Posts Tagged seizure

[WEB SITE] 11 THINGS TO NEVER DO WHEN SOMEONE TELLS YOU THEY HAVE EPILEPSY

I remember the very first time that someone spoke the words, “Everything will be okay!” speaking about my epilepsy. Fire engulfed my stomach. When a family member spoke this to me, I knew they meant well, however, I wanted to curl into a ball and cry until I had no strength left in me. The way it looked, it didn’t look okay in that very moment.

I didn’t hold anything against them. Of course not. They meant well. Men, women and children are being diagnosed with epilepsy in The United States every single day and around the world. Medicines and treatments are being created all the time. Those battling epilepsy doing everything in their power to live as normally and healthy as possible. Meeting with family and friends in social situations.

It’s hard to know what to say or how to react to the news that someone you care about has a life-threatening medical condition with compassion. There really is no perfect handbook for this kind of situation, and I have experienced quite a few blunders.

Below, I’ve put together my list of Things To Never Do or Say When Someone Tells You They Have Epilepsy:

  1. Don’t raise an eyebrow and ask, “Is it contagious?”
  2. Don’t all of a sudden stop answering calls and texts
  3. Don’t start whispering or lowering your voice to ask any questions you may have about epilepsy.
  4. Don’t say “That’s sad!” and that’s it. This does not help.
  5. Don’t dismiss their epilepsy off as “No big deal.”
  6. Don’t ask if their condition came from something that the person did.
  7. Don’t say, “I know how you feel.” Unless you’ve been treated for the same type of condition and have undergone exactly the same treatment, you really don’t know how the person feels.
  8. Don’t say “Just be grateful you don’t have (Insert another medical condition)” No matter what medical condition you have, its a life-altering-condition. Epilepsy can in fact be life threatening. You don’t need to be reminded that things can always be worse. Comparing medical conditions is not helpful.
  9. Don’t say nothing. When a friend reaches out it makes the person feel wanted and needed. A lot of people are afraid and don’t know what to say, but simply not saying anything can make a person feel isolated and alone. It’s better off saying something rather than nothing.
  1. Don’t treat the person any differently. Treat them just as you’ve always known them your entire relationship. They will notice a difference. They want to be treated with the same amount of respect, dignity, and compassion. Just because a medical condition has entered the picture doesn’t mean an alteration of relationship needs to occur.
  2. Don’t do more for the the person than they are comfortable having others do. Being treated like child or invalid when they are not can be degrading. Independence is very important to a person.

All the reactions listed above, are ones that I have encountered at least once before. Yes, they have knocked me back a step or two, even hurt me a little, over time though I’ve grown a thicker skin and even allowed myself to smile and laugh a bit on the inside.

Thankfully, for each of these responses, there is a greater or an even more powerful response! Take a look at my tips for

What To Do When Someone Reveals They Have Epilepsy:

  1. Tell them, “I’m not sure what to say, but I want you to know that I care.”
  2. Assure them, “If you would like to talk about it, I’m here.”
  3. Assure them, “Please let me know if there is anything that I can do to help.”
  4. Offer interest in understanding what the person is going through. However, understand that the person may not want to talk about it right away.
  5. Bring humor into the picture if it appears to be the right moment for it. Humor can change moods and even lighten the load. This can help the person and even the family to connect to things outside of epilepsy. Find a way to bring happiness and joy into that persons life.
  6. Offer to help them with things they may need such as running errands, going to the doctor, preparing a meal, picking up prescriptions etc. Be as specific as possible. Try to steer clear of “Call me if you need anything.”
  7. Allow there to be room for normal non-epilepsy talk in a day. Sometimes a person can feel as though their entire lives are consumed by their condition. When that is the case, it feels great to have distraction. Take notice from the person how much they do and do not want to talk about epilepsy.

Epilepsy fighters, family, and friends are all in the journey together. We who are diagnosed, know that family and friends have the best intentions. Words don’t always come out like one might hope when stress, fear, worry, all kinds of emotions are running rampant. However, it is communication that is extremely helpful and that is what matters the most. That the lines of communication always remain open. It’s very helpful to be open and to communicate that you would like to be there and you want to do what you can to help.

I encourage epilepsy fighters, family and friends to take a look at both of the lists together and use these lists as a learning opportunity to think about what might be helpful and how this can offer support. It is my hope to make the epilepsy journey a little less stressful and exhausting.

Source: 11 THINGS TO NEVER DO WHEN SOMEONE TELLS YOU THEY HAVE EPILEPSY – health care vision

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[WEB SITE] 6 Things That Can Trigger a Seizure Even If You Don’t Have Epilepsy

Harrison Ford has played a hero in the movies, but in real life, he gives that distinction to his 26-year-old daughter, Georgia. Earlier this month, the actor revealed that Georgia has epilepsy, and that it took years for her to get the proper treatment. “I admire her perseverance, her talent, her strength,” he told the Daily News.Epilepsy isn’t always easy to identify. The disorder typically isn’t diagnosed until a person has had two or more “unprovoked” seizures—that is, seizures that don’t have a clear trigger, explains Vikram Rao, MD, PhD, an assistant professor of neurology at the University of California, San Francisco.It turns out there are multiple things that can trigger a seizure, which is essentially a surge of electrical activity in the brain. And just because you have one, that doesn’t mean you’ve got epilepsy. But you should always get checked out by a doctor afterwards, says Dr. Rao.Here, six things that are known to trigger seizures even in people who don’t have a neurological condition—and what to do when a seizure strikes.

Stress

Seizures triggered by stress look similar to epileptic seizures, mainly because they can have the same symptoms—numbness, confusion, convulsions, and more. But there are differences in the brain electrical activity between the two types. In fact, research suggests that somewhere between 5% and 20% of people with epilepsy may be misdiagnosed and, in fact, suffering from seizures provoked by anxiety or underlying trauma.RELATED: 25 Surprising Ways Stress Affects Your Health

Low blood sugar

Your brain is a huge consumer of glucose, says Dr. Rao. When your blood sugar levels drop too low—a state called hypoglycemia—your brain has trouble functioning normally and the result could be a seizure. Since hypoglycemia is a potential a side effect of diabetes medications, diabetics may be at a higher risk for this type of seizure.

Heatstroke

You already know that playing soccer for hours on a scorching-hot day can be dangerous. In that kind of heat (and under that kind of exertion), people can have trouble cooling themselves down. Once your internal thermostat reaches about 104 degrees Fahrenheit, you risk damaging your organs, including your brain: “The brain doesn’t function as well at higher temperatures,” says Dr. Rao. Once heat illness sets in, the brain can misfire, possibly triggering a seizure.

Alcohol Withdrawal

An estimated 2 million people may experience alcohol withdrawalevery year, according to a 2004 study in the journal American Family Physician. People can develop a tolerance to (or dependence on) alcohol, and the wiring in their brains can reflect that. So when some people quit cold turkey, it leaves their brains in a new, altered state that can set them up for a seizure, usually within 48 hours after their last drink, says Dr. Rao.

Certain medications

Antidepressants like bupropion (a.k.a. Wellbutrin and Zyban) have been associated with seizures in certain studies. And some antibiotics, like penicillins and quinolones, and pain medications like tramadol (sold under the brand name Ultram) might increase the risk of seizures too.

Sleep deprivation

Too-little sleep is a powerful trigger for seizures, says Dr. Rao. (He’s seen seizures in college students who’ve stayed up for days in a row cramming for an exam.) “No one knows the exact reason behind this,” says Dr. Rao, “but sleep is restorative. We spend one-third of our lives sleeping, so we know it’s important.”RELATED: 30 Sleep Hacks for Your Most Restful Night Ever

What to do if someone has a seizure

Oftentimes, less is more. Rule number one: Keep the person safe. That means making sure she doesn’t accidentally hurt herself, either on a nearby sharp object or by falling down the stairs.As Anto Bagić, MD, PhD, the chief of the epilepsy division at the University of Pittsburgh Medical Center puts it: “There’s no ‘heroic’ measure necessary.” Don’t try to restrain the person (she might panic and lash out even more aggressively) and do not put anything in her mouth (she might choke on it). Besides, it’s a myth that people can swallow their tongue during a seizure.Either give her some space or, if necessary, guide her to a safer area, Dr. Bagić explains. If she’s lying on the floor, gently turn her on her side so that her saliva doesn’t block her airway.Most seizures resolve themselves within five minutes, so if it goes on for longer than that, you should call 911, says Dr. Bagić. More often, however, the person will regain consciousness after a few minutes—and when she does, stay calm.“When people are coming back [from a seizure], that’s when they’re at their most vulnerable,” says Dr. Bagić. “It can be scary if the first thing they see is people staring at them or panicking.”Another key point: Stay with the person until you’re sure that she’s completely recovered. Do all that, and it’ll be heroic enough.

Source: 6 Things That Can Trigger a Seizure Even If You Don’t Have Epilepsy – women health benefits

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[WEB SITE] Have an epileptic friend? Here are 13 things you need to know

 

Epilepsy or seizure disorder is a chronic neurological condition that may not require hospitalisation but requires intense care because it cannot be cured. This makes the role of caregivers, family me

Epilepsy or seizure disorder is a chronic neurological condition that may not require hospitalisation but requires intense care because it cannot be cured. This makes the role of caregivers, family members and friends extremely crucial in the lives of patients suffering from epilepsy.

Epilepsy manifests itself differently in different patients and hence the need for care also changes with it. While some people with epilepsy can mange themselves well, other may need help all the time or specifically during an episode of epileptic seizure. Being highly unpredictable in nature, epileptic seizures can occur at any time during the day making the sufferer unable to plan or ask for help by themselves. That’s why, as a family member, relative, friend, colleague or a partitioning caregiver you need to be well aware about the condition. To make it easy for you, here’s a simple guide explaining everything you need to know about the special needs of those with epilepsy.

After being diagnosed with epilepsy

The initial few months after diagnosis of epilepsy are the most challenging to deal with. Patients might find it hard to accept the diagnosis or may even feel miserable that their condition has made them dependent on others. But as caregivers, you can instil positivity and make them feel loved.

  • Providing emotional support: ‘Generally, due to the stigma associated with the condition, a lot of epileptic patients are likely to get depressed and feel rejected by the society. Despite increasing awareness, the discrimination in the society has still not improved,’ says Dr Sudhir Kumar, senior consultant neurologist. At this point, your role as a carer goes beyond being just a parent, relative or a friend. You need to be patient and emotionally supportive so that sufferers accept their condition and slowly adapt to the changes in their lives.
  • Educate yourself about the condition: Epileptic seizures are of different types and the caring needs are different for each type. So it’s advisable for you understand what kind of seizure the patient is prone to and be aware of what’s normal during that pattern of seizure and what’s not. Some kind of seizures display a peculiar pattern, for example — women suffering from epilepsy are likely to an epileptic attack before their menstrual periods due to hormonal changes during that phase of the month. If you identify such patterns or triggers, you will be able to provide proper care during the episode of epileptic attack.
  • Helping with medication: Epilepsy cannot be cured. Seizure patients, are therefore, instructed to take antiseizure or antiepileptic medications to control the frequency of attacks. Failure to take these medicines regularly can increase the frequency of seizures.  So, patients will need help in standardising a routine and timing their medications, at least in the initial few months.
  • Accompanying as an eye-witness: If you have witnessed the person closely during an episode of seizure, you’ll be playing a crucial role in describing the episode to the doctor. Dr Arjun Srivatsa, neurosurgeon and founding trustee of Spine Trust India, suggests carers to note the physical changes or even record a video during the episode.
  • Reminding them about diet and lifestyle: Carers can help patients to adapt to lifestyle changes and changes to their homes to make it more safe. As far as diet is concerned, epilepsy patients can eat what they desire but a ketogenic diet has shown promising results in reducing epileptic attacks. Dr Kumar says, ‘Epilepsy patients should not skip their meals because fasting for a long time can cause in hypoglycemia, affecting the brain.’

During an episode of seizure

  • Stay calm: Witnessing a person during an episode of seizure could be frightening and disturbing. But the first rule in caring for these patients is to not panic.
  • Prevent falls and injuries: In case, the seizure takes place suddenly in an unpredictable way, try holding the person to prevent falling suddenly to the ground. If the episode has occurred inside the house, slowly make the person lie down. Place a pillow or a blanket under the head. Make the person lie straight since lying on the stomach could cause suffocation.
  • Ensure safety: Epileptic patients lose their consciousness during a seizure episode so it’s you who has to be careful about the surroundings. Make sure there are no obstacles or sharp objects around the patient to prevent injuries.
  • Don’t stop the shaky movements: An episode of seizure typically lasts for a few minutes before the patient regains consciousness. So, don’t hold the person or try to stop their movements while they’re shaking.
  • Note the pattern of seizure: If you’re observing the person for the first time after he/she has been diagnosed with epilepsy, note down the following — how the body moved during the seizure, how long the episode lasted for, what was the person’s last reaction before entering a seizure and what was the immediate reaction after the episode was over. These things will not only help you become a better caregiver but also help the consulting doctor to treat the patient in an effective way. If possible record the episode on your smartphone.
  • Understand what’s an emergency: Normally, if the episode of seizure exceeds 3 minutes, it could be life-threatening for the patient. So identifying an emergency is very critical. Call a doctor or emergency medical help immediately if:
    • The patient has repeated seizures within a period of 24 hours
    • The patient suffers a head injury during a seizure
    • You notice that the patient is not able to breathe properly
    • The patient doesn’t gain consciousness immediately after the episode is over
    • The patient develops symptoms like dizziness, vomiting, nausea after the episode is over

After an episode of seizure

  • Make sure that the patient is fully conscious: After reverting to a normal state, the person might feel a bit disoriented. In such case, you might have to reorient the patient and gauge whether he/she has regained full consciousness. Make sure the patient is comfortable after reverting to normal state.
  • Do not offer food or fluids: Unless the patient is fully conscious and awake don’t force them to drink or eat anything. Make them sit upright and try conversing with them to understand their state of mind.
  • Understanding emotions: Following an epileptic attack, it’s natural for the patient to express a range of emotions including anger and frustration. You need to realise that these can also be due to effects of the medications.

The pressure and responsibility felt while caring for someone with epilepsy can be overwhelming at times but is definitely rewarding.

Photo source: Getty images

Source: Have an epileptic friend? Here are 13 things you need to know – Health Care Guide

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[ARTICLE] The efficacy of lacosamide as monotherapy and adjunctive therapy in focal epilepsy and its use in status epilepticus: clinical trial evidence and experience – Full Text  

Lacosamide (LCM) is approved for anticonvulsive treatment in focal epilepsy and exhibits its function through the slow inactivation of voltage-gated sodium channels (VGSCs). LCM shows comparable efficacy with other antiepileptic drugs (AEDs) licensed in the last decade: in three randomized placebo-controlled trials, significant median seizure reduction rates of 35.2% for 200 mg/day, 36.4–39% for 400 mg/day and 37.8–40% for 600 mg/day were reported. Likewise, 50% responder rates were 38.3–41.1% for 400 mg/day and 38.1–41.2% for 600 mg/day. Similar rates were reported in post-marketing studies. The main adverse events (AEs) are dizziness, abnormal vision, diplopia and ataxia. Overall, LCM is well tolerated and has no clinically-relevant drug–drug interactions. Due to the drug’s intravenous availability, its use in status epilepticus (SE) is increasing, and the available data are promising.

Epilepsy is a common and chronic neurological disorder that imposes a substantial burden on individuals, caregivers and society as a whole [Strzelczyk et al. 2008; Riechmann et al. 2015]. Antiepileptic drugs (AEDs) play a central and crucial role in treatment, as the majority of epilepsy patients require anticonvulsant treatment for an extended period of time. Because up to 30% of epilepsy patients are refractory to medical treatment [Kwan and Brodie, 2000; Kwan et al. 2011], the development of new therapeutic options is strongly warranted. Due to ongoing seizures, patients with drug-refractory epilepsy are affected by increased morbidity and mortality, social stigma, reduced employment opportunities and impaired quality of life for themselves and their caregivers [Smeets et al. 2007; Jacoby et al. 2011; Ryvlin et al. 2013; Riechmann et al. 2015]. Introduction of new AEDs provides an opportunity to achieve better seizure control for some of these patients [Luciano and Shorvon, 2007; Callaghan et al. 2011]. Furthermore, AEDs with an excellent efficacy and safety profile are needed for use as initial monotherapy as they might be continued for decades in patients [Glauser et al. 2013].

Lacosamide (LCM) was approved in 2008 in the European Union and in the USA as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalization in adults and adolescents with epilepsy. LCM is licensed for adolescents older than 16 years in the European Union and older than 17 years in the USA. Additionally, the US Food and Drug Administration has approved LCM as monotherapy in focal epilepsy in 2014.

LCM is a functionalized amino acid with a distinct mode of action: the drug enhances the slow inactivation of voltage-gated sodium channels (VGSCs) [Doty et al. 2007, 2013]. In contrast, traditional sodium channel blockers affect the fast inactivation of VGSCs. The slow inactivation of VGSCs results in the stabilization of hyperexcitable neuronal membranes, the inhibition of neuronal firing, and the reduction of long-term channel availability without affecting physiological function [Doty et al. 2013].

LCM is available as film-coated tablets (50 mg, 100 mg, 150 mg, 200 mg), syrup (10 mg/ml) and solution (10 mg/ml) for intravenous infusion. Bioequivalence among the three LCM formulations has been demonstrated, allowing for direct conversion without titration [Cawello et al. 2012]. LCM exhibits several favorable pharmacokinetic characteristics as rapid absorption, high oral bioavailability (100%) not affected by food, linear and dose-proportional pharmacokinetics with low interindividual and intraindividual variability [Cawello et al. 2012, 2014a]. LCM has low plasma protein binding of less than 15%. LCM is metabolized by CYP2C19, CYP2C9, and CYP3A4 into the pharmacologically inactive O-desmethyl-LCM and undergoes primarily renal elimination with less than 1% of the dose eliminated in the feces [Cawello et al. 2012, 2014b]. LCM has an elimination half-life of 13 h, which supports a twice-daily dosing regimen. Steady-state plasma concentrations after each dose adaptation are achieved after 3 days. In patients with severe renal impairment or end-stage renal disease, a maximum dose of LCM of 300 mg should not be exceeded. Hemodialysis significantly decreases systemic LCM exposure, by approximately 57% [Doty et al. 2013]. LCM dosage supplementation up to 50% of the divided daily dose should be considered directly after the end of hemodialysis. Also in patients with mild or moderate hepatic impairment a maximum dose of 300 mg/day should not be exceeded [Doty et al. 2013]. LCM exhibits low potential for clinically-relevant pharmacokinetic drug–drug interactions with AEDs as well as other common medications [Cawello et al. 2010, 2012, 2013; Stockis et al. 2013; Cawello et al. 2014a, 2014b; Cawello, 2015].

Continue —> The efficacy of lacosamide as monotherapy and adjunctive therapy in focal epilepsy and its use in status epilepticus: clinical trial evidence and experience – Nov 29, 2016

 

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[WEB SITE] ADD Program receives $19.5 million NIH contract to test drugs for treating epilepsy

The University of Utah College of Pharmacy’s Anticonvulsant Drug Development (ADD) Program has been awarded a five-year $19.5 million contract renewal with the National Institutes of Health (NIH) to test drugs to treat epilepsy, and the major focus of the project is to address needs that affect millions of people worldwide -identify novel investigational compounds to prevent the development of epilepsy or to treat refractory, or drug-resistant, epilepsy.

The ADD program began in 1975 and since then has tested the vast majority of drugs used to control seizures in patients with epilepsy, helping millions of people worldwide. Unfortunately, almost one-third of the estimated 50 million people with the disorder has refractory, or unresponsive, epilepsy that isn’t adequately controlled by medications currently available. The contract renewal, awarded through the National Institute of Neurological Disorders and Stroke (NINDS) to the U Department of Pharmacology and Toxicology, represents a shift in the mission to identify new therapies, according to ADD Director Karen S. Wilcox, Ph.D., professor and chair of pharmacology and toxicology and principal investigator of the contract.

“We’re proud that over the past 41 years, the ADD program has played a key role in identifying and characterizing many of the drugs now available to treat patients with epilepsy and to control their seizures,” Wilcox says. “Now, we’re looking for drugs that can modify or prevent the disease, particularly in those patients either with refractory epilepsy or at risk for developing epilepsy following a brain injury.”

Epilepsy is a group of neurological disorders characterized by a tendency for repeated seizures over time. It occurs when permanent changes in the brain result in abnormal or excessive neuronal activity in the brain. An estimated 2.9 million people in the United States and 50 million people worldwide have active epilepsy, according the Centers for Disease Control and World Health Organization. There is no cure for epilepsy and the mainstay of treatment is anti-seizure medications.

ADD is a long-standing program dedicated to testing drugs to treat epilepsy. It has received continuous funding from NINDS’ Epilepsy Therapy Screening Program (ETSP) (formerly known as the Anticonvulsant Screening Program) since its founding in 1974. In collaboration, the ETSP and the ADD Program have evaluated more than 32,000 compounds. ADD received the contract in a competitive bidding process. The renewal of the contractual relationship between the NINDS and the University of Utah reflects the ongoing commitment of the NIH and the ETSP to finding and developing novel therapies for epilepsy and represents a unique partnership between government, industry, and academia.

“The NIH-NINDS ETSP is pleased to continue the productive relationship with the University of Utah,” says Dr. John Kehne, a Program Director at NINDS and head of the ETSP. “These and other efforts supported by the NINDS will help to discover new pharmacotherapies to address the unmet medical needs of people living with epilepsy.”

In addition to its focus on evaluating potential candidate drugs for the treatment of therapy-resistant epilepsy, the mission of the ADD Program includes efforts to identify novel therapies for different types of epilepsy. The program also serves as a base for innovative basic research that sheds new light on the pathophysiology of epilepsy and provides a unique training environment for students, research fellows, and visiting scientists. Currently, the ADD program employ18 researchers, technicians, and staff. Cameron S. Metcalf, Ph.D is associate director and a co-Investigator of the contract and Peter J. West, Ph.D., and Misty D. Smith, Ph.D, research assistant professors of pharmacology and toxicology, are also co-investigators on the contract renewal.

Although there currently is no cure for epilepsy, Wilcox, who previously served as a co-Investigator of ADD before taking over as PI in 2016, believes that can be changed.

“The brain has remarkable plasticity throughout a person’s life,” she says. “If we learn enough about neuroscience and the details of how the brain works, it’s very possible to find a cure.”

Source: University of Utah Health Sciences

Source: ADD Program receives $19.5 million NIH contract to test drugs for treating epilepsy

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[WEB SITE] New Approach Could Alter the Course of Epilepsy After Brain Injury – Epilepsy Research UK

Posted Nov 2 2016 in Brain science; genetics

Removing granule cells (types of neuron) at a certain time point after an epilepsy-causing brain injury could have disease-modifying effects, according to a study published the Journal of Neuroscience.

Granule cells that are generated in the weeks before and after an epilepsy-causing brain injury can abnormally integrate into certain areas of the brain, mediating the development of temporal lobe epilepsy.

The authors, based in Cincinnati, write: “These findings support the long-standing hypothesis that newly generated … granule cells are pro-epileptogenic and contribute to the occurrence of seizures.”

For the study, the researchers induced status epilepticus in a rodent model using a chemical. Three days later they removed the granule cells from the animals’ brains that had been generated up to five weeks before the chemical ‘injury’, and they noticed a 50% reduction seizure frequency.

The scientists also noticed a 20% increase in seizure duration, which wasn’t expected. They explain that this paradoxical effect may reflect a disruption of the balancing mechanisms that normally act to reduce seizure duration when seizures occur frequently.

Previous studies had shown that inhibiting granule cell production before an epilepsy-causing brain insult could reduce the development of epilepsy. This new study provides proof-of-concept data demonstrating that granule cell removal therapy applied at a certain time point after injury can have disease-modifying effects in epilepsy.

Author: Dr Özge Özkaya

Click here for more articles about brain science including genetics.

Source: New Approach Could Alter the Course of Epilepsy After Brain Injury | Epilepsy Research UK

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[WEB SITE] Small device detects initial signal of epileptic attack and provides effective relief

Researchers at Linköping University have developed in collaboration with French colleagues a small device that both detects the initial signal of an epileptic attack and doses a substance that effectively stops it. All this takes place where the signal arises – in an area of size 20×20 µm known as a “neural pixel”.

The results, from the Laboratory for Organic Electronics at LiU’s Campus Norrköping, have been published in the prestigious journal Proceedings of the National Academy of Sciences (PNAS), with Asst. Prof. Daniel Simon as main author.

According to a recently produced estimate, no less than six percent of the Earth’s population suffers from some type of neurological illness such as epilepsy or Parkinson’s. Some medicines are available, but when these are taken orally or injected into the bloodstream, they also end up where they aren’t needed and may cause serious problems. All medicines have more or less severe side effects, and no fully satisfactory treatment for neurological illnesses is available.

Neurons, or nerve cells, are the cells in the body that both transmit and receive nerve impulses. The small 20×20 µm device developed by the scientists can both capture signals and stop them in the exact area of nerve cells where they arise. No other part of the body needs to be involved.

“Our technology makes it possible to interact with both healthy and sick neurons. We can now start investigating opportunities for finding therapies for neurological illnesses that arise so rapidly and so locally that the patient doesn’t notice them,” says Daniel Simon.

The experiments were conducted in the laboratory on slices of brains from mice. The device consists of a sensor that detects nerve signals, and a small ion pump that doses an exact amount of the neurotransmitter GABA, a substance the body itself uses to inhibit stimuli in the central nervous system.

“The same electrode that registers the activity in the cell can also deliver the transmitter. We call it a bioelectronic ‘neural pixel’, since it imitates the functions of biological neurons,” says Daniel Simon.

“Signalling in biological systems is based on chemical signals in the form of cations, which are passed between transmitters and receptors, which consist of proteins. When a signal is transferred to another cell, the identification of the signal and the triggering of a new one occur within a very small distance – only a few nanometers. In certain cases, it happens at the same point. That’s why being able to combine electronic detection and release in the same electrode is a major advance,” says Professor Magnus Berggren.

The small ion pump, which was developed at the Laboratory for Organic Electronics, attracted a great deal of attention when it´s first application as a therapeutic device was published a year ago. The sensor that captures the nerve signal has subsequently been developed by the LiU researchers’ collaborators at the école Nationale Supérieure des Mines in Gardanne, France. The mouse experiments were performed at Aix-Marseille University. The entire device is manufactured from conductive, biocompatible plastic.

Source: Linköping University

Source: Small device detects initial signal of epileptic attack and provides effective relief

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[WEB SITE] Study shows continuous electrical stimulation suppresses seizures in patients with epilepsy.

When surgery and medication don’t help people with epilepsy, electrical stimulation of the brain has been a treatment of last resort. Unfortunately, typical approaches, such as vagal nerve stimulation or responsive nerve stimulation, rarely stop seizures altogether. But a new Mayo Clinic study in JAMA Neurology shows that seizures were suppressed in patients treated with continuous electrical stimulation.

Epilepsy is a central nervous system disorder in which nerve cell activity in the brain becomes disrupted. In the study, 13 patients with drug-resistant epilepsy were deemed unsuitable for resective surgery, which removes a portion of the brain — usually about the size of a golf ball — that was causing seizures. When patients are evaluated for surgery, a grid of electrical contacts is placed on the brain to record seizures and interictal epileptiform discharges (IEDs). IEDs are electrical discharges that occur intermittently during normal brain function, and have been used as markers to locate portions of brain affected by epilepsy.

In the study, the grid of electrical contacts was used for stimulation at levels the patient would not notice. If the stimulation provided clinical benefit to the patient, this temporary grid was replaced with more permanent contacts that could offer continuous stimulation.

Ten of the 13 patients, 77 percent, reported improvement for both epilepsy severity and life satisfaction. The majority of patients experienced more than 50 percent reduction in seizures, and 44 percent were free of disabling seizures. The reduction in IED rate occurred within minutes of initiating stimulation.

“This study suggests that subthreshold cortical stimulation is both effective clinically and reduces interictal epileptiform discharges,” says lead author Brian Lundstrom, M.D., Ph.D., a neurology epilepsy fellow at Mayo Clinic. “We think this approach not only provides an effective treatment for those with focal epilepsy but will allow us to develop ways of assessing seizure likelihood for all epilepsy patients. It would be of enormous clinical benefit if we could personalize treatment regimens for individual patients without waiting for seizures to happen.”

During seizures, abnormal electrical activity in the brain sometimes results in loss of consciousness. For people with epilepsy, seizures severely limit their ability to perform tasks where even a momentary loss of consciousness could prove disastrous — driving a car, swimming or holding an infant, for example. Approximately 50 million people worldwide have epilepsy, according to the World Health Organization.

Seizures sometimes have been compared to electrical storms in the brain. Seizure signs and symptoms may include:

•Temporary confusion
•A staring spell
•Uncontrollable jerking movements of the arms and legs
•Loss of consciousness or awareness

Treatment with medications or surgery can control seizures for about two-thirds of people with epilepsy. However, when drug-resistant focal epilepsy occurs in an area of the brain that controls speech, language, vision, sensation or movement, resective surgery is not an option.

“For people who have epilepsy that can’t be treated with surgery or medication, effective neurostimulation could be a wonderful treatment option,” Dr. Lundstrom says.

The risks of subthreshold cortical stimulation are relatively minimal and include typical infection and bleeding risks as well as the possibility that the stimulation would not be subthreshold and would be noticed by the patient, Dr. Lundstrom says. The authors note that further investigation is needed to quantify treatment effect and examine the effect mechanism. The authors plan to examine the efficacy of this approach in a prospective clinical trial.

This study represents ongoing efforts to restore normal function to epileptic brain tissue by using neurostimulation. Other efforts are aimed at understanding the physiologic changes that chronic stimulation produces in brain tissue.

Source: Study shows continuous electrical stimulation suppresses seizures in patients with epilepsy

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[WEB SITE] Research could pave way for more effective and safer anti-epilepsy drugs

Columbia University Medical Center (CUMC) researchers have discovered how a new epilepsy drug works, which may lead the way to even more effective and safer medications.

The findings were published today in Neuron.

The most commonly used anti-epilepsy drugs are ineffective for about 30 percent of people with seizure disorders.

A new direction in the treatment of epilepsy is aimed at inhibiting AMPA receptors, which help transmit electrical signals in the brain and play a key role in propagating seizures. Currently, perampanel is the only FDA-approved drug that targets AMPA receptors. But because perampanel is associated with significant side effects, its clinical use has been limited.

“The problem is that AMPA receptors are heavily involved in the central nervous system, so if you inhibit their function, you cause an array of unwanted effects,” said study leader Alexander I. Sobolevsky, PhD, professor of biochemistry and molecular biophysics at CUMC. “If we hope to design better drugs for epilepsy, we need to learn more about the structure and function of these receptors.”

In this study, Dr. Sobolevsky employed a technique called crystallography to determine how perampanel and two other inhibitors interact with the AMPA receptors to stop transmission of electrical signals. The study was conducted using rat AMPA receptors, which are almost identical to human receptors.

In the new study, the researchers were able to pinpoint exactly where the drugs bind to AMPA receptors.

“Our data suggest that the inhibitors wedge themselves into the AMPA receptor, which prevents the opening of a channel within the receptor,” said Dr. Sobolevsky. When that channel is closed, ions cannot pass into the cell to trigger an electrical signal.

According to the researchers, these findings may allow drug makers to develop medications that are highly selective for the AMPA receptors, which could be safer and more effective than currently available anti-epilepsy drugs.

Source: Research could pave way for more effective and safer anti-epilepsy drugs

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[ARTICLE] Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy – Full Text

Abstract

BACKGROUND: Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.

OBJECTIVE: To elucidate rates and predictors of seizure freedom with VNS.

METHODS: We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.

RESULTS: Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.

CONCLUSION: Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.

 

Approximately 1% of the population has epilepsy, and seizures are refractory to antiepileptic drugs (AEDs) in approximately 30% of these individuals.1 Many patients with drug-resistant temporal or extratemporal lobe epilepsy can become seizure-free with surgical resection or ablation, but other patients with epilepsy are not candidates for resection given the presence of primary generalized seizures, nonlocalizable or multifocal seizure onset, or seizure onset from an eloquent brain region.2-5 Treatments based on neuromodulation, such as vagus nerve stimulation (VNS), have, therefore, become an increasingly important part of multimodal epilepsy treatment. VNS therapy was approved by the US Food and Drug Administration in 1997 as an adjunctive therapy for reducing seizures in patients with medically refractory epilepsy, and more than 80 000 patients have received treatment with VNS.6-8 The efficacy of VNS therapy has been evaluated by randomized controlled trials,9,10 retrospective case series,11,12 meta-analysis,13 and registry-based studies.14 These studies show that about 50% to 60% of patients achieve ≥50% reduction in seizure frequency after 2 years of treatment, and response rates increase over time, likely related to neuromodulatory effects with ongoing stimulation.13 Complete seizure freedom, however, is less common with VNS therapy and other neuromodulation treatment modalities.

Given that a minority of patients achieve seizure freedom with VNS, rates and predictors of seizure freedom have not been well studied and remain poorly understood. The vast majority of studies that evaluate VNS therapy focus on rate of response over time (defined as ≥50% reduction in seizures) and predictors of response; there has never been a large-scale evaluation of seizure freedom as a primary end point in patients treated with VNS. However, seizure freedom is the single best predictor of quality of life in patients with epilepsy,15,16 and therefore a better understanding of seizure freedom rates and predictors in patients treated with VNS therapy is critically needed. Importantly, this information may lead to improved patient selection and counseling in the treatment of drug-resistant epilepsy.

Here, we provide the first large-scale study of VNS therapy with a primary goal of defining seizure freedom rates and predictors, and comparing predictors of seizure freedom with those of overall response to treatment. Our study includes univariate and multivariate analyses of registry data including 5554 patients treated with VNS, and also includes a systematic review of the literature including 2869 patients across 78 studies, to help confirm registry-based results.

Continue —> Rates and Predictors of Seizure Freedom With Vagus Nerve Sti… : Neurosurgery

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