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The Burden of Headaches in People With Epilepsy

Tue, 08/23/2016 - 15:07

The majority of people with epilepsy experience headaches, regardless of their sex or age, according to a study published in Seizure – European Journal of Epilepsy.

Headaches can have an extremely negative impact on quality of life. Their high prevalence in people with epilepsy (shown here) suggests they need to be recognised and managed.

The authors, based at Vilnius University, in Lithuania, write: “Clinicians should recognise headache as a common comorbidity of epilepsy, as it may influence antiepileptic drug choice, and may need specific treatment.”

For the study, the researchers recruited 280 people with epilepsy and asked them to complete a carefully-designed questionnaire. This requested information about various social and demographic factors, their health status, whether or not they experienced headaches and the type of headaches they suffered. An expert neurologist also interviewed the participants.

The results showed that more than 83% of subjects reported some type of headache. Almost 78% of these were inter-ictal (occurring in between seizures) and included: tension-type headaches (39%), migraines (31.7%), headaches caused by medication-overuse (7.8%) and persistent headache attributed to earlier traumatic head injury (16%).

To analyse the burden headaches had on people’s lives, the researchers used a recognised measure called the ‘Headache-Attributed Lost Time (HALT)’ index. They found that more than 40% of the headaches were grade 1 on the index, corresponding to minimal or infrequent impact; approximately 10% were grade 2, corresponding to mild or infrequent impact; almost 15% were grade 3, corresponding to moderate impact; and around 35% were grade 4, corresponding to severe impact.

When they compared their findings with those from an earlier study of the ‘general population’, the team discovered that the frequencies of most types of headache were similar. However, they found migraines to be more common in men with epilepsy than in the general population, and headaches caused by medication overuse to be more common in people with epilepsy than in the general population.

The authors conclude that headaches in epilepsy may need specific treatment and should receive more clinical attention.

Author: Dr Özge Özkaya

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Epilepsy surgery in childhood does not impact on language in the long term

Mon, 08/22/2016 - 03:32

Language skills remain largely unchanged following epilepsy surgery in childhood, according to new research published in the scientific journal Epilepsy and Behaviour.

There have been few investigations into brain function after epilepsy surgery in childhood, and these have largely focused on memory and intelligence rather than language.

During the current study, researchers at the Hospital for Sick Children, in Toronto, recruited 97 children who were being considered for epilepsy surgery. Sixty-one of the 97 subsequently underwent surgery.

Following recruitment, subjects underwent an initial (baseline) assessment of their language skills, using standardised tests of picture naming, vocabulary, letter fluency, understanding and intelligence.  An average of seven years later, the participants (61 of whom had undergone surgery, 36 of whom had not) underwent ‘follow-up’ language assessment with the same types of tests.

The researchers used the data to compare language between a range of population ‘categories’,  e.g. surgical vs non-surgical, pre-surgical vs post- surgical and seizure freedom vs seizure continuation.

The results showed that the language performance of people who underwent surgery and those who didn’t were similar at baseline and at follow-up. This suggests that surgery itself does not have a detrimental effect on language skills in the longer term.

The team found that children who had spent a larger proportion of their lives free of seizures at follow-up generally obtained higher scores in all language tasks. However, interestingly, this was only the case across comparison groups, because at an individual level no significant improvement in language was seen after seizures became controlled. This implies that the effects of uncontrolled seizures may prevent the improvement of language, even once seizures have stopped.

The researchers also found that people who were older at the onset of epilepsy, those who had a higher IQ, and those who attained higher scores at baseline also tended to achieve higher scores at follow-up in all language tasks. People who had a localised, one-sided seizure focus tended to do better in some languages tasks at follow-up.

Identifying the long-term effects of surgery in childhood on cognitive ability is important, because it provides information to doctors, families and people with epilepsy to allow them to make informed decisions about whether or not to pursue epilepsy surgery.

Author: Dr Özge Özkaya

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Grey Matter Loss Differs in Right and Left Temporal Lobe Epilepsy

Fri, 08/19/2016 - 05:22

In people with temporal lobe epilepsy (TLE), grey matter – the darker part of the brain that consists of densely packed nerve cell bodies – becomes reduced in particular areas. A recent study, published in the Journal of Clinical Neurology, has now shown that this decrease is more pronounced in people with right-sided TLE than in those with left-sided TLE.

The research also suggests that the extent of grey matter ‘volume’ reduction is linked to clinical characteristics such as the duration of the person’s condition and the frequency of their seizures.

During the study, the researchers, led by Dr Seung Bong Hong, at Sungkyunkwan University School in South Korea, recruited a total of 60 people with TLE, half left-sided and half right-sided, who had undergone successful epilepsy surgery. They also enrolled 30 age-matched, healthy controls for comparison. The researchers examined the brains of the subjects using magnetic resonance imaging (MRI) and made measurements of their grey matter volume.

The results showed a decrease in grey matter in four structures of the brain in people with left TLE compared with controls. Two of the four structures were only affected on one side of the brain, one was affected on both sides and the other was affected only on the right side.

In subjects with right-sided TLE, grey matter loss was found to affect more brain structures than in those with left-sided TLE, but a large proportion were affected on both sides of the brain.  This meant that grey matter reduction was more extensive in the right-sided TLE group overall.

In people with right-sided TLE, more extensive loss of grey matter was associated with a longer duration of epilepsy, a lower age of onset and more frequent seizures. In those with left-sided TLE, however, it was linked to a lower age of onset and a history of febrile seizures.

The results of this study, which correlate epilepsy pathology with clinical outcomes, suggest that the imaging methods used here may be useful in gaining a deeper understanding of the epileptic networks involved in TLE. This will hopefully lead to better management of the condition.

As the findings were in people who had responded well to epilepsy surgery for previous two years, this work could also contribute to the complex field of surgical assessment in the future.

Author: Dr Özge Özkaya

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‘Sirolimus’ for seizures in tuberous sclerosis complex needs further investigation

Thu, 08/18/2016 - 05:02

According to a recent study, published in the journal Neurology, sirolimus* add-on treatment does not significantly reduce seizure frequency in children with tuberous sclerosis complex (TSC) and drug-resistant epilepsy.

The authors state, however, that due the small size of the study, larger ones are needed to verify this finding.

TSC is a genetic condition that causes tumours to form in different organs, and very often the brain. Here they can cause difficult-to-treat (drug-resistant) seizures, developmental delay, intellectual disability and autism. Previous research has suggested that sirolimus might be effective in reducing seizure frequency in children with TSC and many doctors prescribe it off-label.

During the present study, a team at Erasmus MC, in Rotterdam, recruited 23 children with TSC and drug-resistant epilepsy, aged between one and 11 years. The children were then randomly assigned to one of two groups: 1) in which sirolimus was added to their existing (‘standard’) epilepsy treatment regime immediately, and 2) in which sirolimus was added after six months. The team examined seizure frequency in both groups during the sixth month of sirolimus treatment.

The scientists found that, although sirolimus add-on treatment decreased seizure frequency by an average of 40% compared with standard therapy, this reduction was not ‘statistically significant’ (meaning that the chance that the result could have occurred by chance was too high for it to be conclusive). No change was seen in the children’s cognitive performance (which was also tested) when sirolimus was added to standard therapy.

Adverse side effects associated with sirolimus were also a problem, with five children leaving the trial before it had ended because of these.

However, the number of participants in the study may have been too small for the ‘true’ effects of sirolimus to be detected, particularly as recruitment targets weren’t met. Larger studies are warranted, to properly assess the effects of sirolimus add-on treatment in this population.

*Sirolimus is an inhibitor of a signalling complex called ‘mammalian target of rapamycin complex 1’ (mTORC1). This signalling pathway plays a role in acquired forms of epilepsy and may also be involved in TSC.

Author: Dr Özge Özkaya

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Prolongued status epilepticus is linked to brain wasting

Wed, 08/17/2016 - 06:02

Brain atrophy, or wasting, and re-organisation of neurons occur in the brains of people with super-refractory status epilepticus (SRSE), according to a study published in JAMA Neurology. The research also shows that the severity of brain atrophy is related to the duration of SRSE.

This is the first study to show that brain atrophy occurs even after difficult-to-treat status epilepticus is controlled with anaesthetic drugs.

Dr Sara Hocker, from the Mayo Clinic in Rochester, Minnesota, and co-authors, reported: “In the hours, days, and weeks after prolonged seizures, long-term changes in gene expression” occur. This is accompanied by the chronic rupture of small blood vessels and “results in seizure-induced neuronal death and neuronal reorganization.”

During the study, Dr Hocker and her colleagues reviewed the medical records of people with SRSE who were admitted to Mayo Clinic Hospital between 2001 and 2014.

A total of 42 people with SRSE were admitted during this time period, 19 of whom met the study criteria: to have had an MRI scan within two weeks of the onset of the SRSE and another MRI within six months of the SRSE resolution, with a minimum of one week between scans. All 19 subjects had received anaesthetic agents to control their seizures.

The researchers analysed the participants’ MRI scans, paying particular attention to the area of the ventricles (fluid cavities) compared with the total area of the brain. A ratio of these (ventricular area/total brain area), known as the ventricular-brain ratio, is a common measure of cerebral atrophy or wasting, and a larger ratio suggests a higher degree of wasting.

Looking at the scans in two groups (initial MRI and follow-up MRI), the team found that the  average ventricular-brain ratio amongst the follow-up scans was significantly larger than the average ventricular area amongst the initial scans. This suggests that wasting of brain matter had occurred.

The scientists also discovered that the longer people stayed in hospital and were treated with anaesthetic agents, the more wasting they had in their brain.

Finally, they found that the difference in ventricular-brain ratio was smaller in older people with SRSE, but this was probably due to the fact that the older people already had a larger ventricular-brain ratio at the initial MRI due to their age.

The study was not able to tell whether cerebral atrophy was caused by complications associated with SRSE or the effect of antiepileptic drugs (AEDs).

According to the authors, future studies should focus on which areas of the brain are most affected in SRSE, the association of atrophy with clinical variables, and the influence of atrophy on long-term cognitive function in survivors of SRSE.

SRSE is defined as status epilepticus (or a seizure, or series of seizures lasting for five minutes or more) that continues or recurs 24 hours or more after the onset of anaesthetic therapy.

Author: Dr Özge Özkaya

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Another cannabidiol trial announced, in Israel

Tue, 08/16/2016 - 07:18

Disclaimer: Epilepsy Research UK is completely neutral and is not affiliated with any commercial company, or any particular device/product.

The medical company, MMJ PhytoTech Limited, has recently announced that it will begin a new phase two clinical trial by the end of this year to test the effectiveness of its new drug compound, PTL101, in treating children with drug-resistant epilepsy.

During the trial, PTL101 will be administered in the form of capsules containing organically-derived, highly purified cannabidiol – one of more than 100 active ‘cannabinoids’ identified in cannabis.

In a press release, Andreas Gedeon, Managing Director of MMJ PhytoTech said: “We are very pleased to be commencing the Phase 2 clinical trial of our PTL101 capsules, as it marks another critical milestone in the company’s evolution.”

The trial will take place at a centre in Israel and, at present, there has been no indication from the company as to whether it will extend to other sites across the world. We will keep you informed as and when any information regarding this becomes available.

According to the company, the success of the phase 2 trial will be a major step towards the licensing of PTL101 capsules as a prescription therapy that could benefit children with drug resistant epilepsy around the world.

Approximately one third of people with epilepsy do not respond to existing antiepileptic drugs (AEDs) designed to reduce seizures. Some current AEDs are also very difficult to tolerate, because they cause unwanted side effects such as tiredness and slowed thinking.

Author: Dr Özge Özkaya

Click here for more articles about other treatments for epilepsy.

 

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Pregnant woman with epilepsy should be offered emotional support

Mon, 08/15/2016 - 06:23

Pregnant women and new mothers with epilepsy have reduced life satisfaction, even in societies with high levels of welfare, according to a study published in the scientific journal Epilepsy & Behavior.

The authors therefore suggest: “mothers with epilepsy and their partners should be examined for emotional complaints and partnership satisfaction during and after pregnancy.”

The team of researchers, led by Dr Nils Erik Gilhus, at the University of Bergen, in Norway, analysed more than 100,000 women with and without epilepsy from the Norwegian Mother and Child Cohort Study, during weeks 15-19 of pregnancy and at six and 18 months after birth.

They found that 0.6-0.8% of the women had epilepsy at all three assessment points, and that, compared with those without epilepsy, these women had lower life satisfaction and self-esteem both during and after pregnancy. They also reported lower satisfaction in their relationships and higher levels of work strain during pregnancy, and less general well being and belief in their own abilities 18 months after the birth of their baby.

The authors found that divorce and separation were more common in mothers with epilepsy compared with those without, and that fewer women with epilepsy had a paid job 18 months after giving birth.

Previous work has shown that anxiety about birth and post-natal depression are seen more frequently in women with epilepsy that in those without. Such emotional distresses in pregnant women may have a negative effect on birth outcome. Therefore it is important that women with epilepsy are offered adequate support in order to achieve good emotional health.

Author: Dr Özge Özkaya

Click here to read more stories about living with epilepsy.

 

 

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An exciting advance for the study of epilepsy

Thu, 08/11/2016 - 06:20

Researchers in Singapore have improved the production high quality, functional human inhibitory (‘GABAergic’) neurons in the laboratory, according to a study published in the leading journal Cell.

These neurons can now be used to develop models to study epilepsy, as well as other neurological conditions. They can also be used to screen the effects of antiepileptic drugs (AEDs) without the need to conduct long and complicated clinical trials in people.

In a press release, Senior Author Dr Shawn Je, from Duke-NUS Medical School, said: “Our quick, efficient and easy way to mass produce GABAergic neurons for lab use is a game changer for neuroscience and drug discovery. With increased recognition of the essential role of GABAergic neurons in almost all neurological and psychiatric diseases, we envisage our new method to be widely used to advance research and drug screening.”

So far it has been difficult to obtain a consistent supply of mature and functional GABAergic neurons in the laboratory, because the process involves a number complex stages and requires a long time, usually resulting in poor yield.

To overcome these problems, Dr Je and his team first identified genetic factors involved in GABAergic neurons development in the brain. They then used different combinations of these factors to try and turn human pluripotent stem cells (immature cells that are able to become one of a number of specialised cell types) into GABAergic neurons in just six to eight weeks. Previously, the time required was between 10 and 30 weeks. The efficiency of this new protocol is also dramatically higher than before, with more than 80% of the stem cells successfully becoming GABAergic neurons .

When they transplanted these GABAergic neurons into the brains of mice, the researchers found that they matured and became part of the neuronal circuits in the animals’ brains.

GABAergic (inhibitory) neurons are a specialised type of brain cell that ‘dampen’ the activity of neurons. They work with so called ‘excitatory’ neurons, which activate other neurons, to produce a balance of neuronal activity that allows normal brain function. If GABAergic neurons do not work properly, this balance is disrupted, increasing the risk of neurological conditions such as epilepsy.

Author: Dr Özge Özkaya

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Some AEDs may Induce Psychotic Disorders in a small proportion of People

Tue, 08/09/2016 - 07:16

This article is for awareness and is not intended to raise alarm.

Antiepileptic drugs may induce psychotic disorders in a small minority of people, according to a new study published in the leading journal Brain.

The study also showed, however, that antiepileptic drug-induced psychotic disorder (AIPD) generally has a better outcome than psychotic disorders caused by other factors.

The authors speculate that AIPD could be improved by stopping the causative antiepileptic drug. They state: “If treated properly, the cases with AIPD might have shorter duration of the psychotic episode than other types of psychosis. The timely cessation of the offending drug and avoidance of prescription again would offer protection against further AIPD.”

Professor Patrick Kwan, Chair of Neurology at the University of Melbourne, and his team, analysed the medical records of 2630 people with epilepsy obtained between 1993 and 2015 at the Royal Melbourne Hospital.

They found that 98 people (3.7%) also had psychotic disorders, which in 14 (14.4%) was triggered by the use of antiepileptic drugs. The researchers concluded from this that in approximately 1/7 cases, psychotic disorders seen in people with epilepsy could be induced by the use of AEDs.

Female gender, temporal lobe epilepsy and use of levetiracetam showed significant association with AIPD compared with other types of psychosis. Carbamazepine, on the other hand, was associated with a decreased risk of AIPD (this was the drug mostly used by the group that did not develop AIPD).

It is recognised that people with epilepsy have a higher risk of developing psychiatric problems. The present study suggests that certain antiepileptic drugs might also contribute to this risk.

Psychotic disorders are severe mental disorders characterised by delusions (false believes) and hallucinations (false perceptions). They can be caused by alcohol, some drugs, brain tumours, brain infections and stroke.

Author: Dr Özge Özkaya

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Dystrophin Protein may be a Potential Treatment Target for Epilepsy

Tue, 08/09/2016 - 04:14

The hippocampal form of an essential muscle protein called dystrophin is found in higher levels in people with temporal lobe epilepsy (TLE), according to a new study published in the scientific journal Frontiers in Cellular Neuroscience.

This could be the result of a compensatory mechanism – in response to too much excitation in the brain (hyperexcitation) – that tries to restore the inhibitory balance. Exploring the relationship between the different forms of dystrophin found in the central nervous system and hyperexcitation may highlight a new treatment target for epileptic seizures.

The researchers, led by Dr Johan Vles, at Maastricht University Medical Centre in the Netherlands, took biopsies from the brains of people with TLE and looked at the distribution of the dystrophin protein within them. They compared this to similar samples obtained from deceased donors who did not have epilepsy (controls).

They found that the level of full-length dystrophin in the hippocampus (an important memory structure) was 60% higher in people with TLE than in controls.

The team then looked at the levels of dystrophin in the hippocampus and the cerebellum (which helps regulate muscle activity) of a rat model of TLE, and compared them to control animals; however they saw no differences between the two groups in either region.

Taken together, these results suggest that the increase in dystrophin in TLE is specific to the hippocampus and also unique to human epilepsy. Investigation of the mechanisms behind the increase in hippocampal dystrophin in response to hyperexcitation could lead to new therapies.

Dystrophin is an essential muscle protein and mutations in the dystrophin gene that result in the absence of the protein cause a muscle-wasting condition known as Duchenne muscular dystrophy. In addition to the role it plays in muscle tissue, dystrophin also functions as an anchoring protein within the central nervous system, which explains why Duchenne muscular dystrophy may be accompanied by cognitive and behavioural difficulties and epilepsy.

Author: Dr Özge Özkaya

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Eye Movements Could be Used as a Measure of Epilepsy Progression

Mon, 08/08/2016 - 10:56

Research published in the scientific journal PLOS One suggests that children with epilepsy have irregularities in their pattern of saccadic eye movement. This refers to the fast, jerking movement of the eyes that allows people to scan their environment and build a mental 3D image of it.

According to the authors of the study, these irregularities may be indicative of abnormal development of the cerebral cortex – the outer layer of the brain that plays a role in memory, attention, perception, awareness, thought, language and consciousness – and disrupted communication between different areas of the brain.

These results suggest that it may be beneficial to assess eye movement as part of neuropsychological assessments in people with epilepsy, because it could provide doctors with valuable information about the person’s cognitive function, the progress of their condition and the effectiveness of treatment.

The researchers, led by Dr Trevor Crawford, Reader of Neuropsychology at Lancaster University, analysed the saccadic eye movement of 26 children with epilepsy aged 8 to 18 and compared this to the saccadic eye movement of 48 healthy controls in the same age range.

The team asked the children to look at a fixation point and presented them with a visual target. They then asked the children to make a saccade away from the target (known as antisaccade) or towards the target (known as (prosaccade).

The researchers analysed a number of factors about the subjects’ eye movements, including speed of response, accuracy, error rate and maximum speed of eye movement, and then compared the results of those with epilepsy who were taking  antiepileptic drug (AEDs), those with epilepsy who were not taking AEDs and healthy controls.

They found that children with epilepsy who were taking AEDs had a more variable processing speed, reduced accuracy, increased maximum eye speed and made a greater number of errors.

Younger children with epilepsy who were not taking AEDs showed deficits in realising their own errors (error monitoring), which were related to attention problems that had been reported in them.

Saccadic eye movements can be used to evaluate different aspects of brain function. In epilepsy they could be used to follow how the condition progresses and assess how well an AED works.

Author: Dr Özge Özkaya

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Is it good research? New online tool launched to help people tell good science from bad

Mon, 08/08/2016 - 09:57

News from the University of Glasgow

What’s the difference between good and bad quality research? Why do the findings in one study appear to contradict the results in another? Which piece of expert advice should I really trust?

Although health research appears in the media almost every day, most people find it difficult to know which studies are good quality and which ones are not. At present, only a small section of society, mainly clinicians and researchers, are taught how to critically appraise scientific health evidence.

Now academics behind a new online tool that will help people “ask the right questions” and “understand and evaluate” health research, hope to change that.

Understanding Health Research is a new website that has been created by the MRC/CSO Social and Public Health Sciences Unit (MRC/CSO SPHSU), University of Glasgow, in collaboration with an advisory panel of academics. The site, which is launched today, offers a free, interactive, online service designed to help people better understand complex health research and “go beyond the headlines”.

Designed to be useful for a range of people including patients, carers, students, policymakers, health professionals, researchers and those working in the third sector, the site guides users through the process of understanding health research.

Users are presented with a step-by-step series of questions to answer about the piece of research they are interested in, and given guidance on what these questions mean and why the answers matter to them. The line of questioning varies according to the answers given, and it attempts to raise critical thinking about what to look out for when trying to work out what might be good research – e.g. funding sources, peer review, and ethics – as well as asking about the specific type of research being appraised.

Ultimately the site hopes to further understanding of a piece of published health research, explaining and reinforcing key scientific concepts along the way.

At the end of the process, the user is provided with a summary of their answers so that they can use these to come to their own conclusions about the research they have been looking at.

Dr Shona Hilton, Deputy Director MRC/CSO SPHSU, said: “Understanding Health Research is a tool that can really help people to ask the right questions to understand and evaluate research studies.

“Without the tools to assess contradictory health messages and claims about new discoveries and treatments, the public are vulnerable to false hope, emotional distress, financial exploitation and serious health risks.”

With an increasing focus on ‘open access’ publishing in science, scientific health research is easier to access than ever, but the content of research remains largely inaccessible to people without scientific training.

The Understanding Health Research site also provides succinct, Plain English introductions to complex scientific concepts and links to resources that help promote health literacy.

Dr David Ogilvie, MRC Epidemiology Unit, University of Cambridge, said: “More and more scientific papers are out there on the internet, freely available for anyone to read. But providing access to papers is not the same thing as making research accessible to people.

“Tools like Understanding Health Research can help make science more democratic and more useful by making it easier for people to engage with it, whether they work with health evidence in their jobs or are just interested citizens.”

Charity Sense about Science (http://www.senseaboutscience.org/) is supporting the promotion of this resource as part of its Ask for Evidence campaign (www.askforevidence.org).

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New Trial of Cannabidiol Gel to Treat Epilepsy

Mon, 08/08/2016 - 09:22

Please note that Epilepsy Research UK does not endorse/promote individual epilepsy treatments or pharmaceutical companies.

Zynerba Pharmaceuticals, a US-based pharmaceutical company, has ‘dosed’ the first participant in its STAR1 clinical trial, which aims to evaluate the safety and effectiveness of a cannabidiol gel called ZYN002 in adults with refractory focal epilepsy.

Armando Anido, Chairman and Chief Executive Officer of Zynerba Pharmaceuticals, said in a press release: “The dosing of the first patients in the STAR 1 clinical trial in adults with refractory epilepsy is a significant milestone for the company.” He added: “We are pleased by the pace of the clinical program for ZYN002.”

The randomised phase two clinical trial aims to recruit 180 adults with refractory, or drug resistant, epilepsy. Following an eight-week baseline period to assess their seizure types and frequencies, the participants will receive one of two different doses of the drug, or an identical looking placebo, every 12 hours for 12 weeks.

Researchers will evaluate the change in the participants’ seizure frequency over the 12-week period of treatment. The first results from the trial are expected in the first half of 2017.

The study is currently being conducted in Australia and New Zealand and there are currently no sites in the UK recruiting participants; however any results arising from this trial may also be beneficial for people in the UK.

Previous research has shown that cannabidiol treatment may be beneficial in reducing seizure frequency in people with drug-resistant epilepsy. The ZYN002 gel is a synthetic cannabidiol designed to be transmitted through patches on the skin in a consistent and controlled way. As the drug is absorbed through the skin directly, it does not go through the gastrointestinal system and is not degraded by stomach acids. In addition, liver metabolism is avoided, potentially allowing lower doses of the drug to be used to obtain a beneficial effect.

Click here for more articles about anti-epileptic drugs and pregnancy risks.

 

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Care for children with epilepsy should be mindful of accompanying disorders

Fri, 08/05/2016 - 02:59

Almost 80% of children with epilepsy also have an accompanying disorder, known as a comorbidity, according to a new study published in the scientific journal Pediatrics. This highlights the importance of a comprehensive approach to care.

The authors state: “The management should not only focus on the epileptic seizures, but should also include thorough assessments of all aspects of health, including development, psychiatric symptoms, nutrition, growth, and sleep.”

The researchers, led by Dr Richard Chin, at the University of Edinburgh, analysed data obtained between 2008 and 2013 for more than one million children born in Norway between 1996 and 2013. They divided the children into three groups: those with ‘complicated’ epilepsy (who also had accompanying medical/neurological/developmental disorders (comorbidities)), those with ‘uncomplicated’ epilepsy (who had no additional disorders) and those without epilepsy.

They found that, of these children, 0.6% had epilepsy and, of these, approximately 80% also had at least one comorbidity.

The team found that children with epilepsies that were difficult to treat, or worsened/evolved, had higher rates of comorbidity than both children with ‘easier to treat’ epilepsies and children without epilepsy. However, the rate of comorbidity was still high in children whose epilepsy was easier to manage.

The prevalence of all medical conditions was higher in children with epilepsy and almost 50% of the children with epilepsy had developmental or psychiatric difficulties. This figure was less than 10% for the general population.

Children with epilepsy are known to be at higher risk of other neurological disorders such as intellectual disability and autism, as well as developmental and psychiatric conditions. The present study is one of few nationwide studies assessing a broad range of medical conditions in children with epilepsy.

Author: Dr Özge Özkaya

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Study links ‘new’ genetic mutation to an increased risk of SUDEP

Wed, 08/03/2016 - 06:13

A mutation in a gene called RyR2 may increase the risk of sudden unexpected death in epilepsy (SUDEP), according to a new study published in the leading scientific journal Proceedings of the National Academy of Sciences (PNAS).

The authors believe that this is an important step towards being able to predict the risk of SUDEP in a person with epilepsy and take necessary measures to avoid it.

In a press release, Senior Author Dr Jeffrey L. Noebels, from the Baylor College of Medicine in Houston, said: “We have been looking for genes that cause epilepsy to see if any of them might give us a clue as to who might be at risk (of SUDEP). Specifically, we have been looking at genes that might explain what appears to be a collapse of the cardiac and respiratory system after a seizure.”

Dr Noebels and his team have identified mutations in several genes expressed* in the brain and heart that cause an abnormal heartbeat and epilepsy in rodents. Most recently, they have shown that a mutation in the RyR2 gene causes both heart problems and seizures in mice.

The Ryr2 (or ryanodine receptor 2) gene encodes a protein that plays a role in regulating the level of calcium inside cells. Calcium levels inside neurons influence their communication by mediating the amount of neurotransmitter that is released from them. The mutation in the Ryr2 gene causes the amount of calcium inside cells to be higher than normal, resulting in the amount of neurotransmitter released from neurons to be too high. This triggers seizures.

The authors found that it was much easier to experimentally trigger blackouts in the brainstem of mice carrying a mutation in the Ryr2 gene than in mice that did not have the mutation. Mice that had these blackouts in the brain stem, where breathing and heart function are regulated, were prone to sudden death.

Approximately 6% of people with epilepsy have a higher than usual incidence of SUDEP, and SUDEP is the most common cause of premature death in people with epilepsy.

The term ‘gene expression’ refers to the process by which information from a gene is used to create a functioning gene product, very often a protein.

Author: Dr Özge Özkaya

Click here to read more stories about living with epilepsy.

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Rare Heart Condition May Increase Risk of Seizures in Epilepsy

Tue, 08/02/2016 - 10:55

There may be a link between a rare heart condition known as long QT syndrome (LQTS) and a risk of having epileptic seizures, according to a study published in the scientific journal Neurology. This means that by screening for the genes that cause LQTS, clinicians could potentially predict someone’s risk of seizures.

The study authors say that this is an example of how ‘looking outside the classic organ of interest’ can sometimes be helpful in tackling a certain condition.

In a press release, First Author Dr David Auerbach, Senior Instructor of Medicine at the University of Rochester Medical Center, said: “You could begin applying these findings today by telling physicians treating LQTS patients to look outside the heart.”

Using the Rochester-based LQTS patient registry, which contains information about more than 18,000 people with LQTS and their family members, the researchers analysed 965 people with three different LQTS-causing mutations, and 936 people without any LQTS mutations.

They found that all of the LQTS mutations were associated with similar heart rhythm characteristics, but very different seizure frequencies. Seizures were a lot more common in people with LQT1 or LQT2 mutations than in those with LQT3 or no mutation, and people with LQT2 were at greatest risk of having seizures.

When the researchers looked into the LQTS-causing genes in more detail, they saw that the risk of seizures, and of heart arrhythmias (abnormal heart rhythms), was influenced by the specific location of the mutation on the genes. For example, in some cases a mutation in a certain location increased the risk of seizures and arrhythmias, but the same mutation on the same gene but in a different location decreased the risk.

LTQS is a rare genetic condition in which repolarisation of the heart is delayed after a heartbeat, resulting in fainting and sometimes even sudden death. Mutations in three different genes are associated with LQTS: KCNQ1 (LQT1), KCNH2 (LQT2), and SCN5A(LQT3).

Author: Dr Özge Özkaya

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New Virtual Brain Could Help People with Epilepsy

Tue, 08/02/2016 - 06:30

Researchers at Aix-Marseille University and Assistance Publique des Hôpitaux de Marseille (APHM) have developed an exciting new model of ‘personalised’ brain networks, based on information obtained in a non-invasive way. The work is published in the journal NeuroImage.

The team hopes to be able to use this model, known as the Virtual Epileptic Patient (VEP), to predict how seizures occur in individuals and develop new, personalised therapies.

The researchers, led by Professor Fabrice Bartolomei, took recordings from the brain of a 41-year-old woman with bitemporal epilepsy (on both sides) and, using computer imaging and mathematical modelling, made a virtual reconstruction of her brain. They are using this as a “template” and are adding information about the organisation of the brain in different individuals onto it.

The virtual brain can be used to test mathematical models of brain activity, and it will hopefully allow scientists to reproduce the seizure focus in individuals (the area in the brain where seizures arise), in order to gain important information about how seizures start and spread. Moreover, it will potentially help surgeons decide where in the brain to operate, and allow them to trial different surgical procedures in a virtual way to find out which will offer the best outcome.

According to a press release, the team is now developing trials to demonstrate the value of the virtual brain in clinical applications. The long-term aim is to use the VEP to predict the effects of different antiepileptic drugs on an individual’s brain and be able to administer a treatment that will give the best outcome for that person (personalised medicine).

Approximately 1% of the world’s population has epilepsy, but the condition affects each person in a different way. The ability to map epileptic activity in individual brains will help scientists develop new, more effective treatment strategies.

Author: Dr Özge Özkaya

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People with Epilepsy Find it Easier to Understand Positive Emotions than Negative Emotions

Tue, 08/02/2016 - 05:44

People with epilepsy may have difficulties with certain aspects of social cognition, and especially with identifying negative emotional states such as sarcasm and insincerity, according a study published in the scientific journal Epilepsia.

The research also showed that the age of epilepsy onset can significantly impact on social cognition, with more marked effects arising when onset is during periods of significant social development in childhood and adolescence.

These findings are important because they imply that, even though a person’s performance in standard generalised cognitive assessments gives a good indication of their basic social cognitive ability, it does not reveal as much about their level of advanced social cognition. This suggests that current generalised measures may not be as useful as once thought for standard neuropsychological assessment.

For the study, a team led by Dr Robert Roth, Associate Professor of Psychiatry at Geisel School of Medicine in Dartmouth, assessed social cognition in 43 people with focal epilepsy and 22 healthy controls. They used a dynamic video-based instrument called “The Awareness of Social Inference Test”, which accurately models real-world social situations.

During the test, the researchers asked participants to watch short videos of people interacting and answer questions about what they believe was occurring.

The results showed that people with epilepsy had no difficulty identifying positive emotions, for example happiness, but that they found it more difficult than controls to pinpointing negative emotions such as anger, fear and disgust. Moreover, people with epilepsy had no problem identifying sincere exchanges, but they were less adept than controls at telling when exchanges were insincere or sarcastic.

An awareness of these traits is important, and it may help prevent some people with epilepsy from being vulnerable in certain social situations.

Social cognition is a group of strategies that people use to process, store and apply information about other people and social situations in order to make sense of the social world. The main social cognitive skill is the ability to understand and react to the mental state of others. Other social cognitive skills include attachment formation, social communication, self-understanding and perception of others.

Author: Dr Özge Özkaya

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New Guidance on Epilepsy care for people who are Homeless

Wed, 07/27/2016 - 04:49

The Queen’s Nursing Institute (QNI), in London, has published guidance for community nurses to help them support homeless people who have epilepsy.

The guidance, entitled Working with Epilepsy and Homelessness: Guidance for Community Nurses, was produced by ten epilepsy specialist nurses in collaboration with ten specialist homeless health professionals.

In a press release, David Parker-Radford, Homeless Health Project Manager at the QNI said: “Epilepsy diagnosis and ongoing treatment can be complex and require multiple health appointments and tests. This means it is even more vital that epilepsy services find proactive ways to reach vulnerable high-risk people, including those who may not be registered with a GP.”

He added: “All people living with epilepsy have the right to excellent care and treatment – not only those with stable support and housing.”

The 12-page long guidance comprises background information about the causes of epilepsy, the different types of seizures, and available treatments.

It also details the needs of homeless people, their particular risk factors and the practicalities of living with epilepsy if homeless.

Finally, it gives advice for nurses about first aid, supporting homeless people with epilepsy and coordinating their care.

The benefits of the guidance are two-fold. First, it offers knowledge to community nurses about epilepsy therefore allowing them to be more confident when supporting these people. Second, it allows epilepsy professionals to have a greater understanding of the risks and realities associated with homelessness.

The guidance was produced in response to evidence suggesting that homeless people are significantly more likely to have or develop epilepsy than the general population.

Author: Dr Özge Özkaya

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ERUK final report: A new technique to improve the diagnosis and treatment of epilepsy

Tue, 07/26/2016 - 06:54

Background

Electroencephalography (EEG) is widely used in the diagnosis of epilepsy, but it relies on a person having a seizure whilst being monitored. This can lead to delays in diagnosis and treatment, unnecessary anxiety and reduced quality of life.

To try and address this problem, Professor John Terry, at the University of Exeter, has been working alongside neurologists in London to develop computer models that can detect ‘hidden’ information within brain networks, in short resting EEG recordings (during which no seizure has taken place), and accurately identify whether or not a person has generalised epilepsy.

The study

In 2012, Professor Terry and his team were awarded £139,595 to refine their models and find out whether they could:

  1. differentiate more accurately between people with and without generalised epilepsy.
  2. distinguish, based on differences in brain network properties, between people with focal and generalised epilepsy.
  3. identify, based the activity of neuronal networks, people who have responded to antiepileptic drug (AED) treatment and those who have not.

If successful, the models would have real potential  to enhance the diagnosis of epilepsy, and perhaps even allow neurologists to predict a) whether or not a person would respond to an AED, and b) what the best AED treatment for a person might be, thus reducing the time to optimal therapy.

This grant has now come to an end and the final report has been submitted.

Results

With regards to aims one and two above, the findings are extremely encouraging. The researchers now have a model that can distinguish with considerable accuracy, from resting EEG recordings, groups of people with generalised epilepsy from healthy controls (who do not have epilepsy). Professor Terry reports that in a test of 30 people with epilepsy and 38 without epilepsy, the model had a misdiagnosis rate of less than 5%. This is highly significant, and the team has already been exploring how they might incorporate the model into a clinical device. On the advice of feedback from commercial companies, they intend to develop a working prototype in the near future.

In terms of differentiating between people with focal and generalised epilepsy, the preliminary data obtained through this grant suggest that this should indeed be possible using computer network modelling. Professor Terry was awarded another ERUK project grant in 2015 to progress these findings and we look forward to hearing the outcome.

For a number of reasons, mainly an unexpected lack of viable resting EEG data from before and after AED treatment, it wasn’t possible to make a lot of progress on aim three. However, there has been significant follow-on funding generated from this grant, particularly from EPSRC, which will enable the team to carry out this research.

Significance

This grant has further highlighted the potential of computer models as clinical tools for the diagnosis and management of epilepsy. There is a lot more work to be done to establish their full potential, but the funding is in place and the preliminary evidence is encouraging. We are very excited about this work, as it stands to make a real difference to people’s treatment journeys and quality of life.

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