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Addressing the Side Effects of Antiepileptic Drugs as a Quality Indicator in Epilepsy Care

Tue, 11/01/2016 - 13:36

According to a new study published in the Journal of Patient Preferences and Adherence, patient-reported medication adherence has potential as a quality indicator in the care of people with epilepsy.

To assess whether addressing the side effects caused by antiepileptic drugs (AEDs) at every visit to the neurologist increases patient-reported medication adherence, a team of researchers led by Dr Daniel Hoch, at Harvard Medical School, identified 243 adults with epilepsy who were seen at two academic hospitals. All had had at least two visits to the hospital over a period of three years.

In order determine whether AED side effects were addressed at the visits, the researchers conducted phone interviews with the participants and also analysed their medical records.

A total of 62 subjects (25%) completed the phone interviews. According to their medical records, AED side effects were addressed in 48 (77%) them; however the phone interviews themselves revealed this number to be 51 (82%).

Twenty-eight of the participants (45%) reported complete adherence to medication. Amongst the remaining 34 subjects, the most common reason for incomplete adherence (reported by 31 or 91%) was missing medication due to forgetfulness.

The team found no evidence (based on either the medical records or interview data) that addressing AED side effects increased the likelihood of (self-reported) complete medication adherence. They conclude from this that addressing side effects at every visit doesn’t have a positive impact on(self-reported) adherence, but they make the following recommendation: “Addressing AED side effects remains a neglected part of epilepsy care and should be incorporated in the devel­opment of a model that can predict quality of care.”

Author: Dr Özge Özkaya

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Epilepsy Surgery in the Back of the Brain Can Achieve Excellent Results if Performed Early, Study Suggests

Sun, 10/30/2016 - 06:53

Surgery in the back of the brain can attain excellent results if it is conducted early, according to a study published in the scientific journal, Epilepsy and Behavior.

Currently this type of surgery is rarely performed, because it is associated with a high number of failures due to the fact that it is extremely difficult to localise the origin from which the seizures spread in this part of the brain.

A team of researchers led by Dr Stefano Francione, at the Niguarda Ca’ Granda Hospital, in Milan, analysed the outcome of brain surgery in 125 adults and 83 children who had drug- resistant epilepsy, and in whom the focus of the epilepsy was at the back of the brain.

They followed the patients for at least five years after surgery with electroencephalography (EEG), magnetic resonance imaging (MRI) and neurologic and neuropsychological evaluation.

They found that seizure freedom was achieved in 70% of individuals following surgery, whilst a further 10% only had rare disabling seizures following surgery.

Importantly, the earlier the surgery was performed the more likely it was to be successful, with best results being obtained when the operation was carried out in childhood.

“Duration of epilepsy represents a most consistent predictor of surgical outcome, with early surgery being correlated with higher chances of surgical success,” the authors write.  “We recommend an early surgical referral in cases of [drug resistant] posterior cortex seizures,” they add.

They also note that surgical failure could be predicted as early as within the first six months following surgery.

Author: Dr Özge Özkaya

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Neuro Chip Could Help Scientists Identify Drugs that Work Best to Treat Epilepsy

Thu, 10/27/2016 - 11:20

Researchers at the University of Calgary, in Canada, have developed a neuro chip that enables long-term, high fidelity recordings from brain cells at a resolution 15 times higher than existing setups.

According to Pierre Wijdenes and the co-authors of the study, which is published in the journal, Scientific Reports, this new technology could help better understand brain function and offers great opportunities, not only to test different drug compounds and find the best medication that works for a particular patient, but also to develop new drug discovery devices in the future.

“So we’re actually getting closer to personal medication in a sense,” said Wijdenes in a news release. However, he added that the new chip is a “baby step” towards developing personalised treatments and warned that this kind of approach is likely still decades away.

So far, the scientists have used the chip to take recordings from the neurons of a fresh water snail, Lymnea stagnalis, which provides structurally and functionally well-characterised neurons that are relatively large in size.

They isolated individual neurons from the snails, cultured them in the laboratory and placed them on the chip inside an incubator. They then studied their electrophysiological activity over time.

According to the researchers, whereas most setups can only record neuronal activity for a few minutes, the new neuro chip allows them to take continuous recordings for several weeks. This means that they can evaluate the effects of different drug compounds on neuronal activity over time.

Senior Author Dr Naweed Syed told the Calgary Metro: “We don’t know what goes wrong with conditions like epilepsy. This technology is proof of concept that we can integrate technology with the brain. We are hoping in the future we will be able to use these chips to regain lost brain function.”

Author: Dr Özge Özkaya

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Could Voluntary Exercise Delay Status Epilepticus?

Wed, 10/26/2016 - 07:38

Voluntary exercise can increase the time it takes for the development of status epilepticus following a stimulation, according to experimental research published in the scientific journal, Epilepsy and Behavior.

During the study, researchers led by Dr Ricardo Mario Arida, at Universidade Federal de São Paulo, in Brazil, used female adult rodents to try and establish whether exercise programmes can interfere with seizure susceptibility.

While many studies have investigated the effects of exercise on epilepsy, these have been exclusively performed in male animals by convention.

“However, females are also worthy of investigation because of their cyclical hormonal fluctuations and possible pregnancy,” the authors write.

For the present study, the team divided the female rodents into three groups. They subjected them to controlled, forced and voluntary exercise, and then induced epileptic seizures in them using the drug pilocarpine.

The scientists observed the animals for four hours and recorded: the time that passed until the animals developed status epilepticus; the number of animals that developed status epilepticus; and the intensity of motor signs induced by the drug.

Although they saw no difference among the three groups of animals in the time that passed for first motor signs to appear, or in the number of animals that developed status epilepticus, they found that in animals that were provided with an exercise wheel in their cage (the voluntary exercise group), the time it took for status epilepticus to develop was longer compared to animals in the controlled exercise and forced exercise groups. In other word, in animals that exercised as they wanted status epilepticus developed later.

“Our behavioral results are not enough to explain physiological and molecular pathways, but there are mechanisms described in literature which may allow us to propose possible explanations,” the authors write.

They also note that future studies should address the possible mechanism behind these results, and that gender specific differences should be considered.

Status epilepticus is defined as a continuous seizure lasting more than 30 minutes, or two or more seizures without full recovery of consciousness between them. According to some scientists, any seizures that lasts more than five minutes should to be treated as status epilepticus.

Author: Dr Özge Özkaya

 

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New Compound Could Protect Against the Development of Seizures in Drug-Resistant Epilepsy

Tue, 10/25/2016 - 08:31

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

A study has shown that huperzine A, a naturally occurring compound often used in traditional Chinese medicine, has a protective effect against experimentally-induced seizures in rodent models of epilepsy. The work is published in the scientific journal, Frontiers in Pharmacology.

According to the authors, huperzine A may therefore provide a new treatment option for people with drug-resistant epilepsy.

For the study, researchers from the US induced epileptic seizures in mice either chemically or using an electric-based methods. They found that treating the animals with huperzine A eliminated all seizures in the majority of animals.

The scientists also used mouse models of Dravet syndrome and genetic epilepsy with febrile seizures plus (GEFS+), and saw that huperzine A conferred protection against seizures in these ‘mutant’ animals. Moreover, this protection was sustained for three weeks when the compound was injected daily to mouse models of GEFS+.

The researchers conclude that huperzine A may also increase seizure resistance in people with Dravet syndrome and GEFS+, as well as in other forms of drug-resistant epilepsy.

Biscayne, a Florida-based pharmaceutical company, has already developed a synthetic form of huperzine A called BIS-001. They are planning to start a phase one clinical trial to test its safety and efficacy in adults with drug resistant epilepsy, as well as in children, once juvenile animal safety testing has been completed.

Dr Steven Schachter, Co-Author of the study and a scientific co-founder of Biscayne,  said in a press release: “We are eager to test BIS-001 in clinical trials to see if the dramatic elimination of seizures observed in these animals can be replicated in patients, who are in great need of better treatment options.”

Dravet syndrome is caused by a mutation in a gene called SCN1A and is characterised by prolonged and recurrent early-life febrile seizures, drug-resistant afebrile epilepsy and cognitive and behavioural difficulties.

Mutations in the SCN1A gene can also cause GEFS+, which is an inherited form of epilepsy characterised by early-life febrile seizures and the development of several types of adult epilepsy.

Current antiepileptic drugs (AEDs) often fail to treat both Dravet syndrome and GEFS+.

Author: Dr Özge Özkaya

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Restricting Calorie Intake May be Beneficial in Epilepsy

Fri, 10/21/2016 - 13:24

Restricting calorie intake could protect brain cells from damage and have a beneficial effect in epilepsy, according to a rodent study published in the scientific journal, Aging Cell.

Several studies on animal models have suggested a link between calorie intake and a longer lifespan, however the molecular mechanism of how restricting calorie intake can protect against disease is not well understood.

Now, researchers at the Center for Research on Redox Processes in Biomedicine (Redoxoma), in Brazil, have shown that reducing calorie intake by 40% can increase the amount of calcium that is retained in mitochondria (the cell’s powerhouses) when calcium levels inside cells are abnormally high. This could help prevent neuronal death associated with epilepsy and other neurological conditions.

First Author, Dr Ignacio Amigo, said: “More than promoting the advantages of eating frugally, we aim to understand the mechanisms that make not over consuming calories better for health. This can point to new targets for the development of drugs against various diseases.”

The team gave one group of rodents food and water ad libitum (meaning that they could eat and drink as much as they wanted) for 14 weeks, and they restricted the food intake of another group of animals by 40%. The first group of animals became overweight at the end of the 14 weeks period, whilst those in the second group did not.

The animals were then injected with a substance called kainic acid, which promotes calcium influx into neurons and is used to induce seizures. When they isolated the mitochondria from the brain cells of the animals, the researchers saw that there was a higher level of mitochondrial calcium uptake in the mitochondria of the animals whose diet was restricted.

It is known that calcium plays an important role in the communication between nerve cells. Conditions like epilepsy can cause an excessive release of calcium into neurons due to the over activation of receptors called glutamate receptors, which can damage and even kill the neurons. Previous research has shown that an increased mitochondrial calcium uptake can have a protective effect against this calcium influx.

The researchers also observed that the activity of antioxidant enzymes was increased in the mitochondria of the diet-restricted animals, suggesting an enhanced capacity to manage oxidative stress and therefore protect against neurological conditions.

According to the team, the proteins whose activity has been altered by a reduced calorie intake could potentially be targeted to develop new therapies for conditions such as epilepsy, where excessive calcium influx leads to neuronal death.

Author: Dr Özge Özkaya

 

 

 

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Distinct Brain Activity in Between Seizures Can Affect Thinking Ability in Adults with Epilepsy

Thu, 10/20/2016 - 09:40

Interictal epileptiform discharges (IEDs) – distinct patterns of brain activity that happen in between epileptic seizures – are associated with poorer cognitive performance (thinking ability) in adults with epilepsy, according to a study published in the scientific journal, Epilepsy Research.

Therefore, reducing IEDs could improve cognitive performance and have positive effects on the quality of life of people with epilepsy.

The study, led by Dr Sheng-Di Chen, at Ruijin Hospital, in Shanghai, recruited 167 seizure-free adults who underwent electroencephalography (EEG) testing and extensive cognitive evaluations. The data were then analysed for links between IEDs (shown on EEG) and cognitive performance.

The results showed that people with general IEDs achieved lower scores in cognitive tests. These scores were associated with lower verbal fluency and language scores.

Further analysis showed that sleep-phase IEDs were also associated with lower performance in cognitive tests. Moreover, non-rapid eye movement IEDs were linked with difficulties in processing and interpreting visual information about where objects are in space as well as with memory. IEDs whilst awake were associated with poorer performance in trial making test, which measures visual search, scanning and processing speed, as well as mental flexibility and executive functioning (the ability to plan, organize and complete tasks).

The authors conclude: “Cognitive performance is associated with IEDs in adult epilepsy patients, and could serve as a springboard for further research into reducing IEDs to bring about better cognitive performance.”

Difficulties with thinking are one of the major consequences of epilepsy, and they have been shown to reduce quality of life. It is recognised that IEDs are associated with poorer cognitive performance in children, but no such association has previously been shown in adults with epilepsy.

Author: Dr Özge Özkaya

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The Generation of Epileptiform Discharges May Not Be Random and May Be Controlled by Biological Clocks

Wed, 10/19/2016 - 07:40

A study published in the journal, Epilepsy and Behavior, suggests that the generation of epileptiform discharges (EDs – distinct patterns of brain activity that can arise in between epileptic seizures) is not a random process but the result of complex interactions controlling sleep-wake cycles. It also highlights that the majority of EDs may, in fact, occur during sleep.

On the basis of their findings, the investigators propose that 24-hour electroencephalography (EEG) recordings that capture natural sleep may be more useful than routine EEG in diagnosing genetic generalised epilepsy.

During the study, the team, led by Dr Wendyl D’Souza, at the University of Melbourne, studied 24-hour EEG recordings from people diagnosed with genetic generalised epilepsy. They analysed almost 7,000 EDs within 105 abnormal EEGs.

The researchers found that there were significant changes in ED counts across the 24-hour period, and that the distribution was largely influenced by the person’s state of arousal. The majority of EDs (67%) occurred during non-REM sleep, peaking from 23:00 through to 07:00, and in 24 people (23%), EDs occurred only in sleep. Overall just 33% of the EDs occurred during wakefulness. In-depth analysis of the EEGs revealed a difference in the nature of the EDs arising in non-REM sleep and in wakefulness.

Dr D’Souza and colleagues conclude that EDs are generated as a result of complex interactions among biorhythms. “A deeper understanding of those biorhythms including the intrinsic circadian clock of epilepsy is likely to enhance our knowledge in diagnosis, seizure prediction methods and treatment,” they write.

Author: Dr Özge Özkaya

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Women with Epilepsy who are Overweight Should Be Closely Monitored in Pregnancy to Avoid Complications

Tue, 10/18/2016 - 09:19

Women with epilepsy who are overweight are at a higher risk of developing complications during pregnancy and delivery, according to a new study published in the scientific journal, Epilepsia.

The authors state that these women should be regarded as a high-risk group, and that they should be referred to a nutritionist both before an antiepileptic drug (AED) is started and when a pregnancy is planned.

For the study, which was based on the Norwegian Mother and Child Cohort Study linked to the Medical Birth Registry of Norway, researchers led by Dr Marte Bjørk, at the University of Bergen, analysed the birth records of almost 100,000 pregnant women across Norway, from between 1999 and 2008.

A total of 706 women had a diagnosis of epilepsy and, among them, 259 were classed as overweight (having a body mass index (BMI) of 25 or more) and 416 were classed as ‘normal’ weight. Of the women who did not have epilepsy, 30,516 were overweight and 67,977 were normal weight.

The researchers noted from their subjects that women with epilepsy were more likely to be overweight than those without epilepsy. Looking specifically at the women who were overweight, they discovered that those with epilepsy had an increased risk of many birth complications (e.g. needing a caesarean section, having excessive bleeding during delivery, having a smaller than normal baby and developing depression and anxiety) compared to those without epilepsy.

The team then compared women with epilepsy who were overweight and normal weight. Here, they found that those who were overweight had a greater risk of needing a caesarean section, of having high blood pressure linked to pregnancy and of preeclampsia. The babies of the women with epilepsy who were overweight also had a higher risk of being transferred to the neonatal ward.

The authors recommend that blood sugar and signs of preeclampsia, anxiety and depression be more closely monitored in women with epilepsy who are overweight. They also suggest that additional ultrasounds should be considered for these women, to assess any growth abnormalities in the baby.

Author: Dr Özge Özkaya

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

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People with Epilepsy Want to Know About the Risk of SUDEP, Study Suggests

Mon, 10/17/2016 - 07:25

People with epilepsy want neurologists to inform them about the risk of sudden unexpected death in epilepsy (SUDEP), according to a study published in the scientific journal Epilepsy and Behavior. Those who took part in the study also believed that the optimal timing and setting to provide SUDEP counselling should be determined on a case-by-case basis.

Dr Rajesh Ramachandran Nair and Dr Susan M Jack, at McMaster University, in Ontario, invited 42 people to take part in the study. Their aim was to better understand the views of adults with epilepsy on a) whether the issue of SUDEP should be discussed, and b) when and how this discussion should take place.

A total of 23 people, aged between 18 and 65 years, agreed to participate in the study. Nineteen were interviewed by telephone and four joined a focus group to share their views.

All participants felt that people diagnosed with epilepsy should be informed about SUDEP, and many believed that the best time to receive this information was at diagnosis.

Most subjects thought that the discussion about SUDEP should take place face to face, with a neurologist, and that people should then be given written information (including possible ways of preventing SUDEP) to take home.

Many participants believed that information about SUDEP should be incorporated into the general information given about epilepsy, rather than being provided separately.

SUDEP is the leading cause of disease-related death in people with epilepsy, with an incidence of between 0.9 and 9 per 1000 people per year.

Although published guidelines and position statements from professional organisations recommend routine counselling about SUDEP, research has shown that only a small proportion of neurologists offer this to their patients, because they fear causing anxiety and stress.

Author: Dr Özge Özkaya

 SUDEP Awareness Day is on 23 October 2016, and there are lots of ways in which you can get involved!

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Diazepam is as Effective as Lorazepam in Treating Status Epilepticus

Mon, 10/17/2016 - 06:08

A recent study, published in the scientific journal Epilepsy and Behavior, shows that lorazepam injection is not more effective than diazepam injection in controlling seizures.

According to guidelines and expert consensus, lorazepam should be used preferentially over diazepam as the initial treatment of convulsive status epilepticus. However, this new study suggests that there is not enough evidence to support this practice.

The researchers, led by Dr Eugen Trinka, at Paracelsus Medical University, in Salzburg, systematically searched several databases for randomised controlled clinical trials comparing the effects of lorazepam and diazepam injections in the treatment of convulsive status epilepticus.

They identified five randomised clinical trials, involving a total of 656 subjects (320 of whom had been allocated to lorazepam injection and 336 of whom had been allocated to diazepam injection).

The researchers assessed the efficacy of both drugs by looking at measures such as: the cessation of clinical seizures and whether seizures stopped after a single dose of medication; whether status epilepticus continued and required a different antiepileptic drug; the need for ventilator support; and the presence of clinically relevant low blood pressure.

The results showed no significant difference, for any of these measures, between the people treated with lorazepam and those treated with diazepam injection. The scientists conclude from this that there is no evidence supporting the preferential use of lorazepam injection over diazepam injection as a first-line treatment of convulsive status epilepticus. They do note, however, that a difference in efficacy between the two drugs that requires a larger number of participants to detect may still exist.

The authors state that, in the future, researchers should use consistent definitions of status epilepticus and report results using clear and standardised methods. They add: “Individual patient data should also be provided to allow more detailed and informative analyses.”

Author: Dr Özge Özkaya

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Addressing Executive Dysfunction Could Improve Quality of Life For Children with Drug-Resistant Epilepsy

Fri, 10/14/2016 - 10:26

The authors of a recent study recommend that executive functioning (the set of skills that allows people to plan, organise and complete tasks) be assessed and ‘targeted’ in children with drug-resistant epilepsy. They also call for further research to find out what the best targeting methods might be.

Executive functioning in children is tightly linked to cognition (the ability to think), and poor control of executive functioning may lead to weaknesses in areas that depend on skills such as memory and reading, for example academic achievement. It is known that children with epilepsy are vulnerable to executive dysfunction; however this is the first study to properly explore the relationship between executive functioning and quality of life.

During the investigation, researchers from Australia and the US carried out tests to measure the intellectual quotient (IQ) of 54 children with drug-resistant epilepsy, who were candidates for surgery. Parents were asked to complete ‘Quality of Life in Childhood Epilepsy’ (QOLCE) and ‘Behavior Rating Inventory of Executive Function’ (BRIEF) questionnaires, rating their child’s quality of life and executive function.

When analysing the results, the scientists needed to take into consideration factors that might have their own influence on quality of life or even executive ability (e.g. IQ, seizure frequency, an earlier age of epilepsy onset, taking  more epilepsy drugs). They report that, based on their data, clinically impaired executive function was linked to almost a 10 fold increased risk of a poor quality of life.

The authors conclude that the identification of executive dysfunction at home is an essential part of pre-surgical evaluation, and that targeting this area for intervention may improve the quality of life of these children.

Author: Dr Özge Özkaya

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Antiepileptic Surgery in Childhood Does Not Seem to Improve Memory Over Time

Fri, 10/14/2016 - 07:07

A new study published in the journal, Epilepsia, suggests that short-term improvements in memory following childhood epilepsy surgery might not be sustained in the long term.

These findings may be helpful for physicians, people with epilepsy and their families to better understand the possible outcomes of epilepsy surgery in childhood, and the effects of continuing antiepileptic drug (AED) treatment.

For the study, Klajdi Puka and Dr Mary Lou Smith, at the University of Toronto, analysed the verbal and visual memory skills of 88 people (average age 20.05 years) who had been diagnosed with drug-resistant epilepsy in childhood, and who had undergone evaluation for surgical treatment. Fifty-three of the subjects had actually undergone epilepsy surgery – between 4 and 11 years earlier – and the remaining 35 served as non-surgical controls. The researchers used standardised recall tests (involving stories, faces, word pairs and word lists) to assess the participants’ memory abilities, and they compared the results to those the subjects had achieved during surgical evaluation. Please note: the older tests were performed at what is referred to as the baseline time point, whilst the new ones were long-term follow-up assessments.

When the team analysed the results, they found no improvement in the subjects’ memory abilities over time (i.e. between baseline and follow-up). They also discovered that the participants’ memory outcomes were largely independent of whether or not they had undergone surgery.

People who were seizure-free at follow-up were shown to have better story recall at both time points than those who weren’t, but no improvement in their scores was found between the time points.

For subjects with epilepsy outside of the temporal lobe (extra-temporal lobe epilepsy), word list recall significantly declined over time regardless of whether or they had undergone surgery, or what their seizure status was.

The side of the seizure focus (the region in which seizures originate) only appeared to make a difference in people with temporal lobe epilepsy – those with left temporal lobe epilepsy (TLE) achieving lower story recall scores at follow-up than those with right TLE.

The researchers also observed that participants who underwent surgery tended to achieve seizure freedom sooner (if they did at all), and use fewer AEDs at follow-up, than those who did not.

The authors conclude from this that memory outcomes in the long term are independent of surgical status, and that there appears to be no improvement in memory performance over time, even in people who are seizure-free at follow-up. They also note, however, that surgery may be linked to more prompt seizure freedom and the need for fewer AEDs at follow-up.

Children with epilepsy can experience difficulties with many types of memory, including episodic memory (memory of events), semantic memory (memory of abstract concepts) and autobiographical memory. They are also prone to abnormally rapid forgetting. This is the first study to examine the long-term effect of surgery on memory.

Author: Dr Özge Özkaya

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Study Highlights the Link Between Excessive Alcohol Drinking and SUDEP

Wed, 10/12/2016 - 08:04

The findings of a study at Southern Illinois University suggest that alcohol withdrawal in people with epilepsy (i.e. the alcohol-free period that follows a prolonged period of regular/heavy drinking) increases the risk of death following a seizure. This could be caused by respiratory compromise and longer seizure duration, which are both recognised risk factors for sudden unexpected death in epilepsy (SUDEP). Efforts to prevent excessive drinking in people with epilepsy should, therefore, form part of the strategy to reduce SUDEP risk.

According to the authors of the study, which is published in the scientific journal Epilepsy and Behavior, people with epilepsy who drink heavily/excessively should be carefully monitored during withdrawal periods, when they are particularly susceptible to seizures.

For the investigation, researchers led by Dr Carl Faingold evaluated the effects of ethanol (alcohol) withdrawal in a genetic rodent model of epilepsy. They subjected the rodents a four-day ‘binge’ ethanol treatment, and then induced epileptic seizures in them 18-24 hours after the last ethanol dose (i.e. during alcohol withdrawal). The team then assessed the animals’ breathing patterns, how long they were confused for after a seizure and how many of them suffered seizure-induced death.

They compared the findings with those from two other animal groups, which they also included in the study. One contained the same epilepsy models that were in the original group, but these received a non-alcoholic treatment instead of ethanol, and the other contained healthy (non-epileptic) rodents who received ethanol treatment. Aside from these differences, all procedures and assessments undergone by the animals were the same.

The scientists found that, following seizures, all of the epilepsy models showed a loss of the ‘righting reflex’ (which allows the body to gain an upright position following a fall) and respiratory distress. These signs were not seen in the healthy animals.

They also observed that epilepsy models subjected to ethanol withdrawal showed a significant increase in both the duration of confusion following a seizure, and respiratory distress, compared to those that did not receive ethanol.

Finally, the researchers found that significantly more of the epilepsy models subjected to ethanol withdrawal experienced seizure-induced death than either the epilepsy models not treated with ethanol or the healthy animals.

They conclude that ethanol withdrawal causes a significant increases in the duration of confusion following a seizure as well, as respiratory distress, which contributes to the greater incidence of mortality in rodents that are genetically prone to epilepsy.

In this experiment, the team in Illinois aimed to create a state of alcohol withdrawal that was as close as possible to the human condition. Their results suggest that alcohol consumption is something that should be specifically discussed by people with epilepsy and their doctors.

Author: Dr Özge Özkaya

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Treating Depression in People with Temporal Lobe Epilepsy May Improve Their Cognitive Abilities

Tue, 10/11/2016 - 07:05

Depression may worsen cognitive abilities (thinking skills) in people with temporal lobe epilepsy (TLE), according to a study published in the Journal of Neuropsychiatry and Clinical Neuroscience. Treating depression in this group of people could therefore lead to improvements in cognition.

The study, led by Dr Jennifer Davis, at Brown University in Rhodes Island, analysed how depression contributes to reduced executive functioning in people with TLE.

Executive functioning is defined as a set of cognitive processes that are necessary for the cognitive control of behaviour. In other words, it is a set of skills that allows people to plan, organise and complete tasks. There are eight key executive functions that are used to organise and act on information, which include impulse control, emotional control, flexible thinking, working memory, self monitoring, planning and prioritising, task initiation and organisation. A significant proportion of people with TLE experience impairment in executive functioning.

The researchers recruited a total of 82 people, of whom 29 had TLE only, 22 had TLE and depression and 31 had depression only. They asked the participants to complete the Delis-Kaplan Executive Function System, a neuropsychological test that measures a variety of verbal and nonverbal executive functions and provides an evaluation of higher-level cognitive functions.

The results showed that subjects with both TLE and depression had poorer executive functioning than those with TLE only.

According to the authors: “These findings support the notion that depression may further contribute to executive difficulties in individuals with TLE.” They suggest that the types of deficits associated with depression in TLE may be different than those associated with other types of depression. They conclude that future studies should investigate which aspects of executive functioning improve when depression is treated in TLE.

Author: Dr Özge Özkaya

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Surgery Could Improve Psychiatric Problems in Epilepsy

Sat, 10/08/2016 - 03:59

Surgery for refractory (drug-resistant) epilepsy may improve psychological changes and psychiatric problems seen in some people with epilepsy, according to a study published in the scientific journal, Epilepsia.

First Author Dr Sònia Ramos-Perdigués, at Can Misses Hospital, in Spain, said: “The results of this study suggest that surgery for refractory epilepsy may provide additional benefit in patients with a psychiatric history and should be considered in this population.”

In order to assess the relationship between epilepsy surgery and psychiatric disorders, the researchers analysed the psychiatric outcome in people with drug-resistant epilepsy who underwent surgery.

They first evaluated the psychiatric condition of 85 participants before surgery using tools such as the ‘Wechsler Adult Intelligence Scale’ and ‘Hospital Anxiety and Depression Scale’, and then repeated the assessments six month after surgery. They compared the results to those obtained from 68 subjects with drug-resistant epilepsy who were not eligible for surgery,

The results showed that the perception of distress significantly improved in participants who underwent surgery compared to those who did not. Several other measures of psychological changes such as somatisation, where psychological distress in unconsciously expressed as physical symptoms, and paranoia also improved. Finally, symptoms of depression and anxiety decreased following surgery.

“Epilepsy patients with a history of psychiatric disorders may be concerned about the potential effect of surgery on their mental condition. As a result, some patients and physicians might have been reluctant to utilize surgery for refractory epilepsy, for fear of worsening emotional suffering,” said Dr Ramos-Perdigués.

This study suggests that the contrary may be the case and provides evidence that surgery could improve psychiatric functioning in drug-resistant epilepsy.

Author: Dr Özge Özkaya

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Folic Acid and Vitamin B12 May Help Reduce Risk of Stroke in People Taking AEDs

Thu, 10/06/2016 - 07:58

The use of antiepileptic drugs (AEDs) may decrease the levels of folic acid and vitamin B12 in the blood, according to a study published in the international scientific journal, Biomedical Reports.

According to the authors this could be linked to a higher risk of stroke in people with different types of epilepsy. Therefore, giving these people regular folic acid and vitamin B12 supplements may be beneficial*.

For the study, a team of scientists at The First People’s Hospital of Xuzhou, in China, analysed 68 people with epilepsy. Eight of them had autonomic seizures, 10 had absence seizures, 13 had complex partial seizures, 28 had generalized tonic-clonic seizures and nine had simple partial seizures. All participants received appropriate AED treatment for their type of epilepsy.

After one year of treatment, the researchers analysed the differences in the level of folic acid and vitamin B12 in the blood of the participants, as well as any events of stroke.

They found that there was no difference in the levels of folic acid and vitamin B12 in the blood of participants who had different types of epilepsy. This was the case both before and after the start of treatment with AEDs. However, when they looked at the levels of folic acid and vitamin B12 in the blood of the participants in each group before and after AED treatment, they saw that the levels had decreased following treatment.

The researchers also found that there was no difference in the incidence of strokes between the groups, but that strokes were associated with the levels of folic acid and vitamin B12 in the blood. In-depth statistical analysis revealed that levels of folic acid and vitamin B12 may be independent risk factors for the development of stroke in epilepsy.

The authors conclude that, although additional studies are required to confirm these results, folic acid and vitamin B12 supplements might decrease the risk of stroke in people who are taking AEDs.

Author: Dr Özge Özkaya

*Please note that taking supplements without medical advice may be harmful. Please consult with your doctor before taking any supplements.

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

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Newly Identified Biomarker Could Predict the Onset and Progression of Epileptic Seizures

Thu, 10/06/2016 - 07:45

Researchers at the University of Colorado have identified a new biomarker that could predict the onset and progression of seizures associated with epilepsy.

Biomarkers are substances found in the blood or urine that can indicate a biological state or a medical condition. They are invaluable in helping clinicians diagnose or predict the progression of a condition and measure how well the body responds to a certain treatment.

The study, published in the scientific journal Redox Biology, suggests that the ratio of two forms of an amino acid (building blocks of proteins) called cysteine could be used as a reliable biomarker to predict the onset or progression of epileptic seizures.

Dr Manisha Patel and Dr Li-Ping showed that the levels of cysteine decreased by 42% and 62% respectively in two different rat models of epilepsy, whilst the levels of cystine, the oxidised form of the amino acid, increased by 46% and 23% respectively. When the scientists treated the animals with an antioxidant, the decrease in the cysteine/cystine ratio was abolished.

The researchers concluded that the ratio of cysteine/cystine could be a reliable measure of epilepsy.

In a press release, Dr Patel said: “Currently the field of epilepsy lacks peripheral blood-based biomarkers that could predict the onset or progression of chronic seizures following an epileptogenic injury. We are confident that this study is a significant step toward changing this, and will one day help those living with temporal lobe epilepsy.”

Author: Dr Özge Özkaya

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The Coil is a Safe and Acceptable Method of Contraception for Women with Epilepsy, Study Suggests

Wed, 10/05/2016 - 08:59

The progestin-containing intrauterine device, also known as the coil, is a safe and well-tolerated form of contraception for women with epilepsy, according to a study published in the scientific journal, Epilepsia.

“Although popular among all women, complex drug interactions limit the efficacy and safety of oral contraceptives for [women with epilepsy],” the authors write.

They add: “Effective contraception enables women with epilepsy to plan their pregnancies and improve outcomes for themselves and their children.”

For the study, a team of researchers led by Dr Alison Pack, from Columbia University Medical Center, analysed 20 women with well-controlled epilepsy, who were on a stable antiepileptic drug (AED) regime. The AED most frequently taken amongst the group was lamotrigine. The average age of the women was 28, and 60% of them had not been pregnant before. All had experienced multiple seizures in the past.

The researchers measured the lowest (or ‘trough’) concentration of AED in the blood of the women before insertion of the coil, and again three weeks, three months and six months after. They did this because, for seizure control and AED safety to be maintained, it is important the level doesn’t change significantly.

The results showed that the lowest concentration of AED in the blood of the women remained stable during the six months following insertion of the coil.

The researchers also asked the women to record their seizures in a daily diary. They then compared the seizures that occurred during the month before insertion of the coil with those occurring in the six month following insertion.

During the month prior to insertion of the coil, 75% of the women did not have any seizures, whilst the remaining 25% had between one and three seizures.

After insertion of the coil, seizure frequency increased in three women, remained unchanged in 13 women and decreased in four women. Interestingly, none of the women said they felt a decrease in seizure control as a result of the coil.

The authors report that all participants were either “somewhat satisfied” or “very satisfied” with the coil, and that all participants continued to use it six months after insertion. They also confirm that no pregnancies occurred during the study.

These results suggest that the coil is an acceptable form of contraception for women with epilepsy.

Author: Dr Özge Özkaya

Click here to read more stories about living with epilepsy.

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Gluten-free Diet Could Help Control Seizures in People With Epilepsy who Have Celiac Disease

Tue, 10/04/2016 - 05:50

A gluten-free diet could help control seizures in people with epilepsy who have celiac disease, according to a study published in the scientific journal Advances in Clinical and Experimental Medicine.

The researchers, led by Dr Mohammad Ghadami, at Kermanshah University of Medical Sciences, in Iran, studied 113 people with epilepsy in two Iranian hospitals. They first measured the levels of a protein called ‘anti-immunoglobulin A (IgA) antibody’ in their blood, which is indicative of celiac disease. They then took two to three small intestine biopsies from those tested positive for IgA antibodies, to confirm the presence of celiac disease. A total of seven people (6% of all those with epilepsy) were diagnosed with celiac disease in this way.

These seven people then received a gluten-free diet for five months and their seizure activity was recorded. The results showed that at the end of the five months, seizures were completely under control and antiepileptic drugs were discontinued for six of the seven subjects. For the remaining one paticipant, anticonvulsant drugs were reduced by half and seizures were controlled.

These findings suggest that people with epilepsy who have gastrointestinal symptoms should be screened for celiac disease, since the administration of a combination of a gluten-free diet and anticonvulsant treatment may be effective in treating them.

Celiac disease is a genetic autoimmune condition affecting the small intestine, which gets worse when gluten-containing foods such as wheat and its products are consumed.

Although the mechanisms underlying the association between celiac disease and epilepsy are not fully understood, some researchers have speculated that antibodies related to celiac disease may be toxic for neurons and trigger the development of epilepsy. A number of studies have shown that epilepsy can also develop in other immune-mediated conditions such as systemic lupus and myasthenia gravis.

Author: Dr Özge Özkaya

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