Posts Tagged seizure

[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.

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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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[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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[BLOG POST] Mozart and epilepsy: the rhythm beats on

 

I can’t seem to get away from the theme of Mozart and epilepsy. When I first looked at this, in a blog post titled Mozart and seizures? The links between epilepsy and music, I took the topic rather lightly, more a subscript than a headline you may say. But I have since learnt to take the links between epilepsy and music more seriously.

By Barbara Krafft – The Bridgeman Art Library, Object 574471, Public Domain, Link

 

The major trigger for my ‘road to Damascus’ conversion is a 2018 paper titled Study of the Mozart effect in children with epileptic electroencephalograms, published in the journal Seizure. The paper was an eye-opener because it gave a very helpful comprehensive context to the broader beneficial effect of music…not just in epilepsy, but in other neurological disorders such as Parkinson’s diseasedementia and sleep disordersThe authors, Elyza Grylls and colleagues, started on the established premise that Mozart’s music has a beneficial effect on epilepsy. What they wanted to know was if other forms of music have a similar settling effect on epilepsy, or if only Mozart’s music carries the magic touch. The authors therefore played Mozart’s Sonata for two pianos in D major (K448) to 40 children with epilepsy who were undergoing an EEG (electroencephalogram, or electrical brain wave test). They then compared this with the effect of playing other types of music. Remarkably, they found that only Mozart’s Sonata led to a significant reduction in EEG epileptic discharges.

Public Domain, Link

The authors concluded that there was indeed an anti-epileptic effect of Mozart’s music, the so-called  ‘Mozart therapy’. But what is so special about K448? They speculate that it has to do with the structure of Mozart’s music, containing as it does, long periodicities. Interestingly, the music of Yanni, which is similarly structured, has somewhat a similar effect on brain wave activity. On the contrary, and sorry to Beethoven fans, Fur Elise doesn’t have this effect.

By W.J. Baker (held the expired copyright on the photograph) – Library of Congress[1]Contrairement à une erreur fréquemment répandue le buste a été réalisé par Hugo Hagen, non pas à partir du masque mortuaire mais, comme de nombreux autres, d’après le masque réalisé en 1812 par Franz Klein pour un buste qu’il devait réaliser ensuite., Public Domain, Link

So what does the structure of Mozart’s music do to the brain? One suggestion is that Mozart’s music enhances the body’s parasympathetic drive; this reduces the heart rate, and thereby inhibits the brain’s propensity to epileptic seizures. The suppression of this parasympathetic drive is of course the theory behind using vagus nerve stimulation (VNS) to treat drug-resistant epilepsy. For more on VNS, see my previous blog, Vagus nerve stimulation: from neurology and beyond!

By Bionerd – MRI at Charite Mitte, Berlin (used with permission), CC BY 3.0Link

You have surely wondered by now if K448 is the only one of Mozart’s compositions to have an anti-epileptic effect. It doesn’t matter if you have not, because the authors of another interesting paper did. They titled their study, published in 2018, Mozart’s music in children with drug-refractory epileptic encephalopathies: comparison of two protocols. Published in the journal Epilepsy and Behaviour, the authors, Giangennaro Coppola and colleagues, compared the effect of K448 with a set of his other compositions. Intriguingly they found that the composition set actually had a greater effect in epilepsy than K448…by a wide margin of 70% to 20%! Furthermore, the set was better tolerated by the children; they were less irritable and had a better nighttime sleep quality.   

https://www.publicdomainpictures.net/en/view-image.php?image=76907&picture=dog-amp-child-painting

It therefore appears as if it all rosy in the garden of music and the brain. But it is not! As every rose grows on a thorny tree, so do some forms of music trigger epileptic seizures. This so-called musicogenic epilepsy is well-recognised, and two recent culprits are the music of Sean Paul, discussed in the journal Scientific American , and the music of Ne Yo, explored by NME. Therefore you should craft your playlist wisely.

By CLASSICNEYO – Own workCC BY-SA 4.0Link

So, is it time for neurologists to start prescribing music?

Or is it too much of a double-edged sword?

Music is #SimplyIrresistible. Luca Florio on Flickr. https://www.flickr.com/photos/elle_florio/29516744480

via Mozart and epilepsy: the rhythm beats on – The Neurology Lounge

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[Abstract] The Role of EEG in the Erroneous Diagnosis of Epilepsy

Summary

Errors in diagnosis are relatively common in medicine and occur in all specialties. The consequences can be serious for both patients and physicians. Errors in neurology are often because of the overemphasis on “tests” over the clinical picture. The diagnosis of epilepsy in general is a clinical one and is typically based on history. Epilepsy is more commonly overdiagnosed than underdiagnosed. An erroneous diagnosis of epilepsy is often the result of weak history and an “abnormal” EEG. Twenty-five to 30% of patients previously diagnosed with epilepsy who did not respond to initial antiepileptic drug treatment do not have epilepsy. Most patients misdiagnosed with epilepsy turn out to have either psychogenic nonepileptic attacks or syncope. Reasons for reading a normal EEG as an abnormal one include over-reading normal variants or simple fluctuations of background rhythms. Reversing the diagnosis of epilepsy is challenging and requires reviewing the “abnormal” EEG, which can be difficult. The lack of mandatory training in neurology residency programs is one of the main reasons for normal EEGs being over-read as abnormal. Tests (including EEG) should not be overemphasized over clinical judgment. The diagnosis of epilepsy can be challenging, and some seizure types may be underdiagnosed. Frontal lobe hypermotor seizures may be misdiagnosed as psychogenic events. Focal unaware cognitive seizures in elderly maybe be blamed on dementia, and ictal or interictal psychosis in frontal and temporal lobe epilepsies may be mistaken for a primary psychiatric disorder.

via The Role of EEG in the Erroneous Diagnosis of Epilepsy : Journal of Clinical Neurophysiology

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[NEWS] Predicting seizures before they happen

Date: June 10, 2019

Source: RCSI

Summary: A new study has found a pattern of molecules that appear in the blood before a seizure happens. This discovery may lead to the development of an early warning system, which would enable people with epilepsy to know when they are at risk of having a seizure.

FULL STORY

A new study has found a pattern of molecules that appear in the blood before a seizure happens. This discovery may lead to the development of an early warning system, which would enable people with epilepsy to know when they are at risk of having a seizure.

Researchers at FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, hosted at RCSI (Royal College of Surgeons in Ireland) led the study, which is published in the current edition of the Journal of Clinical Investigation (JCI).

FutureNeuro and RCSI researchers have discovered molecules in the blood that are higher in people with epilepsy before a seizure happens. These molecules are fragments of transfer RNAs (tRNAs), a chemical closely related to DNA that performs an important role in building proteins within the cell. When cells are stressed, tRNAs are cut into fragments. Higher levels of the fragments in the blood could reflect that brain cells are under stress in the build up to a seizure event.

Using blood samples from people with epilepsy at the Epilepsy Monitoring Unit in Beaumont Hospital, Dublin and in a similar specialist centre in Marburg, Germany, the group found that fragment levels of three tRNAs “spike” in the blood many hours before a seizure.

“People with epilepsy often report that one of the most difficult aspects of living with the disease is never knowing when a seizure will occur,” said Dr Marion Hogg, FutureNeuro investigator, Honorary Lecturer at RCSI, and the study’s lead author.

“The results of this study are very promising. We hope that our tRNA research will be a key first step toward developing an early warning system.”

Approximately 40,000 people in Ireland have epilepsy and one third of those do not respond to current treatments, meaning they continue to experience seizures. The World Health Organisation estimates that more than 50 million people worldwide have epilepsy.

“New technologies to remove the unpredictability of uncontrolled seizures for people with epilepsy are a very real possibility,” said Professor David Henshall, Director of FutureNeuro and Professor of Molecular Physiology and Neuroscience at RCSI who was a co-author on the paper.

“Building on this research we in FutureNeuro hope to develop a test prototype, similar to a blood sugar monitor that can potentially predict when a seizure might occur.”

Story Source:

Materials provided by RCSINote: Content may be edited for style and length.


Journal Reference:

  1. Marion C. Hogg, Rana Raoof, Hany El Naggar, Naser Monsefi, Norman Delanty, Donncha F. O’Brien, Sebastian Bauer, Felix Rosenow, David C. Henshall, Jochen H.M. Prehn. Elevation of plasma tRNA fragments precedes seizures in human epilepsyJournal of Clinical Investigation, 2019; DOI: 10.1172/JCI126346

via Predicting seizures before they happen — ScienceDaily

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[Abstract] Pharmacology and epilepsy : update on the new antiepileptic drugs

New antiepileptic drugs are regularly approved for treatment and offer large therapeutic opportunities. Efficacy of these drugs is relatively similar on-label with different mechanisms to be combined for a synergic effect. Treatments such as cannabidiol have benefitted from large media coverage despite limited clinical evidence so far. The objective of antiepileptic drugs is to stop the recurrence of epileptic seizures with as few adverse events as possible. When confronted to a difficult-to-treat epilepsy, referral to a specialised centre is strongly advised. The aim is to confirm that the diagnosis is correct, that the treatment is well adapted (indication, pharmacokinetic and compliance) and to evaluate the indication for non-pharmacological treatments such as epilepsy surgery.

 

via [Pharmacology and epilepsy : update on the new antiepileptic drugs]. – Abstract – Europe PMC

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