Posts Tagged seizure

[WEB PAGE] Mozart may reduce seizure frequency in people with epilepsy

June 10, 2020. Source: University Health Network

Summary

A new clinical research study has found that a Mozart composition may reduce seizure frequency in patients with epilepsy.

A new clinical research study by Dr. Marjan Rafiee and Dr. Taufik Valiante of the Krembil Brain Institute at Toronto Western Hospital, part of University Health Network, has found that a Mozart composition may reduce seizure frequency in patients with epilepsy.

The results of the research study, “The Rhyme and Rhythm of Music in Epilepsy,” was recently published in the international journal Epilepsia Open. It looks at the effects of the Mozart melody, “Sonata for Two Pianos in D Major, K. 448” on reducing seizures, as compared to another auditory stimulus — a scrambled version of the original Mozart composition, with similar mathematical features, but shuffled randomly and lacking any rhythmicity.

“In the past 15 to 20 years, we have learned a lot about how listening to one of Mozart’s compositions in individuals with epilepsy appears to demonstrate a reduction in seizure frequency,” says Dr. Marjan Rafiee, lead author on the study. “But, one of the questions that still needed to be answered was whether individuals would show a similar reduction in seizure frequency by listening to another auditory stimulus — a control piece — as compared to Mozart.”

The researchers recruited 13 patients to participate in the novel, year-long study. After three months of a baseline period, half of the patients listened to Mozart’s Sonata once daily for three months, then switched to the scrambled version for three months. The others started the intervention by listening to the scrambled version for three months, then switched to daily listening of Mozart.

Patients kept “seizure diaries” to document their seizure frequency during the intervention. Their medications were kept unchanged during the course of the study.

“Our results showed daily listening to the first movement of Mozart K.448 was associated with reducing seizure frequency in adult individuals with epilepsy,” says Dr. Rafiee. “This suggests that daily Mozart listening may be considered as a supplemental therapeutic option to reduce seizures in individuals with epilepsy.”

Epilepsy is the most common serious neurological disorder in the world, affecting approximately 300,000 Canadians and 50 million people worldwide.

Many experience debilitating seizures. The treatment is often one or more anti-seizure medications. But for 30 per cent of patients, the medications are not effective in controlling their seizures.

“As a surgeon, I have the pleasure of seeing individuals benefit from surgery, however I also know well those individuals for whom surgery is not an option, or those who have not benefitted from surgery, so, we are always looking for ways to improve symptom control, and improve quality of life for those with epilepsy,” says Dr. Taufik Valiante, senior author of the study and the Director of the Surgical Epilepsy Program at Krembil Brain Institute at UHN and co-Director of CRANIA.

“Like all research, ours raises a lot of questions that we are excited to continue to answer with further research and support from the epilepsy community.”

While these results are promising, the next step is to conduct larger studies with more patients, over a longer period of time.


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Materials provided by University Health NetworkNote: Content may be edited for style and length.


Journal Reference:

  1. Marjan Rafiee, Kramay Patel, David M. Groppe, Danielle M. Andrade, Eduard Bercovici, Esther Bui, Peter L. Carlen, Aylin Reid, Peter Tai, Donald Weaver, Richard Wennberg, Taufik A. Valiante. Daily listening to Mozart reduces seizures in individuals with epilepsy: A randomized control studyEpilepsia Open, 2020; 5 (2): 285 DOI: 10.1002/epi4.12400

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[Abstract] Epilepsy after severe traumatic brain injury: frequency and injury severity

ABSTRACT

Objective

To estimate national frequency of posttraumatic epilepsy (PTE) after severe traumatic brain injury (TBI) and assess injury severity (Glasgow Coma Scale (GCS) and posttraumatic amnesia (PTA)) as prognostic factors for PTE.

Methods

Data on patients ≥18 years surviving severe TBI 2004–2016 were retrieved from the Danish Head Trauma Database (n = 1010). The cumulative incidence proportion (CIP) was estimated using death as competing event. The association between injury severity and PTE was assessed using multivariable competing risk regressions.

Results

CIP of PTE 28 days and one year post-TBI was 6.8% (95% confidence interval (CI) 5.4–8.5) and 18.5% (95% CI 16.1–21.1%), respectively. Injury severity was not associated with PTE within 28 days post-TBI but indicated higher PTE-rates in less severely injured patients. PTA-duration >70 days was associated with PTE 29–365 days post-TBI (Adjusted sub-hazard ratio 4.23 (95% CI 1.79–9.99)). GCS was not associated with PTE 29–365 days post-TBI.

Conclusion

The PTE frequency was higher compared to previous estimates. Increasing injury severity was associated with PTE 29–365 days post-TBI when measured with PTA, but not with GCS. Though nonsignificant, the increased PTE-risk within 28 days in lower severity suggests an underdiagnosing of PTE.

Source: https://www.tandfonline.com/doi/abs/10.1080/02699052.2020.1763467

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[WEB SITE] Epilepsy – The Path to Diagnosis – MyEpilepsyTeam

Article written by Kelly Crumrin

Epilepsy can be difficult to diagnose, in part because doctors rarely witness seizures firsthand. Epilepsy can also be challenging to distinguish from other conditions, including meningitis, schizophrenia, migraines, sleep disorders, heart problems, multiple sclerosis (MS), attention deficit hyperactivity disorder (ADHD), and transient ischemic attacks – temporary low blood flow to part of the brain, sometimes called a “mini-stroke.” It is possible to have one or more of these conditions in addition to epilepsy, further complicating diagnosis.

It is also important to note that not all seizures are caused by epilepsy. Epilepsy is defined as a neurological disorder that involves recurrent seizures caused by abnormal electrical activity in the brain. Nonepileptic seizures do not originate from abnormal electrical activity and may require different treatment than epileptic seizures.

Typically, a neurologist diagnoses epilepsy, but it may also be diagnosed by a pediatrician, emergency room physician, or general practitioner.

How is epilepsy diagnosed?

There is no single test to diagnose epilepsy. Instead, the doctor will consider your medical history and may perform a variety of diagnostic tests.

Medical history

The doctor will take a thorough history, asking detailed questions about what happens during seizures, how long they last, and how often they occur. The physician may ask about a history of head injuries, infections, or other neurological symptoms. The doctor will likely ask about family history of seizures. A clear picture may emerge from the medical history to help the doctor assess risk factors that strengthen the suspicion of epilepsy or rule out other conditions.

Electroencephalography (EEG)

EEG is a test that visualizes brainwaves to monitor seizure activity. For an EEG, the technologist will place electrodes on your scalp. The electrodes pick up the tiny electrical charges resulting from brain activity. Most EEGs take one to one-and-a-half hours to set up and complete the test. Receiving an EEG is painless and cannot harm you.

About half of EEGs performed on people who have seizures produce normal results. Even if you have frequent seizures, your EEG may be normal if you are not having a seizure during the test. You may be asked to rapidly blink your eyes, stare at blinking lights, or breathe deeply for several minutes to provoke seizure activity.

Ambulatory EEGs record brainwaves for a longer period of time, usually 24 hours or three days, to increase the chances of recording seizure activity. Ambulatory EEGs may be performed at home, at an outpatient clinic, or as an inpatient at a hospital.

During a video EEG, video and audio of your movement, behavior, and sounds are recorded along with brainwave patterns. Video EEGs allow the neurologist to see what is happening in your brain during specific seizure behavior. Video EEGs can be done on an inpatient or outpatient basis.

When EEGs do capture seizure activity, they are very valuable tools. Some brainwave patterns are distinctive indicators of certain types of epilepsytypes of seizures, or other neurological disorders. Sometimes, EEG results can even indicate where in the brain the seizures originate.

If your EEG results are normal, it is not conclusive whether or not you have epilepsy. Further tests will be performed.

Brain imaging

Imaging tests are performed to evaluate brain function and structure. The most common neuroimaging procedures are magnetic resonance imaging (MRI) and computed tomography (CT or sometimes CAT) scans. Neuroimaging scans can detect potential causes of seizures including tumors, scar tissue, abnormal blood vessel formations, or hydrocephalus (an excess of spinal fluid).

Other tests

Blood or saliva tests may be ordered to check for genetic causes of epilepsy.

Some people with epilepsy may have speech or auditory processing problems, so tests may be performed to measure processing ability. Assessment tests may be performed by audiologists (hearing specialists) or speech and language pathologists.

The doctor may order a test to quantify cognitive (related to thinking, memory, and reasoning) abilities in relation to normal or abnormal brain structures. Cognitive assessments may be performed by doctors, psychologists, educators, or other specialists.

What is the prognosis for epilepsy?

Roughly 60 percent of people diagnosed with epilepsy who receive appropriate treatment will become seizure-free within a few years. Some people never have another seizure, while others have sporadic seizures or uncontrolled seizures despite being on anti-epileptic drugs (AEDs).

What is remission?

Some doctors define remission from epilepsy as 10 years without having a seizure, and being off of AEDs for the past five years. Other doctors consider someone in remission after two years without seizures (the last year off AEDS), or five years without seizures (the last two off AEDs). The chances for remission are higher if the cause of epilepsy is unknown, seizures are few and far between, seizures are responsive to AEDs, and there are no underlying neurological problems.

Age at diagnosis

The age at which a person receives an epilepsy diagnosis varies widely and is often correlated to the cause of epilepsy. Some forms of epilepsy, especially those that are caused by birth trauma or a genetic mutation, are diagnosed in infancy or early childhood. Other types of epilepsy don’t develop until adolescence or adulthood.

Resources

External resources

MyEpilepsyTeam resources

FAQ

Is it possible to have seizures without having epilepsy?

Yes, it is possible to have seizures that are not caused by epilepsy. Nonepileptic seizures can look and feel like epileptic seizures, but they do not involve abnormal electrical activity in the brain. Nonepileptic seizures can have several different causes. Febrile seizures, caused by high fever, are very common in children. Another type of nonepileptic seizure is the psychogenic seizure. Psychogenic seizures are caused by psychological stress, sometimes related to an anxiety disorder. Nonepileptic seizures can also be caused by heart problems and metabolic conditions such as diabetes. Women are at a higher risk for nonepileptic seizures. It is possible for someone who has epilepsy to experience one or more nonepileptic seizures.

Kelly leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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[Abstract + References] Cannabinoids for the Treatment of Epilepsy: a Review

Abstract

Purpose of review

Treatment-resistant epilepsy (TRE) is associated with severe morbidity and mortality and affects over 30% of epilepsy patients. Despite advances in epilepsy management over the last 30 years, this rate has largely remained unchanged. Through a largely patient driven movement and despite federal regulations, cannabidiol (CBD) emerged as a candidate drug for improving the management of treatment-resistant epilepsies. This review highlights the available research on CBD and its therapeutic role in the treatment of TREs.

Recent findings

Randomized controlled trials have established CBD as an add-on treatment option for the management of seizures in Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), and there is a growing body of additional literature supporting CBD’s use as an add-on therapy in other TREs. Several studies have shown CBD to be a safe anti-seizure medication with dose-dependent mild-moderate adverse events which resolve with treatment de-escalation. CBD does affect toxicity with other anti-seizure medications including clobazam and valproate.

Summary

CBD is a safe and efficacious adjunctive therapy in the management of treatment-resistant epilepsies.

References and Recommended Reading

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via Cannabinoids for the Treatment of Epilepsy: a Review | SpringerLink

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[WEB PAGE] Types of Epilepsy | MyEpilepsyTeam

 

Article written by Kelly Crumrin

Epilepsy is a spectrum of neurological disorders that involve recurring seizures caused by abnormal electrical activity in the brain. Diagnosing the specific type of epilepsy helps you and your doctor better know what to expect regarding seizure progression, any challenges in learning and physical development, and which treatments will be most effective.

Each type of epilepsy involves specific types of seizures and other symptoms.

Localized epilepsies and syndromes

Some types of epilepsy are referred to as localized, which means they are known by the location in the brain where seizures originate. A related term is focal epilepsy, which indicates seizures that have abnormal electrical activity focused in one area of the brain. Other types of epilepsy are known as syndromes, or collections of specific signs and symptoms that point to a certain medical condition. Each type of epilepsy has unique characteristics. Some syndromes are considered benign, meaning children will eventually become seizure-free with age, while other types of epilepsy are lifelong conditions.

Temporal lobe epilepsy (TLE)

Approximately 60 percent of people with epilepsy have temporal lobe epilepsy (TLE), or seizures that originate in the temporal lobe of the brain. The temporal lobe is located on the sides of the brain, near the ears, and is responsible for processing sound and language as well as memories relating to sound and vision. About one-third of TLE or other cases of focal epilepsy are resistant to anti-epileptic drugs (AEDs). Surgery may be recommended, and vagus nerve stimulation may also be therapeutic.

TLE usually develops between late adolescence and early adulthood, often after a head injury or febrile (fever-induced) seizure. For women with TLE, hormonal changes during the menstrual cycle can increase seizure activity. Focal onset seizures are most common for people with TLE, though some people may experience prolonged seizures or, in rare circumstances, status epilepticus. Read more about seizure types and symptoms.

Frontal lobe epilepsy (FLE)

Frontal lobe epilepsy is the second most common form of focal epilepsy after TLE. FLE may be inherited, or it may be caused by a structural problem such as a birth defect, an abnormal blood vessel, trauma, or scaring caused by infection. In about 50 percent of FLE cases, no cause is ever determined.

The frontal lobes of the brain are large, and some of its functions include reasoning, paying attention, regulating emotion, organizing, and solving problems. Researchers have not discovered the functions of many areas. It is possible for a seizure to begin in the frontal lobe and proceed without symptoms before spreading to other parts of the brain, leading to a tonic-clonic seizure. FLE seizure symptoms can vary widely, depending on the function of the affected part of the lobe. Learn more about seizure symptoms and types.

FLE is usually responsive to medications, but in cases where AEDs are ineffective, surgery or vagus nerve stimulation may help.

Occipital lobe epilepsy and parietal lobe epilepsy

Epilepsy that originates in the occipital and parietal lobes is much less common than TLE and FLE. Seizures that begin in these lobes are usually idiopathic – of unknown cause. The occipital lobe is in the back of the brain and is primarily responsible for vision. The parietal lobe is located on the top and upper sides of the head and is known as the “association cortex” because it is where perception becomes reality. Sounds are recognized as words, visual images are created, and touch becomes associated with an object.

In both types of epilepsy, AEDs are the first treatment option. If medication fails, surgery may be recommended.

Panayiotopoulos syndrome (PS)

Also known as early onset occipital epilepsy, PS commonly begins in early childhood. Typically, onset is between the ages of 3 and 10. PS affects boys and girls equally, and it is idiopathic (cause unknown). As many as 6 percent of children who have nonfebrile (not caused by fever) seizures have PS. PS frequently stops two to three years after the first seizure.

Children with PS will have focal seizures that can spread to a generalized seizure. Seizures in PS often last 20 to 60 minutes, and more than half occur during sleep. Pale skin, a sick feeling, and vomiting are typical symptoms during a PS seizure. Some children may also have tonic-clonic movements. Read more about types of seizures.

If seizures are infrequent, medication may not be needed. However, if they are needed, AEDs are usually effective at controlling PS seizures. Neurologists often teach parents how to initiate rescue therapy and create an emergency plan for children with PS.

Benign rolandic epilepsy (BRE)

Also known as benign epilepsy with centrotemporal spikes (BECTS), BRE usually begins around ages 6 to 8. Boys are slightly more likely to have BRE than girls. BRE accounts for approximately 15 percent of all epilepsies in children.

Benign rolandic epilepsy is characterized by numbness, twitching, or tingling of the face or tongue. Seizures may inhibit speech and cause drooling. The child remains conscious during the seizure. Seizures are not frequent and occur mostly at night. AEDs may be prescribed if the seizures happen during the day or disrupt sleep, but many children do not need medication. Seizures stop by early adolescence in almost all children with BRE.

Generalized epilepsies and syndromes

In contrast to localized types of epilepsy discussed above, generalized types of epilepsy feature seizures that do not originate, or do not remain confined, in one lobe or area of the brain. Generalized epileptic syndromes tend to be idiopathic – of unknown cause. Idiopathic generalized epilepsies account for one-third of epilepsy cases.

Juvenile myoclonic epilepsy (JME)

JME, also known as Janz syndrome, begins between the ages of 8 and 26, but most commonly between the ages of 12 and 16. Absence seizures may be the first type of seizure most people with JME experience, although this type happens less often. Mild myoclonic seizures, generalized tonic-clonic (GTC), or clonic-tonic-clonic seizures (GTC seizures that begin with a clonic phase) seizures are the most common types. Myoclonic seizures tend to occur immediately upon waking in the morning. Photosensitivity – seizures triggered by flashing or flickering light – affects 40 percent of people with JME. Photosensitive seizures usually show on an electroencephalography (EEG) test. Read more about seizure types.

Most cases of juvenile myoclonic epilepsy are treatable with AEDs. Most people with JME need to remain on medication for life.

Childhood absence epilepsy (CAE)

CAE accounts for 2 to 8 percent of childhood epilepsy. Childhood absence epilepsy typically begins between the ages of 3 and 11, most frequently between ages 5 and 8. One-third of children with CAE have a family history of seizures, suggesting that the cause may be genetic. Siblings of children with CAE have a 1-in-10 chance of developing epilepsy.

Children with CAE experience absence seizures (formerly known as petit mal seizures). The child is not aware or responsive during seizures, and may stare, blink, or roll their eyes up. You may notice a chewing motion or other repetitive movements. Seizures last about 10 seconds, after which the child immediately returns to normal. The child is usually not aware they have had a seizure. Seizures may be infrequent or happen as often as 100 times a day. One-third of children with CAE have concentration and memory problems before seizures start; these issues often improve after AEDs are started. Rarely, children who have very frequent seizures may develop learning difficulties.

If AEDs are not effective, the ketogenic diet may help children with CAE. At least two-thirds of children with CAE respond to treatment, and their seizures will cease by mid-adolescence. However, 10 to 15 percent of children with CAE will develop other seizure types during adolescence – typically myoclonic seizures, generalized tonic-clonic seizures, or both. Read more about seizure types.

Juvenile absence epilepsy (JAE)

JAE is similar to childhood absence epilepsy; however, it starts later in childhood (generally between ages 9 and 13) and is usually a lifelong condition. Two percent of people with epilepsy have juvenile absence epilepsy (JAE). Although it is rare to have a family history of seizures, the cause of JAE is thought to be genetic.

People with JAE experience absence seizures lasting from 10 to 45 seconds. Seizures may happen infrequently or 100 times a day. Seizures often happen during exercise. Seventy-five percent of those with JAE will also have tonic-clonic seizures. The risk of absence status epilepticus (also known as nonconvulsive status epilepticus), in which seizures can last minutes or even hours, is higher in people with JAE.

Children with JAE generally develop normally, though they may experience learning difficulties if they have frequent seizures. One-third of children with JAE have concentration and memory problems before seizures start; these issues often improve after AEDs are started. AEDs work well to treat JAE and must be taken for life.

Lennox-Gastaut syndrome (LGS)

LGS is an uncommon epilepsy syndrome; between 2 and 5 percent of children with epilepsy have LGS. Lennox-Gastaut syndrome often starts between the ages of 3 and 5. Atonic seizures, also known as drop attacks, are most common in children with Lennox-Gastaut syndrome (LGS). Seizures may happen multiple times a day and cause the child to suddenly drop to the ground. Drop attacks may be perceived as a trip or the result of poor balance. Injuries are common, making the seizures very upsetting for the child. Atypical absence seizures and tonic seizures are also common, especially at night, but children with LGS may experience other types of seizures as well.

LGS is very difficult to treat and is often referred to as intractable or refractory. Some AEDs can be effective, and the ketogenic diet may help. Surgery may be recommended if diet and medication do not work, though surgical treatment will not stop the seizures altogether.

Children with LGS have moderate to severe learning difficulties, with some children exhibiting developmental delays before their first seizure. Twenty percent of children who have West syndrome (infantile spasms) will develop LGS.

Progressive myoclonic epilepsies

The progressive myoclonic epilepsies are a group of rare syndromes characterized by a combination of tonic-clonic and myoclonic seizures. Disorders that fall under this category include Lafora disease, mitochondrial encephalopathies, severe myoclonic epilepsy of infancy (also referred to as Dravet syndrome), and Unverricht-Lundborg disease (also known as Baltic myoclonus). The cause is often hereditary but may be unknown. Progressive myoclonic epilepsies affect males and females equally and start at different ages, depending on the specific condition. Read more about seizure types.

In progressive myoclonic epilepsies, seizures are difficult to control. As the condition progresses, people with PME accumulate cognitive (relating to thinking and memory) and motor (relating to movement) disabilities.

Medications may be successful at first, but effectiveness declines over months or years as the disease progresses.

Other epilepsy syndromes

Epilepsy is a broad spectrum involving dozens of neurological disorders. While those described above are the most commonly diagnosed, there are many other syndromes that cause epilepsy. Examples include Angelman syndrome, Doose syndrome (myoclonic astatic epilepsy), Dravet syndrome, neurocutaneous syndromes (such as Sturge-Weber syndrome), Rasmussen’s syndrome, and Rett syndrome.

Resources

External resources

MyEpilepsyTeam resources

via Types of Epilepsy | MyEpilepsyTeam

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[WEB PAGE] Study reveals three effective treatments to stop epilepsy seizures

 

There are effective treatments to stop life-threatening epilepsy seizures when the initial treatment has failed, a sweeping new study reveals.

The study offers important answers about three such emergency drugs that are used to treat prolonged seizures, known as status epilepticus, even though physicians have had little understanding of the drugs’ effectiveness. Until now, there has been no clear indication of which is best or how much should be given.

The study found that the three drugs – intravenous levetiracetam, fosphenytoin, and valproate – were all about equally effective at stopping the potentially deadly seizures when the default choice, benzodiazepines, proved unable to do so. The results were so clear that the shocked researchers stopped their trial early.

When we planned the study, we didn’t even know if these drugs work 10%, 25% or 50% of the time. So the big, big takeaway is that each of these drugs works about 45 percent of the time. And this is an important finding because it tells us patients can get better. They don’t have to be placed on a on a ventilator [breathing machine].”

Jaideep Kapur, MBBS, PhD, investigator and the head of the University of Virginia Brain Institute

Effect on Clinical Practice

The study’s findings, published in the prestigious New England Journal of Medicine, both affirm existing clinical practices and suggest a major change.

Doctors can feel confident that their preferred drug of choice is as effective as the other options, Kapur noted, but they also should significantly increase how much levetiracetam they give when they choose it.

“Prior to this, people were using their best guess as to which drug to use and how much of it to use. And this puts those things to rest and tells you exactly how much of which to use, and what to expect,” said Kapur, of the UVA School of Medicine’s Department of Neurology.

The trial organizers tested the maximum safe dose of each of the drugs so there would be no question whether too little had been used to gauge the medicine’s effectiveness. In so doing, they gave twice as much levetiracetam as many doctors administer.

“When I started 25 years ago, there was not a single scientifically proven drug [for status epilepticus]. We didn’t know which drug to use, even for the first-line treatment, and how much of them to use,” Kapur said. “And 25 years later, we can treat more than 80% of the patients – 85% of the patients – using scientifically proven drugs. 85% of our patients will get better, will stop having seizures and start waking up. That is the effect of scientific research on improving care of patients, and this is real.”

About the Epilepsy Seizure Trial

The randomized, double-blinded trial looked at the effect of the drugs in 384 patients at 57 emergency departments in the United States between November 2015 and the end of October 2017.

The researchers originally planned to study 795 patients over five years, but the results were so clear that was deemed unnecessary. “Clinical trials are notorious for going over long and over budget, and we came in under budget,” Kapur said.

That was possible, he said, because of the participation of many top experts in both the United States and Europe. Participating sites included the University of Michigan, Medical University of South Carolina, UVA, Children’s National Medical Center in Washington, D.C., and many more.

“It was an amazingly accomplished group of people,” Kapur said. “We had the best experts from all over the United States and Europe. For me, it’s been a great joy working with the team as the leader of the Brain Institute. That’s the spirit I want to bring to UVA. That’s really what motivated me to start the Brain Institute: to fashion these teams within UVA, so that we can do really significant, societally impactful research.”

UVA Emergency Medicine physician Stephen Huff, MD, led the study at the UVA site, which enrolled seven subjects. Amy Fansler, Emily Gray and Lea Becker helped organize the study.

Kapur expressed his gratitute to all the patients who participated in the study. “President Ryan [UVA President Jim Ryan] has said we must be great and good,” Kapur said, “and this is the kind of good we want to do.”

Next Steps

The researchers are now looking more closely at the drugs’ effectiveness and dosing in children. That will offer important information on how best to treat the young patients, as the causes of status epilepticus in adults and children often differ.

 

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[Abstract + References] Epileptic and Nonepileptic Seizures after Traumatic Brain Injury

Abstract

Representing approximately 5% of epilepsy in the civilian population and up to 50% in certain military populations, posttraumatic epilepsy warrants both increased clinical attention and research considerations. In this chapter, we will discuss the important definitions when considering posttraumatic epilepsy including the timing of posttraumatic seizures and the severity of head injuries. We will also review the epidemiology and risk factors for posttraumatic epilepsy in both the civilian population and the military and will describe the association of head trauma and psychogenic nonepileptic seizures. Our clinical discussion focuses on the timing of posttraumatic seizures, the utility of diagnostic testing, treatment of posttraumatic epilepsy, and outcomes of these patients. In addition, we elucidate potential pathophysiologic mechanisms underlying posttraumatic epilepsy and consider its role as a model for epileptogenesis in current and future research. We highlight the relevant studies in each section and underscore the theme that more research is certainly needed in most areas of posttraumatic epilepsy.

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via Epileptic and Nonepileptic Seizures after Traumatic Brain Injury | SpringerLink

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[ARTICLE] Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study – Full Text

Abstract

Although seizures are frequently seen after cerebrovascular accidents, their effects on long-term outcome in stroke patients are still unknown. Therefore, the aim of this study was to investigate the relationship between post-stroke seizures and the risk of long-term disability and mortality in stroke patients. This study is part of a larger population-based study. All patients were prospectively followed up by a face-to-face interview or a structured telephone interview. We enrolled 635 patients with first-ever stroke and without a history of seizures. Prevalence of ischemic stroke (IS) was 85.2%, while the remaining 14.8% of patients were affected by intracerebral hemorrhage (ICH). During the study period, 51 subjects (8%) developed post-stroke seizures. Patients with post-stroke seizures were younger, had a higher prevalence of ICH, had a more severe stroke at admission, were more likely to have an IS involving the total anterior circulation, and were more likely to have a lobar ICH than patients without seizures. Moreover, subjects with seizures had more frequently hemorrhagic transformation after IS and cortical strokes. At 24 months, the risk of disability in patients with seizures was almost twice than in those without seizures. However, the negative effect of seizures disappeared in multivariate analysis. Kaplan-Meier survival curves at 12 years were not significantly different between patients with and without post-stroke seizures. Using the Cox multivariate analysis, age, NIHSS at admission, and pre-stroke mRS were independently associated with all-cause long-term mortality. In our sample, seizures did not impair long-term outcome in patients affected by cerebrovascular accidents. The not significant, slight difference in favor of a better survival for patients with seizures may be attributed to the slight age difference between the two groups.

1. Introduction

Seizures are frequently seen after cerebrovascular accidents. Acute symptomatic or early seizures (ES) affect between 3% and 6% of all stroke patients [1,2,3,4,5,6], whereas unprovoked or late seizures (LS) have been reported in 10 to 12% of stroke patients [7,8].
Although determinants and correlates of ES and LS after stroke have been largely investigated [1,6,9,10,11,12,13,14,15,16,17], the effect of seizures on long-term outcome in stroke patients is still unknown. In fact, previous studies focused their interest on short-term mortality [2,12,18,19,20,21,22], and only a few of them reported results on disability that was assessed only at discharge [13,18,19,21,22].
Recently, Claessens et al. conducted a retrospective study to explore a possible association between post-stroke seizures and long-term mortality. After correction for possible confounding variables, the authors concluded that seizures were not significantly related to mortality risk [23]. Conversely, in the prospective Future study, Arntz et al. showed that post-stroke seizures negatively affect long-term disability and mortality [24,25]. Differences in the population study might explain these conflicting findings. In particular, Claessens et al. included only patients with intracerebral hemorrhage (ICH), whereas Arntz et al. included only young patients, aged 18 to 50 years, after transient ischemic attack (TIA), ischemic stroke (IS) or ICH [23,24,25]. Bearing in mind that ICH accounts for almost 15% of all strokes and that cerebrovascular accidents are largely more common in subjects older than 50 years, these results cannot be directly generalizable to all stroke patients.
Therefore, the aim of this study was to investigate the relationship between post-stroke seizures and the risk of long-term disability and mortality in patients affected by cerebrovascular accidents.[…]

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[WEB SITE] Epilepsy and Stress-Related Seizures

Are your seizures triggered by stress? You’re not alone. Stress is a hot topic on MyEpilepsyTeam, where members talk about their challenges managing life’s ups-and-downs with epilepsy.

“Stress is definitely one of my biggest triggers,” said one member, echoing the comments of many others in the community. Another observed: “Just about everyone on this site has issues with stress. The inability to handle it is what we all have in common.”

What triggers members’ stress seizures?
Whether it’s brought on by a major life event, or a buildup of everyday challenges, stress affects each person differently. Members of MyEpilepsyTeam share what triggers their stress – and seizures. They include:

Major life events. Divorce, death, caretaking, and other major life changes can trigger seizures. One man reported a “higher than normal stress level” and recurrence of seizures after losing his job of 14 years. Another blamed a recent seizure on stress associated with her father’s death. The stress of caring for an ill parent – and “having a lot on my plate” – caused another member to seize.

Family Relationships. Stressful or abusive family dynamics can “unlock” seizures – as some members call it – and even increase their frequency.

“My brother stressed me out so much as a child, the doctor said it ‘unlocked’ my stress seizures,” shared one member of MyEpilepsyTeam. “Going through a rough time with alcoholic family members caused lots of stress, and my seizures acted up,” explained another. One woman added: “I had loads of seizures until I divorced my husband. I’ve been seizure-free ever since.”

Other Relationships. Being around difficult, toxic, or insensitive people is stressful for everyone, but even more so for those prone to seizures. “When I’m around someone who makes me feel anxiety or depression, I get a seizure,” reported one member. “Being around people who don’t understand – and always ask if you’re alright – makes me so nervous,” said another.

Holidays. End of year festivities can trigger stress – and depression – for some MyEpilepsyTeam members. “I know there’s an increased chance of triggering a seizure during high-stress times of year like Christmas, with the additional stress of getting all the gift shopping done on time,” explained one man.

Sleep, alcohol, and other stress triggersUnhealthy habits are not only physically and mentally draining, they also cause excessive activity in the brain that can trigger a seizure. “My doctor says there are five things our brain does not like – lack of sleep, low sugar, stressful situations, missing medications, alcohol, and street drugs,” explained one member. “Our brains can only take so much stress,” added another.

Managing Stress with Epilepsy
According to the Epilepsy Foundation, nine out of 10 people who actively manage their stress say it has reduced their risk of seizures. Members of MyEpilepsyTeam talk about the ways they reduce anxiety.

Starting therapy or counseling. Therapy, biofeedback, and music and arts therapy are just some of the therapeutic approaches to managing stress in people with epilepsy.

Counseling helped one member “out of a big slump” as a teenager. “Not only was it therapeutic, but I learned much more about epilepsy itself. It made it easier to cope,” she said. Finding a therapist who understands epilepsy is important, noted one member. “You may have to see several until you find the right connection. Not everyone is easy to talk to.”

Setting boundaries. Avoiding stressful situations is key for people with epilepsy. “I now stay away from my parents’ place, since that’s where most of my stress comes from,” explained one member. “I just do my best to stay positive and brush off the negatives as best I can,” wrote one woman. Another proclaimed: “I refuse to give anyone or anything control over me.”

Starting an exercise or relaxation routine. A daily practice of meditation, yoga, music, massage, deep breathing, and other relaxation techniques can cultivate healthier responses to stressful situations. Mindfulness – which trains the mind to focus on the present moment – has proven to be an effective stress management tool for people with epilepsy.

“I’m doing lots of exercising: Walking, morning stretching, and sometimes some yoga, if possible,” said one member of MyEpilepsyTeam. Another shared, “I use yoga to calm me down. Thirty minutes a day after work helps me loads.” Using a relaxing essential oil helps another member stay focused during his “time outs.”

One man with a daily yoga and meditation practice said, “Now I’m clear, no more seizures. I can’t emphasize enough, when we take back control by not allowing issues in life to get the best of us, a huge 180-degree turn happens.”

Getting Support. Being part of an active and supportive community – such as MyEpilepsyTeam – is important to managing the stress that triggers seizures. “The creation of this network was the greatest gift to all of us who have seizure disorders,” said one grateful member. Added another, “We understand each other here and what we go through each day.”

Taking medication on schedule. The number-one reported cause of increased seizures is missed medications. And taking medications on schedule is the most important ways to prevent them. “I’m lucky – medication controls my seizures,” said a MyEpilepsyTeam member who sticks to his prescription.

On MyEpilepsyTeam, the social network and online support group for those living with epilepsy, members talk about a range of personal experiences including stress and seizures.

Here are some questions-and-answers about stress and seizures:

Here are some conversations about stress and seizures:

Can you relate? Have another topic you’d like to discuss or explore? Go to MyEpilepsyTeam today and start – or join – a conversation. You’ll be surprised how many others share similar stories.

via Epilepsy and Stress-Related Seizures | MyEpilepsyTeam

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[BLOG POST] TBI AND ALCOHOL?

Canva - Assorted Wine Bottles.jpgAccording to MSKTC, “Drinking increases your chances of getting injured again, makes cognitive (thinking) problems worse, and increases your chances of having emotional problems such as depression. In addition, drinking can reduce brain injury recovery.”  Traumatic brain injury (TBI) has many side-effects including cognitive problems, depression, difficulty with balance and alcohol only intensifies these challenges. Alcohol can cause dizziness, staggering and falling, and this is not good for anybody.  In fact, many TBI injuries are alcohol related. Maria Magana recants how she got her TBI by saying, Sadly my TBI was from an alcohol/benzo issue. Yeah I was dumb as hell, but I learned through the hardest way. So I really hate talking to other TBI people about it.”  Alcohol related TBI injuries could be more common than you think. Additionally, accidental alcohol related deaths are not unheard of. Wendy Harris said, “ My uncle was a TBI survivor and he recently passed away bt drinking, falling, ang hitting his head.”  Both the coordination issues that comes with alcohol and the balance issues with TBI, together, can cause a deadly combination.  Furthermore, MSKTC continued by saying, “ says, “Traumatic brain injury puts survivors at risk for developing seizures (epilepsy). Alcohol lowers the seizure threshold and may trigger seizures.”  All of these complications are unnecessary troubles for a TBI survivor to have and we forgot to mention that the majority of TBI survivors are on medications such as muscle relaxers, blood thinners, and seizure medications that more than often counteract with alcohol.  With that said, let’s throw the anti alcohol disclaimer out the window and explore the pros and cons of alcohol consumption post TBI.

“POSITIVE” SIDE EFFECTS OF ALCOHOL

Canva - Clear Drinking Glass With Beer.jpgFor most, an alcoholic drink or two is a nice way to celebrate an occasion or to go with a nice meal. Some actually despise all alcohol – the taste, feeling, and smell.

But those who love alcohol love the sensation of being tipsy, wild, and feeling out of control. The unusual feeling is also encouraged by peers through a form of peer pressure and FOMO (fear of missing out). You’re at a party, and friends are drinking all around you, so why wouldn’t you, too? Roger Osburn, a fellow TBI survivor answred this question by saying, “Alcohol exacerbates my TBI related challenges. I do not drink anymore but sometimes will have a glass of wine, always remembering later why I don’t. It can be challenging socially.”

Canva - Shallow Focus Photography of Clear Cocktail Glass (1).jpgFor people with alcohol addictions, it’s a way to feel “numb,” separate themselves from reality, and to cope with various mental illnesses.  The problem is, individuals with TBI have higher rates of alcohol abuse than their peers, according to NCBI.  Additionally, according to MSKTC, “Up to two-thirds of people with TBI have a history of alcohol abuse or risky drinking.”  Alcohol consumption and TBI are closely related as is TBI and alcoholism.  While recreational alcohol is tolerable for the average person, for a TBI survivor, such behavior is ill-advised.  Below is a testimony given by a TBI survivor who requested to stay anonymous.  With that said, This is only anecdotal experience, and  cannot speak for everybody, and if you would like to share your experience with TBI and alcohol please do so in the comments below.

“Do you want a glass of wine?”  A friend I met in the hospital, Ben, came to visit me at my house with a bottle of wine.  Ben attempted to make a generous greeting by brandishing a bottle of wine however, I was skeptical in taking part of his offering as I am recovering from a traumatic brain injury.  I did not know how alcohol would affect my brain recovery, how alcohol would interfere with my medication, or how alcohol would make me feel. Additionally, I have to get my blood checked regularly, because I am on blood thinners, and I did not know how thin my blood would get by consuming wine. Despite my reluctance, I threw my caution to the wind and I told myself, “I was shot in the head, a glass of wine will not hurt.”  I began sipping the wine and next thing I knew it was time to take my muscle relaxers, this was not good. I took my medication and over the course of the night I took three more doses of TBI related medications which was dangerous, stupid, and made me very sick. For the next week my stomach was torn up, I was exhausted, and both my body and mind felt like it was hit by a dozen semi trucks and I still had therapy eight hours a day, everyday for the next week.  Luckily I am confined to a wheelchair because had I been walking around drunk or buzzed I would be putting myself at risk for a second brain injury.My experience with the wine I drank was so bad that I cut Ben off and told him we could not hang out again.”

Canva - Margarita Glass in Shallow Photo

via TBI AND ALCOHOL? – treatment

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