Archive for category Epilepsy
Scientists from Italy conducted a study, during which they established the beneficial effects of Mozart’s piano music on people’s mental health. They proved that the works of the composer help with epilepsy.
The “Mozart effect” has been known since the end of the last century. However, until recently, no research has provided convincing evidence of its existence, and therefore doctors are skeptical about it. Scientists from the University of Pisa carried out scientific work, during which they carried out a detailed analysis of 147 published articles devoted to this phenomenon. After reviewing all the materials, Dr. Federico Sicca and Gianluca Sesso chose the 12 most accurate. They compared the results obtained by experts working independently of each other, revealing patterns. In their opinion, listening to classical works of Mozart daily can have a significant impact on health. The number of seizures with epilepsy among fans of such music decreases from 31% to 66%. Even a one-time listening has a positive impact. Probably, the effect is due to special rhythmic structures, but the therapeutic effect can be revealed when listening to compositions by other authors.
Their colleague from the Lithuanian University of Medical Sciences Vesta Steiblienė agrees with them. In her opinion, interest in non-invasive methods of brain stimulation is growing and is increasingly being practiced by doctors, but for widespread use and acceptance of recommendations, such neurostimulation should be studied more carefully and accurately. Since it is already obvious now that Mozart’s music really has an effect, but it is not clear at the expense of what exactly.
Author(s): Rani Haley Lindberg, Devin Wells MDOriginally published: August 7, 2012 Last updated: April 5, 2016
- essentials of assessment,
- rehabilitation management and treatments,
- cutting edge/emerging and unique concepts and practice,
- gaps in the evidencebased knowledge,
Seizure is the transient onset of paroxysmal events due to abnormal electrical activity within the brain as a result of excessive or synchronous neuronal activity.1
- Acute symptomatic seizures: seizures resulting from acute central nervous system (CNS) insult including but not limited to metabolic, toxic, structural, infectious, or inflammatory insults.2
- Unprovoked seizures: seizures that occur in the absence of active CNS insult or beyond the time interval estimated for acute seizures.2
- Seizures can be focal (with or without dyscognitive features) or generalized. Generalized seizures include absence, tonic-clonic, atonic, and myotonic seizures.
- Status epilepticus denotes that the seizure is prolonged or immediately recurrent without return of consciousness.
Epilepsy is a brain disorder in which there is a chronic underlying CNS disorder resulting in unprovoked, recurring seizures
Seizure precipitants include but are not limited to the following:
- Traumatic brain injury
- Hypoxic-ischemic events in the brain
- Intracranial hemorrhage
- Infection of the central nervous system
- Metabolic disorder
- Congenital abnormalities of the brain
- Neurodegenerative disorders
- Drug withdrawal or intoxication
- Brain tumors/mass lesions
- Primary or idiopathic epilepsy (unknown cause)
While seizures can be unprovoked, in some cases they may be triggered by factors such as fatigue, sleep deprivation, or flickering lights.
Epidemiology including risk factors and primary prevention
According to the World Health Organization 2015 update, there are approximately 50 million people world-wide who are living with epilepsy: a prevalence of 4 to 10 per 1000 people. Around 5% of the population will have at least 1 seizure within their lifespan.3 Incidence of neonatal seizures is 1-1.2% of live births. Younger children are at a higher risk if they have congenital, genetic, or developmental conditions; in adults, neoplastic, vascular, and degenerative etiologies are more common. The highest incidence of epilepsy occurs at the extremes of life. Men are at higher risk than women for epilepsy.
Focal seizures are the most common seizure type, yet generalized seizures are more common in children. Seizures developing 1 week post-TBI occurs in 14-53% of the moderate to severe TBI survivors. 50% of TBI survivors with penetrating brain injuries develop epilepsy. In individuals aged 15 to 24, TBI is the leading cause of epilepsy.
An impairment of the biochemical processes at the neurotransmitter and ion channel level causes hyperexcitability and neuronal hypersynchrony. Seizures are a result of this abnormal and excessive neuronal activity because of an imbalance between excitatory and inhibitory forces within the brain.
The primary excitatory neurotransmitter in the brain is glutamate, and the primary inhibitory neurotransmitter is gamma-aminobutyric acid (GABA). Antiepileptic drugs (AEDs) facilitate neuronal inhibition and/or reduce excitation.
Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)
Individuals in whom the sole cause of a seizure is a correctable condition, for example a metabolic disturbance without an underlying structural lesion, are rarely at risk for future epilepsy or recurrent seizures in the absence of recurrence of the condition.
The risk of seizure recurrence in someone with an unprovoked or idiopathic initial seizure is estimated to be 30-70% in the first 12 months, depending on seizure type and etiology. Abnormal neurologic exam, postictal paralysis, abnormal electroencephalogram (EEG), and strong family history of seizures increase the risk of seizure recurrence.
Approximately 60-70% of individuals whose seizures are completely controlled can eventually discontinue antiepileptic therapy.
Specific secondary or associated conditions and complications
Consequences and complications associated with seizures and epilepsy include but are not limited to:
- Impairment of consciousness
- Physical injuries during the event
- Anoxic injury to the brain
- Learning disabilities
- Memory loss
- Language deficits
- Impaired self-esteem
- Mood disorders (e.g., anxiety, depression, adjustment disorders)
- Loss of independence and limitations in participation, including specific work activities and driving.
Side effects of AEDs are common and include osteoporosis, weight gain, negative cognitive impairments, nausea, sedation, and/or ataxia.
2. essentials of assessment
A comprehensive history is necessary to confirm seizure activity, to characterize the seizure, and to identify risk factors for seizure. An accurate description of surrounding events, including witness interview, helps identify sources that elicit seizures, the presence of any aura, and ictal and postictal behaviors.
- Aura may include abnormal smell or taste, deja vu feeling, or an intense feeling that a seizure is imminent.
- Patients or witnesses may report: generalized convulsions, repetitive movements, staring spells, visual or auditory disturbances, or dysesthesias
History should also include a comprehensive review of medications, alcohol or drug use/abuse, family history, and thorough medical history, including history of head trauma, stroke, neurodegenerative diseases, and intracranial infections. In patients with confirmed epilepsy, history should assess seizure control and the functional/social impact of seizures.
Differential diagnosis includes but is not limited to transient ischemic attacks, vaso-vagal/syncopal episodes, delirium, migraine headaches, movement disorders, and psychological factors.
A careful neurologic examination in the interictal period, including assessment of cortical function and mental status, is essential. Presence of TBI or other premorbid neurological disorder can mask signs and symptoms of seizure. Thus, observation for subtle clues and symptoms is essential to seizure diagnosis.
The physical manifestation of a seizure is dependent on its classification:
- Generalized tonic-clonic seizures: Abrupt onset with loss of consciousness; generalized muscle rigidity, followed by jerking/twitching movements. Often followed by a postictal phase characterized by deep sleep with deep respirations and gradual awakening accompanied by a headache.
- Focal seizures with dyscognitive features (complex partial seizures): altered consciousness without loss of consciousness often associated with repetitive behaviors or automatisms (lip smacking, snapping fingers, facial grimacing). The postictal phase includes confusion, somnolence, and headaches.
- Absence seizures (typically occurs during childhood): staring spell with impaired consciousness; during is typically 5-10 seconds.
- Subclinical seizures: abnormal electroencephalographic activity without physically symptoms or signs.
The physical exam should be comprehensive to assist in searching for an underlying cause of seizure, such as infection or a systemic disorder.
Depending on the cause and duration of the seizure, there can be subsequent impairments in mobility, self-care, behavior, cognition, mood, self-esteem, learning abilities, and speech/language. In mesial temporal sclerosis, the most commonly diagnosed focal structural abnormality in patients with epilepsy, associated neuropsychiatric impairments may include decreased memory, cognition, depression, anxiety, and psychiatric comorbidities.
Laboratory tests include:
- Comprehensive metabolic panel including sodium, glucose, calcium, magnesium, renal and liver function levels
- Hematology studies
- Toxicology screens
- Serum prolactin level (elevated post seizure, must be drawn within 1 hour of the event)
- Lumbar puncture is indicated if there is suspicion of a central neurologic infectious process
Neuroimaging studies are typically indicated for evaluation of the brain structure. Magnetic resonance imaging (MRI) is preferred over computerized tomography (CT)11, given that it facilitates better identification of structural causes of epilepsy, such as mesial temporal sclerosis, cortical dysplasia, brain tumors, vascular malformations, TBI, cerebral infarction/hemorrhages, and infectious process.
An epilepsy protocol for the MRI should be performed, which would ideally include the following:
- Standard T1-weighted images.
- T2-weighted fast spin-echo sequences.
- Gradient echo (T2) sequences.
- Fluid-attenuated inversion recovery sequences.
- Three-dimensional (3D) volume acquisition sequences with high definition of the gray-white junction; 3D fast spoiled gradient recalled echo acquisition at the steady state.
Functional imaging techniques such as positron emission tomography (PET), single-photon emission computerized tomography (SPECT), functional magnetic resonance imaging (fMRI), and magnetic resonance spectroscopy (MRS) are helpful in localizing/mapping epileptic foci and can aide in surgical management of epilepsy.
Supplemental assessment tools
EEG is an essential diagnostic tool when evaluating seizures. Epileptiform abnormalities usually increase the likelihood that the patient will experience another seizure over the next 2 years. EEG abnormalities can be nonspecific and a normal EEG does not rule out epilepsy. Long-term video EEGs are helpful in recording multiple seizures. Epileptiform discharges are associated with epilepsy, while nonepileptiform abnormalities are nonspecific EEG abnormalities that do not support the diagnosis of epilepsy.
Neuropsychological testing can be used in nonoperative or postoperative epilepsy patients to assess level of cognitive functioning. Results can assist with recommendations for vocational and cognitive rehabilitation.
Early predictions of outcomes
In individuals with TBI resulting in loss of consciousness or amnesia lasting less than thirty minutes (mild injury), there is a 0.5% cumulative five-year probability of seizures. In moderate injury, or loss of consciousness for 30 minutes to 24 hours or skull fracture, there is a 1.2% probability and for severe injuries (loss of consciousness or amnesia >24hours, cerebral contusion, SDH) there is a 10% probability.13
In hospitalized TBI patients with initial GCS of 13 to 15, the 2 year incidence of epilepsy is 8%. For GCS 3 to 8, the 2 year incidence is 16.8%.12
Refractory epilepsy requiring multiple medications is more likely in those with focal seizures due to underlying structural abnormalities, multiple seizure types, or comorbid developmental delays.
Seizures can be triggered by environmental factors such as loud noises and flashing lights.
Environmental safety considerations include avoiding heights/climbing activities, scuba diving, and swimming alone.
Social role and social support system
Seizures and epilepsy can significantly impact functional independence, learning abilities, employability, insurability/financial resources, self-esteem, mood, ability to drive or operate heavy equipment, and vocational skills.
Support systems should provide resources within the home and the community to provide these patients, families, and support network with education, and counseling about seizure triggers, physical and psychosocial consequences of seizures, and coping with seizure/epilepsy diagnosis.
States differ in their requirements for reporting seizure/epilepsy diagnoses to the Office of Driver Services. Physicians should be knowledgeable of their local state law and regulations regarding drivers with an active history of epilepsy.4
3. rehabilitation management and treatments
Available or current treatment guidelines
The following are recommendations for seizure prophylaxis with antiepileptic drugs (AEDs) in patients with TBI:5
- Immediate seizures (within first 24 hours) post-TBI do not require any additional prophylaxis after 7 days.
- Early seizures (between days 1 and 7) post-TBI should be treated for at least 24 months with AEDs, unless there was a casual time-limited intracranial abnormality (hydrocephalus, active hemorrhage, or infectious process). Early seizures are associated with a higher incidence of intracranial bleeding. Incidence of early seizures post-TBI decreases significantly with seizure prophylaxis the first 7 days post-TBI.
- Late seizures (after 7 days) post TBI should be treated for at least 24 months.
- Any seizure post-TBI that is considered status epilepticus, requires treatment with AEDs for at least 12-24 months.6
- Individuals with frequent seizures during the first year post-trauma are less likely to have seizure remission.7
Recommendations for seizure prophylaxis for newly diagnosed brain tumors:8
- Anticonvulsant medications are not proven effective in preventing initial seizures. Because of a lack of efficacy and potential side effects, prophylactic anticonvulsants should not be routinely used in patients with newly diagnosed brain tumors.
- In patients with brain tumors who have not had a seizure, tapering and discontinuing anticonvulsants after the first postoperative week is appropriate, particularly in those patients who are medically stable and who are experiencing anticonvulsant-related side effects.
At different disease stages
- Initial seizure: Treat acute underlying cause (metabolic derangements, alcohol and drug withdrawal, intracranial hemorrhages, infectious process, hypoxic events, drug toxicity). If there is strong evidence of an epileptogenic focus, then AED treatment should be initiated.
- Initiate an AED after 2 or more unprovoked seizures.
- Choice of AED should take into consideration drug effectiveness for the seizure type, potential adverse effects including neurological/cognitive impairments, medication interactions, comorbid medical conditions, age and sex (pregnancy risk), lifestyle, cost, and patient preferences.
- Monotherapy is preferred. 10-15%of people need two AEDs to control seizure activity. Up to 80% of patients can become seizure free on AED treatment.
- First-line antiepileptic drugs include:
- Generalized tonic-clonic seizures: valproic acid or lamotrigine
- Focal seizures: carbamazepine, lamotrigine, or phenytoin
- Absence seizures: valproic acid or ethosuximide for absence seizures
- Routine follow up of patients on AEDs should include AED serum level, blood counts, albumin level (for phenytoin), and hepatic and renal function monitoring.
- After a seizure-free period of 2-4 years, it is reasonable to consider discontinuation of AEDs. Tapering should be performed slowly; there is no well-defined accepted tapering schedule. It should be done over a 2-3 month period at minimum.
- Treatment for seizures resistant to AEDs include: Vagal nerve stimulators or surgical procedures9 such as anteromedial temporal resection, corpus callosotomy, functional hemispherectomy (hemispherotomy), and multiple subpial transection.
- Status epilepticus: Benzodiazepines are the first line of treatment followed by phenytoin, barbiturates, and propofol.
Coordination of care
Medical care should be coordinated with measures to address psychosocial consequences. Treatment team should include primary care physician, neurologist, physiatrist, neurosurgeon, psychiatry/psychology, physical therapy, occupation therapy, speech therapy, and vocational therapist.
Emerging and unique interventions include transcranial magnetic stimulation and deep brain stimulation and are discussed below.
4. cutting edge/emerging and unique concepts and practice
Cutting edge concepts and practice
Up to one third of patients do not have a response to current AED’s and therapies. 19
Clobazam is a benzodiazepine which is used for treatment of various types of epilepsy, though only approved for Lennox-Gastuat syndrome in the United States. It has less sedating effects that other benzodiazepines and has high safety profile and efficacy in refractory epilepsy. 17
Deep brain stimulation (DBS) is a newer area of study that is useful in treating pharmacologically refractory epilepsy.10 Stimulation of the anterior nuclei of the thalamus (ANT) has been shown to be useful in adjunctive treatment of refractory epilepsy; the FDA approved DBS in the ANT as treatment for severe and refractory partial-onset seizures. Other deep brain areas, such as the subthalamic nucleus, caudate nucleus, cerebellum, are being studies as it relates to DBS. More well-controlled, larger studies are needed for other deep brain structures.
Transcranial magnetic stimulation (TMS) is another area being studies for improvement in refractory cases of epilepsy. Low-frequency high intensity repetitive TMS has a significant antiepileptic effect when delivered to epileptogenic areas of the brain and can also reduce interictal epileptic discharge improving psychological conditions in patients.15
Responsive neurostimulator (RNS) is a device that when implanted in the cortical or subcortical epileptogenic areas of the brain detects abnormal activity and delivers electrical stimulation to inhibit seizures prior to the onset of symptoms. Clinical trials are ongoing currently, but data supports the RNS device as a therapy option for refractory partial seizures.16
Other treatment options that are being explored include Synchrotron radiation and lactate dehydrogenase inhibition.18,19
5. gaps in the evidence-based knowledge
Gaps in the evidence-based knowledge
Although there are multiple resources providing recommendations regarding prophylaxis for seizures/epilepsy in high risk populations such as patients with CNS pathology, there are limited references providing a consensus to develop evidence-based guidelines for prevention and treatment.
- Fisher RS, van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005 Apr. 46(4):470-2.
- Beghi E, Carpio A, Forsgren L, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51:671-675.
- Moran NF, Poole K, Bell G, et al. Epilepsy in the United Kingdom: seizure frequency and severity, anti-epileptic drug utilization and impact on life in 1652 people with epilepsy. Seizure. 2004;13:425-433.
- Shareef YS, McKinnon JH, Gauthier SM, Noe KH, Sirven JI, Drazkowski JF. Counseling for driving restrictions in epilepsy and other causes of temporary impairment of consciousness: how are we doing? Epilepsy Behav. 2009;14:550-552.
- Temkin NR. Risk factors for posttraumatic seizures in adults. Epilepsia. 2003;44 Suppl 10:18-20.
- Christensen J, Pedersen MG, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet. 2009;373:1105-1110.
- Emanuelson I, Uvebrant P. Occurence of epilepsy during first 10 years after traumatic brain injury acquired in childhood up to the age of 18 years in the south western Swedish population-based series. Brain Inj. 2009;23:612-616.1. 64p.
- Kerrigan S, Grant R. Antiepileptic drugs for treating seizures in adults with brain tumors. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD008586.
- Wyllie E, Comair YG, Kotagal P, Bulacio J, Bingaman W, Ruggieri P. Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol. 1998;44:740-748.
- Wakerley B, Schweder P, Green A, Aziz T. Possible seizure suppression via deep brain stimulation of the thalamic ventralis oralis posterior nucleus. J Clin Neurosci. 2011;18:972-973.
- Salmenpera TM, Duncan JS. Imaging in epilepsy. Journal of Neurol Neurosurg Psychiatry. 2005(76): iii2-iii10.
- EnglanderJ, Bushnik T, et al. Analyzing risk factors for late posttraumatic seizures: a prospective, multicenter investigation. Arch Phys Med Rehabil. 2003; 84 (3): 365
- Annegers JF, Hauser WA, et al. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998;338 (1): 20
- SANTE Trial of Deep Brain Stimulation in Epilepsy Published; FDA Panel Recommends Approval in Close Vote. Medscape. Mar 19, 2010
- Sun W, Mao W, et al. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy: A controlled clinical Study. Epilepsia 2012; 53: 1782-1789
- Bergey G, Morrell M, et al. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology. 2015; 84: 810-817
- Gauthier A, Mattson R. Clobazan: A safe, efficacious, and newly rediscovered therapeutic for epilepsy. CNS Neuroscience & Therapeutics; 2015; 21: 543-548.
- Romanelli P, Bravin A, et al. New radiosurgical paradigms to treat epilepsy using synchrotron radiation. Epilepsy Toward the Next Decade. 2014; 231-236
- Rho J, Inhibition of Lactate Dehydrogenase to Treat Epilepsy. N Engl J Med. 2015; 373:187-189
- Sada N, Lee S, Katsu T, Otsuki T, Inoue T. Epilepsy treatment: targeting LDH enzymes with a stiripentol analog to treat epilepsy. Science 2015;347:1362-1367
This study aimed to systematically review studies focusing on levels of physical activity (PA) in people with epilepsy (PWE) compared with non‐epilepsy controls, and identify factors associated with PA in PWE.
Intervention studies were also reviewed to consider the effects of psychological interventions on levels of PA, and the effects of PA‐based interventions on seizure activity, psychiatric comorbidity, and health‐related quality of life (HRQoL). PRISMA guidelines were followed. Searches were conducted using PubMed, Cochrane Controlled Register of Trials, PsycINFO, and Embase.
Forty‐six studies met inclusion criteria, including case‐control, cross‐sectional, and intervention studies. Assessment measures included questionnaires, activity trackers, and measures of physiological fitness. Twelve of 22 (54.5%) case‐control studies utilizing self‐report questionnaire measures reported that PWE were performing lower levels of PA, less likely to be engaging in PA, or less likely to meet PA guidelines than controls. The remaining studies did not find a difference between PWE and controls. Eight of 12 (67%) case‐control studies utilizing exercise/fitness tests reported that PWE performed significantly poorer than controls, whereas in two studies PWE performed better than controls. One of three studies investigating the relationship between PA and seizure frequency found that increased self‐reported PA was associated with having fewer seizures, whereas two did not find a significant relationship.
All seven cross‐sectional studies that included measures of HRQoL and depression/anxiety found a positive relationship between levels of PA and HRQoL/reduced levels of depression and anxiety. All four studies that used PA‐based interventions demonstrated improvements in levels of PA and increased HRQoL. Study quality was almost universally low. In conclusion, there is some evidence that PWE engage in less PA than peers, and that interventions can improve PA levels and HRQoL. However, there is a need for more robust study designs to better understand PA in individuals with epilepsy.
September 8th, 2020
University spinout company Neuronostics has received funding to develop its BioEP platform, an AI-based system for faster, more accurate diagnosis of epilepsy and to monitor response to treatment with anti-epileptic drugs (AEDs).
BioEP works by creating mathematical models of the brain using short segments of electroencephalogram (EEG) recordings. Computer simulations rapidly reveal the ease with which seizures can emerge and form the basis of the BioEP seizure risk score.
Neuronostics is developing BioEP in partnership with the University of Birmingham, where mathematician Professor John Terry, co-founder of the company, is Director of Centre for Systems Modelling & Quantitative Biomedicine.
Professor Terry’s research aims to improve diagnosis and treatment for people with epilepsy. He explains: “We build personalised models of the brain using EEG that is routinely collected when seeking to diagnose epilepsy. From these models the risk of epilepsy can be quickly determined. In contrast, multiple EEG recordings are often required to reach a clinical diagnosis at present. This is expensive, time-consuming, and exposes people with suspected epilepsy to risk.”
The funding, from the National Institute for Health Research (NIHR), will enable the research partnership to progress a prototype clinical platform that can provide a risk score showing the individual’s susceptibility to seizures. This measurement can be used in diagnosis, and as an objective assessment of response to treatment with AEDs, resulting in faster seizure control for people with epilepsy.
The clinical utility of the BioEP seizure risk score has already been demonstrated in a cohort of people with idiopathic generalized epilepsy.1 Using just 20 seconds of an EEG recording that would be considered inconclusive in the current clinical pathway, BioEP achieved 72% diagnostic accuracy. This matches the accuracy achieved in the current diagnostic pathway, which typically takes a year, and involves multiple follow-ups.2
The company is interested to hear from commercial partners in EEG hardware manufacturing, digital EEG analysis, and companion diagnostics or prognostics, and research and clinical partners with interests in epilepsy, traumatic brain injury and dementia. For collaboration enquiries please email: firstname.lastname@example.org.
The NIHR funding was delivered through the AI in Health and Care Award, part of the NHS AI Lab, which was launched by the UK Government earlier this year to accelerate the adoption of Artificial Intelligence in health and care.
1. H Schmidt et al. A computational biomarker of idiopathic generalized epilepsy from resting state EEG Epilepsia 57: e200-e204 (2016).
2. S Smith. EEG in the diagnosis, classification, and management of patients with epilepsy Journal of Neurology, Neurosurgery & Psychiatry 76: ii2-ii7 (2005).
For further media information please contact: Ruth Ashton, Reputation & Communications Development Manager, University of Birmingham Enterprise, email: email@example.com.
Neuronostics was established in 2018 and is focussed on developing clinical decision support tools and at home monitoring devices for people with suspected neurological conditions. Neuronostics is currently Medilink SW Start up of the Year and has been supported by grant funding in excess of £1M. Neuronostics’ first product—BioEP—is a revolutionary, patented, biomarker of the susceptibility to seizures in the human brain, informed by clinical EEG recordings.
About the University of Birmingham
The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries.
The National Institute for Health Research (NIHR) is the nation’s largest funder of health and care research. The NIHR:
● Funds, supports and delivers high quality research that benefits the NHS, public health and social care
● Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
● Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
● Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
● Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
Provided by University of Birmingham
The ketogenic diet is a popular topic among the epilepsy community. Some MyEpilepsyTeam members have been able to reduce the number of seizures they have by maintaining this rigorous diet. The ketogenic diet requires eating minimal to no carbohydrates and increasing healthy fats.
On MyEpilepsyTeam, the social network and online support group for those living with epilepsy, members talk about a range of personal experiences and struggles. The ketogenic diet is one of the top 10 topics most discussed.
Here are some conversations about the ketogenic diet:
Here are some question and answer threads about the ketogenic diet:
Can you relate?
Have another topic you’d like to discuss or explore? Go to MyEpilepsyTeam today and start the conversation. You’ll be surprised just how many others may share similar stories.
Feel free to ask a question here.
Epilepsy is a chronic and debilitating neurological disorder, with a worldwide prevalence of
0.5–1% and a lifetime incidence of 1–3%. An estimated 30% of epileptic patients continue to experience
seizures throughout life, despite adequate drug therapy or surgery, with a major impact on society
and global health. In recent decades, dietary regimens have been used effectively in the treatment of
drug-resistant epilepsy, following the path of a non-pharmacological approach. The ketogenic diet
and its variants (e.g., the modified Atkins diet) have an established role in contrasting epileptogenesis
through the production of a series of cascading events induced by physiological ketosis. Other dietary
regimens, such as caloric restriction and a gluten free diet, can also exert beneficial effects on
neuroprotection and, therefore, on refractory epilepsy. The purpose of this review was to analyze
the evidence from the literature about the possible efficacy of different dietary regimens on epilepsy,
focusing on the underlying pathophysiological mechanisms, safety, and tolerability both in pediatric
and adult population. We believe that a better knowledge of the cellular and molecular biochemical
processes behind the anticonvulsant effects of alimentary therapies may lead to the development of
personalized dietary intervention protocols.
Seizures are common among patients with low grade glioma (LGG) and can significantly impact morbidity. We sought to determine the association between the clinical and molecular factors with seizure incidence and refractoriness in LGG patients
We conducted a retrospective review at University of Virginia in patients with LGG (WHO Grade II) evaluated between 2002-2015. Descriptive statistics were calculated for variables of interest and the Kaplan-Meier method was used to estimate survival curves, which were compared with the log-rank test
291 patients were included; 254 had molecular testing performed for presence of an IDH mutation and/or 1p/19q co-deletion. Sixty-eight percent of patients developed seizures prior to LGG diagnosis; 41% of all patients had intractable seizures. Utilizing WHO 2016 integrated classification, there was no significant difference in seizure frequency at pre- and post-operative periods or in developing intractable seizures, though a trend toward increased pre-operative seizure incidence among patients with IDH mutation was identified (p=0.09). Male gender was significantly associated with higher seizure incidence on pre-operative (p&0.001) and post-operative periods (p&0.001); men were also more likely to develop intractable seizures (p=0.01)
Seizures are common among patients with LGG. Differences in pre- or post-operative and intractable seizure rates by WHO 2016 classification were not detected. Our data showed a trend toward higher seizure incidence pre-operatively in patients with IDH mutant LGG. We describe a unique association between male gender and seizure incidence and intractability that warrants further studyTopic:
[ARTICLE] Medication use in poststroke epilepsy: A descriptive study on switching of antiepileptic drug treatment – Full Text
- It is unknown why patients switch their antiepileptic drugs in poststroke epilepsy.
- We found that 40% of patients needed to switch.
- 13% of patients switched because of ineffectivity of the first prescribed AED.
- Dosages at the time of switching were higher in case of ineffectivity than in case of side effects.
Currently, as evidence-based guidelines are lacking, in patients with poststroke epilepsy (PSE), the choice of the first antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. Although, it is not uncommon that patients with PSE subsequently switch their first prescribed AED to another AED, reasons for those switches are not reported yet. In the present study, we therefore assessed the reasons for switching the first prescribed AED in patients with PSE.
We gathered a hospital-based case series of 53 adult patients with poststroke epilepsy and assessed the use of AEDs, comedication, and the reasons for switches between AEDs during treatment. We also determined the daily drug dose (DDD) at the switching moment.
During a median follow-up of 62 months (Interquartile range [IQR] 69 months), 21 patients (40%) switched their first prescribed AED. Seven patients switched AED at least once because of ineffectivity only or a combination of ineffectivity and side effects, whereas 14 patients switched AED at least once because of side effects only. The DDD was significantly (p < 0.001) higher in case of medication switches due to ineffectivity (median 1.20, IQR 0.33) compared to switching due to side effects (median 0.67, IQR 0.07). There was no difference in the use of comedication between the group that switched because of ineffectivity compared to the group that switched because of side effects.
In our case series, up to 40% of patients with epilepsy after stroke needed to switch their first prescribed AED, mostly because of side effects in lower dosage ranges.
Stroke is the cause of about 10% of all epilepsy and 55% of newly diagnosed seizures among the elderly . Nevertheless, there are no specific evidence-based guidelines regarding treatment of patients with poststroke epilepsy (PSE). Therefore, the choice of antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. From the 2013 International League Against Epilepsy (ILAE) report on initial monotherapy for epileptic seizures and syndromes, it appears that carbamazepine, levetiracetam, phenytoin, and zonisamide have ‘level A’ evidence for treating focal epilepsy in adults [2, 3, 4, 5]. This may already guide the choice of the AED by mainly effectivity arguments. On the other hand, according to a recent study by Larsson et al., in patients with PSE, retention rates are highest for levetiracetam and lamotrigine, and lowest for carbamazepine and phenytoin , meaning that carbamazepine and phenytoin are more often switched to another drug or discontinued. A 2018 review of randomized controlled trials on AED for the treatment of PSE found that levetiracetam and lamotrigine were better tolerated than carbamazepine . However, reasons for discontinuation or switching of AEDs in patients with PSE are not reported. We therefore aimed to study the reasons for switching the first prescribed AED in patients with epilepsy after stroke.[…]
Ebook Title : Epilepsy Complementary And Alternative Treatments
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Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking. These episodes can result in physical injuries, including occasionally broken bones. In epilepsy, seizures have a tendency to recur and, as a rule, have no immediate underlying cause.
Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to their condition.
The underlying mechanism of epileptic seizures is excessive and abnormal neuronal activity in the cortex of the brain. The reason this occurs in most cases of epilepsy is unknown. Some cases occur as the result of brain injury, stroke, brain tumors, infections of the brain, or birth defects through a process known as epileptogenesis. Known genetic mutations are directly linked to a small proportion of cases. The diagnosis involves ruling out other conditions that might cause similar symptoms, such as fainting, and determining if another cause of seizures is present, such as alcohol withdrawal or electrolyte problems. This may be partly done by imaging the brain and performing blood tests. Epilepsy can often be confirmed with an electroencephalogram (EEG), but a normal test does not rule out the condition. Epilepsy that occurs as a result of other issues may be preventable.
Seizures are controllable with medication in about 70% of cases; inexpensive anti-seizure medications are often available. In those whose seizures do not respond to medication, surgery, neurostimulation or dietary changes may then be considered. Not all cases of epilepsy are lifelong, and many people improve to the point that treatment is no longer needed. As of 2015, about 39 million people have epilepsy.
Nearly 80% of cases occur in the developing world. In 2015, it resulted in 125,000 deaths, an increase from 112,000 in 1990. Epilepsy is more common in older people. In the developed world, onset of new cases occurs most frequently in babies and the elderly. In the developing world, onset is more common in older children and young adults due to differences in the frequency of the underlying causes. About 5–10% of people will have an unprovoked seizure by the age of 80, and the chance of experiencing a second seizure is between 40 and 50%. In many areas of the world, those with epilepsy either have restrictions placed on their ability to drive or are not permitted to drive until they are free of seizures for a specific length of time.
The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, ‘to seize, possess, or afflict’. Seizures Main article: Epileptic seizure The most common type (60%) of seizures are convulsive. Of these, one-third begin as generalized seizures from the start, affecting both hemispheres of the brain. Two-thirds begin as focal seizures (which affect one hemisphere of the brain) which may then progress to generalized seizures. The remaining 40% of seizures are non-convulsive. An example of this type is the absence seizure, which presents as a decreased level of consciousness and usually lasts about 10 seconds.
Focal seizures are often preceded by certain experiences, known as auras. They include sensory (visual, hearing, or smell), psychic, autonomic, and motor phenomena. Jerking activity may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a Jacksonian march. Automatisms may occur, which are non-consciously-generated activities and mostly simple repetitive movements like smacking of the lips or more complex activities such as attempts to pick up something. There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence and atonic seizures. They all involve loss of consciousness and typically happen without warning.