What's Current?

Four studies explore memory decline in people with epilepsy

Science Daily - Sun, 12/06/2015 - 06:28
Four studies presented at the American Epilepsy Society's (AES) 69th Annual Meeting uncover the biological factors that mediate memory decline in people with epilepsy, particularly those with seizures that affect the temporal lobe. Loss of neurons from the hippocampus, a brain region that processes and stores memories, is a common cause of temporal lobe epilepsy. People with temporal epilepsy caused by hippocampal sclerosis (TLE-HS) have impaired memory and find it particularly challenging to recall details of specific events in everyday life.
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Novel devices, technologies provide insights into seizure control, surgical targets

Science Daily - Sun, 12/06/2015 - 06:28
Three studies to be presented at the American Epilepsy Society's 69th Annual Meeting describe novel devices and technologies that could reshape current understanding of the complex mechanisms underpinning seizure development in the brain. Two of the three studies unveil information about the neural networks that produce and propagate seizure activity, providing information that could help refine and target surgical interventions.
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Autoimmune epilepsy outcomes depend heavily on antibody type

Science Daily - Fri, 12/04/2015 - 14:59
Immune dysfunction is increasingly recognized as a cause of drug-resistant epilepsy but how or why the immune system attacks nerve cells -- and the consequences on seizure control -- are not well understood. Two studies explore how different types of autoimmune response elicit markedly different responses in patients with drug-resistant epilepsy.
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Micro-map of hippocampus lends big hand to brain research

Medical News Today - Fri, 12/04/2015 - 07:00
Researchers at The Neuro compile new tool designed to be shared with experts world-wide to accelerate research.
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Micro-map of hippocampus lends big hand to brain research

Science Daily - Thu, 12/03/2015 - 15:02
A new detailed map of the hippocampal region of the brain is helping the scientific community accelerate research and develop better treatments for patients suffering from epilepsy and other neurological and psychiatric disorders.
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A step towards gene therapy against intractable epilepsy

Medical News Today - Thu, 12/03/2015 - 11:00
By delivering genes for a certain signal substance and its receptor into the brain of test animals with chronic epilepsy, a research group at Lund University in Sweden and colleagues at University...
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Drug could suppress intractable epilepsy

Science Daily - Thu, 12/03/2015 - 08:29
Scientists have found a way to rapidly suppress epilepsy in mouse models by manipulating a known genetic pathway using a cancer drug currently in human clinical trials for the treatment of brain and breast cancer.
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Ketogenic diet change cPLA2/clusterin and autophagy related gene expression and correlate with cognitive deficits and hippocampal MFs sprouting following neonatal seizures

Epilepsy Research Journal - Thu, 12/03/2015 - 00:00
A ketogenic diet (KD) is a high-fat, low-carbohydrate and restricted-protein diet that is a world-widely used last resort for medically intractable epilepsy. Recent evidence also suggests that KD may have some beneficial effects in a lot of metabolic diseases such as obesity, diabetes, GLUT1 deficiency syndrome and pyruvate dehydrogenase (PDH) deficiencies (Gano LB et al., 2014; Veggiotti P et al., 2014). In animal studies, CD-1 mouse neonates whose mothers were fed a KD prior to and during gestation demonstrated altered maternal metabolic status as well as offspring physiological growth and brain structure (Sussman D et al., 2013.).
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Brain surgery through one-inch opening successfully treats epileptic seizures in children

Science Daily - Mon, 11/30/2015 - 11:37
A minimally-invasive endoscopic surgery has been developed by researchers, demonstrating efficacy in treating intractable epileptic seizures in children.
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An economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy: An interim analysis

Epilepsia - Sun, 11/29/2015 - 23:21
Summary Objectives

To gain insight into the cost-effectiveness of the ketogenic (KD) diet compared with care as usual (CAU) in children and adolescents with intractable epilepsy, we conducted an economic evaluation from a societal perspective, alongside a randomized controlled trial.

Methods

Participants from a tertiary epilepsy center were randomized into KD (intervention) group or CAU (control) group. Seizure frequency, quality adjusted life years (QALYs), health care costs, production losses of parents and patient, and family costs were assessed at baseline and during a 4-month study period and compared between the intervention and control groups. The incremental cost-effectiveness ratios (ICERs) (i.e., cost per QALY and cost per responder), and cost-effectiveness acceptability curves (CEACs) were calculated and presented.

Results

In total, 48 children were included in the analyses of this study (26 KD group). At 4 months, 50% of the participants in the KD group had a seizure reduction ≥50% from baseline, compared with 18.2 of the participants in the CAU group. The mean costs per patient in the CAU group were €15,245 compared to €20,986 per patient in the KD group, resulting in an ICER of €18,044 per responder. We failed, however, to measure any benefits in terms of QALYs and therefore, the cost per QALY rise high above any acceptable ceiling ratio. It might be that the quality of life instruments used in this study were not sufficiently sensitive to detect changes, or it might be that being a clinical responder is not sufficient to improve a patient's quality of life. Univariate and multivariate sensitivity analyses and nonparametric bootstrapping were performed and demonstrated the robustness of our results.

Significance

The results show that the KD reduces seizure frequency. The study did not find any improvements in quality of life and, therefore, unfavorable cost per QALY ratio's resulted.

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Validation of the Generalized Anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy

Epilepsy Research Journal - Sat, 11/28/2015 - 00:00
Many epidemiological studies have found the prevalence of depression and anxiety to be higher in people with epilepsy (PWE) than in those without epilepsy (Kwon and Park, 2014). Comorbid anxiety in PWE has been highlighted because of its negative impact on quality of life (QOL), which has been shown to be equal to that of depression(Johnson et al., 2004; Kanner et al., 2010; Kwon and Park, 2013). The prevalence of anxiety in adult PWE ranges from 11% to 50%, depending on the population investigated and the anxiety measure instrument used (Munger Clary, 2014).
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Temporal lobe volume predicts Wada memory test performance in patients with mesial temporal sclerosis

Epilepsy Research Journal - Sat, 11/28/2015 - 00:00
Verbal memory decline is one of the major concerns associated with surgery for temporal lobe epilepsy (TLE), especially after dominant anterior temporal lobectomy (ATL). Accurate prediction of memory decline prior to ATL is challenging. The Wada test (also known as the intracarotid amobarbital procedure) was originally developed to determine hemispheric language dominance in prospective ATL candidates to prevent significant language disturbances after surgery (Wada and Rasmussen, 2007). Subsequently, the test was adopted for memory assessment before resective surgery (Milner and Rasmussen, 1962).
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De novo DNM1 mutations in two cases of epileptic encephalopathy

Epilepsia - Fri, 11/27/2015 - 00:30
Summary

Dynamin 1 (DNM1) is a large guanosine triphosphatase involved in clathrin-mediated endocytosis. In recent studies, de novo mutations in DNM1 have been identified in five individuals with epileptic encephalopathy. In this study, we report two patients with early onset epileptic encephalopathy possessing de novo DNM1 mutations. Using whole exome sequencing, we detected the novel mutation c.127G>A (p.Gly43Ser) in a patient with Lennox-Gastaut syndrome, and a recurrent mutation c.709C>T (p.Arg237Trp) in a patient with West syndrome. Structural consideration of DNM1 mutations revealed that both mutations would destabilize the G domain structure and impair nucleotide binding, dimer formation, and/or GTPase activity of the G domain. These and previous cases of DNM1 mutations were reviewed to verify the phenotypic spectrum. The main clinical features of DNM1 mutations include intractable seizures, intellectual disability, developmental delay, and hypotonia. Most cases showed development delay before the onset of seizures. A patient carrying p.Arg237Trp in this report showed a different developmental status from that of a previously reported case, together with characteristic extrapyramidal movement.

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Ictal onset patterns of local field potentials, high frequency oscillations, and unit activity in human mesial temporal lobe epilepsy

Epilepsia - Thu, 11/26/2015 - 23:45
Summary Objective

To characterize local field potentials, high frequency oscillations, and single unit firing patterns in microelectrode recordings of human limbic onset seizures.

Methods

Wide bandwidth local field potential recordings were acquired from microelectrodes implanted in mesial temporal structures during spontaneous seizures from six patients with mesial temporal lobe epilepsy.

Results

In the seizure onset zone, distinct epileptiform discharges were evident in the local field potential prior to the time of seizure onset in the intracranial EEG. In all three seizures with hypersynchronous (HYP) seizure onset, fast ripples with incrementally increasing power accompanied epileptiform discharges during the transition to the ictal state (p < 0.01). In a single low voltage fast (LVF) onset seizure a triad of evolving HYP LFP discharges, increased single unit activity, and fast ripples of incrementally increasing power were identified ~20 s prior to seizure onset (p < 0.01). In addition, incrementally increasing fast ripples occurred after seizure onset just prior to the transition to LVF activity (p < 0.01). HYP onset was associated with an increase in fast ripple and ripple rate (p < 0.05) and commonly each HYP discharge had a superimposed ripple followed by a fast ripple. Putative excitatory and inhibitory single units could be distinguished during limbic seizure onset, and heterogeneous shifts in firing rate were observed during LVF activity.

Significance

Epileptiform activity is detected by microelectrodes before it is detected by depth macroelectrodes, and the one clinically identified LVF ictal onset was a HYP onset at the local level. Patterns of incrementally increasing fast ripple power are consistent with observations in rats with experimental hippocampal epilepsy, suggesting that limbic seizures arise when small clusters of synchronously bursting neurons increase in size, coalesce, and reach a critical mass for propagation.

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Mining continuous intracranial EEG in focal canine epilepsy: Relating interictal bursts to seizure onsets

Epilepsia - Thu, 11/26/2015 - 04:59
Summary Objective

Brain regions are localized for resection during epilepsy surgery based on rare seizures observed during a short period of intracranial electroencephalography (iEEG) monitoring. Interictal epileptiform bursts, which are more prevalent than seizures, may provide complementary information to aid in epilepsy evaluation. In this study, we leverage a long-term iEEG dataset from canines with naturally occurring epilepsy to investigate interictal bursts and their electrographic relationship to seizures.

Methods

Four dogs were included in this study, each monitored previously with continuous iEEG for periods of 475.7, 329.9, 45.8, and 451.8 days, respectively, for a total of >11,000 h. Seizures and bursts were detected and validated by two board-certified epileptologists. A published Bayesian model was applied to analyze the dynamics of interictal epileptic bursts on EEG and compare them to seizures.

Results

In three dogs, bursts were stereotyped and found to be statistically similar to periods before or near seizure onsets. Seizures from one dog during status epilepticus were markedly different from other seizures in terms of burst similarity.

Significance

Shorter epileptic bursts explored in this work have the potential to yield significant information about the distribution of epileptic events. In our data, bursts are at least an order of magnitude more prevalent than seizures and occur much more regularly. Our finding that bursts often display pronounced similarity to seizure onsets suggests that they contain relevant information about the epileptic networks from which they arise and may aide in the clinical evaluation of epilepsy in patients.

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Altered self-identity and autobiographical memory in epilepsy

Epilepsia - Wed, 11/25/2015 - 23:37
Summary Objective

Research suggests that individuals with chronic epilepsy display differences in their self-identity. The mechanisms by which self-identity is altered, however, are not well understood. Neural networks supporting autobiographical memory retrieval in the mesial temporal (MT) lobe are thought to be fundamental to self-identity processes. Thus, we examined differences in self-identity and autobiographical memory in patients with either MT or non–mesial temporal (NMT) foci with early or late age of habitual seizure onset.

Methods

Participants included 102 adults: 51 healthy individuals and 51 patients with drug-resistant focal seizures (19 MT, 32 NMT). We used the Ego Identity Process Questionnaire to profile the identity development of participants, and examined how this related to memory function assessed using the Autobiographical Memory Test.

Results

Patients and controls had strikingly different self-identity profiles, with early onset MT patients showing the least identity development compared to controls and other patient groups. In contrast, late-onset NMT patients showed the highest level of identity development of the patient groups and closely resembled healthy controls (p < 0.05 for all comparisons). For all MT patients, poor autobiographical memory retrieval was correlated with altered self-identity (p < 0.001). No associations between autobiographical memory and self-identity were evident in the NMT group.

Significance

Self-identity in epilepsy may be modulated by the extent to which seizure foci impinge on the autobiographical memory network and the timing of seizure onset. Early disruption to MT regions of the autobiographical memory network may constitute a neurocognitive mechanism by which self-identity is altered in chronic focal epilepsy.

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Health-related behaviors and comorbidities in people with epilepsy: Changes in the past decade

Epilepsia - Wed, 11/25/2015 - 23:37
Summary Objective

We aimed to explore the patterns of health-related behaviors (HRBs) such as smoking and physical activity in people with epilepsy in the community and examine whether behaviors have changed over the past decade.

Methods

We conducted a repeated cross-sectional study using data from a series of five cycles (2001–2011) of the Canadian Community Health Survey, a national population-based survey. The proportions and odds ratios with 95% confidence intervals for HRBs and comorbidities in people with epilepsy (PWE) compared to respondents without epilepsy were calculated for each survey over the 10-year period, and estimates were examined for changes over time.

Results

The study included 522,722 participants of whom 3,220 (0.6%) had epilepsy. The proportion of PWE who did not participate in physical activity decreased over time (2001 = 17.2%, 2010/2011 = 8.5%), as did the proportion of PWE who smoked cigarettes (2001 = 32.3%, 2010/2011 = 18.0%). PWE had consistently reduced alcohol consumption in comparison to the general population. Fewer than half of participants met the recommended daily guidelines for fruit and vegetable consumption. An apparent reduction in the prevalence of heart disease occurred in PWE (2001 = 11.7%, 2010/2011 = 4.0%), but not in people without epilepsy; however, similar trends were not observed for other cardiovascular comorbidities studied.

Significance

Apparent improvements in smoking cessation and physical activity occurred in PWE. Despite these improvements, physicians should continue to counsel their patients on the importance of healthy lifestyle choices. Further exploration into the reasons for the apparent decrease in the prevalence of heart disease in PWE is warranted.

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New diet provides hope for treating patients with drug resistant epilepsy

Science Daily - Wed, 11/25/2015 - 08:38
A specific diet can be used to help treat patients with uncontrolled epilepsy, a new study indicates. The findings reveal how the ketogenic diet acts to block seizures in patients with drug-resistant epilepsy.
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Focal epileptic seizures linked to abnormalities in 3 main brain regions

Medical News Today - Wed, 11/25/2015 - 05:00
A new study that used functional magnetic resonance imaging (fMRI) and computation pattern analysis to identify differences in regional brain activity between subjects with focal epilepsy and healthy...
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Researchers identify dietary fat that could offer more effective epilepsy treatment

Medical News Today - Wed, 11/25/2015 - 03:00
In a new study, decanoic acid, which forms part of the MCT ketogenic diet, was found to be more effective than current medications in preventing seizures in people with epilepsy.
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