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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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A new genetic link to Temporal Lobe Epilepsy

Tue, 07/26/2016 - 02:20

There may be an association between natural differences (known as polymorphisms) in a gene called ADAM10 and temporal lobe epilepsy, according to new research led by Dr Keshen Li from Jinan University in China.

The study, published in the scientific journal Frontiers in Neurology, is the first that shows such an association and suggests that by analysing these natural differences early on, it could be possible to predict someone’s risk of temporal lobe epilepsy.

The team of researchers examined the regulatory region of the ADAM10 gene in 496 people with temporal lobe epilepsy and in 528 healthy volunteers. They saw that in people with temporal lobe epilepsy the frequency of ‘component‘ A in the DNA was consistently increased compared to healthy controls, who had a higher frequency of component C at the same position on the DNA.

Further analyses suggested that the presence of A on both chromosomes at that location could be a factor that makes people more susceptible to temporal lobe epilepsy, whilst having one A and one C could be protective against generalised tonic-clonic seizures and drug resistant temporal lobe epilepsy.

It is important to note that all of the people recruited to this study were of Han Chinese decent and that the genetic polymorphisms might be different in other ethnic groups. The authors write: “Caution should be exercised before generalizing these findings to other ethnic populations.” However, at the very least these findings will guide future research that could ultimately lead to new diagnostic techniques and better treatments for temporal lobe epilepsy.

It is known that there are as many as 6,771 polymorphisms in the ADAM10 gene, which encodes for a cell-surface protein crucial in Alzheimer’s disease. Two of these differences, found in the regulatory region of the gene, are particularly important because they have been shown to decrease or ‘downregulate’ the expression* of the ADAM10 gene and give rise to epileptic seizures in Alzheimer’s disease.

Experiments in rodents have also shown that downregulating ADAM10 results in repetitive seizures, which may well mean that low levels of ADAM10 can also cause seizures in people. A ‘reverse’ experiment showed that in mice where ADAM10 was mildly overexpressed, induced seizures were less severe and recovery times were shorter, again suggesting that ADAM10 may be protective against seizures.

* 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

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New findings could help scientists prevent the Development of Epilepsy

Mon, 07/25/2016 - 14:14

Scientists at Louisiana State University, and at Spain’s University of Alcala, have developed compounds that can prevent seizures in a rodent model of epilepsy. They believe that so-called ‘neuroprotective’ compounds like these may also prevent epilepsy in humans in the future.

In earlier work, the team screened a range of compounds that block a specific inflammatory molecule in neurons, and discovered that one in particular, LAU-0901, stopped seizures in epilepsy models. In the current study they focused on LAU-0901, and a more refined version of it known as LAU-09021, to try and find out exactly how they work.

They found that the compounds’ actions preserved dendritic spines, which are vital to communication between neurons. Dendritic spines are damaged during seizures and other ‘insults’, causing a chain of events that make neurons hyperexcitable, which promotes the development of epilepsy. The team discovered that the animals were still protected from seizures up to 100 days after treatment with LAU-09021, suggesting that the process of epilepsy development had been arrested.

These findings, published in the journal Scientific Reports, indicate that, in the future, new therapies that preserve dendritic spines could potentially stop seizures and prevent the development of epilepsy.

Senior Author Dr Nicolas Bazan, at the Louisiana State University Health Sciences Center, said: “Most of the anti-epileptic drugs currently available treat the symptom – seizures – not the disease itself. Understanding the potential therapeutic usefulness of compounds that may interrupt the development process may pave the way for disease-modifying treatments for patients at risk for epilepsy.”

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New Method to look at Synapses in the Living Human Brain

Sat, 07/23/2016 - 15:44

Researchers at Yale University have developed a new, non-invasive method to examine synapses – the points of communication between neurons. The work is published in the leading journal Science Translational Medicine.

In the future, this novel technique could improve the diagnosis and treatment of epilepsy, and of other neurological conditions.

In a press release, Dr Richard Carson, Professor of Radiology and Biomedical Imaging and Senior Author of the study, said: “This is the first time we have synaptic density measurement in live human beings. Up to now any measurement of synaptic density was post-mortem (after death).”

The researchers developed a radioactive tracer that binds to a protein called SV2A, found at synapses. They injected the tracer into the body and, using a type of imaging called positron emission tomography (PET), were able to visualise synapses in the brain of animals, healthy people and people with epilepsy. They then used mathematical tools to calculate synaptic density, the number of functional synapses per volume of brain tissue, to assess how much and how well the subjects’ neurons were communicating. They discovered that in the brains of people with temporal epilepsy, synaptic density measurements reflected damage to certain regions.

The scientists hope that this method can eventually be used routinely, to monitor the course of various neurological conditions, including epilepsy, and assess how well certain drugs are working. Its non-invasive nature will help make assessment a more comfortable and less daunting experience for patients, which is so important.

There are trillions of synapses in the brain, which transmit signals from one neuron to another. Changes in the density of synapses are associated with a number of neurological disorders, including epilepsy.

Author: Dr Özge Özkaya

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People with Epilepsy are more likely to be Smokers, Study Suggests

Wed, 07/20/2016 - 05:15

There is a strong correlation between epilepsy and smoking according to a study of people living in French-speaking Switzerland.

Although it has yet to be established whether or not epilepsy actually causes smoking, there appears to be a genetic link between susceptibility to epilepsy and to nicotine addiction. There is also a more indirect association, as people find benefit in smoking to relieve stress or depression associated with epilepsy.

For the study, published in the Journal of Neurology, a team of scientists led by Dr Fabienne Picard, from University Hospitals and Medical School of Geneva, analysed 429 people, aged 16 years and older, who had epilepsy and who lived in French-speaking Switzerland.

The data were compared with those from the ‘Tabakmonitoring’ database, which provides annual, detailed information about tobacco use habits in Switzerland’s ‘general’ population, according to linguistic region.

For the epilepsy group, a questionnaire requesting information about their epilepsy type and smoking habits was sent to neurologists to complete with their epilepsy patients. Being a ‘current smoker’ was defined as having had at least one cigarette per day for the previous six months.

Sixteen of the questions were about tobacco consumption (frequency, amount, type, attempts at cessation), and 13 questions were about the type of epilepsy the person had. Four of the questions explored the possible link between epilepsy and smoking (two concerned the relationship between the timings of epilepsy onset and the starting smoking) and two looked at the possible subjective effect of tobacco consumption on seizure frequency. Three questions were about general health (including two screening questions about depression).

The results showed that 32.1% of people with epilepsy were smokers, compared to 19% of the ‘general’ French-speaking Swiss population. The highest prevalence of smoking was seen amongst people with idiopathic generalised epilepsy (44.3%) compared to 27.8% for other types of epilepsy.

These findings are important because they suggest that people with epilepsy may need additional education and support concerning the issue of smoking. Future studies will hopefully focus on understanding the mechanism underlying the relationship between tobacco smoking and epilepsy, so measures to ‘address’ it can be developed.

Author: Dr Özge Özkaya

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New evidence that Nighttime Seizures Disrupt Memory Consolidation

Tue, 07/19/2016 - 05:31

Nighttime seizures disrupt sleep-dependent memory consolidation, according to a pilot study published in the journal Clinical Neurophysiology.

This finding is important, because it will help scientists to better understand the effect of seizures on memory consolidation, and the factors that may influence this. There is currently only limited data in adults, and some conflicting data in children, regarding sleep dependent memory consolidation in epilepsy, although the association is not new.

For the current study, a team led by Dr Ellen Bubrick, from Harvard Medical School, in Boston, recruited 11 people with focal epilepsy aged between 21 and 56 years.

The researchers asked the subjects to complete a memory test, during which they were required to remember the positions of 15 pairs of coloured images of animals and everyday objects, on a 5 x 6 matrix. Participants were first shown where the object pairs were located (the ‘training’ stage), and then asked to remember this after either 12 hours of continuous wakefulness, or 12 hours that included sleep.

The results showed that memory retention after 12 hours of wakefulness was 62.7%, but this increased to 83.6% when the 12-hour period included sleep. This suggests that sleep enhances memory consolidation in epilepsy.

During the study, three of the participants had daytime seizures and three had nighttime seizures. The scientists found that the daytime seizures had no effect on memory, as assessed, but that nighttime seizures resulted in a drop in retention rates.

Memory difficulties are commonly seen in people with epilepsy, and these can sometimes be more debilitating than the seizures themselves. If the effects of seizures on sleep-dependent memory seen here are confirmed in larger studies, it may be possible to develop ways of managing them in the future.

Author: Dr Özge Özkaya

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New Project Could Help reduce Memory Loss Following paediatric epilepsy Surgery

Mon, 07/18/2016 - 05:09

The US National Institute of Health (NIH) has awarded Dr Noa Ofen and colleagues, at Wayne State University in Detroit, $1.9 million (almost £1.5 million), over five years, to examine the formation of memory networks in the developing brain.

Dr Ofen hopes her findings will be applied to paediatric epilepsy surgery, to help predict and reduce the risk of subsequent memory problems.

Dr Ofen comments: “Little is known about how memory systems develop in the human brain. In this project, we will use a combination of unique neuroimaging methodologies that allow us to add new insights about the neural basis of memory development. We also hope this project will be a first step toward clinical applications that can ultimately improve the quality of life of children with focal epilepsy.”

For the study, the researchers will take electrical recordings using electrodes directly implanted on the surface of the brain, whilst the person performs standard memory tasks. This method, known as electrocorticography (ECoG), is highly invasive, and so subjects will be children with focal epilepsy, who are undergoing pre-surgical assessment and need to have ECoG as part of this. The technique will allow the researchers to examine exactly what neurons are doing during memory formation, and study, in real time, information that is predictive of whether information/experiences will be remembered after surgery.

The team will use the information gained during ECoG to map memory networks within the brain. They will also collect functional MRI data from a subset of the children, and from a large number of healthy controls, to try and determine how age naturally affects the activation of and connections between major regions of memory networks.

This project will be instrumental in identifying, in great detail, the functions of memory networks in the developing brain. The team also hopes to extend the mapping of memory networks to key areas of the brain, so that measures can be taken to avoid damaging these during epilepsy surgery. This will help to reduce the risk of subsequent memory problems and greatly improve quality of life.

Author: Dr Özge Özkaya

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Children with Epilepsy should be monitored early for ADHD

Fri, 07/15/2016 - 04:37

Children with epilepsy and febrile seizures have a higher risk of developing attention deficit and hyperactivity disorder (ADHD), according to a new study published in the scientific journal Pediatrics.

This finding suggests that the parents of children with epilepsy or febrile seizures should be told to be vigilant about ADHD symptoms and pay close attention to academic performance, a factor easily influenced by ADHD. It also indicates that paediatricians should monitor all children with epilepsy or febrile seizures for ADHD. These measures will allow ADHD to be identified early and hopefully treated before symptoms develop further.

In a press release, Dr Josiane LaJoie, a paediatric neurologist at New-York University Langone Comprehensive Medical Center (who wasn’t involved this particular research), said: “It is vital that, when caring for a child with epilepsy, some of the medical visit involves attention to academic achievement and psychosocial functioning.”

During the study, a team from Aarhus University, in Denmark, alongside colleagues in Norway, collated medical data from more than 900,000 people born in Denmark between 1990 and 2007, for between five and 22 years (up to 2012). Approximately 13,500 (1.5%) were diagnosed with epilepsy and almost 34,000 (3.8%) experienced febrile seizures. More than 21,000 (2.3%) developed ADHD in this time period.

The researchers found that children with epilepsy were almost three times as likely to develop ADHD than those without epilepsy. The risk of developing ADHD was also approximately 20% to 35% higher in children with febrile seizures compared to children without.

The analysis took into account other risk factors that may have contributed to the development, such as socioeconomic status, low birth weight and a family history of epilepsy, febrile seizures or psychiatric disorders.

These results are striking, however the researchers were not able to show that epilepsy and febrile seizures actually caused ADHD in these people.

Previous studies have shown similar associations between epilepsy and febrile seizures, but the current one analysed a much larger number of subjects, over a longer period of time.

Epilepsy, febrile seizures, and ADHD are all conditions of the central nervous system. It is therefore not surprising that there is a link between them. All three conditions may share common genetic and environmental risk factors that may explain these associations, but further research is needed to confirm this.

Author: Dr Özge Özkaya

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Measures should be put in place to Prevent Suicide in people with epilepsy

Thu, 07/14/2016 - 04:18

Suicide rates are higher in people with epilepsy compared to the general population, according to results published in the journal Epilepsy and Behaviour. Suicide prevention measures should therefore be put in place to prevent such deaths.

Rosemarie Kobau, one of the authors of the study, commented: “Caregivers of people with epilepsy and other members of the public can participate in programs such as Mental Health First Aid, an evidence-based program available in many U.S. communities that teaches people about mental illness symptoms, and how to recognize and intervene during a mental health crisis.”

The programme also exists in England, and more information about it can be found on the Mental Health First Aid England webpage.

During the study, scientists from the US Centers for Disease Controls and Prevention (CDC) used data collected over eight years, between 2003 and 2011, to determine how often and in what circumstances suicide occurs in people with epilepsy.

They found that an average of 17 out of 100,000 people with epilepsy, aged 10 years and older, died from suicide each year during the study period, compared to 14 out of 100,000 in the general population.

The team then focused on people aged 40-49 years, and discovered that the suicide rates were 29% amongst those with epilepsy and 22% in the general population.

Looking at the relationships between suicide rate and a) race/ethnicity, b) education and c) marital status, there were no significant differences between the epilepsy and general population ‘groups’. In both, approximately one-third of suicides were committed by people with the lowest level of education.

When the researchers examined the locations in which the suicides occurred most, they found that 81% of people with epilepsy committed suicide in residential settings, compared to 76% of people without epilepsy.

This result suggests that it may be beneficial that caregivers, relatives, and others living with people with epilepsy to assess the availability of potentially harmful materials in the home to reduce the risk of suicide.

According to Samaritans, there were more than 6.500 suicides in the UK and Republic of Ireland in 2014. It is thought that there might be a link between epilepsy, psychiatric disorders and suicide.

If you feel that you, or someone you know is at risk of suicide, you can contact Samaritans any time, from any phone, on 116 123.

Author: Dr Özge Özkaya

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