Posts Tagged Epilepsy

[NEWS] New guidance on use of valproate in women, girls of child bearing age with epilepsy published

Apr 2 2019

 

New guidance to support regulations around the use of valproate in women and girls of child bearing age with epilepsy has been published by specialists from 13 UK healthcare bodies including seven Royal Colleges.

And NICE has published a summary of updated guidance for healthcare professionals bringing together all its recommendations and other safety advice on the drug valproate.

The use of sodium valproate during pregnancy is associated with up to a 40 per cent risk of neuordevelopmental disorders and a 10 per cent risk of physical disabilities for an unborn child.

In March 2018, the Medicines and Healthcare products Regulatory Agency published guidelines which meant that valproate could no longer be prescribed for girls and women of childbearing age unless no other effective treatment was available.

Any girl or woman prescribed valproate should also be fully informed of the risks associated with the medication and the need for effective contraception.

But a year on, implementation of the guidelines have thrown up specific challenges with complex issues and individual situations where the best interests of the patient did not always appear to be met.

Claire Glazebrook, Director of Fundraising, Marketing and External Affairs at Epilepsy Society, said:

Over the last year our Helpline has received multiple calls from women, parents and healthcare professionals, all struggling to interpret the guidelines and what they mean for them as individuals. And we know that this experience is replicated across other patient organizations and clinics.

I hope this guidance will help to answer some of their questions and provide clarity in what can be a very emotional and challenging decision.

For some girls and women, they have no option but to take sodium valproate as it may be the only drug that will control their seizures. But that of course means there are some very important and potentially heartbreaking issues to consider around planning a family.

All these women and girls deserve consistency in the advice and information that they receive.”

The new pan-college guidance has been drawn up by Judy Shakespeare of the Royal College of General Practitioners and Sanjay Sisodiya of the Association of British Neurologists and Royal College of Physicians. Sanjay Sisodiya is also Director of Genomics at Epilepsy Society and Professor of Neurology at UCL.

He said: This work has come together through much valued contributions from specialists across all the national bodies involved.

“In some cases the new regulations have lead to situations where the best interests of the patients may not appear to be best served. Some of the points raised by the regulations are also complex ethical issues. We do not attempt to address all these issues in this document but hope that it will bring greater clarity for clinicians  leading to better care for women and girls with epilepsy. All women and girls have individual needs and where possible should be involved in the choices they make about their own health and plans to start a family.”

Writing in the guidance, Professor Dame Sally Davies, Chief Medical Officer for England said:

I am very pleased that the Medical Royal Colleges have come together to produce this important and helpful guidance, so that doctors and other healthcare professionals across primary and secondary care are on the same page regarding the use of sodium valproate – including around instances where its use is still appropriate.”

via New guidance on use of valproate in women, girls of child bearing age with epilepsy published

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[Abstract] Vagus Nerve Stimulation for the Treatment of Epilepsy

First page of article

Vagus nerve stimulation (VNS) was the first neuromodulation device approved for treatment of epilepsy. In more than 20 years of study, VNS has consistently demonstrated efficacy in treating epilepsy. After 2 years, approximately 50% of patients experience at least 50% reduced seizure frequency. Adverse events with VNS treatment are rare and include surgical adverse events (including infection, vocal cord paresis, and so forth) and stimulation side effects (hoarseness, voice change, and cough). Future developments in VNS, including closed-loop and noninvasive stimulation, may reduce side effects or increase efficacy of VNS.

via Vagus Nerve Stimulation for the Treatment of Epilepsy – Neurosurgery Clinics

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[Abstract] Management of epilepsy in women

Journal home page for The Lancet NeurologySummary

Epilepsy is a common neurological condition in women worldwide. Hormonal changes occurring throughout a woman’s life can influence and be influenced by seizure mechanisms and antiepileptic drugs, presenting unique management challenges. Effective contraception is particularly important for women with epilepsy of childbearing potential because of antiepileptic drug-related teratogenicity and hormonal interactions; although studies reveal many women do not receive contraceptive and preconceptual counselling. Management challenges in this population include the higher risk of pregnancy complications and peripartum psychiatric problems than in women without epilepsy. Research is needed to clarify the precise role of folic acid supplementation in prevention of congenital malformations in children born to women with epilepsy. To optimise treatment of low bone density in women with epilepsy, studies investigating bone densitometryfrequency and calcium and vitamin D supplements are required. Understanding of the mechanisms linking seizures and the menopause will help to develop effective therapeutic strategies, and advances in managing epilepsy could improve quality of life for women with this condition.

 

via Management of epilepsy in women – ScienceDirect

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[NEWS] Focused ultrasound offers potential new epilepsy treatment

29 Jan 2019 Tami Freeman
Clinical trial
Researchers at the Ohio State University College of Medicine are studying how well focused ultrasound can treat medication-refractory lobe focal onset epilepsy. (Courtesy: Ohio State University)

Focused ultrasound treatments use multiple ultrasound beams focused deep within the body to provide non-invasive, targeted therapy for a wide range of clinical applications. Now, researchers at The Ohio State University College of Medicine have begun a clinical trial investigating the use of transcranial focused ultrasound to control a specific type of epilepsy in which seizures are not controlled by medication.

The study will enrol up to 10 patients with medication-refractory lobe focal onset epilepsy. Patients will receive MR-guided focused ultrasound through an intact skull to ablate tissue deep in the brain. The treatment works by passing 1024 ultrasound beams through the scalp, skull and brain tissue (without causing any harm) until they converge at a focal point to ablate a specific part of the brain involved in epilepsy.

“We’re pursuing this clinical trial because we know there’s a large unmet clinical need. More than 20 million people worldwide live with uncontrollable seizures because no available treatment works for them,” explains neurosurgeon Vibhor Krishna, who is leading the study. “Our goals are to test the safety of this procedure and study changes in seizure frequency in these patients.”

Earlier this month, a 58-year-old man became the first patient to be treated with focused ultrasound for epilepsy at Ohio State. During the three-hour surgery in an intraoperative MRI-surgical suite, he remained awake and alert, providing real-time feedback to the treatment team. His feedback helped the team safely ablate the brain region involved in spread of his epilepsy without causing undesirable side effects.

After treatment, the research team plan to monitor all the patients closely for one year. They will use neurological exams and neuro-psychological exams to assess language, memory and executive functioning.

“This is an important step in the evolution of focused ultrasound as a mainstream therapy for disorders affecting the brain,” said Neal Kassell, founder and chairman of the Focused Ultrasound Foundation, which is funding the clinical trial. “Ultimately, the results of this study could lead to new, more effective therapies for certain patients with epilepsy.”

 

 

via Focused ultrasound offers potential new epilepsy treatment – Physics World

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[NEWS] Scientists can monitor brain activity to predict epileptic seizures few minutes in advance

 

Elizabeth Delacruz can’t crawl or toddle around like most youngsters nearing their second birthday.

A rare metabolic disorder that decimated her mobility has also led to cortical blindness – her brain is unable to process images received from an otherwise healthy set of brown eyes. And multiple times a day Elizabeth suffers seizures that continually reduce her brain function. She can only offer an occasional smile or make soft bubbly sounds to communicate her mood.

“But a few months ago I heard her say, ‘Mama,’ and I started to cry,” said Carmen Mejia, a subtle quaver in her voice as she recalled the joy of hearing her daughter. “That’s the first time she said something.”

Ms. Mejia realizes it may also be the last, unless doctors can find a way to detect and prevent the epileptic seizures stemming from a terminal disease called pyruvate dehydrogenase deficiency (PDHD) – which occurs when mitochondria don’t provide enough energy for the cells.

A UT Southwestern study gives parents like Ms. Mejia renewed hope for their children: By monitoring the brain activity of a specific cell type responsible for seizures, scientists can predict convulsions at least four minutes in advance in both humans and mice. The research further shows that an edible acid called acetate may effectively prevent seizures if they are detected with enough notice.

Although the prediction strategy cannot yet be used clinically – a mobile technology for measuring brain activity would have to be developed – it signifies a potential breakthrough in a field that had only been able to forecast seizures a few seconds ahead.

“Many of the families I meet with are not just bothered by the seizures. The problem is the unpredictability, the not knowing when and where a seizure might occur,” said Dr. Juan Pascual, a pediatric neurologist with UT Southwestern’s O’Donnell Brain Institute who led the study published in Science Translational Medicine. “We’ve found a new approach that may one day solve this issue and hopefully help other scientists track down the root of seizures for many kinds of epilepsy.”

Debunked theory

The critical difference between the study and previous efforts was debunking the long-held belief among researchers that most cells in epilepsy patients have malfunctioning mitochondria. In fact, Dr. Pascual’s team spent a decade developing a PDHD mouse model that enabled them to first discover the key metabolic defect in the brain and then determine only a single neuron type was responsible for seizures as the result of the metabolic defect. They honed in on these neurons’ electrical activity with an electroencephalogram (EEG) to detect which brainwave readings signaled an upcoming seizure.

“It’s much more difficult to predict seizures if you don’t know the cell type and what its activity looks like on the EEG,” Dr. Pascual said. “Until this finding, we thought it was a global deficiency in the cells and so we didn’t even know to look for a specific type.”

Predicting seizures

The study shows how a PDHD mouse model helped scientists trace the seizures to inhibitory neurons near the cortex that normally keep the brain’s electrical activity in check.

Scientists then tested a method of calculating when seizures would occur in mice and humans by reviewing EEG files and looking for decreased activity in energy-deficient neurons. Their calculations enabled them to forecast 98 percent of the convulsions at least four minutes in advance.

Dr. Pascual is hopeful his lab can refine EEG analyses to extend the warning window by several more minutes. Even then, live, clinical predictions won’t be feasible unless scientists develop technology to automatically interpret the brain activity and calculate when a seizure is imminent.

Still, he said, the discovery that a single cell type can be used to forecast seizures is a paradigm-shifting finding that may apply to all mitochondrial diseases and related epilepsies.

Potential therapy

Dr. Pascual’s ongoing efforts to extend the prediction time may be a crucial step in utilizing the other intriguing finding from the study: the use of acetate to prevent seizures.

The study showed that delivering acetate into the blood stream of PDHD mice gave their neurons enough energy to normalize their activity and decrease seizures for as long as the acetate was in the brain. However, Dr. Pascual said the acetate would probably need more time – perhaps 10 minutes or more – to take effect in humans if taken by mouth.

Acetate, which naturally occurs in some foods, has been used in patients for decades – including newborns needing intravenous nutrition or patients whose metabolism has shut down. But it had not yet been established as an effective treatment for mitochondrial diseases that underlie epilepsy.

Among the reasons, Dr. Pascual said, is that labs have struggled to create an animal model of such diseases to study its effects; his own lab spent about a decade doing so. Another is the widespread acceptance of the ketogenic diet to reduce the frequency of seizures.

But amid a growing concern about potentially unhealthy side effects of ketogenic diets, Dr. Pascual has been researching alternatives that may refuel the brain more safely and improve cognition.

Frequent seizures

Elizabeth, among a handful of patients whose EEG data were used in the new study, has been prescribed a ketogenic diet and some vitamins to control the seizures. Her family has seen little improvement. Elizabeth often has more than a dozen seizures a day and her muscles and cognition continue to decline. She can’t hold her head up and her mother wonders how many more seizures her brain can take.

Elizabeth was only a few months old when she was diagnosed with PDHD, which occurs when cells lack certain enzymes to efficiently convert food into energy. Patients who show such early signs often don’t survive beyond a few years.

Ms. Mejia does what she can to comfort her daughter, with the hope that Dr. Pascual’s work can someday change the prognosis for PDHD. Ms. Mejia sings, talks, and offers stuffed animals and other toys to her daughter. Although her little girl can’t see, the objects offer a degree of mental stimulation, she said.

“It’s so hard to see her go through this,” Ms. Mejia said. “Every time she has a seizure, her brain is getting worse. I still hope one day she can get a treatment that could stop all this and make her life better.”

‘Big questions’

Dr. Pascual is already conducting further research into acetate treatments, with the goal of launching a clinical trial for patients like Elizabeth in the coming years.

His lab is also researching other epilepsy conditions – such as glucose transporter type I (Glut1) deficiency – to determine if inhibitory neurons in other parts of the brain are responsible for seizures. If so, the findings could provide strong evidence for where scientists should look in the brain to detect and prevent misfiring neurons.

“It’s an exciting time, but there is much that needs to happen to make this research helpful to patients,” Dr. Pascual said. “How do we find an automated way of detecting neuron activity when patients are away from the lab? What are the best ways to intervene when we know a seizure is coming? These are big questions the field still needs to answer.”

via Scientists can monitor brain activity to predict epileptic seizures few minutes in advance

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[Abstract + References] Neuron–glia interactions in the pathophysiology of epilepsy

Abstract

Epilepsy is a neurological disorder afflicting ~65 million people worldwide. It is caused by aberrant synchronized firing of populations of neurons primarily due to imbalance between excitatory and inhibitory neurotransmission. Hence, the historical focus of epilepsy research has been neurocentric. However, the past two decades have enjoyed an explosion of research into the role of glia in supporting and modulating neuronal activity, providing compelling evidence of glial involvement in the pathophysiology of epilepsy. The mechanisms by which glia, particularly astrocytes and microglia, may contribute to epilepsy and consequently could be harnessed therapeutically are discussed in this Review.

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via Neuron–glia interactions in the pathophysiology of epilepsy | Nature Reviews Neuroscience

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[ARTICLE] SUPPORTIVE PRINCIPLES IN THE PHARMACOLOGICAL MANAGEMENT OF THE PATIENTS WITH EPILEPSY

Abstract

Background: Pharmacological management of patients with epilepsy is still a very challenging approach for the best outcome of these patients. When considering the appropriate treatment choice for patients it is necessary to take into account several factors that can influence the effectiveness and quality of life. Cancelling or changing treatment suddenly can lead to uncontrolled seizures. After a short period without seizures, many patients are tempted to abandon treatment. Cessation of treatment can be discussed after a seizure-free period for at least two years. Treatment should be discontinued gradually by reducing the dosage and constant supervision of the physician. This paper analyses briefly the general pharmacological and treatment methods in several forms of adult epilepsy.

Conclusions: Management of epilepsy means more than observing the medication prescribed by the specialist. It is also important for the patient to maintain his general health status, monitor the symptoms of epilepsy and response to treatment and take care of his safety. Involvement in the management of one’s own affection can help the patient to control his condition and to continue his routine in usual manner. The objective of antiepileptic treatment is to reduce epileptic seizures to zero without intolerable side effects. New treatments should focus not only on reducing the frequency and intensity of seizures but also improving the quality of life of patients. Key words: patient, epilepsy, therapy and dynamics.

Introduction

The analysis of the specialized literature reveals that many issues regarding differential treatment of epilepsy require subsequent clarification. As far as we are concerned, we have designed and developed therapeutic recommendations, in our opinion, effective, supporting the results of treating epilepsy in its various stages, from premonition to status variants. In this context, the main element in the choice of preparations, besides the trivial clinical signs, was the use of sub-curative monitoring data, including repeated EEG examinations, which fixed the subjective response of patients. Choosing the best possible medicine or an optimal combination of medicines is sometimes difficult. The perfect antiepileptic should be long, nonsedative, well tolerated, very active in various types of convulsive and with non-harmful effects on vital organs and functions. In addition, it must be effective in various forms of active epilepsy and in treating underlying epileptic seizures and capable of restoring the electroencephalogram between seizures to its normal form [5; 9; 10; 18; 23; 24; 27; 31; 38; 40; 41; 43].

It is still debatable whether such a drug will ever be discovered, and especially one that will control all types of epilepsy. The thorough study of pharmacological properties allows us to appreciate which of the existing antiepileptics will meet the current requirements of our patients under study. Due to the fact that patients differ considerably after clinical response to known anticonvulsants and the possibilities of treatment with associated drugs are insufficiently and superficially researched, testing of more efficient substances including new combinations continues. Due to the modern medication, which benefits from a wide and sufficiently efficient range of specific drugs, a large proportion of the recurrent and the disabling sequelae of the disease can be prevented. The adverse effects of drugs are low, so many of the past patients who have been labelled for life by this suffering can now live a productive life. The actual ability to control this disease effectively prevents more of its severe consequences [12; 13; 15; 22; 29; 46; 50].

General principles of pharmacotherapy of epilepsies

In the treatment of psychiatric disorders of our patients with epilepsy we have taken into account the following principles:

Appropriate selection of the remedy, its dosing, routes of administration and possible side effects. And we took into account the following:

  1. The syndrome of psychic state – the gradual expression of the disorders, the relationship between productive and negative alterations and the type of impairment of psychic processes.
  2. The dynamic characteristics of the psychic state – the duration of the disturbances, the changes in the presence of paroxysmal manifestations.
  3. The somatic and neurological condition of the patient with epilepsy. This parameter is important in the context

of the evidence of side effects of favorable and unfavorable preparations. Somatic mood dictates and the route of administration of drugs: parenteral in gastrointestinal disorders, endonasal or transorbital (by electrophoresis) when parenteral administration is not preferred.

Individual features of the patient with epilepsy (age, weight, response to anticonvulsant therapy and others) are also considered. It is often forgotten that lower doses are indicated for children and older people as the exchange of substances in them is slow and standard dose treatment leads to accumulation of preparations and adverse effects [6; 7; 14; 19].

We recommend the gradual increase of the doses, with the preference of the minimal effective doses of the drugs. All the above-described drugs are initially indicated at minimal doses, then the dose gradually increases until the first positive effects are displayed, the subsequent increase of the doses is made after a certain period of time to stabilize the positive effect.

Complex treatment – it is necessary to prescribe unimoment of anticonvulsant remedies from different classes and groups in combination with non-medication methods. Polipharmacologic treatment has certain priorities in comparison with monotherapy because it addresses different links of the pathological process. It is important to avoid the multidimensional effects of many drugs, the doubling of the mechanisms of action and the predilection of some and the same psychological processes.

Continuous therapy. The treatment of productive disorders is done until their complete jugulation (sometimes with the purpose of preventing relapse and longer), of the deficient ones by alternating the cures, with gradual modifications [28; 30; 34; 39; 42].

Principles of medication of psychosomatic syndromes in epilepsy

Criteria for the effectiveness of psychotropic remedies administered in epilepsy are those of improving the knowledge and behavioral processes. More differentiated treatment is based on syndrome of mental disorders.

  1. Deficient disorder (transient dementia, mental-mental diminution, etc.) The treatment is continuously practiced, alternating the belts. It is rational to indicate the preparations of different subgroups. The following criteria are taken into consideration when drawing up the treatment scheme:

a) Main mechanism of action: nootrop, general metabolism, cerebrovascular or actoprotector;

b) Predominant action on mediating processes: GABA (piracetam, fenibut, gamma-aminobutyric acid); cholin-ergic (gliatiline); dopaminergic (nakom); and combined (meclofenoxate, glycine, glutamic acid);

c) With predominant action on the function of the encephalic structures: the cerebral and subcortical (nakom), on the left hemisphere (gliatilline); on the right hemisphere (cortexil);

d) With action on psychomotor activity: major stimulation (piracetam, nakom vinpocetine), mean enhancement (aminalone, gamma-aminobutyric acid, cerebrolizine, nicergoline, tanakan), diminishment (fenibut, glycine, ci-narizine);

e) Route of administration: parenteral, internal, endo-nasal, transorbital (by electrophoresis), mixed. Duration of treatment: from 7 days to 4 months (nakom, fenibut). On the basis of this therapy it is also possible to indicate prophylactic doses of anticonvulsants.

  1. For different types of excitation (chaotic, twilight, delusional, manic, psychopathic, etc.) the support treatment are the sedative neuroleptics. Major tranquilizers, barbiturates and other anticonvulsants, may also be indicated sedative antidepressants.
  • Hallucinatory delusions. More rational are antipsy-chotic neuroleptics. In the case of neuroleptic syndrome with caution are added corrective remedies. That adjuvant preparations use daytime tranquilizers, in depressive or anxious states are used antidepressants.
  • Emotional productive disruptions. In the states of excitation are indicated predominantly sedative neuroleptics and tranquilizers, antidepressants – in depression, tranquilizers and antiepileptics – in dysphoria, in anxiety states -neuroleptics and tranquilizers.

  • Productive districts nearby. Psychoparticular depressions are typically treated with “inor” euroleptics, preferably “behavioral correctors” or low doses of risperidone and tranquilizers; in neurotic manifestations (asthenia, obsessions, hysteria, hypocondria) are used tranquilizers and low doses of antidepressants [1; 2; 3; 4; 8; 11; 25; 26].
    КиберЛенинка: https://cyberleninka.ru/article/n/supportive-principles-in-the-pharmacological-management-of-the-patients-with-epilepsy

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    [NEWS] Wireless ‘pacemaker for the brain’ could be new standard treatment for neurological disorders

    A grey-colored sits on an illustration of a brain

    A new neurostimulator developed by engineers at UC Berkeley can listen to and stimulate electric current in the brain at the same time, potentially delivering fine-tuned treatments to patients with diseases like epilepsy and Parkinson’s.

    The device, named the WAND, works like a “pacemaker for the brain,” monitoring the brain’s electrical activity and delivering electrical stimulation if it detects something amiss.

    These devices can be extremely effective at preventing debilitating tremors or seizures in patients with a variety of neurological conditions. But the electrical signatures that precede a seizure or tremor can be extremely subtle, and the frequency and strength of electrical stimulation required to prevent them is equally touchy. It can take years of small adjustments by doctors before the devices provide optimal treatment.

    WAND, which stands for wireless artifact-free neuromodulation device, is both wireless and autonomous, meaning that once it learns to recognize the signs of tremor or seizure, it can adjust the stimulation parameters on its own to prevent the unwanted movements. And because it is closed-loop — meaning it can stimulate and record simultaneously — it can adjust these parameters in real-time.

    “The process of finding the right therapy for a patient is extremely costly and can take years. Significant reduction in both cost and duration can potentially lead to greatly improved outcomes and accessibility,” said Rikky Muller, an assistant professor of electrical engineering and computer sciences at Berkeley. “We want to enable the device to figure out what is the best way to stimulate for a given patient to give the best outcomes. And you can only do that by listening and recording the neural signatures.”

    WAND can record electrical activity over 128 channels, or from 128 points in the brain, compared to eight channels in other closed-loop systems. To demonstrate the device, the team used WAND to recognize and delay specific arm movements in rhesus macaques. The device is described in a study that appeared today (Dec. 31) in Nature Biomedical Engineering.

    A WAND chip in a hand

    Ripples in a pond

    Simultaneously stimulating and recording electrical signals in the brain is much like trying to see small ripples in a pond while also splashing your feet — the electrical signals from the brain are overwhelmed by the large pulses of electricity delivered by the stimulation.

    Currently, deep brain stimulators either stop recording while delivering the electrical stimulation, or record at a different part of the brain from where the stimulation is applied — essentially measuring the small ripples at a different point in the pond from the splashing.

    “In order to deliver closed-loop stimulation-based therapies, which is a big goal for people treating Parkinson’s and epilepsy and a variety of neurological disorders, it is very important to both perform neural recordings and stimulation simultaneously, which currently no single commercial device does,” said former UC Berkeley postdoctoral associate Samantha Santacruz, who is now an assistant professor at the University of Texas in Austin.

    Researchers at Cortera Neurotechnologies, Inc., led by Muller, designed the WAND custom integrated circuits that can record the full signal from both the subtle brain waves and the strong electrical pulses. This chip design allows WAND to subtract the signal from the electrical pulses, resulting in a clean signal from the brain waves.

    A close up picture of an integrated circuit

    Existing devices are tuned to record signals only from the smaller brain waves and are overwhelmed by the large stimulation pulses, making this type of signal reconstruction impossible.

    “Because we can actually stimulate and record in the same brain region, we know exactly what is happening when we are providing a therapy,” Muller said.

    In collaboration with the lab of electrical engineering and computer science professor Jan Rabaey, the team built a platform device with wireless and closed-loop computational capabilities that can be programmed for use in a variety of research and clinical applications.

    In experiments lead by Santacruz while a postdoc at UC Berkeley, and by electrical engineering and computer science professor Jose Carmena, subjects were taught to use a joystick to move a cursor to a specific location. After a training period, the WAND device was capable of detecting the neural signatures that arose as the subjects prepared to perform the motion, and then deliver electrical stimulation that delayed the motion.

    “While delaying reaction time is something that has been demonstrated before, this is, to our knowledge, the first time that it has been demonstrated in a closed-loop system based on a neurological recording only,” Muller said.

    “In the future we aim to incorporate learning into our closed-loop platform to build intelligent devices that can figure out how to best treat you, and remove the doctor from having to constantly intervene in this process,” she said.

    Andy Zhou and Benjamin C. Johnson of UC Berkeley join Santacruz as co-lead authors on the paper. Other contributing authors include George Alexandrov, Ali Moin and Fred L. Burghardt of UC Berkeley. This work was supported in part by the Defense Advanced Research Projects Agency (W911NF-14- 2- 0043) and the National Science Foundation Graduate Research Fellowship Program (Grant No. 1106400). Authors Benjamin C. Johnson, Jan M. Rabaey, Jose M. Carmena and Rikky Muller have financial interest in Cortera Neurotechnologies, Inc., which has filed a patent application on the integrated circuit used in this work.

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    via Wireless ‘pacemaker for the brain’ could be new standard treatment for neurological disorders | Berkeley News

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    [WEB SITE] The New Seizure Terminology

    Active Epilepsy in Primary Care

    Epilepsy is a disorder of the brain characterized by an enduring predisposition to having seizures, defined as episodes of abnormally excessive or synchronous neuronal activity in the brain, resulting in transient signs or symptoms.[1,2] Approximately 1.2% of the US population, or about 3.4 million people, have active epilepsy. Active epilepsy refers to a patient who is currently on antiepileptic medications and/or has had one or more seizures in the past year.[3,4]

    Although there are healthcare providers who specialize in epilepsy—namely neurologists and epileptologists—only 53%–67% of patients in the United States with active epilepsy reported recently (“in the past year”) seeing a neurologist or epileptologist.[5,6] Meanwhile, 86% reported recently seeing a general practitioner.[5]

    Given that primary care providers are likely to see patients with seizures and epilepsy—some of whom may not be in the care of a neurologist or epileptologist—we would like to review the most current seizure terminology to help these clinicians better understand the different types of seizures and the importance of standardized terminology around seizures.

    Accurate Seizure Classification

    Accurately classifying different types of seizures using the latest standardized terminology is essential for several reasons. First, it allows healthcare providers and patients to accurately and effectively communicate with one another about seizure type using the same clear language. Second, some medications or therapies are more effective or only approved for specific seizure types and not others, so that errors in classifying seizure type may lead to ineffective treatment. Third, some types of drug-resistant seizures can effectively be treated by surgery, whereas others cannot. Fourth, current and future clinical research studies may have certain inclusion and exclusion criteria based on seizure type, so that knowledge of seizure type would be important prior to enrollment. Finally, accurate classification would lead to a better understanding of seizure type burden in the population, allowing various clinical, research, and public health resources to be allocated appropriately.

    Historical Seizure Terminology

    For centuries, seizures have been described using various terms. For instance, the terms “grand mal” (referring to seizures with bilateral tonic-clonic movements and loss of consciousness) and “petit mal” (seizures with behavioral arrest) have been used since the 1800s. With a better understanding of seizures and the advent of video electroencephalography (EEG), the International League Against Epilepsy (ILAE) published the first official classification of seizure types in 1981, introducing such terms as “partial vs generalized” and “simple vs complex.” However, many of these historical terms have been criticized as being imprecise or nonspecific (eg, petit mal may refer to many different types of seizures with behavioral arrest) or confusing and misleading (eg, the term “partial” might suggest that a seizure was not a “full” one). With increasing knowledge, several iterations of ILAE’s classification of seizure types have been published over the years to improve clarity, with the most recent being published in 2017.[17]

    Continue —> The New Seizure Terminology

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    [NEWS] New study sheds light on why seizures happen after TBI

    BY  ON JANUARY 22ND, 2019

    New study sheds light on why seizures happen after TBI

    An astrocyte cell grown in tissue culture stained with antibodies 
    Image Source: Gerry Shaw/Wikimedia Common

    Researchers have known that severe or repeated brain injuries may trigger seizures in individuals for years, but why this is has remained a mystery. However, a new animal study published in the journal JNeurosci may provide some much-needed insight into the relationship between traumatic brain injury and epilepsy.

    The study, conducted by Stefanie Robel, Oleksii Shandra, and colleagues, identified a unique cellular response to repeated brain injuries in mice that appears to contribute to the development of seizures similar to those experienced by humans after traumatic brain injury.

    For the study, the team induced brain injuries in mice that are analogous to traumatic brain injury or concussions in humans. While observing the mice, the researchers also noticed that a unique group of astrocytes in the brain responded atypically to these injuries. The mice that showed this response also developed spontaneous recurrent seizures within one month.

    In the case of severe traumatic brain injury, astrocytes may change to form a scar. This is important for allowing the brain, but these “scars” have also been linked to epilepsy. However, this scarification does not happen as a result of more mild traumatic brain injuries or concussions.

    Instead, the researchers observed that the astrocytes responded in different ways almost immediately after the injury which were linked to later seizures.

    At first, the team assumed the astrocytes were “dead” because they were no longer producing the proteins that characterize astrocytes. However, the team noticed they were in fact still working, but not responding to the injury in a unique way.

    “Our experiments show a strong relationship between changes in astrocytes and the eventual occurrence of a seizure,” says Robel, an assistant professor with the Fralin Biomedical Research Institute and the School of Neuroscience in Virginia Tech’s College of Science.

    “The findings point to a unique population of astrocytes that respond within 30 minutes of an injury being at the root of a problem where seizures may occur after a latency period of weeks or months, suggesting a therapeutic window to prevent seizure disorders after concussive injuries.”

    via New study sheds light on why seizures happen after TBI – Neurologic Rehabilitation Institute

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