Archive for category Epilepsy

[WEB PAGE] Epilepsy – Symptoms and causes – Mayo Clinic

Overview

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.

Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn’t mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.

Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.

Epilepsy care at Mayo Clinic

Symptoms

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain, they’re called focal (partial) seizures. These seizures fall into two categories:

  • Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don’t cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
  • Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.

Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.

  • Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness.
  • Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
  • Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
  • Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
  • Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
  • Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

When to see a doctor

Seek immediate medical help if any of the following occurs:

  • The seizure lasts more than five minutes.
  • Breathing or consciousness doesn’t return after the seizure stops.
  • A second seizure follows immediately.
  • You have a high fever.
  • You’re experiencing heat exhaustion.
  • You’re pregnant.
  • You have diabetes.
  • You’ve injured yourself during the seizure.

If you experience a seizure for the first time, seek medical advice.

Causes

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:

  • Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic influence.

    Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.

  • Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
  • Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
  • Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
  • Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
  • Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.

Risk factors

Certain factors may increase your risk of epilepsy:

  • Age. The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.
  • Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
  • Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
  • Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly.
  • Dementia. Dementia can increase the risk of epilepsy in older adults.
  • Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk.
  • Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won’t develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.

Complications

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

  • Falling. If you fall during a seizure, you can injure your head or break a bone.
  • Drowning. If you have epilepsy, you’re 15 to 19 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
  • Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.

    Many states have driver’s license restrictions related to a driver’s ability to control seizures and impose a minimum amount of time that a driver be seizure-free, ranging from months to years, before being allowed to drive.

  • Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, talk to your doctor as you plan your pregnancy.

    Most women with epilepsy can become pregnant and have healthy babies. You’ll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It’s very important that you work with your doctor to plan your pregnancy.

  • Emotional health issues. People with epilepsy are more likely to have psychological problems, especially depression, anxiety and suicidal thoughts and behaviors. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects.

Other life-threatening complications of epilepsy are uncommon, but may happen, such as:

  • Status epilepticus. This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes or if you have frequent recurrent seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
  • Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows it may occur due to heart or respiratory conditions.

    People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medications may be at higher risk of SUDEP. Overall, about 1 percent of people with epilepsy die of SUDEP.

 

via Epilepsy – Symptoms and causes – Mayo Clinic

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[WEB SITE] Artists react to epilepsy research project in new exhibition

‘Illuminating the Self’ is a thrilling new exhibition featuring artist’s reactions to the CANDO research project. The exhibition opens on Saturday 18th January at the Hatton Gallery and Vane Gallery, both in Newcastle upon Tyne.

The CANDO project involves a team of over 30 neuroscientists, engineers and clinicians based at Newcastle University, Imperial College London, University College London and The Newcastle Hospitals NHS Foundation Trust. Led by Professor Andrew Jackson and Professor Anthony O’Neill, CANDO proposes an alternative treatment to epilepsy, using a small implant to modulate abnormal activity to prevent seizure development.

CANDO is keen to engage with the public and the epilepsy community to ensure that it meets the needs of people with epilepsy. To facilitate this, they have collaborated with renowned artists Susan Aldworth and Andrew Carnie to create a remarkable exhibition, ‘Illuminating the Self’, demonstrating their artistic response to the project. The exhibitions aim to stimulate discussion and understanding of epilepsy and the use of technology within the brain.

The project is highly interdisciplinary, involving engineers, scientists and clinicians, as well as an advisory group of people affected by epilepsy. It’s challenging but also extremely satisfying to work together and attempt something that initially sounds like science-fiction, but could have real benefits in future.
Professor Andrew Jackson

‘Blue Matter’ – Andrew Carni

ERUK caught up with project lead Professor Andrew Jackson ahead of the launch to discuss this unique event.

How would you describe the CANDO project and how did you identify the need to explore this area of research?

The CANDO project is developing a combined gene therapy and optoelectronic implant for the treatment of focal epilepsy. As you know, treatment options for drug-resistant epilepsy are limited. While surgery can be effective, there are many areas of the brain that cannot be safely resected. We want instead to develop an implant that can control patterns of brain activity within and around the focus, supressing seizure activity and preventing it from spreading. While some existing devices attempt to do this using electrical stimulation, the new technique of optogenetics promises control of brain circuits with much greater precision.

‘Out of the Blue’ – Susan Aldworth

‘Crack of Light’ – Andrew Carnie

What is the most exciting or interesting part of being involved in CANDO?

The project is highly interdisciplinary, involving engineers, scientists and clinicians, as well as an advisory group of people affected by epilepsy. It’s challenging but also extremely satisfying to work together and attempt something that initially sounds like science-fiction, but could have real benefits in future. I also feel that it is important to try to translate our growing scientific understanding of the brain into better therapies. The promise of optogenetics, unlike drugs, is to deliver therapy in the right place, at the right time, to the right brain cells. This could open the door to new treatments for many neurological conditions, so it’s exciting to be involved in a project aiming to advance this field.

What are your intended goals for the ‘Illuminating the Self’ exhibition?

‘Illuminating the Self’ has been supported by a public engagement grant from Wellcome, who fund the research together with EPSRC, and has two broad goals. First, we want to help provide a voice for those who experience epilepsy. For example, Susan Aldworth has collected testimonials from people around the country, and these form an integral part of her new installation for the exhibition. Second, we wanted to explore societal issues around the use of emerging technologies like gene therapies and implants in the brain. As scientific and engineering progress advances, what are the benefits and risks of manipulating brain function and how should we safeguard ourselves in the bioengineered future? Andrew Carnie’s art explores what we mean by the self, through notions of hybridity in biology and medicine. Both artists have spent time interacting with the CANDO team, and produced an astonishing range of artworks that reflect and examine the scientific and clinical ambitions of the project.

‘Illuminating the Self’ opens from Saturday 18th May to Saturday 9th May at the Hatton Gallery and Vane Gallery, Newcastle Upon Tyne. To find out more about the CANDO research project and Illuminating the Self visit their website here.

 

via Artists react to epilepsy research project in new exhibition | Epilepsy Research UK

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[Abstract] Effects of Seizure Frequency, Depression and Generalized Anxiety on Suicidal Tendency in People with Epilepsy

Highlights

  • Seizure frequency was positively associated with suicidal tendency.
  • Depression mediated the relationship between seizure frequency and suicidal tendency.
  • Generalized anxiety moderated the effect of seizure frequency on suicidal tendency.

Abstract

Purpose

The highest risk of suicide was identified among patients diagnosed with both epilepsy and comorbid psychiatric disease. The most common comorbid psychiatric conditions of epilepsy are anxiety and depression. This study examines whether and how seizure frequency, depression and generalized anxiety interact to influence suicidal tendency.

Methods

A consecutive cohort of PWE was recruited from the First Affiliated Hospital of Chongqing Medical University. Each patient completed the Neurological Disorders Depression Inventory for Epilepsy scale[NDDI-E], the Generalized Anxiety Disorder-7 (GAD-7), and the suicidality module of Mini-International Neuropsychiatric Interview(MINI) v.5.0.0. Spearman’s correlation and moderated mediation analysis were used to examine the associations among seizure frequency, depression, generalized anxiety and suicidal tendency.

Results

Seizure frequency was positively associated with suicidal tendency. Depression severity partially mediated the relationship between seizure frequency and suicidal tendency. The indirect effect of seizure frequency on suicidal tendency was positive, and accounted for 50.2% of the total effect of seizure frequency on suicidal tendency. The indirect effect of seizure frequency on suicidal tendency through depression severity was positively moderated by generalized anxiety severity.

Conclusions

Reducing seizure frequency may be the basis of suicide prevention in PWE. At the same time, the effect of seizure frequency on suicidal tendency can be partially explained by the mediation of depression severity, and the magnitude of the indirect effect of seizure frequency on suicidal tendency was contingent upon generalized anxiety severity. In addition to depression severity, generalized anxiety severity also exerts an important effect on suicidal tendency in PWE.

via Effects of Seizure Frequency, Depression and Generalized Anxiety on Suicidal Tendency in People with Epilepsy – ScienceDirect

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[WEB SITE] What Happens During a Sexual Seizure? – Psychology Today

Orgasms and Epilepsy

By Amee Baird Ph.D. Posted Jan 11, 2020

Of all neurological diseases, epilepsy is the one that has been most frequently linked to sex. “Coitus brevis epilepsia est” (“Sex is a brief seizure”) is an ancient proverb attributed to Galen, the famous physician of the Roman Empire. In the 18th and 19th centuries, some doctors, including Samuel-Auguste Tissot and Edward Sieveking, argued that excessive masturbation could cause epilepsy. At the time, castration and clitoridectomy (removal of the clitoris) were reportedly performed on people with severe epilepsy.

Renowned neurologists John Hughlings Jackson and William Gowers did not consider sex to be the origin of epilepsy. Rather, they identified neurophysiological (brain-based) causes and laid the foundations for current views of the origins of epilepsy.

The notion that sex causes epilepsy has been well and truly debunked, but in rare cases, an association between sex and seizures does exist. Temporal lobe seizures can be triggered by an orgasm, or even cause orgasms. Orgasm-induced seizures occur much more commonly in women than in men and are usually associated with a right temporal lobe seizure focus.

Andrew Baird

Source: Andrew Baird

These seizures can be frightening for partners and have a significant impact on a person’s sex life. They can lead to a life spent avoiding sex and fear of orgasm, which can have a devastating effect on relationships. In one case, the husband of a woman who experienced orgasm-induced seizures was so frustrated by their sex life that he threatened divorce if neurosurgery to cure her seizures was not successful. 

In contrast to orgasm-induced seizures, seizures that result in orgasms may be savoured by those who experience them. Orgasmic “auras” (a feeling or warning sign that a seizure is about to happen) linked to seizures are also more common in women and typically arise from the right temporal lobe.

Case studies of women who experience these pleasurable seizures have found that they often keep them a secret from their doctors – for decades in some cases – even when they are undergoing investigations for epilepsy and know that orgasmic auras are part of their seizures. Some people have refused to have neurosurgery to cure their seizures out of fear of losing these unexpected orgasms.

Spontaneous orgasms might sound like fun, but these sexual seizures can occur suddenly and in unexpected situations. Imagine travelling on a bus during peak hour on your way to work, standing in the aisle jammed in between other passengers, and suddenly feeling a wave of tingling. You know what is coming, and you know that you are about to experience it in front of an audience of strangers.

Brain imaging studies of healthy men and women have found that orgasm, and its lead-up, is predominantly associated with activation (and, in some earlier studies, deactivation) in the temporal and frontal brain regions, including the amygdala and orbitofrontal cortex; other regions involved in sensory, motor and reward processes are also implicated. It appears that if the neurons (the nerve cells) in those very brain regions are highly sensitive, perhaps due to scar tissue or other causes of seizures, such as hippocampal sclerosis, then a seizure can be triggered by the activation or stimulation of those exact regions that occurs during orgasm.

Apart from orgasm, there are other sexual behaviours that can occur during a seizure. Sexual automatisms (automatic behaviours that the person later has no memory of) include writhing, thrusting, rhythmic movement of the pelvis and legs, and rhythmic handling of genitals or masturbation. These are rare and occur relatively equally in men and women who experience frontal lobe seizures.

Sexual “ictal” manifestations (that is, those that occur during a seizure) have also been reported, such as erotic feelings, genital sensations and sexual desire; these have been found to occur most commonly in women with right temporal lobe seizures.

So although sex does not cause epilepsy, sexual behaviours can be associated with certain types of seizures that arise from the temporal (typically right-sided) or frontal lobes, brain regions that are critical parts of our sexual neural network.

This is an adapted excerpt from Sex in the Brain: How Your Brain Controls Your Sex Life (NewSouth Publishing, 2019; and forthcoming Columbia University Press, 2020).

References

Ozkara, C., Ozdemir, S., Yılmaz, A., Uzan, M., Yeni, N., & Ozmen, M. (2006). Orgasm‐induced seizures: A study of six patients. Epilepsia, 47(12), 2193–2197.

 

Rémillard, G.M., Andermann, F., Testa, G.F., Gloor, P., Aube, M., Martin, J.B., …  Simpson, C. (1983). Sexual ictal manifestations predominate in women with temporal lobe epilepsy: A finding suggesting sexual dimorphism in the human brain. Neurology, 33(3), 323–330.

 

Shorvon, S.D. (2011). The causes of epilepsy: Changing concepts of etiology of epilepsy over the past 150 years. Epilepsia, 52(6), 1033–1044.

 

Spencer, S.S., Spencer, D.D., Williamson, P.D., & Mattson, R.H. (1983). Sexual automatisms in complex partial seizures. Neurology, 33(5), 527–533.

 

Stoléru, S., Fonteille, V., Cornélis, C., Joyal, C., & Moulier, V. (2012). Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: A review and meta-analysis. Neuroscience & Biobehavioral Reviews, 36(6), 1481–1509.

 

via What Happens During a Sexual Seizure? | Psychology Today

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[Abstract + References] Therapeutic Drug Monitoring of Antiepileptic Drugs in Women with Epilepsy Before, During, and After Pregnancy – Review

Abstract

During pregnancy, the pharmacokinetics of an antiepileptic drug is altered because of changes in the clearance capacity and volume of distribution. These changes may have consequences for the frequency of seizures during pregnancy and fetal exposure to antiepileptic drugs. In 2009, a review was published providing guidance for the dosing and therapeutic drug monitoring of antiepileptic drugs during pregnancy. Since that review, new drugs have been licensed and new information about existing drugs has been published. With this review, we aim to provide an updated narrative overview of changes in the pharmacokinetics of antiepileptic drugs in women during pregnancy. In addition, we aim to formulate advice for dose modification and therapeutic drug monitoring of antiepileptic drugs. We searched PubMed and the available literature on the pharmacokinetic changes of antiepileptic drugs and seizure frequency during pregnancy published between January 2007 and September 2018. During pregnancy, an increase in clearance and a decrease in the concentrations of lamotrigine, levetiracetam, oxcarbazepine’s active metabolite licarbazepine, topiramate, and zonisamide were observed. Carbamazepine clearance remains unchanged during pregnancy. There is inadequate or no evidence for changes in the clearance or concentrations of clobazam and its active metabolite N-desmethylclobazam, gabapentin, lacosamide, perampanel, and valproate. Postpartum elimination rates of lamotrigine, levetiracetam, and licarbazepine resumed to pre-pregnancy values within the first few weeks after pregnancy. We advise monitoring of antiepileptic drug trough concentrations twice before pregnancy. This is the reference concentration. We also advise to consider dose adjustments guided by therapeutic drug monitoring during pregnancy if the antiepileptic drug concentration decreases 15–25% from the pre-pregnancy reference concentration, in the presence of risk factors for convulsions. If the antiepileptic drug concentration changes more than 25% compared with the reference concentration, dose adjustment is advised. Monitoring of levetiracetam, licarbazepine, lamotrigine, and topiramate is recommended during and after pregnancy. Monitoring of clobazam, N-desmethylclobazam, gabapentin, lacosamide, perampanel, and zonisamide during and after pregnancy should be considered. Because of the risk of teratogenic effects, valproate should be avoided during pregnancy. If that is impossible, monitoring of both total and unbound valproate is recommended. More research is needed on the large number of unclear pregnancy-related effects on the pharmacokinetics of antiepileptic drugs.

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via Therapeutic Drug Monitoring of Antiepileptic Drugs in Women with Epilepsy Before, During, and After Pregnancy | SpringerLink

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[Infographic] The Worst Epilepsy Advice

We asked and you answered! We posted this question: What bits of “advice” do you wish people would stop telling you? and hundreds of you took the time to respond.

What did we learn? From the unconcerned (“It’s all in your mind”) to the plain unhelpful (“Just don’t stress”), advice is hurled at us from friends, family, coworkers, even strangers. While most suggestions are probably well-intentioned, hearing them over and over can make us feel that our condition is minimized and misunderstood.

Some of the most common answers we heard:

  • It’s all in your mind.
  • If you’re stressed, lay down.
  • Can’t you use marijuana for that?
  • Calm down.
  • Try to stop shaking.
  • You don’t look like you have epilepsy…
  • Did you take your pills?
  • You should get a job
  • Just don’t stress

via Your Answers: The Worst Epilepsy Advice (Infographic) | MyEpilepsyTeam

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[Abstract] The hidden side of travel: Epilepsy and tourism

Highlights

    Reveals how the invisible disability of epilepsy affects the travel experience

    Social stigma of epilepsy is found to have greater impact on travel than seizures.

    Illuminates the plurality of lived experiences of disability in a travel context

    Problematises travel as visible, an escape from normality, independent and authentic

    Challenges the discourse of visibility in the disablist environment of tourism

Abstract

Previous tourism research has examined the barriers and travel experiences of people with physical/mobility and sensory impairments. This paper advances tourism knowledge by revealing the travel experiences of people with the invisible and stigmatising condition of epilepsy. The study employed a phenomenological approach to explore whether, and how, the hidden neurological condition affects the travel experience. Analysis of the data revealed three main themes relating to the experience of travel for individuals with epilepsy: seizure episodesinvisibility of the condition; and managing anxiety. The paper illuminates the hidden side of travel for people with epilepsy and its social stigma, and problematises the socially constructed nature of travel as mostly visible, an escape from normality, independent and authentic.

via The hidden side of travel: Epilepsy and tourism – ScienceDirect

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[WEB SITE] The Parts of Epilepsy We Often Don’t Talk About

 

Growing up, my biggest secret was that I had epilepsy. I have had it since I was 5.  Neurologists kept saying, “She’ll grow out of it.” I’ve tried medication after medication, trying to control the seizures and limit the number of side effects.  I’ve tried weaning off medication, only for a seizure to return within one or two days. Life becomes more bearable when my seizures are controlled, but I never feel carefree.  Epilepsy is much more than having seizures.

With my epilepsy comes fear.  I am constantly cautious and afraid.  I am afraid of having a seizure during school, at work or in public.  Although I’ve been seizure-free for over a year, I am afraid of driving down the road and feeling that tingling in my stomach and not being able to pull the car over quickly or safely enough. I am afraid of injuring my brain and body beyond repair. I am afraid of who will see me. I am afraid of waking up from a seizure and being alone. I am afraid of forgetting my medication.

With my epilepsy comes depression. For me, epilepsy has always brought along depression for company. With each anti-seizure medication, the depression waxes and wanes, but it always lingers like a permanent resident in my brain.  When I am honest about my suicidal thoughts, doctors prescribe an antidepressant. We both hope the depression will fade, but I am usually met with a new set of side effects.  Together, both conditions appear invincible, but I always fight back. Depression tells me to die instead of taking the pills from the container. Depression tells me the darkness is here to stay.  Depression steals my energy and my smiles. When I am always outnumbered, and the fight is unfair, I wonder how much of who I have become is due to the medication and how much is truly me.

Too often, with epilepsy comes shame. All through grade school, I heard kids at school make fun of seizures and even pretend to have seizures. I listened and watched. As one of the quietest students in class, my lips felt zippered shut, but my face turned red. They did not know what it feels like to lose control of your body. They didn’t know what it was like to wake up confused and disoriented, not knowing how long the seizure lasted or what was happening before it. I was not brave enough to speak up.

My closest friends didn’t know I had epilepsy. I snuck away at sleepovers to take my medication at 8:00 p.m. I made excuses as to why I couldn’t drive, why I wouldn’t drink alcohol, why I occasionally arrived to school late, why I visited a hospital that was over an hour away rather than the local doctor’s office, or why there was a bruise on my forehead.  When I started telling people outside of my family, they would reply with phrases such as “I didn’t know that you were an epileptic,” “I need to be careful around you,” or “At least it’s not something terminal.” They may not have known their words were insensitive or hurtful, but I have never been met with comfort or acceptance after telling my story. Only shame.

Epilepsy can be somewhat of an invisible illness. Sometimes I can hide it. Other times, I can’t. Epilepsy is much more than having seizures.  For some people, myself included, it’s a lifelong challenge.

Having epilepsy can mean battling depression, anxiety, insomnia, muscle weakness, lethargy, weight gain, and a host of other negative side effects from seizures and medications. It can mean staying home from work or school because of an aura. It can mean keeping secrets from best friends. It can mean refusing to give up regardless of what others think and say, how many medications you’ve tried, and the side effects that never subside. I have often wondered who I would be without epilepsy. While I fight the shame and stigma within myself, I have learned and accepted that epilepsy is a part of who I am.

But only one part.

RESOURCES

If you or someone you know needs help, visit our suicide prevention resources.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.

via Epilepsy Is About More Than Seizures | The Mighty

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[Abstract] Do Women with epilepsy benefit from epilepsy specific pre-conception care?

Abstract

BACKGROUND

To determine how pre-conception care (PCC) influenced the outcome of epilepsy, pregnancy and malformation risk in women with epilepsy (WWE)

METHODS

All primigravida in the Kerala registry of epilepsy and pregnancy (KREP) with the final outcome of pregnancy known who were enrolled prospectively in pre-conception stage (PCC group) or first trimester of pregnancy (PRG group) were included. The two groups were compared for fetal and maternal outcomes including seizure control and complications of pregnancy.

RESULTS

There were 320 (30.4%) in PCC group and 732 in PRG group. Both groups were comparable for epilepsy classification, maternal birth defects and family history of epilepsy but the PCC group had significantly higher education (48.9%, p = .027) and employment (22.1%, p < .001). They had higher usage of folate in pre-pregnancy month (87.5%, p < .001) and first trimester (96.3%, p < .001) than PRG group. Fewer women in the PCC group were off AEDs in first trimester (5% vs 9.3%, p = .018). Within monotherapy group, use of levetiracetam (10.8%, p = .017), valproate ( 34%, p = .002) in PCC group and carbamazepine (39.1%, p = .04), phenobarbitone (13.3%, p = .001) in PRG group was significantly high. More women in this group were seizure free during pregnancy (62.8%, p = .005) than PRG group. Early fetal loss was better captured in PCC (90.6%,p = .025) than in the PRG. There was no difference in malformation rate between PCC (7.2%) and PRG groups (6.1%, p = .3).

CONCLUSION

PCC reduced the risk of seizures during pregnancy and improved the periconceptional use of folate but did not influence the fetal malformation risk.

 

via Do Women with epilepsy benefit from epilepsy specific pre-conception care? – ScienceDirect

 

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[Abstract] Prediction Tools for Psychiatric Adverse Effects After Levetiracetam Prescription

Educational Objective
To determine whether routine clinical data can be used to predict which patients with epilepsy will experience a psychiatric adverse effect from levetiracetam.

Key Points

Question  Can routine clinical data be used to predict which patients with epilepsy will experience a psychiatric adverse effect from levetiracetam?

Findings  Among 1173 patients with epilepsy receiving levetiracetam in this open cohort study, 2 prediction models were created: one for the overall population and one for those without a history of a psychiatric sign, symptom, or disorder during the study period. The corresponding areas under the curve were 68% and 72%, respectively, and specificity was maximized using threshold cutoffs of 0.10 (full model) and 0.14 (second model); a score below these thresholds indicates safety of prescription.

Meaning  Levetiracetam has rapidly become a drug of first choice, and these models can be used to predict the risk of psychiatric adverse effects.

Abstract

Importance  Levetiracetam is a commonly used antiepileptic drug, yet psychiatric adverse effects are common and may lead to treatment discontinuation.

Objective  To derive prediction models to estimate the risk of psychiatric adverse effects from levetiracetam use.

Design, Setting, and Participants  Retrospective open cohort study. All patients meeting the case definition for epilepsy after the Acceptable Mortality Reporting date in The Health Improvement Network (THIN) database based in the United Kingdom (inclusive January 1, 2000, to May 31, 2012) who received a first-ever prescription for levetiracetam were included. Of 11 194 182 patients registered in THIN, this study identified 7400 presumed incident cases (66.1 cases per 100 000 persons) over a maximum of 12 years’ follow-up. The index date was when patients received their first prescription code for levetiracetam, and follow-up lasted 2 years or until an event, loss to follow-up, or censoring. The analyses were performed on April 22, 2018.

Exposure  A presumed first-ever prescription for levetiracetam.

Main Outcomes and Measures  The outcome of interest was a Read code for any psychiatric sign, symptom, or disorder as reached through consensus by 2 authors. This study used regression techniques to derive 2 prediction models, one for the overall population and one for those without a history of a psychiatric sign, symptom, or disorder during the study period.

Results  Among 1173 patients with epilepsy receiving levetiracetam, the overall median age was 39 (interquartile range, 25-56) years, and 590 (50.3%) were female. A total of 14.1% (165 of 1173) experienced a psychiatric symptom or disorder within 2 years of index prescription. The odds of reporting a psychiatric symptom were significantly elevated for women (odds ratio [OR], 1.41; 95% CI, 0.99-2.01; P = .05) and those with a preexposure history of higher social deprivation (OR, 1.15; 95% CI, 1.01-1.31; P = .03), depression (OR, 2.20; 95% CI, 1.49-3.24; P < .001), anxiety (OR, 1.74; 95% CI, 1.11-2.72; P = .02), or recreational drug use (OR, 2.02; 95% CI, 1.20-3.37; P = .008). The model performed well after stratified k = 5-fold cross-validation (area under the curve [AUC], 0.68; 95% CI, 0.58-0.79). There was a gradient in risk, with probabilities increasing from 8% for 0 risk factors to 11% to 17% for 1, 17% to 31% for 2, 30% to 42% for 3, and 49% when all risk factors were present. For those free of a preexposure psychiatric code, a second model performed comparably well after k = 5-fold cross-validation (AUC, 0.72; 95% CI, 0.54-0.90). Specificity was maximized using threshold cutoffs of 0.10 (full model) and 0.14 (second model); a score below these thresholds indicates safety of prescription.

Conclusions and Relevance  This study derived 2 simple models that predict the risk of a psychiatric adverse effect from levetiracetam. These algorithms can be used to guide prescription in clinical practice.

via Prediction Tools for Psychiatric Adverse Effects After Levetiracetam Prescription | Clinical Pharmacy and Pharmacology | JN Learning | AMA Ed Hub

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