDDIE has shown to be an excellent suicidality screening instrument allowing the development of further care pathways for suicide prevention in epilepsy centers.

Categories: What's Current?

Pathologic electrographic changes after experimental traumatic brain injury

Epilepsia - Fri, 03/25/2016 - 03:06
Summary Objective

To investigate possible electroencephalography (EEG) correlates of epileptogenesis after traumatic brain injury (TBI) using the fluid percussion model.

Methods

Experiments were conducted on adult 2- to 4-month-old male Sprague-Dawley rats. Two groups of animals were studied: (1) the TBI group with depth and screw electrodes implanted immediately after the fluid percussion injury (FPI) procedure, and (2) a naive age-matched control group with the same electrode implantation montage. Pairs of tungsten microelectrodes (50 μm outer diameter) and screw electrodes were implanted in neocortex inside the TBI core, areas adjacent to TBI, and remote areas. EEG activity, recorded on the day of FPI, and continuously for 2 weeks, was analyzed for possible electrographic biomarkers of epileptogenesis. Video-EEG monitoring was also performed continuously in the TBI group to capture electrographic and behavioral seizures until the caps came off (28–189 days), and for 1 week, at 2, 3, and 6 months of age, in the control group.

Results

Pathologic high-frequency oscillations (pHFOs) with a central frequency between 100 and 600 Hz, were recorded from microelectrodes, beginning during the first two post-FPI weeks, in 7 of 12 animals in the TBI group (58%) and never in the controls. pHFOs only occurred in cortical areas within or adjacent to the TBI core. These were associated with synchronous multiunit discharges and popSpikes, duration 15–40 msec. Repetitive pHFOs and EEG spikes (rHFOSs) formed paroxysmal activity, with a unique arcuate pattern, in the frequency band 10–16 Hz in the same areas as isolated pHFOs, and these events were also recorded by screw electrodes. Although loss of caps prevented long-term recordings from all rats, pHFOs and rHFOSs occurred during the first 2 weeks in all four animals that later developed seizures, and none of the rats without these events developed late seizures.

Significance

pHFOs, similar to those associated with epileptogenesis in the status rat model of epilepsy, may also reflect epileptogenesis after FPI. rHFOSs could be noninvasive biomarkers of epileptogenesis.

Categories: What's Current?

Longitudinal stability of interictal spikes in benign epilepsy with centrotemporal spikes

Epilepsia - Fri, 03/25/2016 - 03:00
Summary Objective

To describe the natural history of electroencephalography (EEG) changes in patients with benign epilepsy with centrotemporal spikes (BECTS) over 1 year.

Methods

Centrotemporal spikes were visually evaluated based on 24-h ambulatory EEG studies to determine the total, left, right, and bilateral centrotemporal spikes patients were awake and asleep. These spike rates were then used to compare the entire night of sleep to the first 2 h of sleep, the repeatability of spike frequency over two recordings (done within days to weeks), and longitudinal changes in spike rate over 6 and 12 months.

Results

Nineteen children with newly diagnosed and untreated BECTS were included in this analysis. An excellent correlation was found between the centrotemporal spike rate during the entire duration of sleep and the first 2 h of sleep (intraclass correlation [ICC] 0.87, 95% confidence interval [CI] 0.67–0.95). In addition, an excellent correlation was found between two recordings completed an average of 23 days apart while patients were asleep (ICC 0.92, 95% CI 0.80–0.97) and good correlation while patients were awake (ICC 0.70, 95% CI 0.39–0.87). The average change in spike rate between recordings at baseline and at 6 months was a decrease of 64.7% (range −100% to +51.5%, p = 0.01) and the average change in rate between recordings at baseline and at 12 months was a decrease of 57.7% (range −100% to +29.1%, p = 0.01). In addition, within 6 months, most children had decreased centrotemporal rates, with 30% of children being spike-free. This absence of spikes did not continue in all children, since the majority (60%) had some spikes at 1 year following diagnosis.

Significance

Centrotemporal spike rates during sleep are stable when compared over days to weeks; however, when comparing spike rates over months there is a larger degree of variability.

Categories: What's Current?

Anticonvulsant drug–induced cell death in the developing white matter of the rodent brain

Epilepsia - Fri, 03/25/2016 - 02:45
Summary Objective

During critical periods of brain development, both seizures and anticonvulsant medications can affect neurodevelopmental outcomes. In rodent models, many anticonvulsants trigger neuronal apoptosis. However, white matter apoptosis (WMA) has not been examined after anticonvulsant drug treatment. Herein, we sought to determine if anticonvulsant drugs induced apoptosis in the developing white matter (WM) in a rodent model.

Methods

Postnatal day (P)7 rats were treated with phenobarbital (PB-75), MK-801 (dizocilpine, 0.5), lamotrigine (LTG-20), carbamazepine (CBZ-100), phenytoin (PHT-50), levetiracetam (LEV-250), or saline; all doses are mg/kg. Brain tissue collected 24 h after treatment was stained using the terminal deoxynucleotidyl transferase dUTP nick end labeling method. The number of degenerating cells within WM, that is, anterior commissure (AC), corpus callosum, cingulum, and hippocampus-associated WM tracts, was quantified.

Results

Saline-treated rats showed low baseline level of apoptosis in developing WM on P8 in all the areas examined. PB, PHT, and MK-801 significantly increased apoptosis in all four brain areas examined. Exposure to CBZ, LTG, or LEV failed to increase apoptosis in all regions.

Significance

Commonly used anticonvulsants (PB, PHT) cause apoptosis in the developing WM in a rat model; the N-methyl-d-aspartate (NMDA) receptor antagonist MK-801 has a similar effect. These results are consistent with reports of anesthesia-induced WMA during brain development. Consistent with the lack of neuronal apoptosis caused by LTG, LEV, and CBZ, these drugs did not cause WMA. Many infants treated with anticonvulsant drugs have underlying neurologic injury, including WM damage (e.g., following intraventricular hemorrhage [IVH] or hypoxic-ischemic encephalopathy [HIE]). The degree to which anticonvulsant drug treatment will alter outcomes in the presence of underlying injury remains to be examined, but avoiding drugs (when possible) that induce WMA may be beneficial.

Categories: What's Current?

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe

Epilepsia - Fri, 03/25/2016 - 02:40
Summary Objective

In 2014 the European Union–funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers.

Methods

A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations.

Results

Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used.

Significance

We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods.

Categories: What's Current?

Neuron type-specific gene loss linked to angelman syndrome seizures

Science Daily - Thu, 03/24/2016 - 13:38
A new study has helped determine that UBE3A gene loss specifically from GABAergic neurons is what's critical for seizures in Angelman patients. But UBE3A loss from other neuron types may drive other phenotypes associated with the condition.
Categories: What's Current?

People with epilepsy fear discrimination according to national charity poll

Medical News Today - Thu, 03/24/2016 - 12:00
Many people with epilepsy don't feel comfortable talking about their condition for fear they will be discriminated against, according to a charity poll.
Categories: What's Current?

Epilepsy: first FDA-approved medicine manufactured using 3D printing technology now available

Medical News Today - Thu, 03/24/2016 - 09:00
Aprecia Pharmaceuticals has announced that SPRITAM® (levetiracetam) tablets, for oral suspension, is now available as an adjunctive therapy in the treatment of partial onset seizures, myoclonic...
Categories: What's Current?

Long-term EEG in patients with the ring chromosome 20 epilepsy syndrome

Epilepsia - Thu, 03/24/2016 - 08:00
Summary

The recognizable electroencephalography (EEG) pattern of ring chromosome 20 epilepsy syndrome can be missing in patients with r(20) chromosomal anomaly, and may be found in patients with frontal lobe epilepsy of other origin. This study aims to search for more specific EEG signs by using long-term recordings and measuring the duration of paroxysmal anomalies. The series included 12 adult patients with r(20) anomaly, and 12 controls without any chromosomal aberration. We measured the duration of every paroxysmal burst and calculated the sum of their durations for each long-term EEG recording. We compared patients to controls using the Mann-Whitney U-test. Every patient showed long-lasting paroxysmal EEG bursts, up to 60 min; controls did not show any bursts longer than 60 s (p < 0.0001). The total duration of paroxysmal anomalies was significantly longer in patients (31–692 min) compared to controls (0–48 min) (p < 0.0001). Thus, long-term recordings enhance the contribution of EEG methods for characterizing the ring 20 chromosome epilepsy syndrome.

Categories: What's Current?

Retraction

Epilepsia - Mon, 03/21/2016 - 01:40
Categories: What's Current?

Pages