[WEB] Epilepsy vs. Seizures: Understanding the Terminology

Medically reviewed by Evelyn O. Berman, M.D.

Article written by Barbara Boughton

Although any seizure may be frightening and cause for concern, experiencing one doesn’t mean you have epilepsy.

A person experiences a seizure when there is a sudden surge of abnormal electrical activity in their brain, caused by complex chemical changes in neurons or nerve cells. Seizures are not a disease — they are symptoms of many types of conditions that affect parts of the brain. In a seizure, you may experience symptoms of a temporary loss of consciousness or loss of awareness.

A seizure may also cause:

• Involuntary movements
• Disturbances in taste, vision, and hearing
• Changes in mood and cognitive function

Epilepsy is a disorder characterized by recurrent unpredictable (or unprovoked) seizures. For epilepsy to be considered as a diagnosis, a person must have had two or more unprovoked seizures more than 24 hours apart.

Triggers that may provoke seizures differ from person to person but can include:

• High fever
• Low blood sugar
• Alcohol withdrawal
• Brain injury
• Dehydration
• Missed meals
• Stress
• Sleep deprivation

These triggers may provoke a first seizure in people who are susceptible, but they may not have epilepsy. At the same time, such triggers can help bring on seizures in people with epilepsy.

Sixty-five million people have epilepsy worldwide, and more than 3 million have epilepsy in the United States, according to the Epilepsy Foundation.

The cause of epilepsy varies by age. In some people, epilepsy is a result of genetics or a change in the structure of the brain that brings on seizures. Three out of 10 children with autism spectrum disorder may have seizures. In young adults, seizures are also frequently seen in those with head injuries or tumors. In people over age 65, the most common cause of new-onset seizures is stroke. Six out of 10 seizures are idiopathic (without a known cause).

The International League Against Epilepsy has developed new terms to define seizure types in epilepsy:

• Generalized seizures affect groups of cells on both sides of the brain at the same time.
• Focal seizures affect a group of cells in one part of the brain.
• When the onset of a seizure is unknown, it’s called an unknown-onset seizure. A seizure may also be referred to as having an unknown onset if it is not witnessed by anyone, such as when someone living alone has a seizure at night.

The Difference Between Having Epilepsy and Having a Seizure

Several medical events or conditions are not epilepsy and may cause seizures.

Many people have a single or first seizure sometime in their life. They can be provoked or unprovoked. In most cases, single seizures do not recur and are not a sign of epilepsy unless the person has brain damage, a family history of epilepsy, or neurological abnormalities that cause seizures.

It’s not uncommon for children to have seizures during a high fever. These children are not usually treated with any kind of antiseizure medicine unless there are indications that the seizure may recur. These signs could include nervous system damage or a seizure that is especially prolonged or complicated.

Seizure Types Not Caused by Epilepsy

According to the National Institute of Neurological Disorders and Stroke, an estimated 5 percent to 20 percent of people diagnosed with epilepsy are believed to be misdiagnosed — they have actually experienced a nonepileptic seizure. Physically, these seizures look the same as those caused by epilepsy, but they are not linked with an excessive and abnormal electrical discharge in the brain.

Nonepileptic seizures can have a psychological cause. In clinical practice, they are referred to as psychogenic nonepileptic seizures (PNES). A history of trauma is one risk factor for PNES, and these seizures can be treated with cognitive behavioral therapy and other psychological treatments. A sign of PNES includes a lack of response to antiseizure drugs.

Medical conditions that cause nonepileptic seizures include:

• Narcolepsy — Sudden unreliable bouts of sleep
• Tourette syndrome — Repetitive involuntary tics
• Cardiac arrhythmia — Irregular heartbeats
• Eclampsia — Seizures that happen during pregnancy or shortly after giving birth
• Impaired liver or kidney function
• Abnormalities in the blood’s salt levels

If you experience a seizure, it is important to be evaluated by clinicians and a specialist in neurology. An electroencephalogram (EEG) can help detect if there are any abnormalities in brain waves, ideally 24 hours after a first seizure. The test may be useful in diagnosing epilepsy and in determining whether antiepileptic drugs will be beneficial.

Epilepsy and Recurrent Seizures

Epilepsy is a spectrum disorder, meaning that it has different causes, is marked by different seizure types, and its severity varies from person to person. There are many different types of epilepsy. Some people with epilepsy have very infrequent seizures. Others may experience seizures many times a day.

Most people diagnosed with epileptic seizures can control their symptoms with antiepileptic drugs, surgery, or lifestyle changes. However, as many as 30 percent to 49 percent of those with epilepsy continue to have recurrent seizures. Treatments and health care now available do not completely control epileptic seizures.

Most forms of epilepsy require lifelong treatment, but in some people, the seizures eventually go away. The chances of becoming seizure-free are better in those whose seizures start in childhood or have been effectively controlled by medication.

Some people who have epilepsy that can’t be controlled by drugs may undergo surgery to remove a small defined part of the brain or lesion where the seizures originate, and some may become seizure-free after surgery. Yet, such surgery is usually a last resort and is only tried in certain types of treatment-resistant epilepsy. The good news is that many people with epilepsy lead productive lives, and our understanding of seizures and their treatment is advancing rapidly.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 108,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Are you living with epilepsy? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

Source

[WEB] 10 Common Seizure Triggers and 9 Tips To Avoid Them

Medically reviewed by Amit M. Shelat, D.O.

Article written by Kristopher Bunting, M.D.

Common Triggers | Identifying Triggers | Avoiding Triggers | Get Support

Although epileptic seizures can occur randomly and without warning, many people find that their seizures are caused by specific triggers. Many different things can trigger seizures, and each person’s experiences are different. A seizure trigger can be a specific sight or sound, a substance, or a physiologic state (such as having low blood sugar).

Triggers do not cause epilepsy (the underlying causes of epilepsy vary from genetic predisposition to illness and injury) but rather put your brain into a state where it is more likely to have seizure activity. It is important to identify what provokes your seizures and to learn how you can avoid those triggers.

Common Seizure Triggers

Some of the most common seizure triggers include:

• Missing a dose of epilepsy medication
• Stress
• Lack of sleep
• Alcohol
• Withdrawal from narcotics and/or barbiturates
• Caffeine
• Flashing lights or patterns
• Low blood sugar
• Time of day
• Hormonal changes
• Fever
• Infection or other illness

1. Missed Medication

Failure to take antiepileptic drugs (AEDs) as prescribed is one of the most common seizure triggers. AEDs work by preventing seizure activity in the brain, but for the medication to work properly, you must have a high enough level of medication in your bloodstream. Missing a dose or taking the wrong dose of your AED can decrease these levels and trigger seizures.

2. Stress

Stress is another commonly reported trigger. Emotional or psychological stress, including anxiety, anger, depression, or other heightened emotional states, can trigger a seizure in some people. Stress can also contribute to other triggers, such as lack of sleep.

3. Inadequate Sleep

Lack of sleep is one of the top triggers for epileptic seizures in many people. Lack of sleep may be due to a change in schedule, insomnia, medication side effects, poor sleep quality, alcohol consumption, caffeine consumption, and even seizures during sleep.

4. Alcohol

Alcohol consumption can lead to seizures. Some people with epilepsy can tolerate small amounts of alcohol, but others may have seizures after only one drink. Binge drinking — drinking until you are intoxicated — is a very common trigger. Seizures triggered by alcohol can occur anywhere from one to two hours after drinking and up to 48 hours after stopping heavy drinking. Alcohol can also trigger seizures by changing your blood levels of AEDs and other medications. Finally, alcohol can also negatively affect your sleep, contributing to potential seizures.

5. Caffeine, Nicotine, and Other Substances

Caffeine and nicotine are commonly used stimulants that can lower your seizure threshold. Coffee, tea, soda, and chocolate can all have high levels of caffeine. When taken in large amounts, caffeine and other stimulants can increase the excitability in the brain. Other recreational and illicit drugs such as cocaine, amphetamines, and MDMA (ecstasy or molly) can induce seizures in people with epilepsy.

Some medications, including over-the-counter options, can change how the body processes your AEDs, leading to seizures. Always check with your health care provider or pharmacist to see if any of your medication or supplements interact with your epilepsy medication.

6. Flashing Lights

Flashing lights and certain patterns (such as optical illusions that appear to move) can trigger seizures in some people with photosensitive epilepsy. The frequency of flashing light that triggers seizures varies from person to person. Sometimes, high-contrast geometric patterns can also trigger these types of seizures.

7. Low Blood Sugar

Low blood sugar (also called hypoglycemia) may trigger seizures. Skipping meals or eating at irregular times can cause blood sugar levels to rise and fall.

8. Time of Day

Some people have seizures at a specific time of day or night, including while they are sleeping.

9. Hormonal Changes

During a normal menstrual cycle, the body goes through changes in levels of the hormones estrogen and progesterone. Changing hormone levels can be a seizure trigger.

10. Fever

High fever due to infection or other illnesses can cause febrile seizures. Children are more likely to experience febrile seizures than adults. Note that the occurrence of a febrile seizure in a child does not necessarily mean that the child has or will develop epilepsy.

How To Identify Your Seizure Triggers

Identifying your specific triggers is the first step in finding ways to avoid triggering seizures. Identifying what induces your seizures can also help you and your neurologist or other health care provider pinpoint your diagnosis and determine the best treatment for your situation.

To figure out what triggers you have, try keeping a journal of your seizures. If you are not able to keep a journal, ask a family member or caregiver to help you track your seizures. Journal entries could include:

• The time and date of the seizure
• Your physical location
• What you were doing at the time
• The dose and time of your last AED
• What you had been eating and drinking, especially if it includes alcohol or caffeine
• What other drugs or medications you had been taking, including prescription, over-the-counter, herbal, and illicit substances
• How much sleep you had
• Your mood
• If applicable, where you are in your menstrual cycle or the date of your last period

Make sure to note if you experience auras before your seizures. Auras can be visual disturbances, odd physical sensations, or emotions that you have before your seizure. In epilepsy, auras can be a type of seizure.

All of the information you gather about your seizures should be shared with your doctor or health care provider to help them determine what care is best for you.

How To Avoid Seizure Triggers

Once you know what triggers your seizures, you may be able to avoid those triggers or lessen their impact on you. Depending on the type of trigger, there are many ways to help prevent seizures.

1. Take Your Medication as Prescribed

Take your prescribed AED medication as directed, including taking the right dose at the right time. Do not adjust the dosage or stop taking any antiepileptic medication without consulting your doctor. Take steps to ensure that you take your medication regularly:

• Use a pillbox to organize your medications by day and time.
• Keep track of your doses using a calendar.
• Set alarms for when to take your medicine.
• Use an app that helps you stay organized.

2. Alleviate Stress

Controlling stress can be difficult, but managing stress is important for your health. You cannot always control what causes emotional or psychological stress, but you can identify stressors and work to reduce the negative impact these events can have on your life.

Coping strategies can include anything from meditation to exercise to ensuring your sleeping habits are in good shape. Seeking the help of a psychologist or other counselor is also beneficial for many people who need help dealing with stress and emotional difficulty in life.

3. Get Some Sleep

Getting a good night’s rest is important for proper brain function in all people and especially for those living with epilepsy. Maintaining good sleep hygiene can include keeping a regular schedule for going to bed and waking up, controlling pain that affects sleep, not reading or watching TV in bed, and avoiding caffeine as well as other stimulants, alcohol, and large meals before bedtime. Like taking your medication, getting the proper amount of sleep at the right time is important for controlling seizures.

4. Avoid Alcohol

Not drinking alcohol is generally the safest approach to avoid alcohol-triggered seizures. However, people who are addicted to alcohol or drink significant amounts of alcohol regularly may be at increased risk of seizures when they stop drinking. If you’re dependent on alcohol, seek medical advice to avoid problems from alcohol withdrawal.

5. Avoid Caffeine, Nicotine, and Other Substances

Limiting or eliminating caffeine or nicotine intake can decrease your risk of seizures if those are triggers for you. Other drugs that trigger seizures, including recreational and illicit substances, should be avoided.

6. Avoid Flashing Lights

If you have photosensitive epilepsy, work with your doctor to determine what specific frequencies of flashing lights or types of patterns cause seizures. Your doctor may use a test called an electroencephalogram (also called an EEG) to make the determination.

If it’s not possible to avoid light triggers, you can sometimes lessen the risk of having a seizure by simply covering one eye.

7. Modify Eating Habits

A healthy diet contributes to a healthy body. Try to eliminate food triggers and eat better. You can prevent low blood sugar by eating regularly and avoiding foods that cause your body to produce more insulin.

Eating a ketogenic diet is another approach that may help control seizures, especially when antiepilepsy medication does not work. Adults and children with epilepsy may benefit from a ketogenic diet or a similarly restricted diet. However, consult your doctor before adopting a ketogenic diet. This is a very restrictive regimen and may not be appropriate for everyone with epilepsy.

8. Plan Around Your Menstrual Cycle

Using hormonal treatments, such as certain hormonal birth control methods, can help prevent seizure triggers by altering the normal menstrual cycle. Your doctor may also adjust your AED dose or add AED medications at specific times during your menstrual cycle to help prevent seizures.

9. Treat at the First Sign of Illness

It is not possible to simply avoid getting sick, but seeking medical treatment at the first sign of fever, infection, or other illness can help prevent seizures. Always check for medication interactions, including antibiotics.

Talk With Others Who Understand

MyEpilepsyTeam is the online social network for people with epilepsy. On MyEpilepsyTeam, more than 111,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Do you know your seizure triggers? Share your thoughts in the comments below, or start a conversation by posting on MyEpilepsyTeam.

References

Source

[WEB] Learn More About Vagus Nerve Stimulation and the Disorders It Treats

Vagus nerve stimulation was initially approved to treat drug-resistant epilepsy. Now it is also used for migraine, cluster headache, and stroke rehabilitation.

Illustration by Sam Island

Isla Ritchie was diagnosed with epilepsy in 2014 when she was 11. Her neurologist prescribed various medications to control her tonic-clonic and absence seizures, but she continued to have breakthrough events. During an absence seizure, she would stare blankly into space for a few minutes before returning to her normal alertness without knowing what she had missed. Ritchie’s tonic-clonic seizures were more disruptive: Her limbs would shake, her muscles would stiffen, and she’d lose consciousness. If she was standing, she would fall. Sometimes a seizure would last more than five minutes, and she’d need rescue medication to stop it.

Ritchie and her parents investigated whether she could have brain surgery, but she wasn’t a candidate due to seizure activity on both sides of her brain. In 2015, however, the family, who live in Houston, learned about vagus nerve stimulation (VNS), a procedure in which a device is implanted in the chest to stimulate the vagus nerve—which runs from the brainstem through the neck to the chest and stomach—with electrical impulses. They decided to try it along with Ritchie’s antiseizure medication regimen.

After surgeons implanted the device in October 2015 and fine-tuned the stimulation over six months, Ritchie’s seizures gradually tapered off. Four years have passed since her last one. “I can’t even compare my quality of life to how it was in middle school,” says Ritchie, now 19 and a first-year student at Baylor University in Waco, TX. “Back then, my head felt so fuzzy I couldn’t process things. Now I feel like a 10 out of 10. I’ve come a long way, and I no longer worry every day about having a seizure.”

Life-Changing Treatment

The vagus nerves—one on each side of the neck—are part of the parasympathetic nervous system, often called the “rest and digest” system because it helps the body relax after periods of stress or danger and regulates bodily functions such as digestion and heart rate. The vagus nerves provide a bridge between the brain and peripheral organs, and they play an important role in memory, emotion, and pain, among other bodily functions.

The idea to stimulate the vagus nerve in people with neurologic disorders came from a researcher who experimented on animals with hereditary seizures in the 1980s and found that VNS stopped their seizures, says George Morris, MD, MPH, FAAN, medical director for epilepsy at Ascension Medical Group in Milwaukee.

The U.S. Food and Drug Administration (FDA) approved VNS for the treatment of drug-resistant seizures in humans in 1997. Since then, the FDA has approved the procedure to treat drug-resistant depression, cluster headache and migraine, and for stroke recovery. It’s also being investigated as a treatment for multiple sclerosis, rheumatoid arthritis, diabetes, post-traumatic stress disorder, Parkinson’s disease, cognitive disorders, and traumatic brain injury.

Stopping Seizures

VNS for epilepsy involves a pacemaker-like device surgically implanted under the skin in the left chest area; a wire is attached to the generator, placed under the skin, and wound around the vagus nerve in the neck. The device is programmed to deliver electrical stimulation at regular intervals along the left vagus nerve to the brainstem, which then sends signals to certain areas of the brain; the person with the device doesn’t feel the stimulation.

Despite its varied applications for neurologic disorders, it isn’t clear how VNS improves these conditions. The results of an animal study, published in the Proceedings of the National Academy of Sciences in May 2022, showed that activating the vagus nerve reduced inflammation, which contributes to many different diseases, both neurologic ones and others. VNS also may positively affect rewiring of the brain and alter the balance between activity in the sympathetic nervous system (which is responsible for the body’s fight-or-flight response) and the parasympathetic nervous system.

VNS is used in addition to medication for people with epilepsy. “The goal is to reduce the number of seizures,” says Lily Wong-Kisiel, MD, FAAN, a pediatric epileptologist and associate professor of neurology at Mayo Clinic in Rochester, MN. It also may allow people to decrease the dose of their antiseizure medication.

Although it doesn’t cure epilepsy, VNS appears to become more effective at reducing seizures over time, unlike pharmacological therapies, says Dr. Morris. A study published in Neurosurgery in 2016 involving 5,554 people with intractable epilepsy on the VNS therapy patient outcome registry found that within the first four months of having the VNS device implanted, 49 percent of people saw a reduction in their seizure frequency, while 63 percent experienced a drop in seizures two to four years after having it implanted.

To manage seizures, VNS can be set on three modes: normal, auto-stimulation, and magnet. In normal mode, the device delivers electrical stimulation at regular intervals, so the person doesn’t need to do anything. Auto-stimulation mode, available on newer devices, delivers an extra dose of stimulation based on an increase in heart rate. “Heart rate goes up in many people with epilepsy during and sometimes before a seizure,” Dr. Wong-Kisiel says. The additional stimulation may stop a seizure or shorten it once it’s underway.

Swiping a magnet across the implanted generator to activate the stimulation is another way to disrupt a seizure. This is especially helpful for people who have an aura—a warning or a sense that a seizure is imminent—that precedes a seizure. “The magnetic activation stops or shortens a seizure two-thirds of the time,” says Angus Wilfong, MD, professor and chief of pediatric neurology at the Barrow Neurological Institute at Phoenix Children’s Hospital and professor of child health and neurology at the University of Arizona College of Medicine–Phoenix.

VNS can cause temporary changes in the voice—making it sound hoarse or raspy—when the stimulator fires. But these are fleeting side effects and usually lessen over time, says Dr. Wilfong, adding that unlike antiseizure medications, VNS does not cause weight loss or gain.

In 2013, the American Academy of Neurology (AAN) updated its guideline for using VNS to treat epilepsy, stating that it may be considered adjunctive treatment for children with partial or generalized epilepsy. The guideline also notes that in adults having the procedure, an improvement in mood may be an additional benefit.

Overall, VNS may be considered progressively effective in patients over multiple years of use. In July 2022, the AAN reaffirmed the guideline.

Easing Headache Attacks

Anna Williams, 47, has had migraine since she was a kid and developed cluster headache (an abrupt headache with an excruciating burst of pain that occurs in groups or clusters before temporarily going away) in 2013, which became chronic in 2017. She tried different medications for her migraine and cluster attacks but ended up with mood side effects she couldn’t tolerate. Eventually, she found some relief with a newer type of drug, which helped reduce the duration of the headaches, but she wanted more relief.

In May 2021, Williams found out about a handheld, noninvasive VNS device called gammaCore, which delivers self-administered electrical stimulation through the skin to either the right or left branch of the vagus nerve in the neck. She began using it twice a day to prevent cluster headaches, and within three months her chronic attacks disappeared.

“Initially, I was so focused on the cluster headaches that I didn’t consider gammaCore for migraine,” says Williams, a mother of two teenagers in New Albany, IN. “Once the clusters were in remission, I was able to get my migraine under control by using gammaCore preventively.” Williams had cluster attacks mostly on the left side of her head and migraine attacks mostly on the right, so she began using the device on both sides of her neck three times a day.

A noninvasive portable device like gammaCore can prevent or weaken a migraine or cluster headache when it is held against the side of the neck so electrical stimulation can be delivered through the skin. “It can be applied to either side [of the neck], and the person can control the intensity of the stimulation,” says Deborah I. Friedman, MD, MPH, FAAN, a neurologist and neuro-ophthalmologist in Dallas.

A study in a 2018 issue of the Journal of Headache and Pain found that these devices were significantly more effective than a sham device (acting as a placebo) in reducing the pain of migraine attacks. And in a review of studies published in a 2018 issue of the Journal of Pain Research, investigators found that VNS led to a significant reduction in pain and a decrease in the duration of cluster attacks compared with sham stimulation.

“The stimulation seems to decrease pain signaling and dampen the sympathetic activity in the nervous system, which plays a role in migraine and cluster headaches and supports parasympathetic activity,” says Robert Cowan, MD, FAAN, professor of neurology and neurological sciences at Stanford University School of Medicine in California. “It also helps protect the brain from something called cortical spreading depression, which is like a slow-moving wave of altered brain activity that causes changes in nerve firing and blood vessel function and plays a role in migraine with aura.” When it’s used preventively for chronic migraine or cluster headaches, people see a significant decrease in the number of headache days per month, Dr. Cowan says.

Doctors typically prescribe the device for people whose migraine and cluster headache attacks don’t respond to medication or who can’t tolerate the medications, Dr. Cowan says. In other cases, neurologists prescribe them in conjunction with medication.

Noninvasive VNS has no side effects and can be used during pregnancy and in children, Dr. Friedman says. But it’s expensive and often not covered by insurance. GammaCore, for example, can cost $200 a month for those paying out of pocket. The manufacturer, however, has a patient assistance program to help eligible patients pay for the device.

“It’s important for people to know these types of devices are out there,” Dr. Cowan says. “The challenge is paying for them. We would use them more if they weren’t so expensive or if they were covered by insurance.”

Boosting Stroke Rehab

In one of its newer applications, VNS may enhance stroke recovery. “It has huge effects, but we aren’t sure why,” says A.M. Barrett, MD, FAAN, chair of neurology at the UMass Chan Medical School and UMass Memorial Health Care System and chief of neurology at the VA Central Western Massachusetts Healthcare System.

A study in a 2021 issue of The Lancet investigated the effects of VNS therapy on people who had lost arm function as a result of an ischemic stroke. Those who did VNS therapy along with rehabilitation three times a week for six weeks saw twice the level of improvement in their arm function compared with those who received a sham stimulation along with their rehabilitation. “When you stimulate this nerve in the neck, it sends impulses through the brain that make it more amenable to rewiring and plasticity [reorganization],” says study co-author Steven C. Cramer, MD, FAAN, professor of neurology at UCLA and medical director of research at the California Rehabilitation Institute in Los Angeles. “Combining vagus nerve stimulation with occupational or physical therapy may result in more brain remodeling and improvements in behavior,” Dr. Cramer says.

The therapy can begin six months after a stroke, once acute inflammation has healed, and there’s no upper limit to how long after the stroke it can begin, says Michelle P. Lin, MD, MPH, a stroke neurologist at Mayo Clinic in Jacksonville, FL.

In another new development, research suggests that a noninvasive VNS device placed on the skin of the ear may modulate activity in the vagus nerve after stroke. A study in a 2022 issue of Neural Regeneration Research found that when people who had had an ischemic or hemorrhagic stroke used this device along with conventional rehabilitation, they experienced significant improvement in their motor and sensory functions and emotional responses compared with the control group that had been given a sham transcutaneous VNS device with conventional rehabilitation.

Dr. Barrett is excited about the possibilities of VNS for stroke rehabilitation, especially since the U.S. Centers for Disease Control and Prevention reported that fewer than four out of 10 stroke survivors pursue or receive outpatient therapy. Experts say VNS also may help ease depression and improve cognitive skills and leg movements after a stroke. “I’ve seen people recover from drug-resistant depression with the use of VNS,” says Dr. Barrett. “And I’ve seen it help with depression-related cognitive symptoms.”

It certainly has helped Anna Williams and Isla Ritchie. Williams says VNS put her cluster headache attacks into remission, and she has had only one migraine since July 2022. “It gave me my life back in so many ways,” Williams says. “By using the newer medication with the gammaCore, I can now be more involved in my children’s lives. I can go for daily walks with them, and I can travel again.” 

These days, Ritchie, who lives on Baylor’s campus, belongs to the Honor Society as well as numerous clubs and a sorority. She’s also a dancer, choreographer, and entrepreneur: She and her mother launched a business called Go Bag, which contains necessities for unexpected trips to the ER. “VNS changed my life in a really positive way,” Ritchie says. “I can live my own dream and not be dependent on my parents.”

Source

[WEB] What To Do During a Seizure: Your Epilepsy Questions Answered

Medically reviewed by Shifteh Sattar, M.D.

Article written by Torrey Kim

• If you witness someone having a full-body seizure, try to ensure they are lying down on their side, and never stick anything in their mouth.
• Try to time how long the seizure lasts using a clock.
• It’s important to stay on a prescribed epilepsy treatment unless a doctor advises otherwise.

About 3.5 million people in the United States live with epilepsy, and nearly half a million of those with the condition are children. Although not all cases of epilepsy are considered severe, it’s important to always take the condition seriously. That involves managing and treating the disease to keep seizure activity at bay and knowing what to do when a seizure occurs.

To help better understand severe epilepsy and what to do during a seizure, MyEpilepsyTeam sat down with neurologist Dr. Shifteh Sattar. Dr. Sattar is the director of the Comprehensive Epilepsy Center at Rady Children’s Hospital in San Diego and a clinical professor at the University of California, San Diego School of Medicine.

What’s the first thing someone should do if they witness another person having a seizure?

No. 1 is to stay calm, and that’s one of the hardest things to tell a person who has never seen a seizure before to do, because you will probably be panicked, and rightfully so. Even if you’ve seen many, it’s still easy to get nervous, but the key is to stay calm and turn the person to their side.

Don’t stick anything in their mouth, and try to time how long the seizure lasts.

In the beginning, if you’re witnessing a seizure, it’s important to see if some features can guide the physician in choosing the right medication or treatment plan. For example, you might notice if the person has their head turned to one side, or if one arm is stiffening first, and then they go into a full-body seizure. These details will be important to know.

Those are the most important things to know if the person is having a full-body generalized seizure — where their whole body is stiffening and shaking. But there are many different types of seizures.

If someone is just staring or unresponsive, you want to make sure they’re safe. And if it does progress to a full-body seizure, lay them down and turn them to the side to make sure that if they vomit, they don’t choke on it or aspirate it into their lungs. If you are concerned that they’re choking or if there are any other concerning issues, call 911 immediately.

Editor’s note: If the person having the seizure has a rescue medication and you have been trained on how to administer it, consider giving this medication if it is an appropriate circumstance.

Should someone write down what they observe during the seizure so they can share it with the doctor?

Yes, if you can. I try to advise people to try and remember it because people may be very stressed watching someone have a seizure, and they aren’t going to be in the frame of mind to write things down. Even when people try to guesstimate how much time a seizure lasts, it’s usually very different from the actual timing.

Those kinds of errors even occur in the hospital, not just with parents. Sometimes, when we have children on the video when we’re monitoring them, the nurse might say the seizure lasted three minutes, when in actuality, it was 60 seconds. And that’s OK. It’s not a big deal — it happens everywhere. But that’s why, if you can remember, just look at the clock and then when it stops, you can look back and say, “Oh, it looked like it was three minutes.”

Should people write down what they (or their child) were doing before the seizure — for instance, what they ate, what they were up to — or is that not really relevant for the physician?

It’s relevant if you see it as a pattern. There are situations where people say, “Every time they eat a certain food, they have a seizure,” and we want to know that. But we don’t have any definitive data about food triggers. However, we do know that some people are sensitive to certain things, and if you identify that pattern, then we’ll advise them to maybe stay away from those provoking factors.

We often say that the most common trigger is sleep deprivation. A seizure may also happen when people have physiological stress — for instance, if they’re sick with a cold — but typically, for most patients with epilepsy, there isn’t often a typical trigger except in cases like patients with Dravet syndrome, for example, when they may have sensitivity to heat or temperature changes.

Some people say they (or their child) have a seizure disorder but don’t have epilepsy. Is there a difference? And if so, what is it?

There isn’t actually a difference, and this can be very confusing. One of the first conversations I have at my first visit with families is that generally when you have two seizures — and in the past, we used to say if they were separated by time — then you would be classified as having epilepsy. The criteria have been revised, so it’s been easier for us to make the diagnosis. Sometimes, depending on findings from the diagnostic tests — which are usually magnetic resonance imaging [MRI] or electroencephalogram [EEG] — we may diagnose you with epilepsy after just one seizure, which is the same as a seizure disorder.

For someone with a severe form of epilepsy, such as Dravet syndrome, what would be the risks of going off treatment?

I always say Dravet syndrome is a spectrum, so you can have a mild epilepsy syndrome or a severe one. And I describe mild because sometimes, we do identify the genetic abnormality for Dravet. These children can present with seizures or status epilepticus, but over time, they might have one seizure a year or only when they’re ill. Whereas there’s another end of the spectrum in which they might experience multiple seizures daily, and there can be multiple different kinds.

For those patients, I think there could be different treatment options, but I generally say if you’re diagnosed with epilepsy — and especially with severe epilepsy syndromes — then medication should be used. The physician wants the best for the patient and the parents. We want to work with the family and try to identify the medication that has the fewest side effects and the best effect on controlling seizures. This doesn’t happen often, but we try. I always advise not to come off medications, because the risks are more significant. And the more seizures you have, especially if they’re generalized tonic-clonic, there’s a higher risk for sudden unexpected death in epilepsy [SUDEP].

Is there anything else you’d want people with severe epilepsy to know about living with the condition?

I want to say I feel for them. I think having epilepsy is really hard for the family and the patient. It’s an everyday struggle and it’s a chronic disease. I think people need to realize that.

It’s important to know that certain intractable motor seizures qualify as a diagnosis for children for Make-A-Wish. I like to refer my severe epilepsy patients to Make-A-Wish during their hard times or a rough year because it’s really important for them to have a special moment.

I would love it if there were more support for the families. This is especially true for adults with epilepsy, who may need someone to drive them around. It would be amazing if there were some financial funding from the government that could accommodate that so they can feel more independent.

I also feel for young adults who have intractable epilepsy as they complete their education, finish school-transition programs, and then sometimes, there’s no way for them to move to the next step in life. I really hope that new programs would be created for them. I also believe employers should be more humble and considerate and try to provide opportunities for individuals who have epilepsy.

Find Your Team

Are you or a loved one living with severe epilepsy? When you join MyEpilepsyTeam, you gain a community of more than 112,000 people who are living with epilepsy or who care for a loved one with the condition.

Share your experiences or questions in a comment below, or start a conversation on MyEpilepsyTeam today.

Source

[WEB] Which Antiseizure Medications Are Safe (or Not) During Pregnancy?

By Mary Beth Nierengarten

Article In Brief

An analysis of pregnancies in women with epilepsy found an association between two antiseizure medications, valproate and topiramate monotherapy, and a twofold increased risk of major congenital malformations in children.

The choice and dose of antiseizure medications (ASMs) for women who are pregnant or planning a pregnancy are critical given the teratogenic potential of certain therapies. Now, results from a large, population-based study comparing the safety and potential risk of ASMs on fetal development of major congenital malformations provides some clarity on both concerns.

The analysis, published online Nov. 26 in Annals of Neurology, found that both valproate and topiramate monotherapy were associated with a twofold increased risk of major congenital malformations. Prior evidence from systematic reviews indicated that children exposed prenatally to valproate had a threefold increased risk of developing a congenital malformation, but the risk with topiramate had been less clear. The current study suggests that topiramate may not be a safer alternative to valproate.

The study also confirmed data from prior research showing that lamotrigine and levetiracetam confer a low risk of major congenital malformations and that carbamazepine and oxcarbazepine are relatively safe in terms of risk for major congenital malformations.

Study Details

Using national health register data from 1996 to 2020 from five Nordic countries—Denmark, Finland, Iceland, Norway, and Sweden—investigators constructed a population-based cohort of nearly 5 million pregnancies to examine the comparative safety of common ASMs. Nearly 16,000 women (0.3 percent) used an ASM monotherapy in the first trimester of their pregnancy compared with 4,866,362 women who did not use any ASM.

Most women were treated with lamotrigine monotherapy (8,339); other treatments included carbamazepine (2,674 women), valproate (2,031), oxcarbazepine (1,313), levetiracetam (1,040), and topiramate (509). The study did not include gabapentin and pregabalin or older agents, such as phenytoin and phenobarbital, that are no longer frequently used in Nordic countries.

The investigators found no difference between those taking lamotrigine monotherapy and women taking no ASM after adjusting for such confounding factors as country, year of delivery, maternal age, indications for ASMs, and other chronic conditions, including diabetes, other medication use in the first trimester, and indicators of health care use before pregnancy.

Investigators compared the safety of lamotrigine monotherapy with monotherapies for carbamazepine, valproate, oxcarbazepine, levetiracetam, and topiramate. They also stratified the monotherapy groups by dose and compared each with low-dose lamotrigine.

Both valproate and topiramate increased the risk of congenital malformations by twofold in a dose-dependent manner compared with lamotrigine monotherapy. Both agents were associated with the potential for increased risk for multiple malformations. Valporate was associated with cardiac and nervous system malformations as well as oral clefts, clubfoot, and hypospadias.

The study found no increased risk of congenital malformations with carbamazepine, oxcarbazepine, and levetiracetam monotherapies compared with lamotrigine monotherapy.

“Based on our study, we did not find any meaningful differences in the major congenital malformation risk between these drugs,” said the lead author of the study, Jacqueline Cohen, PhD, senior researcher in the department of chronic diseases and Center for Fertility and Health at the Norwegian Institute of Public Health in Oslo. Dr. Cohen said she was reassured by the comparable safety findings on carbamazepine given that the assessment was based on a higher number of infants exposed to the drug prenatally than assessed in previous studies.

“Our findings, in the context of previous research, suggest that neurologists should avoid prescribing valproate and topiramate to people who may become pregnant unless other treatment options are not effective or not tolerated,” Dr. Cohen said.

“Oxcarbazepine, a medication that had not reached the numbers to allow us to confidently assess its structural risk, is now confirmed to be equally safe to lamotrigine and levetiracetam by analyzing over 1,000 exposed pregnancies.”—DR. PAULA VOINESCU

“The best time for counseling women with epilepsy of childbearing age is at least six months prior to pregnancy so that the seizure medication regimen can be simplified with fewer medications at the lowest possible dose to keep the patient seizure-free.”—DR. MONA SAZGAR

“Major congenital malformations occur very early in pregnancy, and therefore it is best to consider these risks before a patient becomes pregnant,” she said. “All patients with the capacity for pregnancy using these drugs should also use effective contraception and be well informed about the risk associated with using the drugs during pregnancy.”

Clinical Perspectives

Paula Voinescu, MD, PhD, a neurologist and director of the Women’s Epilepsy Program at Brigham and Women’s Hospital in Boston, said the study reinforces that lamotrigine and levetiracetam are associated with the best structural outcomes during pregnancy.

What excites her, she added, is that the study also establishes oxcarbazepine as an equally safe medication.

“Oxcarbazepine, a medication that had not reached the numbers to allow us to confidently assess its structural risk, is now confirmed to be equally safe to lamotrigine and levetiracetam by analyzing over 1,000 exposed pregnancies,” Dr. Voinescu said.

She noted that the study also reinforced that valproate should be the “last resort for women planning for pregnancy given its highest rate for congenital malformations.” It also confirms prior suspicions that topiramate carries a significant risk and should be avoided, she said.

The results showing that carbamazepine was associated with a lower rate of congenital malformation than previously shown should be “comforting” to women who are pregnant or planning a pregnancy, Dr. Voinescu added.

Mona Sazgar, MD, a neurologist in the Comprehensive Epilepsy Program at UC Irvine Health, said she the results of the study reassure her, as they align with prospective pregnancy registry data worldwide, including the North American Antiepileptic Drug Pregnancy Registry.

“The results increase my confidence in counseling women with epilepsy,” Dr. Sazgar said.

She advises pregnant women to stay on their ASMs because not controlling seizures during pregnancy carry potential risks to the fetus.

“I attempt to simplify the medication regimen, aim for monotherapy if possible, and select medications with more favorable side effect profiles,” Dr. Sazgar said. “The good news is that the vast majority of these medications, at least as monotherapy, are considered safe, and most women with epilepsy give birth to healthy babies.”

Dr. Sazgar noted that lamotrigine, oxcarbazepine, and levetiracetam (all included in the current study) have a comparable risk profile with the general population. When using zonisamide, gabapentin, and lacosamide, she checks for baseline pregnancy levels as well as obtains monthly blood draws to guide dosing during pregnancy.

In line with the study results and previous findings, she avoids valproate and topiramate as well as phenobarbital. “If the patient has to be on valproate or phenobarbital and has no other choice, then I will try to use a dose lower than 700 mg for valproate and 150 mg for phenobarbital to minimize risk,” she said.

Dr. Sazgar emphasized that gaps remain in understanding the safety of myriad new ASMs, including perampanel, brivaracetam, clobazam, esclicarbazepine, lacosamide, cenobamate, and cannabidiol. Many women use these therapies to control their seizures, but no adequate data on their safety during pregnancy are available.

Counsel Women Before Pregnant

Dr. Sazgar said she tries to discuss the risks of ASMs during pregnancy before a patient becomes pregnant. “The best time for counseling women with epilepsy of childbearing age is at least six months prior to pregnancy so that the seizure mediation regimen can be simplified with fewer medications at the lowest possible dose to keep the patient seizure-free,” she said.

Once a woman becomes pregnant, she said, it usually is not safe to lower the medication dose or simplify the antiseizure medication regimen. “The goal is to keep the patient seizure-free so both mother and the baby will stay healthy.”

Along with using medications with a low risk of birth defects, Prachi Parikh, MD, assistant professor of neurology at Duke University School of Medicine, said it is critical to check blood levels of medications before pregnancy and then every month. “Medication levels typically drop in the first and second trimester and can lead to breakthrough seizures if not accounted for,” she said.

Disclosures:

Drs. Cohen and Sazgar had no disclosures. Dr. Voinescu has received speakers’ fees from Neurodiem, Stony Brook University, and Physicians’ Education Resources.

Link Up for More Information

• Cohen JM, Alvestad S, Cesta CE, et al. Comparative safety of antiseizure medication monotherapy for major malformations https://onlinelibrary.wiley.com/doi/10.1002/ana.26561. Ann Neurol 2022: Epub 2022 Nov 26.

• Weston J, Bromley R, Jackson CF, et al. Monotherapy treatment of epilepsy in pregnancy: Congenital malformation outcomes in the child https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465055/. Cochrane Database Syst Rev 2016;11(11):CD010224.

• PubMed

• Hernandez-Diaz S, Smith CR, Shen A, et al. Comparative safety of antiepileptic drugs during pregnancy https://n.neurology.org/content/78/21/1692.long. Neurology 2012;78:1692–1699.

• View Full Text | PubMed | CrossRef

• Jentink J, Loane MA, Dolk H, et al. Valproic acid monotherapy in pregnancy and major congenital malformations https://www.nejm.org/doi/full/10.1056/nejmoa0907328. N Eng J Med 2010;362:2185–2193.

• The North American Antiepileptic Drug Pregnancy Registry. Annual update 2022. https://bit.ly/3W80ncT. Accessed Dec 19, 2022.

Source

[WEB] Conditions Related to Epilepsy

Medically reviewed by Amit M. Shelat, D.O.

Article written by Brooke Dulka, Ph.D.

Epilepsy includes a spectrum of seizure disorders caused by abnormal electrical activity in the brain. Approximately 1 percent of the general population has epilepsy, but having a related condition may put you at greater risk. When two or more conditions occur at the same time — such as epilepsy and depression — the conditions are said to be comorbid.

Sometimes, a comorbid disorder occurs alongside epilepsy as a consequence of epilepsy. Other times, a preexisting condition can increase the risk of later developing epilepsy. Epilepsy and comorbid conditions often share underlying biological mechanisms that can increase the risk of either condition.

Managing two conditions at the same time can affect your quality of life. If you have epilepsy, it may help to understand your risk of related conditions so you can work with your doctor or health care team to help prevent or treat the other conditions. Here’s what to know about the comorbidities of epilepsy.

Comorbid Neurological Disorders

Neurological disorders are brain-related conditions. Abnormalities in sodium channels, which help regulate electrical activity in the brain, may be a shared mechanism in many neurological disorders that occur alongside epilepsy.

Alzheimer’s Disease

Alzheimer’s disease is a disease of cognitive decline, brain atrophy, and dementia. Research has found that people who have Alzheimer’s disease are at an increased risk of seizures or epilepsy. Approximately 10 percent to 22 percent of people with Alzheimer’s will experience at least one seizure, typically beginning in the later stages of Alzheimer’s disease.

Research in mice has shown that high levels of beta-amyloid protein in the brain (a characteristic trait of Alzheimer’s disease) can cause seizure activity. This finding has led experts to believe that Alzheimer’s disease may be a risk factor for epilepsy development.

Migraine

Migraines cause intense headaches accompanied by sensitivity to light, nausea, and other symptoms. Headaches (including migraines) appear at a higher rate in people with epilepsy (52 percent of men and 57 percent of women) compared to the general population (16 percent of men and 28 percent of women). Migraines may share common genetic roots with epilepsy.

Brain Tumors

Brain tumors, particularly gliomas, can cause epilepsy to develop. Approximately 40 percent to 60 percent of people with brain tumors will experience seizures.

Encephalitis

Viral encephalitis is an infection of the brain that causes inflammation. Like brain tumors, encephalitis can cause epilepsy. The frequency of seizures in cases of encephalitis ranges from 7 percent to 46 percent.

Cerebrovascular Disease

Cerebrovascular disease refers to a variety of conditions that disrupt blood flow or damage blood vessels within the brain. Problems with blood flow can lead to stroke. According to the Epilepsy Foundation, strokes are the most common cause of epilepsy in the elderly and account for 22 percent to 69 percent of seizures in this age group.

Comorbid Cognitive and Psychiatric Disorders

Several psychiatric and cognitive disorders are related to epilepsy, including attention deficit hyperactivity disorder (ADHD), depression, anxiety, autism, and psychosis.

Attention Deficit Hyperactivity Disorder

ADHD is a disorder of attention and impulsiveness that affects children and adults. ADHD has been shown to occur at a higher rate in children with epilepsy than in the general population. Among all children, rates of ADHD are approximately 9 percent. Research has shown that the rate of ADHD in children with epilepsy, however, is between 27 percent and 40 percent, making ADHD one of the most common psychiatric comorbidities of childhood epilepsy.

Depression

Depression is a mood disorder related to feelings of sadness. Overall, people with epilepsy tend to have depression at higher rates than people without epilepsy. Changes in the brain chemical messengers (neurotransmitters) norepinephrine and serotonin may underlie features of both depression and epilepsy.

Anxiety Disorder

Epilepsy may result in the development of anxiety, a psychiatric condition that causes excessive worry and fear. Anxiety has been reported to occur in approximately 23 percent of people with epilepsy, compared to 11 percent in the general population. Because anxiety medications can be used to treat epilepsy and antiepileptic drugs can be used for anxiety, scientists believe that the conditions also share similar brain biology underpinnings.

Autism

Autism, or autism spectrum disorder, is a developmental disorder of communication. Neurotypical children (children without autism) experience epilepsy rates around 1 percent to 2 percent. However, in children with autism, the rate of epilepsy is around 30 percent. This relationship is likely due to shared genetic risk factors, as research shows that autism and epilepsy share 20 genes.

Psychosis

Psychosis, or when a person loses contact from reality and experiences delusions, can be a symptom of epilepsy. Research shows that people with epilepsy are at eight times the risk of psychosis than the general population.

Comorbid Sleep Disorders

Insomnia and sleep apnea are two sleep disorders that are associated with epilepsy.

Insomnia

Insomnia is a chronic problem of not being able to fall asleep or stay asleep. Insomnia can occur as a symptom of epilepsy. In one study, 55 percent of people with epilepsy experienced insomnia.

Sleep Apnea

Sleep apnea, or obstructive sleep apnea, is a serious condition in which a person repeatedly stops breathing while sleeping. According to one study, about 30 percent of individuals with epilepsy also experienced sleep apnea. The typical treatment for sleep apnea is continuous positive airway pressure (CPAP). CPAP use has also been shown to reduce seizure activity.

Comorbid Autoimmune Disorders

Autoimmune disorders also frequently occur in the context of epilepsy. The International League Against Epilepsy classification system suggests that there may be an immune component of epilepsy that could explain the association between epilepsy and some autoimmune disorders.

Type 1 Diabetes Mellitus

Doctors and researchers have noticed a relationship between type 1 diabetes mellitus (a condition in which the pancreas does not produce enough insulin) and epilepsy. Studies show that approximately 25 percent of people with diabetes also experience epilepsy, whereas epilepsy occurs in approximately 1 percent of the general population. Some scientists believe that changes in brain metabolism related to low blood sugar levels may be the link between these two conditions.

Thyroid Disorders

A thyroid disorder is a condition involving the dysregulation of thyroid hormones, which contribute to many functions in the body. Thyroid conditions and epilepsy have both been linked to mitochondrial dysfunction and oxidative stress. Some research suggests that thyroid disorders may lead to the development of epilepsy.

Myasthenia Gravis

A chronic weakness of skeletal muscles known as myasthenia gravis has also been observed in people with epilepsy. One study shows that about 3 percent of people with epilepsy also experience myasthenia gravis, a condition that affects less than 1 percent of the general population.

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that attacks the brain and spinal cord. This condition occurs more frequently than by chance in people with epilepsy. Some researchers suspect that MS lesions in the brain can act as a focal point for an epileptic seizure.

Lupus

Lupus is an autoimmune disease involving inflammation and pain in connective tissues. Research shows that people with lupus are at nearly a sixfold risk of developing epilepsy compared to people without lupus.

Other Medical Comorbidities

Other medical conditions have also been shown to be comorbid with epilepsy. These disorders related to epilepsy include:

• Musculoskeletal system disorders
• Gastrointestinal and digestive disorders
• Respiratory system disorders
• Chronic pain disorders
• Neoplasia
• Arthritis
• Obesity
• Fractures
• Allergies

Talk To Your Doctor About Related Conditions

Your doctor can help you understand your risk factors for developing related conditions. The doctor can also recommend steps to manage or lower your risk. Always make sure your health care provider is aware of every medication you are taking for any condition, whether the medication is available over the counter or by prescription, including any vitamins or herbal supplements. Some medications can cause dangerous interactions. Open communication with your doctor ensures you can be partners in decision-making about your health.

Condition Guide

• Epilepsy — An Overview
• Epilepsy — The Path to Diagnosis
• Causes of Seizures and Epilepsy
• Seizure Types and Symptoms of Epilepsy
• Treatments for Epilepsy
• Types of Epilepsy

References

1. Epilepsy — Mayo Clinic
2. Characteristic Distribution of Interictal Brain Electrical Activity in Idiopathic Generalized Epilepsy — Epilepsia
3. Defining Comorbidity: Implications for Understanding Health and Health Services — Annals of Family Medicine
4. Depression in Epilepsy — Neurology
5. Association of Epilepsy and Comorbid Conditions — Future Neurology
6. Sodium Channel Mutations in Epilepsy and Other Neurological Disorders — The Journal of Clinical Investigation
7. Epilepsy and Cognitive Impairments in Alzheimer Disease — Archives of Neurology
8. What Is Alzheimer’s Disease? — Alzheimer’s Association
9. Aberrant Excitatory Neuronal Activity and Compensatory Remodeling of Inhibitory Hippocampal Circuits in Mouse Models of Alzheimer’s Disease — Neuron
10. Amyloid Cascade Hypothesis: Pathogenesis and Therapeutic Strategies in Alzheimer’s Disease — Neuropeptides
11. Seizures in Elderly Patients With Dementia: Epidemiology and Management — Drugs & Aging
12. Evidence of Shared Genetic Risk Factors for Migraine and Rolandic Epilepsy — Epilepsia
13. Migraines — Mayo Clinic
14. Evidence for a Shared Genetic Susceptibility to Migraine and Epilepsy — Epilepsia
15. High Prevalence of Headaches in Patients With Epilepsy — The Journal of Headache and Pain
16. Epilepsy-Related Brain Tumors — Seizure
17. Seizure Prognosis in Brain Tumors: New Insights and Evidence-Based Management — The Oncologist
18. Viral Encephalitis and Epilepsy — Epilepsia
19. Cerebrovascular Disease — University of Michigan Health
20. Cerebrovascular Disease — Epilepsy Foundation
21. What Is ADHD? — Centers for Disease Control and Prevention
22. Prevalence of Epilepsy and Attention-Deficit Hyperactivity (ADHD) Disorder: A Population-Based Study — Journal of Child Neurology
23. Childhood Epilepsy, Attention Problems, and ADHD: Review and Practical Considerations — Seminars in Pediatric Neurology
24. Measures of Psychopathology in Children With Complex Partial Seizures and Primary Generalized Epilepsy With Absence — Journal of the American Academy of Child and Adolescent Psychiatry
25. Depression — National Institute of Mental Health
26. Depression in Epilepsy: A Neurobiologic Perspective — Epilepsy Currents
27. Anxiety — Epilepsy Foundation
28. Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis — Epilepsia
29. Using Anxiolytics in Epilepsy: Neurobiological, Neuropharmacological and Clinical Aspects — Epileptic Disorders
30. What Is Autism? — Autism Speaks
31. Epilepsy in Autism — The Lancet Neurology
32. Multiplex Gene and Phenotype Network to Characterize Shared Genetic Pathways of Epilepsy and Autism — Scientific Reports
33. What Is Psychosis? — National Institute of Mental Health
34. Psychosis — Epilepsy Foundation
35. The Prevalence of Psychosis in Epilepsy; A Systematic Review and Meta-Analysis — BMC Psychiatry
36. Comorbidity Between Epilepsy and Sleep Disorders — Epilepsy Research
37. Insomnia — Mayo Clinic
38. Insomnia and Epilepsy: A Questionnaire-Based Study — Journal of Clinical Sleep Medicine
39. Obstructive Sleep Apnea — Mayo Clinic
40. Effect of Continuous Positive Airway Pressure Treatment on Seizure Control in Patients With Obstructive Sleep Apnea and Epilepsy — Epilepsia
41. Epilepsy and Autoimmune Diseases: Comorbidity in a National Patient Cohort — Seizure
42. ILAE Classification of the Epilepsies: Position Paper of the ILAE Commission for Classification and Terminology — Epilepsia
43. Type 1 Diabetes — Mayo Clinic
44. Association Between Seizures and Diabetes Mellitus: A Comprehensive Review of Literature — Current Diabetes Reviews
45. Metabolic Brain Adaptations to Recurrent Hypoglycaemia May Explain the Link Between Type 1 Diabetes Mellitus and Epilepsy and Point Towards Future Study and Treatment Options — Diabetologia
46. Thyroid Disease — Cleveland Clinic
47. Thyroid Hormones: Possible Roles in Epilepsy Pathology — Seizure
48. Myasthenia Gravis Fact Sheet — National Institute of Neurological Disorders and Stroke
49. Treatment of Epilepsy in Patients With Myasthenia Gravis: Is Really Harder Than It Looks? — Journal of Clinical Neuroscience
50. Multiple Sclerosis — Mayo Clinic
51. Association Between Multiple Sclerosis and Epilepsy: Large Population-Based Record-Linkage Studies — BMC Neurology
52. What Is Lupus? — Lupus Foundation of America
53. Comorbidities of Pediatric Systemic Lupus Erythematosus: A 6-Year Nationwide Population-Based Study — Journal of Microbiology, Immunology and Infection
54. Data and Statistics About ADHD — Centers for Disease Control and Prevention
55. Epilepsy — World Health Organization
56. Myasthenia Gravis — National Organization for Rare Disorders

Source

[WEB] What Are Generalized Seizures?

Medically reviewed by Evelyn O. Berman, M.D.

Article written by Liz Aulino, Ph.D.

Generalized seizures are a type of epilepsy that affects up to 40 percent of people with epilepsy. Generalized seizures occur when abnormal electrical activity occurs simultaneously across both hemispheres of the brain. This seizure activity is what makes generalized onset seizures different from other seizure types. Focal seizures, or partial seizures, occur only on one side of the brain.

Types of Generalized Seizures

Generalized seizures can take different forms, each with their own set of signs and symptoms. The differences in symptoms in generalized seizures are caused by the location in the brain where the abnormal electrical activity is happening.

To determine the type of seizure a person is experiencing, a doctor investigates a person’s brain waves following the seizure event, often using an electroencephalogram (EEG). Unusual waves or spikes in the brain’s activity can provide helpful clues as to the type of seizure. There are several types of generalized seizures, grouped by the International League Against Epilepsy into two categories — motor and nonmotor.

Motor Seizures

Motor seizures include symptoms that affect movement.

Generalized Tonic-Clonic Seizures

Generalized tonic-clonic (GTC) seizures used to be called grand mal seizures. A GTC seizure consists of several phases, which can vary between individuals.

The prodromal phase of a seizure happens before the seizure begins. In this phase, a person may experience a distinct feeling they associate with seizures, or a warning sign they’ve learned over time. A person with epilepsy may experience mood swings, headache, or confusion. Only 20 percent of people with epilepsy who experience GTC seizures go through this phase.

An aura is often the first indication of a GTC seizure for many people with epilepsy. Like the prodromal phase, not everyone experiences an aura. Those who have aura may report symptoms such as numbness, loss of vision, a bitter taste, or other sensations, depending on how the brain is affected.

Auras occur in the first part of the ictal phase, or the time from the beginning of a seizure until the end of the seizure. During the ictal phase, a person can experience muscle contractions, twitching, loss of bowel or bladder control, and memory lapses, among many other symptoms. GTC seizures are named after these characteristic muscle contractions — “tonic” means stiffening, and “clonic” means jerking movements.

The time period following a GTC seizure is called the postictal phase. Some people with epilepsy recover quickly. For others, the postictal phase can last as long as several days. A person might experience symptoms like soreness, nausea, or headaches, as well as sadness, memory loss, or confusion during the postictal phase. The length of the postictal phase and the types of symptoms experienced can differ depending on how the brain was impacted during the seizure.

Tonic Seizures

During a tonic seizure, a person’s muscles suddenly stiffen or tighten. Then, the person loses consciousness. Their back arches because the muscles in their arms, legs, and chest tighten, and their eyes roll back in their head. The tightened chest muscles can make it difficult to breathe during a tonic seizure. This can cause a person’s lips or face to turn blue.

Clonic Seizures

During a clonic seizure, a person’s muscles twitch or rhythmically jerk. This usually affects the arms and legs, but muscles in the neck and face may also be affected. Generally the jerking will slow before it stops completely. As the seizure subsides, it is common for the person experiencing symptoms to let out a deep sigh.

Myoclonic Seizures

Myoclonic seizures can occur in clusters. They feature a rhythmic jerking motion as muscles rapidly tighten, then release.

Infants ages 3 to 12 months can develop a type of myoclonic epilepsy called infantile spasms. During this kind of seizure, an infant’s arms fly outward as their knees and back bend. Infantile spasms happen in a series or cluster, unlike colic cramps or reflux.

Nonmotor Seizures

Nonmotor seizures lack symptoms that affect movement. Instead, these seizures can cause changes in cognition, emotion, or sensation.

Absence Seizures

Absence seizures, once called petit mal seizures, are usually short and last less than 10 seconds. During an absence seizure, a person stops what they are doing and goes blank. They may look like they are daydreaming or staring off into space. The person will likely remain upright. Afterward, they will have no memory of what happened.

Absence seizures can occur multiple times a day. Due to their short duration and subtle presentation, people nearby might not even notice the seizure.

Atypical absence seizures tend to be longer, come on slower, and have more symptoms. An atypical absence seizure may last 20 seconds or more. These seizures may also feature facial spasms, eyelid fluttering, or lip-smacking.

Atonic Seizures

Atonic seizures, sometimes called drop attacks, cause a sudden loss of muscle tone. A person experiencing an atonic seizure will go limp, causing them to suddenly fall down if standing or drop their head. The person experiencing the atonic seizure will remain unresponsive until the seizure is over. Atonic seizures are also associated with a rare type of epilepsy, Lennox-Gastaut syndrome, that develops between the ages of 3 and 5.

What Causes Generalized Seizures?

Generalized seizures can occur in people with and without epilepsy. Someone who experiences two or more generalized seizures that are not the result of a fever may be diagnosed with generalized epilepsy.

Generalized epilepsy can be caused by a number of factors, such as damage to the brain or genetics. A person with epilepsy can also develop the condition over time as the result of a brain tumor, stroke, or infectious diseases like meningitis or encephalitis.

Risk factors for generalized epilepsy include:

• A family history of seizures
• A head injury
• Age — a person is more likely to develop epilepsy under the age of 20 or over 65
• A history of having seizures as a child

Read more about causes of epileptic seizures.

Treatment Options for Generalized Seizures

There is no treatment that is effective for all types of generalized seizures. However, many treatments are available for generalized seizures. These include medications, specialized diets, and surgery. Treatments are matched to the type of seizure, where in the brain the seizure originates, and the seizure’s root cause.

Antiepileptic Drugs

Many people can control their symptoms with antiepileptic drugs (AEDs). These medications are thought to work by reducing the electrical activity in the brain that causes epileptic seizures. Depending on the type of seizure, a doctor may prescribe a broad- or narrow-spectrum AED. Broad-spectrum AEDs are effective against more than one seizure type, while narrow-spectrum AEDs are used to treat specific types. For example, absence seizures are frequently treated with a narrow-spectrum AED.

In addition to AEDs, other medications can be used to treat seizures. Sedatives like barbiturates or benzodiazepines are sometimes prescribed. Lennox-Gastaut syndrome is often treated with the benzodiazepine clonazepam (Klonopin).

Diet Changes

Although the majority of those who experience generalized seizures can control their symptoms with medication, some epilepsy may be resistant to traditional treatments. If generalized seizures cannot be controlled with medication, a doctor may prescribe diet modifications.

The ketogenic diet is used to treat children with treatment-resistant epilepsy. This high-fat, low-carbohydrate diet increases ketones in the blood, which helps reduce seizures for some children. A similar, less extreme version of this diet may be prescribed to adults with treatment-resistant epilepsy.

Surgery

In extreme cases where neither medication nor diet has improved seizure activity — or in cases where a person experiences severe, frequent seizures that are life-threatening — a doctor may recommend epilepsy surgery. Surgery for treatment-resistant epilepsy removes the part of the brain where seizures originate. In some cases, this may be a brain lesion or tumor. Depending on the type of seizure, a frontal or temporal lobe resection may be appropriate.

For people with drug-resistant generalized seizures, the most common surgical intervention is a corpus callosotomy. This procedure removes the part of the brain that joins the two hemispheres. This treatment works best in people with atonic, atypical absence, tonic, and tonic-clonic seizures.

Read more about treatments for epileptic seizures.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 105,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Are you living with generalized onset seizures? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

Source

[WEB] Getting Disability Benefits With Epilepsy

Medically reviewed by
Amit M. Shelat, D.O.

Article written by
Annie Keller

• Different types of disability benefits are available for people with epilepsy who qualify.
• Applications for disability depend on your inability to work.
• You may appeal if you are denied disability benefits.

Sometimes even the best accommodations at work aren’t enough to help you keep your job when you have epilepsy. “I can get a job, but I just can’t keep it,” said one MyEpilepsyTeam member in regards to unpredictable seizures. Loss of consciousness, convulsive seizures, and the sleepiness that follows many epileptic seizures can be too much to continue working.

When people with epilepsy can no longer work, many in the United States seek Social Security disability benefits. Disability benefits help replace lost income when people with epilepsy have to leave their jobs. “When work caused too much stress that caused my seizures, I knew it was time to apply for disability,” a MyEpilepsyTeam member wrote.

The process of applying for a disability claim can feel intimidating. Filing an appeal for a rejected claim can also prove challenging. Understanding the process ahead of time, including what the U.S. Social Security Administration (SSA) considers to determine disability, can ease the process.

Disability Benefit Programs in the United States

There are two different federal disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To qualify for either, you must have a disability that limits your ability to work.

Funded through payroll taxes, SSDI gives disability benefits to those who have held full-time jobs in the recent past. If you are approved, you can receive benefits in the sixth month following your disability designation. You will then be eligible for Medicare 24 months after you became disabled.

SSI gives disability benefits to those who are considered low-income; a work history is not a requirement. Once you are approved, you should start to receive benefits in the next month. You may also be eligible for SSI back payments if you became disabled prior to your approval.

In most states, if you qualify for SSI, you are also eligible for Medicaid. In some states and territories — Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, and the Northern Mariana Islands — you will need to apply for Medicaid and SSI separately, though the requirements for both are the same. “Where I live, to receive Medicaid, you have to be working but stay under a certain income,” one MyEpilepsyTeam member shared.

“It is possible to work,” another member said. “But you would have to talk to the Social Security Administration specialist and find out how many hours you can work without getting fined or losing the Social Security benefits.”

Eligibility criteria for SSI recipients varies across states.

Almost every state provides an SSI supplement, with exceptions including Arizona, Mississippi, North Dakota, and West Virginia. The eligibility rules for supplements vary by state.

There is an asset (or “resources”) cap for receiving Supplemental Security Income. Individuals with more than $2,000 of assets and couples with more than $3,000 in assets lose eligibility. The SSA has a list of which resources are considered. Your home, household belongings, and one personal vehicle are not factored into the total.

If you have very limited funds and a work history, you may be eligible to receive SSDI and SSI.

Defining Disability

In determining your eligibility for disability benefits, the Social Security Administration will evaluate the following criteria:

• You are likely ineligible for benefits if you earn $1,260 or more a month. If you earn less, you may still be eligible; the amount you receive may be reduced.
• You must be incapable of performing basic tasks required for most jobs, including standing, walking, lifting, sitting, and remembering. You must not have been able to perform these tasks for at least 12 months.
• You must have a recognized disability. The Social Security Administration provides a Listing of Impairments that prevent working. Epilepsy is on the list, under Neurological Disorders. You can still be eligible even if your specific medical condition isn’t listed.
• You must be unable to perform any work you’ve done previously. A work history is not a prerequisite for receiving SSI.
• You must be unable to engage in what the SSA calls “substantial gainful activity.” The Social Security Administration will consider your diagnosis, age, medical history, education, and work history, as well as any other marketable skills.

Applying for SSDI and SSI

People with epilepsy face considerable paperwork when applying for disability benefits. The Social Security Administration offers a checklist of necessary application information. Below is a summary of what you’ll need to provide.

Information About Yourself and Your Family

• Your full legal name, date of birth, and Social Security number
• Full names and dates of birth of your current or previous spouses, and dates of marriage, divorce, or death
• Full names and dates of birth of your children
• Bank account information

Medical Evidence About Your Epilepsy

• The name and contact information for your neurologist and other medical providers who can discuss your condition and the type of seizures you have (e.g., tonic-clonic, absence, complex partial).
• A complete list of medications, both past and present, along with any side effects you’ve experienced from them, as well as results for medical tests such as CT scans, MRI, and EEGs.
• A description of how epilepsy impacts your ability to do activities like shopping, cooking, cleaning, and other tasks of daily living.

Total Employment History

• Earnings from the past year
• Any current employers or ones you have worked for in the past two years
• A complete work history from the last 15 years, including any jobs from before you became disabled
• Whether you are getting or intend to receive workers’ compensation
• Dates of any military service

Documents

• Birth certificate
• Social Security card
• Proof of citizenship
• W-2 or other tax forms from the previous year
• Any medical records about your condition
• Proof of any workers’ compensation you have received

Members of MyEpilepsyTeam shared their application experiences. “If you can’t find all the paperwork, [it] helps if you recall where you were hospitalized and when,” one member wrote.

Some MyEpilepsyTeam members faced obstacles in documenting their symptoms. “The SSI people need proof (in person) of your disability. The problem is, seizures are random,” wrote one member.

“My seizures are very controlled, about 3-4 per year, and I don’t qualify,” another MyEpilepsyTeam member disclosed.

You can apply for SSDI online if you:

• Have never been married
• Were born in the United States
• Are between 18 and 65
• Are not currently receiving benefits

If you don’t meet any of those criteria, you can still apply at a local Social Security office or over the phone.

Appealing a Disability Application Rejection

Processing an application for disability benefits takes an average of three to five months. It can take even longer to get approved.

Most people are not approved the first time they apply. From 2009 through 2018, only 21 percent of applicants were approved on their first attempt. If you are denied the first time, you can appeal the decision. This is a simple process, and your case will be evaluated by someone who did not evaluate your application the first time. Only around 2 percent of these initial appeals were successful from 2009 to 2018.

If necessary, you have the option to file a second appeal. The second appeal includes a hearing by an administrative law judge, trained in disability laws, who will consider all of your evidence.

You may have a disability attorney represent you at this hearing. Some law firms even specialize in disability cases. A MyEpilepsyTeam member recommended enlisting legal counsel early on: “[The appeals process] can take a long time. The only way to get it done quicker is to hire an attorney and stop trying to do it yourself. “

If you are denied at this level, you can ask the Appeals Council to consider and rule on your case. About 8 percent of SSDI claims between 2009 and 2018 were approved during a hearing with an administrative law judge or the Appeals Council.

If your claim is again denied, the final remaining option is a federal court hearing. One MyEpilepsyTeam member had to go this route: “I was denied three times, then went to the federal level, and I got it.”

Waiting for approval of your disability benefits can be stressful. MyEpilepsyTeam members have shared advice on how to cope with the evaluation process and tips on getting approved.

• “One of the most important things is to have a lot of documentation. [Document] everything on your condition.”
• “Any doctor that you’ve seen who knows and has files on your epilepsy, get a copy of it all. They need proof that you have this disorder.”
• “Be sure the doctors explain the diagnosis and how it limits/affects [your ability to work].”
• “You may have to hire a lawyer briefly when you apply; it will just speed things along.”
• “Send a letter when you reapply telling them how much it affects your life in every way.”
• “Keep trying, and tell your neurologist or family doctor — when filling out the papers — everything you can that is going wrong in your life.”

Consider These International Resources

If you’d like to research more about disability benefits in countries outside of the United States, check out these resources, listed by country:

• Australia — Payments for People Living With an Illness, Injury, or Disability
• Canada — Disability Benefits
• Denmark — Disability Pension
• Finland — Disability Pension
• Great Britain — Personal Independence Payment (PIP)
• Iceland — Disability Pension in Iceland
• Ireland — Operational Guidelines: Disability Allowance
• The Netherlands — Invalidity Benefits
• New Zealand — Disability Allowance
• Norway — Disability Benefit
• South Africa — Old Age, Disability, and Survivors
• Sweden, UK — Benefits for People With Disabilities

Get Support From People Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. More than 109,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Have you applied for Social Security disability benefits for epilepsy? Do you have any advice about the process? Comment below or start a conversation on MyEpilepsyTeam.

References

Source

[WEB] What is Epilepsy? Symptoms, Causes, Diagnosis, Treatments, Precautions, & More

All ages are affected by the chronic, noncommunicable brain disease known as epilepsy. And epilepsy, which affects about 50 million people worldwide, is one of the most prevalent neurological conditions.

TWINKLE

What is Epilepsy? Symptoms, Causes, Diagnosis, Treatments, Precautions, & More

Epilepsy is a central nervous system (neurological) disorder. In epilepsy, abnormal brain activity results in seizures or periods of strange behavior, sensations, and occasionally loss of awareness. 

What is Epilepsy?

A chronic brain condition called epilepsy causes recurrent “fits” or “seizures.” Sudden, excessive electrical discharges in the neurons or brain cells cause seizures. People of any age can develop this condition, and different issues arise for each age group.

Around 50 million people worldwide, 80% of whom reside in developing nations, are thought to have epilepsy, according to the WHO. Although it is a treatable condition, three-fourths of those affected in developing nations do not receive the right care. In India, there are roughly 10 million people who experience seizures linked to epilepsy.

A person is diagnosed with it after experiencing multiple seizures. Additionally, it is evident that not all seizures are caused by epilepsy. Other conditions, such as extremely low blood sugar, fainting, etc., can also cause seizures. The majority of epilepsy cases are diagnosed in children and adults over 65.

Also Read about National Epilepsy Day.

What are the causes of Epilepsy?

Epilepsy can be caused by both genetic and acquired factors, and these factors frequently interact to do so. While older people are more likely to experience brain tumors and strokes, younger people are more likely to experience epilepsies brought on by genetic, congenital, or developmental conditions.

Genetics

The majority of cases are thought to involve genetics, either directly or indirectly. Only 1-2 percent of epilepsies are caused by a single gene defect; the majority are brought on by the interaction of many genes and environmental factors. There are fewer than 200 single gene defects known, and they are all rare.

Phakomatosses

Phakomatoses are a class of multisystemic diseases that primarily affect the skin and central nervous system. They are also referred to as neurocutaneous disorders. They are brought on by abnormal embryonic ectodermal tissue development, which is typically the result of a single genetic mutation.

Acquired

Tumors, strokes, head trauma, previous infections of the central nervous system, genetic abnormalities, and birth-related brain damage are a few other conditions that can result in epilepsy.

Some other common causes of epilepsy are:

• Infection in the brain.
• Congenital abnormalities
• Stroke and brain Tumors
• Damage to the brain due to prenatal and perinatal injury.
• Injury in the head or accident.
• During childhood prolonged high fever.
• Infections like encephalitis or meningitis.
• Low oxygen during birth.
• Some genetic conditions like tuberous sclerosis may result in brain injury.

What are the symptoms of Epilepsy?

Some evidence links epilepsy and celiac disease and non-celiac gluten sensitivity, while other evidence does not. The early signs and symptoms of Epilepsy are:

• Loss of consciousness
• Muscles of arms, legs, or face become stiffed
• Different types of sensations like sort of pricking pins or needles in arms or legs
• Uncontrollable jerking motions in arms or legs etc

How to deal with the seizures caused by epilepsy?

There is proof that epileptic seizures are typically not an arbitrary occurrence. The causes of seizures, also known as triggers, include things like stress, excessive alcohol consumption, flickering lights, and sleep deprivation, among others. The amount of stimulus required to trigger a seizure is known as the seizure threshold, and it is lowered in epilepsy.

And the tips to deal with seizures are:

• Don’t panic.
• Lose tight clothes near the neck.
• Remove sharp objects from the person suffering from seizures.
• Gently roll the person from one side so that any fluid present in the mouth comes out.
• Under the head of the person put some type of soft cloth.
• Do not give or push anything to the mouth of the person.
• Remain with the person until any help arrives.
• Allow the person to rest or sleep.

How to diagnose Epilepsy?

Epilepsy is typically diagnosed based on observation of the onset of seizures and their underlying causes. Initial investigations frequently also include an electroencephalogram (EEG) to check for abnormal brain wave patterns and neuroimaging (CT scan or MRI) to examine the structure of the brain. It is not always possible to identify a specific epileptic syndrome, despite frequent attempts. In complex situations, video and EEG monitoring may be helpful.

Remember that the right medications can be used to treat epilepsy. However, it’s crucial that we start the treatment right away. As soon as the illness is identified, the treatment can begin. By doing this, we can stop the person’s condition from getting worse.

What are the precautionary tips for Epilepsy?

Even though many cases cannot be prevented, efforts to lessen head injuries, offer proper care during childbirth, and eradicate environmental parasites like the pork tapeworm may be successful.

And some other preventive measures are:

• If the epilepsy patient does not suffer from seizures then also it is advised to take proper medication as advised by the doctor.
• Don’t discontinue medicine without the advice of a doctor.
• Before taking any other medication, it is better to consult or take advice from the doctor.
• Don’t drink alcohol because it provokes seizures.

With the use of the right medication, epilepsy can be cured as it is a treatable condition. National Epilepsy Day is observed on November 17 each year to raise awareness of the condition and encourage people to take the recommended medications. Through seminars, lectures, etc., this day also educates people.

Source

[Abstract] Wired for sound: The effect of sound on the epileptic brain

Abstract

Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden’s Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.

Similar articles

• Mozart K.448 and epileptiform discharges: effect of ratio of lower to higher harmonics.Lin LC, Lee WT, Wu HC, Tsai CL, Wei RC, Jong YJ, Yang RC.Epilepsy Res. 2010 May;89(2-3):238-45. doi: 10.1016/j.eplepsyres.2010.01.007. Epub 2010 Feb 2.PMID: 20129759
• Abstracts of Presentations at the Association of Clinical Scientists 143^rd Meeting Louisville, KY May 11-14,2022.[No authors listed]Ann Clin Lab Sci. 2022 May;52(3):511-525.PMID: 35777803
• Study of the Mozart effect in children with epileptic electroencephalograms.Grylls E, Kinsky M, Baggott A, Wabnitz C, McLellan A.Seizure. 2018 Jul;59:77-81. doi: 10.1016/j.seizure.2018.05.006. Epub 2018 May 9.PMID: 29763803
• [Epilepsy, Mozart and his sonata K.448: is the «Mozart effect» therapeutic?].Hernando-Requejo V.Rev Neurol. 2018 May 1;66(9):308-314.PMID: 29696618 Review. Spanish.
• Music in epilepsy: Predicting the effects of the unpredictable.Rafiee M, Istasy M, Valiante TA.Epilepsy Behav. 2021 Sep;122:108164. doi: 10.1016/j.yebeh.2021.108164. Epub 2021 Jul 10.PMID: 34256336 Review.

See all similar articles

Source