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Restless Leg Syndrome Could Be an Early Sign of a Seizure

Mon, 01/23/2017 - 10:54

Restless leg syndrome (RLS) or the urge to move the legs, is more common in people with epilepsy than the general public, according to a study published in the scientific journal Epilepsy and Behavior. The authors suggest that the syndrome could in fact be an early warning indicator for seizures.

The study also showed that RLS seems to occur more often in people with right temporal lobe epilepsy than in those with left temporal lobe epilepsy. This means that the presence of RLS could help doctors predict which the side of the brain is responsible for the epilepsy in some patients.

For the study, researchers led by Dr Paul Carney, a child neurologist at the University of North Carolina, screened epilepsy patients seen at an outpatient clinic between 2005 and 2015 for movement disorders. They evaluated the patients using the International Restless Legs Study Group questionnaire and the NIH RLS diagnostic criteria. They also measured iron levels in their blood, since a low level of iron is a risk factor for RLS, and performed a polysomnography, which is a comprehensive sleep-screening technique.

Almost 100 patients seen in the clinic in this period of time had focal-onset temporal lobe epilepsy. Half of these had right-sided temporal lobe epilepsy and half had left-sided temporal epilepsy. The results showed that moderate-to-severe RLS occurred in 21 of 50 (42%) people with right temporal lobe epilepsy and in 7 of 48 (15%) people with left temporal lobe epilepsy.

The researchers calculated that people who had right temporal lobe epilepsy were more than four times as likely to have RLS as those with left temporal lobe epilepsy. Interestingly, some patients experienced a sensation of worsening RLS before seizures. This is important because it could provide doctors with the opportunity to intervene at an earlier stage before a seizure develops.

RLS, also known as the Willis-Ekbom disease, is a disorder of the nervous system occurring in around 10% of the general population. Although scientists don’t know its exact cause, they think that it could be due to an imbalance in dopamine in the brain, a chemical that sends messages to control muscle movement.

Author: Dr Özge Özkaya

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AED Adherence Could Improve Quality of Life and Sexual Functioning in Women with Epilepsy

Mon, 01/23/2017 - 05:00

Adhering to antiepileptic drugs (AEDs) improves seizure control but can also enhance quality of life and sexual functioning in women with epilepsy, according to a study published in the journal Epilepsy and Behavior.

“Healthcare providers should be aware of these additional benefits of medication adherence and use these arguments to encourage female patients to take their medication, which can eventually increase their sexual satisfaction and overall [quality of life],” wrote Dr Chung-Ying Lin and the co-authors of the study.

The team assessed quality of life and sexual functioning in 576 Iranian women with epilepsy using the Quality of Life in Epilepsy questionnaire and the Female Sexual Function Index respectively. They also measured epilepsy severity using the Liverpool Seizure Severity Scale and medication adherence both subjectively (using the Medication Adherence Report Scale) and objectively (by measuring drugs levels in the participants’ blood).

The results showed a positive correlation between scores from the Medical Adherence Report Scale and those from the Quality of Life in Epilepsy questionnaire.  In other words, greater adherence with medication was associated with improved quality of life. Medication adherence scores were also correlated with overall sexual functioning, and, in turn, improved sexual functioning was associated with improvements in quality of life.

The researchers recognised that there is a complex relationship between medication adherence, seizure control, quality of life, and sexual functioning. Nevertheless, their results indicate that the benefits of AED adherence extend beyond reduction of seizures into other aspects of well-being.

Sexuality is an important component of quality of life. It is estimated that around 20-30% of women with epilepsy experience some form of sexual dysfunction such as decreased sex drive or problems with arousal and infrequent orgasms. Factors that may influence sexual functioning in epilepsy include anxiety, stigmatization, and epileptic activity in the brain.

Author: Dr Özge Özkaya

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PAR1 Involved in Regulating Anxiety-Related Behaviour

Sat, 01/21/2017 - 05:00

A major receptor found in the brain called PAR1 is involved in the regulation of anxiety-related behaviour, suggests a recent study, published in the journal Epilepsy and Behavior.

The study used an animal model of temporal lobe epilepsy (TLE), the most common type of focal epilepsy in adults, which is often associated with psychiatric complications such as depression and anxiety. However, the mechanism of anxiety-related deficits in people with epilepsy are unclear.

The findings are important because they suggest that PAR1-dependent signalling may be associated with emotional disorders in people with epilepsy and that targeting PAR1 signalling might open a new therapeutic avenue to help prevent cognitive problems related to anxiety in TLE.

The research, led by Dr Elena Isaeva at Bogomoletz Institute of Physiology in Kiev, Ukraine, involved inducing epilepsy in rats, which led to a decrease in anxiety-related behaviour of the animals and an increase in their general activity.

When the researchers blocked PAR1 shortly after inducing epilepsy, they saw that the normal anxiety-related behaviour of the animals was restored but the increase in their activity remained unchanged. In rats with epilepsy, blocking PAR1 had a less pronounced effect on memory recall than in control rats and also showed a modest beneficial effect on learning.

The team concluded that PAR1 inhibition in the normal brain is harmful whereas blocking PAR1 in animals with epilepsy may be therapeutic.

“The present study shows for the first time ……. the involvement of PAR1 in the regulation of anxiety-related behaviour”, the researchers wrote.

PAR1, or protease-activated receptor 1, is involved in behaviour and memory formation. It is expressed in areas of the brain that are important for processing emotional reactions and is implicated in the regulation of emotionally-motivated learning.

Author: Dr Özge Özkaya

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Guidelines Comparing Assessment Techniques Prior to Epilepsy Surgery Published

Fri, 01/20/2017 - 05:00

The American Academy of Neurology (AAN) has published new guidelines on mapping of the brain prior to epilepsy surgery, following a systematic review of available evidence.

The guidelines were published in the academy’s journal Neurology and compared results of functional magnetic resonance imaging (fMRI), a type of scan that assesses brain activity by measuring blood flow, with data obtained from the more commonly used intracarotid amobarbital procedure (or Wada test), where a drug called sodium amytal is injected into the main artery in the neck (called the carotid artery) to put one side of the brain to sleep.

Both procedures are aimed at locating brain regions involved in language and memory, to ensure that they are not affected by epilepsy surgery. Unlike the Wada test, which is an invasive method causing discomfort and has risks associated with it, fMRI is non-invasive and considered safe.

The principal author of the guidelines, Dr Jerzy Szaflarski, a neurologist at the University of Alabama, said in a press release: “Because fMRI is becoming more widely available, we wanted to see how it compares to the Wada test. While the risks associated with the Wada test are rare, they can be serious, including stroke and injury to the carotid artery.”

The researchers suggest that fMRI could be used as an alternative to the Wada test. However, it is difficult to generalise the recommendations to the wider population of people with epilepsy because much of the evidence in the review came from studies that recruited small numbers of patients with similar types of epilepsy from a single institution only.

According to Dr Szaflarski larger studies are needed to increase the quality of the evidence that is available. “Doctors should carefully advise patients of the risks and benefits of fMRI versus the Wada test,” he added.

Epilepsy surgery is an option for some people with epilepsy who do not respond to treatment with antiepileptic drugs. The seizure focus (the area of the brain where seizures are generated) may be removed or the spread of seizure activity may be reduced using different surgical techniques.

Author: Dr Özge Özkaya

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Testing of a Modified Antiepileptic Drug in Healthy Volunteers Completed

Thu, 01/19/2017 - 05:00

Adamas, a pharmaceutical company based in California, has announced the completion of a Phase1 clinical trial testing the drug candidate ADS-4101 for the treatment of partial onset seizures.

ADS-4101 is a new version of the existing antiepileptic drug (AED) lacosamide (Vimpat®) that is already approved by the US Food and Drug Administration (FDA) and the European Medicine Agency (EMA). However ADS-4101 is designed to be taken once a day unlike Vimpat, which is usually taken twice a day. It is specially manufactured in an effort to improve seizure control when it is most needed and limit side effects at other times.

“With our confirmed understanding that epileptic seizures primarily occur during the day, we are developing ADS-4101 to deliver high concentrations of medicine during the day when seizures occur,” said Dr Gregory Went, the chairman and chief executive officer of Adamas Pharmaceuticals, in a press release. “We believe ADS-4101’s promising profile may potentially provide a clinically meaningful benefit to patients with epilepsy.”

The trial compared the safety, tolerability, and properties of four different versions of ADS-4101 in 24 healthy volunteers and compared them with lacosamide. According to the company, the best version will then be tested in further clinical trials. “We are encouraged by the results of this Phase 1 clinical trial in ADS-4101 and look forward to advancing the program in 2017,” Went said.

Dr Graeme Sills, chairman of the Board of Trustees of Epilepsy Research UK and Senior Lecturer in Pharmacology at the University of Liverpool, suggested that this report should be considered cautiously. “This is a very interesting concept but much more research is required before we can assess whether it will deliver genuine benefits for people with epilepsy whose seizures are not adequately controlled by existing drugs” he said.

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

Author: Dr Özge Özkaya

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Get active for research!

Wed, 01/18/2017 - 11:37

This year  once again brings a fantastic events calendar with lots of exciting sporting events and challenges to get involved in! Proudly wear your green ERUK colours and make 2017 our best year yet!

Join Team ERUK
No matter what your ability there is something for everyone.  Whether a 5K Fun Run, Sponsored Walk, Marathon or Cycle event there is loads to choose from, in all locations around the UK. If you’re feeling particularly brave why not sign up for a Parachute Jump too!  Details of all the events we have places in can be found in our Event Pages.

Already have your own place?  If you have your own place we would love you to join our team!  There is no minimum sponsorship for own place runners, just email Jo to let us know you have your place and receive your fundraising pack.

Volunteer?
Not able to run? How about volunteering to join our cheering squad for Team ERUK and help them reach the finish line! Contact Jo on 020 8747 5024  or jo@eruk.org.uk for details.

Every pound raised will help us to increase the amount of research we can fund and we really hope to have the biggest running team we’ve ever had out in force throughout 2017!

Jo Finnerty, Events Fundraiser says, “2016 brought some fantastic fundraisers, with Epilepsy Research UK being the Official Charity for the British 10K in July a particular highlight.  Everyone who took part last year went to great lengths to raise awareness for epilepsy and madesponsorship to help boost the research that we can fund. It was a fantastic year!!  I’m really looking forward to 2017  and supporting all those who are out flying the flag for Team ERUK. Each and every one of whom is helping us transform the lives of people with epilepsy and we’re so grateful for their support.”

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Common and Rare Epilepsies Share Genetic Mutations

Wed, 01/18/2017 - 08:02

Several genes previously thought to be associated with only rare types of epilepsy seen in children are also involved in more common types of the condition, according to a study published in the scientific journal The Lancet Neurology.

This finding suggests that therapeutic approaches, which target the precise genetic cause of epilepsy and which are used to tackle rare forms of the condition may also be helpful in treating its more common forms.

“This is a very exciting breakthrough in the treatment of epilepsy, in which current treatment is based on whether a child has focal seizures, which begin in one area of the brain, or generalized seizures,” said Dr James Riviello, Chief of Child Neurology at Columbia University, New York, in a press release. “Genetic testing for epilepsy may allow us to identify the specific anticonvulsant medication that potentially works best for an individual patient. We have already identified children in whom knowing the underlying genetic basis of the epilepsy has guided our treatment choices.”

The study involved the comparison of all protein coding genes from 1,140 people with one of two common types of epilepsy – genetic generalised epilepsy and non-acquired focal epilepsy – with those from 3,877 people without epilepsy.

The researchers found that some people with non-acquired focal epilepsy had significantly more mutations in five specific genes that were previously thought to be associated with rare forms of the condition only. They estimated that these five genes contribute to epilepsy risk in approximately eight percent of people with this common form of the condition. A similar pattern was observed for genetic generalised epilepsy.

According to the authors, as more genes associated with a wide range of epilepsies are identified, more treatments that are targeted to an individual’s genetic subtype can be developed. In the future, with more samples being analysed, the researchers are hoping to find additional genetic variations that contribute to common epilepsies.

The research was coordinated by the Epi4K collaboration, an international consortium of doctors and scientists from around the world. The study was funded in part by Epilepsy Research UK and several UK researchers were involved, including Prof Mark Rees and Dr Graeme Sills, who are both trustees of Epilepsy Research UK.

Author: Dr Özge Özkaya

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People with Drug Resistant Nonlesional Neocortical Epilepsy Could Benefit from Brain Surgery

Tue, 01/10/2017 - 08:14

People with nonlesional neocortical epilepsy could benefit from brain surgery and become seizure-free in the long term according to a study published in the scientific journal JAMA Neurology.

Dr Dong Wook Kim and colleagues explored factors that might help select people with nonlesional neocortical epilepsy who are most likely to benefit from surgery. The researchers analysed data from 109 people, aged seven to 56,with drug resistant neocortical epilepsy (which arises from the surface of the brain), and who attended Seoul National University Hospital in South Korea between 1995 and 2005.

All of the patients had failed to respond to treatment with at least two antiepileptic drugs (AEDs) but none had abnormalities or lesions in the brain identifiable by MRI (hence “nonlesional”). Nevertheless, all of the patients underwent surgery to remove the part of the brain that their doctors believed to be responsible for their seizures.

One year after surgery, 59 of the 109 patients (54%) were completely free from seizures and a further 37 patients (34%)had notable reductions in seizure frequencybut without achieving complete remission.

All of the patients, except one, were then followed up clinically for at least 10 years, and some for as long as 21 years after surgery. A total of 64 patients (59.3%) were seizure-free and 33 patients (30.6%) had a lower seizure frequency at their last clinical follow-up, suggesting that the effectiveness of surgery was maintained in the longer-term.

Although the chance of achieving seizure freedom was lower than would be expected for people with mesial temporal lobe epilepsy or lesional neocortical epilepsy, according to the authors “it was notable that nearly 90% of patients benefited from resection surgery for nonlesional neocortical epilepsy.”

People with nonlesional neocortical epilepsy are not usually considered optimal candidates for surgery, but recent studies have shown that a greater proportion of people with this type of epilepsy are being offered surgical intervention. This study supports the benefits of surgery in those patients but further research is needed to confirm the results presented here.

Author: Dr Özge Özkaya

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Nasal Spray to Treat Cluster Seizures Gets Fast-Track Designation from the FDA

Tue, 01/10/2017 - 08:06

The pharmaceutical company Neurelis Inc. recently announced that the US Food and Drug Administration (FDA) has granted fast-track designation for NRL-1, a special formulation of diazepam, for the treatment of epilepsies that are characterised by clusters of seizures. This means that the new formulation could become available more quickly.

“We are very excited to have received Fast Track Designation status with the FDA,” said Craig Chambliss, President and Chief Executive Officer of Neurelis, in a press release.  “We are looking forward to working with the FDA as we complete our clinical development work….. and prepare for the commercialization of NRL-1.  We are focused on providing epilepsy patients and health care providers with an effective, well-tolerated, and user-friendly product for the treatment of acute repetitive or cluster seizures.”

Diazepam is a drug used to treat anxiety, alcohol withdrawal, muscle spasms, and some types of seizures. NRL-1 is a diazepam nasal spray, which is being developed for the treatment of children and adults with epilepsy who require recurrent use of the drug to control bouts of acute repetitive seizure activity, also known as cluster seizures.

Previous clinical studies have shown that NRL-1 is generally safe and well tolerated and that there is little variability from dose to dose. The new formulation is in its final stage of clinical testing, after which the company will submit a New Drug Application (NDA) to the FDA requesting marketing authorisation for NLR-1. The company says that they plan to market NRL-1 worldwide.

For many years, the only treatment option for people with cluster seizures was to administer diazepam rectally, which was challenging under some circumstances. That changed with licensing of buccal midazolam in the UK in 2011. It is hoped that NRL-1 will offer a further treatment option for people with cluster seizures and allow the delivery of a therapeutic dose of diazepamvia a nasal spray rapidly and easily in many settings.

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

Author: Dr Özge Özkaya

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ADHD Drug Could Improve Brain Function in People with Epilepsy

Thu, 01/05/2017 - 11:02

Methylphenidate (MPH), a drug used for the treatment of attention deficit and hyperactivity disorder (ADHD), could improve cognitive problems in people with epilepsy, according to a study published in the scientific journal Neurology.

This suggestion is based on the results of a clinical trial that included 35 adults with epilepsy aged between 20 and 62 years, who had long-standing cognitive complaints, including poor attention and memory. The trial compared the effect of MPH, given in divided doses one week apart, with an identical looking dummy pill. Neither the participants nor the doctors knew who was getting the drug and who was getting the dummy until the trial had ended.

A total of 31 participants completed the trial, of whom 24 had focal epilepsy, six had generalised epilepsy and one had unclassified epilepsy. The average duration of epilepsy among the participants was 12.5 years with an average frequency of 2.8 seizures per month.

The research was led by Dr Kimford Meador, from Stanford University Medical Center in California, and evaluated cognitive function using three different tests. These were the Medical College of Georgia Paragraph Memory Test, the Conners Continuous Performance Test, which assesses attention and vigilance, and the Symbol-Digit Modalities Test, which measures general brain dysfunction. Seizure frequency and adverse effects of MPH were also monitored.

Overall, MPH treatment resulted in a significant improvement in cognitive performance. No change in seizure frequency was observed in any of the participants and only three people withdrew from the trial due to adverse effects. These included “fogginess” in thinking ability, anxiety and agitation, and tachycardia (fast heart rate while at rest).

The authors concluded that MPH may be effective in improving cognitive deficits in people with epilepsy, but they advised that additional studies are needed to confirm this finding.

Author: Dr Özge Özkaya

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Gene Associated with Bipolar Disorder also Linked to Epilepsy

Thu, 01/05/2017 - 05:36

A gene called ANK3, which is associated with bipolar disorder (formerly known as manic depression) could also be linked to epilepsy, according to a study published in the scientific journal Molecular Psychology.

This new finding means that ANK3 could be targeted and opens new potential avenues for the treatment of epilepsy.

Research led by Dr Edward Cooper, at Baylor College of Medicine in Houston, Texas, has shown that reduced expression of one variant of the ANK3 gene causes an imbalance between nerve cell excitation and inhibition.

The team found that a protein encoded by a variant of the ANK3 gene, which is reduced in people with bipolar disorder, is selectively lost from inhibitory neurons, or neurons that block firing, meaning that the excitation/inhibition balance is shifted towards excessive excitation.

In a press release from Baylor, Dr Cooper said: “We found that reduced expression of one type of ANK3 removes a brake on the output of brain neurons, leading to excesses in firing in circuits for emotions, memory and epilepsy”.

In order to test the effect of this imbalance, researchers created a mouse model lacking the inhibitory form of the ANK3 gene. They found that the animals had frequent epileptic seizures and a high risk of sudden death.

“This showed us that imbalance in ANK3 function can result not only in excessive circuit sensitivity and output leading to bipolar disorder, but also severe epilepsy,” Dr Cooper said.

Dr Cooper and his team discovered, around ten years ago, that ANK3 interacts with two other genes that are mutated in some people with epilepsy. Soon after, genetic testing on a large number of psychiatric patients across the world revealed that ANK3 is linked to bipolar disorder but the connection with epilepsy remained unclear. Through this work the connection between ANK3 and epilepsy has been unravelled for the first time.

Author: Dr Özge Özkaya

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Continuous EEG Recording Could Help Doctors Identify People Most at Risk of Developing Seizures

Tue, 01/03/2017 - 09:02

Continuous electroencephalographic (EEG) monitoring and a detailed interpretation of the data obtained from such monitoring could help doctors classify patients according to their risk of having seizures, according to a study published in the medical journal JAMA Neurology. This knowledge could help them make better clinical decisions such as treating those at higher risk of seizures with more aggressive treatment approaches.

In order to identify the specific characteristics of periodic and rhythmic EEG patterns they may be associated with an increased risk of seizures, Dr Andres Rodriguez Ruiz, of Emory University School of Medicine, and colleagues, reviewed EEG recordings from 4772 critically ill adults. The recordings were taken at Brigham and Women’s Hospital, Yale University Hospital, and Emory University Hospital between February 2013 and September 2015 and corresponded to 5742 sessions averaging 12 hours each. Epileptic seizures occurred during 719 sessions and in 530 of these (74%) periodic/rhythmic patterns were also recorded. 

The researchers analysed the EEGs in detail looking for different patterns of electrical activity called lateralized periodic discharges (LPDs), lateralized rhythmic delta activity (LRDA), generalized periodic discharges (GPDs), bilateral periodic independent discharges (BIPDs), and generalized rhythmic delta activity (GRDA).

The results showed that more LPDs and GPDs were associated with an increased risk of developing seizures. LPDs had the highest association with seizures regardless of their frequency, while LRDAs and GPDs were associated with seizures in a frequency-dependent manner. Finally, the researchers found that patients who had GRDA patterns were not any more likely to have seizures than those with no rhythmic/periodic patterns of activity recorded on the EEG.

According to the authors, “These findings highlight the importance of detailed electroencephalographic interpretation” to group patients according to their risk of developing seizures “and clinical decision making”. They also point to the importance of using a standardized terminology to describe the specific patterns recorded during the EEG.

Continuous EEG monitoring is a powerful technique, which is increasingly being used to monitor brain activity in order to clearly diagnose and detect non-convulsive epileptic seizures with great sensitivity.

Author: Dr Özge Özkaya

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Study Sheds Light Onto How Flashing Images May Trigger Epileptic Seizures

Wed, 12/21/2016 - 11:48

A new study published in the scientific journal, NeuroImage, may help explain how rhythmic stimulations at certain frequencies such as flickering images can lead to epileptic seizures.

In a press release, Senior Author Dr Marc Goodfellow, at the University of Exeter, said: “Our findings help to elucidate mechanisms of the generation and spreading of epileptic seizures in the brain”.

The team used a mathematical model of brain dynamics, to study how seizures are generated. They showed that neuronal tissue displays epileptic-like activity when exposed to enhanced stimulation of certain frequencies. These may be generated by the brain’s own activity or come from the outside such as flashing images.

According to the researchers, this is the result of the ability of neuronal tissue to undergo resonance. Visual stimulation with frequencies close to alpha rhythm, a type of electrical activity in the brain that has a frequency of 8–13 Hz, may interfere with the natural alpha activity occurring in a region of the brain called the visual cortex. This can lead to an increase in the amplitude of the electrical discharges in a “snowball effect” that triggers an epileptic seizure.

“This work shows that the temporal characteristics of the random activity of the brain can have profound effects on its behaviour,” said Co-author Dr Jordi Garcia-Ojalvo, at Universitat Pompeu Fabra, in Barcelona.

Dr Goodfellow added: “This research provides further insight into ways that communication within brain networks can possibly lead to the occurrence of seizures.”

According to the authors, future improvements in computational modelling may help develop tools that are useful for the treatment of epilepsy.

Author: Dr Özge Özkaya

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Rabbi Lionel Blue

Wed, 12/21/2016 - 05:06

Rabbi Lionel Blue passed away on 19th December, aged 86. Rabbi Blue was diagnosed with epilepsy at age 57 and was one of the first people to talk openly about the condition and how it affected his life.   

Rabbi Blue was a greatly valued friend of Epilepsy Research UK. He served as Vice President of the Epilepsy Research Foundation, and latterly Epilepsy Research UK, from 1997 until his retirement due to failing health in 2015.

Through his radio broadcasting, Rabbi Blue enriched the lives of untold individuals with his warm and witty ‘Thought for the Day’. Using the same empathetic skills, Rabbi Blue led several successful Radio 4 Appeals on behalf of Epilepsy Research UK. In doing so, he raised awareness and improved the public’s understanding of epilepsy. We are grateful that he found the time in his busy schedule to support the epilepsy cause.

Our condolences go to all his family, friends and colleagues. We at Epilepsy Research UK, and across the wider epilepsy world, owe Rabbi Lionel Blue a huge debt of thanks.

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Professor Brian Neville

Tue, 12/20/2016 - 12:09

It is with great sadness that we announce the death of Professor Brian Neville, Emeritus Professor of Paediatric Neurology at University College London – Institute of Child Health (UCL-ICH). 

Brian was a great ambassador for epilepsy and dedicated his life to improving the lives of children and young people with the condition. He held the first Prince of Wales’s Chair of Childhood Epilepsy, integrating research between the epilepsy unit at UCL-ICH, Great Ormond Street Hospital and Young Epilepsy.

Brian’s association with Epilepsy Research UK has been a long one. He had been a valuable friend, colleague and trustee of the Fund for Epilepsy before it merged with Epilepsy Research Foundation in 2007 at which point he became a trustee for the newly-formed Epilepsy Research UK. In 2013 Brian became Epilepsy Research UK President.

Brian’s distinguished career leaves a long legacy as a champion and pioneer for the needs of children with epilepsy: pushing for early detection and treatment, initiating an epilepsy surgery programme, and being instrumental in launching an emergency therapy for prolonged or repeated seizures. He is remembered fondly by the young people he treated and the young clinicians and researchers he nurtured.

Our thoughts at this time are with Brian’s family and friends, to whom we offer our sincere condolences and our immense gratitude that Brian chose to work in the field of epilepsy.

 

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Absence Seizures Could Be Prevented, Experimental Study Suggests

Tue, 12/20/2016 - 05:02

It may be possible to reduce, stop or even prevent absence seizures, the most common form of childhood epilepsy, according to a study published in the leading scientific journal Neuron.

Using an advanced technology called optogenetics and a rodent model, researchers at Stanford University School of Medicine showed that it is possible to trigger seizures by inducing synchronized, rhythmic activity within a particular structure in the brain called the thalamocortical tract. Importantly, they also demonstrated that disrupting this activity is sufficient to terminate the seizures.

For the study the team, led by Dr Jeanne Paz, inserted a gene that encodes for a light-sensitive cell-surface protein into a set of nerve cells situated in the thalamocortical tract of rat and mice models of absence seizures. This way, the scientists were able to prevent these cells from firing by shining a yellow light onto them.

In a press release, Dr John Huguenard,one of the authors of the study said:

“A single pulse of yellow light was enough to generate rhythmic firing activity throughout the cortex, in both hemispheres of the brain”.

The researchers then inserted a different kind of light sensitive protein into the brain of the rodents, which made  thalamocortical neurons more excitable when blue light was shone onto them. This disrupted their collective firing synchrony and seizure activity was blocked.

“Our study shows that the thalamus is a choke point whose involvement is essential to the maintenance of absence seizures,” said Dr Paz.

The authors suggested that treatments that are capable of guiding excitatory thalamocortical nerve cells from a tightly synchronized firing pattern (pro-seizure) to a more chaotic one could stop absence seizures.

Absence seizures, also called petit-mal seizures, are a form of epilepsy that is mostly seen in children aged between six to 15. They account for about 1 in 20 cases of epilepsy and are characterized by a sudden loss of consciousness that can last for up to 15 seconds, accompanied by a freezing in place.

Absence seizures are thought to be caused by patterns of rhythmic nerve-cell firing activity that originate in one area of the brain and then spread to the rest of the brain. A nerve circuitry called the thalamocortical tract is involved in this type of seizure.

Author: Dr Özge Özkaya

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Neural Stem Cells Found in Brain Tissue Removed During Epilepsy Surgery

Mon, 12/19/2016 - 09:56

Researchers at the University of Gothenburg, in Sweden, have found neural stem cells in epileptic brain tissue where they normally do not reside. This work is published in the scientific journal, Cerebral Cortex.

Neural stem cells are immature cells in the brain that are able to mature into neurons, astrocytes (non-neuronal support cells) or oligodendrocytes (producers of myelin, which is needed for effective neuronal signalling). They are normally found in the hippocampus, an area of the brain that is involved in learning and memory, and in the subventricular domains.

This finding helps improve scientists’ understanding of how the brain responds to epilepsy.

The team, led, Dr Milos Pekny, analysed the brain tissue obtained from people with drug-resistant epilepsy who underwent surgery. In eight out of 14 tissue samples (57%), they discovered neural stem cells in areas where these types of cells are not normally found.

According to the authors of the study, “This may point to a greater plasticity in the epileptic tissue, which to some extent can be compared to the brain tissue of a newborn.”

When the scientists cultured the brain samples, they saw that the cells that gave rise to neural stem cells were not astrocytes as was previously thought.

New neurons are formed in the brain of adults throughout life. These originate from neural stem cells that are found in the subventricular zone, hippocampus and striatum of the brain. Experiments conducted on mice have shown that in neurological conditions such as brain injury or stroke, astrocytes exhibit neural stem cell-like properties. This study shows that this is not the case in the human brain, at least not in epilepsy.

Author: Dr Özge Özkaya 

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Scientists Identify Network of Genes that Could Be Targeted to Treat Epilepsy

Wed, 12/14/2016 - 03:23

Researchers led by Professor Michael Johnson, at Imperial College London, have identified a network of genes that is associated with epilepsy.

The team believes that targeting the expression of this “epileptic network” of 320 genes, which they called M30, could be a new strategy to treat the condition.

In a news release, Professor Johnson said: “The discovery of this network of genes linked to epilepsy opens avenues for finding new treatments. This uses an approach that is entirely different to the past 100 years of anti-epilepsy drug development.”

The genes that are part of the network are widely expressed in the brain and code for proteins involved in the communications between brain cells.

When the network is impaired, due to genetic mutations or as a result of brain injury, epilepsy is triggered. According to the researchers, potential new treatments for epilepsy should focus on restoring the network.

The team analysed thousands of genes and mutations associated with epilepsy in people with and without the condition. They found that the genes in the M30 network were consistently dampened in the brains of people with epilepsy, as well as in mouse models of the condition. They then used a technique called network biology to determine how these genes interact with each other.

Finally, the researchers used a computer to ‘test’ 1.300 known drugs and predict which ones could increase the expression of these genes and restore the M30 network. They discovered that valproic acid, a drug already used to treat epilepsy, was one of the drugs that could restore the network. The team also identified a number of drugs such as withaferin A that were not formerly considered to be antiepileptic drugs.

“Until recently we have been looking for individual genes associated with diseases, which drug companies then target with treatments. However, we are increasingly aware that genes don’t work in isolation. Identifying groups of genes that work together, and then targeting these networks of genes, may lead to more effective treatments. Our proof of concept study suggests this network biology approach could help us identify new medications for epilepsy, and the methods can also be applied to other diseases,” the authors said.

The study was published in the scientific journal, Genome Biology.

Author: Dr Özge Özkaya

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Carbamazepine Safe and Effective in Newborn Babies with Epilepsy

Tue, 12/13/2016 - 08:52

A new study published in the scientific journal, Epilepsia, suggests that low-dose oral carbamazepine (CBZ – an antiepileptic drug) is safe and effective in newborn babies with benign familial neonatal epilepsy (BFNE); even in status epilepticus where the seizures occur very close together or last a long time. The authors therefore propose that CBZ should be the drug of choice in babies with this condition.

The researchers, led by Dr Maria Roberta Cilio, at the University of California, analysed 19 children with epilepsy from four different centres in the US and Italy. Sixteen children had a family history of newborn seizures and one child had a family history of infantile seizures. Seizures began at 2-5days of life for all children included in the study and happened several times a day. A total of four children developed status epilepticus.

Genetic analysis revealed that 14 of the children had a mutation in the KCNQ2 gene and two of them had a mutation in the KCNQ3 gene. These two genes encode for potassium channels and play an important role in the communication between neurons.

Twelve of the children were treated with up to four AEDs without satisfactory response before being switched to CBZ. These included phenobarbital, pyridoxine, levetiracetam, benzodiazepines and clonazepam. Seventeen of the children (88%) became seizure-free within hours of receiving CBZ or oxcarbazepine (OXC), another antiepileptic drug.

The earlier treatment with CBZ was started the shorter was the time spent in hospital. CBZ did not have any reported side effects.

The authors, who followed, the children for an average of 7.8 years wrote: “All patients had normal development and remain seizure-free”.

Author: Dr Özge Özkaya

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Cannabidiol May Reduce the Frequency and Severity of Epileptic Seizures

Mon, 12/12/2016 - 11:22

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

Treatment with cannabidiol (CBD) improves the frequency and severity of seizures in children and adults with epilepsy, according to research presented at the American Epilepsy Society annual meeting in Huston, Texas.

The findings are based on an open label,* expanded access clinical trial to test the effect of CBD in epilepsy.

The study involved 81 people (42 children and 39 adults) with drug-resistant epilepsy whose condition was confirmed by Video EEG. All participants had failed to respond to at least four antiepileptic drugs (AEDs) and experienced, on average, four seizures per month. The severity of the seizures was measured using the Chalfont Seizure Severity Scale.

The results showed that after one month of treatment with CBD, the frequency of seizures was reduced in the majority of participants. Two third of the subjects also experienced a reduction in the severity of their seizures of more than 50%. This reduction was maintained for up to six months.

In a press release, Senior Author Dr Jerzy Szaflarski, at the University of Alabama at Birmingham, said: “It is encouraging that both frequency and severity of seizures appear to improve in the majority of patients in our study, patients who have limited treatment options. Our research adds to the evidence that CBD may reduce frequency of seizures, but we also found that it appears to decrease the severity of seizures, which is a new finding”.

Dr Martina Bebin, also a senior author on the study, added: “These are encouraging results, but it is important to note that each patient may respond differently to CBD, and the dose for optimal seizures control varies. There appears to be an optimal CBD dose range where the patient achieves maximum benefit. If outside this CBD dosing range, the seizure frequency may not improve and may even increase.”

Author: Dr Özge Özkaya

* Open label clinical trials do not try to disguise the new drug or treatment, meaning that no standard treatment or placebo control is used. This creates bias, as both the patient and the physician are aware of which groups are receiving what type of treatment.

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