Posts Tagged seizure

[Study] Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study – Full Text

Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants.

Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA.

Results: A total of 292 patients (mean age 40.8 years, range 18–86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL.

Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.

Introduction

Epilepsy is a common and chronic neurological disorder that affects about 39 million people worldwide (12). People with epilepsy are subject to social and vocational stigma, have only restricted access to the labor market and significantly reduced employment opportunities (3). Moreover, quality of life (QoL) is significantly reduced for themselves and their caregivers (49). Active epilepsy with persisting seizures is associated with loss of consciousness, uncontrolled movements, falls or periictal abnormal behavior may predispose to accidents and injuries such as burns, contusions, lacerations or fractures (1012).

A prospective longitudinal analysis from Finland on 245 children with epilepsy since 1964 showed a significantly increased age- and sex-adjusted mortality. During the 40-year follow up, 60 (24%) subjects died and 33 (55%) of these events were attributed to the underlying epilepsy. Besides sudden unexpected death in epilepsy (SUDEP) and status epilepticus, epilepsy-related injuries and accidents (ERIA), such as peri-ictal drowning, were common causes of death. Within this cohort, pneumonia, cardiovascular diseases and suicide have been reported as most frequent causes of death not related to seizures or epilepsy (1315). ERIA were shown to be a major cost factor for hospitalizations among patients with epilepsy (16). One major problem with ERIA is unreported cases in daily practice. If not investigated in detail, it can be assumed that approximately 50% of ERIA are falsely not documented as seizure-related in medical documentation (17).

The main aim of our study was to assess the frequency and types of ERIA in a cohort of consecutive patients with epilepsy using a validated questionnaire (18) and to search for variables associated with ERIA. Improved screening parameters for ERIA may help in reducing the frequency and severity of ERIA. A second aim was to assess QoL and depression as possible consequences of ERIA.[…]

 

Continue —>  Frontiers | Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study | Neurology

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[NEWS] New epilepsy target discovered – European Biotechnology

French researchers have found a key driver of chronic epilepsy.

As 30% of patients with epilepsy do not respond to current antiepileptic drugs, finding targets that help suppress the initiation and propagation of seizures in the brain is crucial. Epilepsies are characterized by recurrent seizures, which disrupt normal brain function. Alterations in neuronal excitability and excitation-inhibition balance have been shown to promote seizure generation, yet molecular determinants of such alterations remain to be identified. Results of Elena Dossi and colleagues from INSERM Paris now suggest that inhibiting pannexin channels with drugs already approved for the treatment of gout and malaria could serve as a new therapeutic strategy for non responders to standard therapies.

Pannexin channels are nonselective, large-pore channels mediating extracellular exchange of neuroactive molecules. Recent data suggest that these channels are activated under pathological conditions and regulate neuronal excitability, i.e. in stroke. However, whether pannexin channels sustain or counteract chronic epilepsy in human patients was unknown.

Using brain tissue samples from patients with epilepsy undergoing surgical resection and a mouse model of epilepsy the French researchers showed that the membrane channel pannexin-1 contributes to seizure activity. They analyzed 42 postoperative brain tissue samples obtained from surgical resection of epileptogenic zones in patients suffering from lesional or drug-resistant epilepsy and found that pannexin-1 channels contributed to epileptic activity in the samples. Pannexin-1 channel activation promoted seizure generation and maintenance through adenosine triphosphate signaling via purinergic 2 receptors. Pharmacological inhibition of pannexin-1 channels with probenecid or mefloquine—two medications currently used for treating gout and malaria, respectively—blocked ictal discharges in human cortical brain tissue slices. Furthermore, mice lacking the gene that encodes for pannexin-1 channels were less prone to seizures when exposed to the pro-epileptic compound kainic acid compared to control animals.

 

via New epilepsy target discovered – European Biotechnology

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[ARTICLE] Alcohol Use and Alcohol-Related Seizures in Patients With Epilepsy – Full Text

Purpose: This study aimed to assess alcohol consumption and the occurrence of alcohol-related seizures in patients with epilepsy within the last 12 months.

Methods: In an epilepsy outpatient clinic, a standardized questionnaire was used to collect data retrospectively from consecutive adult epilepsy patients who had been suffering from the disease for at least 1 year. Logistic regression analyses were performed to identify independent predictors.

Results: A total of 310 patients with epilepsy were included. Of these, 204 subjects (65.8%) consumed alcohol within the last 12 months. Independent predictors for alcohol use were antiepileptic drug monotherapy (OR 1.901) and physicians’ advice that a light alcohol intake is harmless (OR 4.102). Seizure worsening related to alcohol consumption was reported by 37 of the 204 patients (18.1%) who had used alcohol. All 37 subjects had consumed large quantities of alcohol prior to the occurrence of alcohol-related seizures regardless of their usual alcohol-drinking behavior. The amount of alcohol intake prior to alcohol-related seizures was at least 7 standard drinks, which is equivalent to 1.4 L of beer or 0.7 L of wine. In 95% of cases, alcohol-related seizures occurred within 12 h after cessation of alcohol intake. Independent predictors for alcohol-related seizures were generalized genetic epilepsy (OR 5.792) and chronic heavier alcohol use (OR 8.955).

Conclusions: Two-thirds of interviewed subjects had consumed alcohol within the last 12 months. This finding may be an underestimate due to patients’ self-reporting and recall error. In all cases, the occurrence of alcohol related-seizures was associated with timely consumption of considerably large amounts of alcohol. Thus, a responsible alcohol intake seems to be safe for most patients with epilepsy. However, subjects with epilepsy and especially those with generalized genetic epilepsy should be made aware of an increased risk for seizures related to heavy alcohol consumption. Factors accompanying acute heavy alcohol intake such as altered sleep architecture, impaired adherence to antiepileptic medication, and metabolic disturbances may further facilitate the occurrence of seizures.

Introduction

Alcohol consumption may trigger seizures in patients with epilepsy. Yet, there is currently little knowledge on the alcohol-drinking behavior of epilepsy patients. In the 1940s, William G. Lennox comprehensively analyzed alcohol consumption and the occurrence of alcohol-related seizures in 1,254 subjects with epilepsy (1). However, only about 30% of patients used alcohol, thus excluding 70% from any analysis of potential alcohol-related effects on the disease. The occurrence of alcohol-related seizures was reported by 21.1% of subjects who had used alcohol, and was more often stated by patients with symptomatic than with idiopathic or cryptogenic epilepsy (as classified at that time). Apart from this, there is little research on the occurrence of alcohol-related seizures in patients with epilepsy. A double-blinded, randomized, interventional study on 52 subjects with epilepsy demonstrated that a social alcohol intake over a 4-month-period did not increase seizure frequencies (2). In another interventional study on 14 patients with epilepsy and 10 healthy controls, acute moderate alcohol consumption initially suppressed epileptiform EEG-activity. Later however, when alcohol blood levels had declined, epileptiform EEG-activity was increased. Seizures occurred in some of those subjects and a rebound phenomenon was discussed (3).

Human and animal data have shown that acute alcohol intake has a biphasic effect on the central nervous system (CNS). Initially, the inhibitory gamma-aminobutyric acid (GABA)-ergic effect of alcohol exerts CNS depressant and anticonvulsant properties (45). In the post-alcohol state, however, when alcohol blood levels decline, neuronal excitability is increased which may facilitate the occurrence of seizures in patients with epilepsy (67).

The use of alcohol is very common in western societies (8). In Germany, 89% of all adults had consumed alcohol within the last 12 months (9). This makes it necessary for neurologists and other physicians to advise patients with epilepsy adequately on how to handle alcohol consumption with their chronic disease. The relationship between alcohol and epileptic seizures is complex. Research has mainly focused on the prevalence and pathophysiology of acute symptomatic seizures in the context of the alcohol withdrawal syndrome in alcohol-dependent subjects (1012) and on the risk to develop epilepsy due to regular alcohol consumption (1314). However, there are only a few studies that have examined the patterns of alcohol drinking in subjects with a known history of epilepsy, and these are limited by outdated results or small sample sizes. In particular, data on seizure worsening associated with alcohol consumption in patients with epilepsy are very sparse. Therefore, we aimed (a) to systematically analyze the alcohol-drinking behavior of patients with epilepsy and (b) to identify independent predictors for alcohol use and the occurrence of alcohol-related seizures.[…]

 

Continue —>  Frontiers | Alcohol Use and Alcohol-Related Seizures in Patients With Epilepsy | Neurology

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[WEB SITE] Living with epilepsy

Life can be happy and meaning ful for those with epilepsy once they manage their condition. Picture created by Freestockcenter – Freepik.com

With medication and by practising a healthier lifestyle, epilepsy patients can lead normal lives.

MOST of us go through life never having to face any major health issues.We grow up, graduate, get a job and prepare to start a new chapter in our lives. Like so many others, Christina too was on that happy path. But in 2009, when she was just 29, her life took a very different and unexpected turn.Despite having been healthy her whole life, she suddenly had an epileptic seizure at work.

“At that time, I was facing elevated challenges at work and the increase in stress levels coincided with the onset of my attack. I had never faced such an episode before,” says Christina.

Unfortunately, once epilepsy is triggered, the condition can’t be reverted. Initially, Christina was in denial, believing that the attacks wouldn’t happen again. But the next one came and it was worse than the last. This time, an ambulance was called to take her to the hospital. There, it was discovered that she had a left hippocampal sclerosis — scarring in the brain — which was the cause of her epilepsy.

THE CHALLENGE
But her difficult journey was just about to get tougher.After being diagnosed, Christina was referred to a hospital, where there weren’t any neurologists to recommend the best course of treatment.

“I was passed from doctor to doctor, and for quite some time, I found that getting the right help was tough.”

At that time, as part of her teaching requirement, Christina, a lecturer, was transferred to another branch. The change was challenging.On top of coming to terms with her diagnosis, doctors did not allow her to drive, and she struggled with the loss of independence and having to adapt to a new environment.

However, after time, the change became a blessing. At the new place, the staff were amazing and the students were very caring and Christina felt like she was part of a family.

Her attacks also became less frequent and milder. This made her realise the importance of a support system and an understanding community for people with epilepsy.

“When I am surrounded by positivity, I too become positive and that helps me face my challenges.”

It was also during this time that she met someone who led her down the right path in managing her epilepsy.

“I had one particularly bad attack during a training session at work, and a gentleman whom I had never met before approached me afterwards. He told me that he too used to experience epileptic seizures and he passed me details of a neurologist.”

The neurologist helped Christina to learn how to manage her condition, both physically and emotionally.It was a turning point for her. Not only was she finally referred to someone who could provide her with adequate treatment, but Christina also started to recognise that there were many others in a similar situation and they too had to make many sacrifices in managing their condition.

Of course, she had already read up on epilepsy and knew that it affected many people but meeting another person with the same condition had a great impact on her. Meeting that gentleman who had successfully faced his condition gave her hope that she could too.These days, when she does have an attack, it’s usually rather mild. She just rests for a bit and nobody can even tell that she has had an attack.

The medication she’s been taking has helped her manage her epilepsy and she doesn’t faint or black out anymore.However, she’s aware that she has to take charge of her condition in other ways too — by practising a healthier lifestyle and not burdening herself with too much work or stress.

Christina has learnt to accept and manage her condition and move forward with her life.

MOVING FORWARD
“Before being diagnosed, I had a rather vague idea of what epilepsy was. I didn’t know that it could be treated through medication and that patients could live normal lives. I have very supportive siblings that understand my condition but often, I find it difficult to talk about it openly with others.”

Christina says many people struggle to fully comprehend her situation, and a lack of understanding also brings the danger of judging and stigmatising people like her.Even the gentleman at work who helped her get help, made her promise that she wouldn’t tell anyone about his condition.

“But here lies the complication — how can we then expect others to be able to comprehend something they aren’t aware of? That is why I chose to share my story, so that people can be aware of epilepsy, to understand that epilepsy does not define a person, it doesn’t define me.”

Christina stresses that epilepsy patients can most definitely lead normal lives. She herself has managed to complete her master’s degree and has been working as a lecturer for over 10 years.She has learnt to adapt to her condition, understanding that she has to adhere to a lifestyle that she can manage.She says in addition to the medication, it is crucial for patients to accept their condition and share the challenges they face.

When things got difficult for Christina, her neurologist arranged for her to see a psychiatrist. The sessions helped a lot as she could talk about her challenges, how she felt and what she was going through.

Christina believes patients can benefit a lot through counselling, especially when going through the more challenging phases of epilepsy.

“For me, it is about living life to the fullest, to wake up and smell the roses. Yes, epilepsy comes with its own set of challenges and sacrifices but I choose to look at the bright side and strive for the best.”

meera@mediaprima.com.my

People with epilepsy need support and understanding from society. Picture from: avenuescounselingcenter.org

NEUROLOGICAL DISORDER
APPROXIMATELY 50 million people suffer from epilepsy worldwide, according to the World Health Organisation, and 80 per cent of its prevalence are found in low and middle income countries, including Malaysia.

It is estimated that epileptic patients make up one per cent of the overall Malaysian population, with an estimated 230,000 diagnosed cases, affecting individuals of all races, ages and gender.Despite this prevalence, a significant lack of awareness of the condition has resulted in often negative — and in extreme cases — malevolent connotations, with epilepsy being associated with individuals who are spiritually possessed.

Epilepsy is a neurological condition where a person experiences multiple and recurrent seizures. These seizures are uncontrollable and the result of sudden changes in the brain’s electrical activity, which are commonly associated with convulsions (when a person’s body shakes rapidly, without control).

However, not all seizures result in convulsions, with symptoms widely ranging in severity. With recent advances in treatment and medical understanding of the condition, patients suffering from epilepsy can lead very normal lives.

Counselling can be beneficial for people with epilepsy. Picture from: http://www.burningnightscrps.org

A MISUNDERSTOOD CONDITION
THE word epilepsy comes from the Greek verb epilepsia, which means to take hold of or to seize.

Throughout history, all over the world and in various different cultures, epilepsy has been the subject of many misconceptions.

It is not difficult to understand why the disease, with its sudden and dramatic seizures was seen as a strange and almost mystical condition.

People with epilepsy were viewed as being possessed by the devil or evil spirits and this sadly, affected society’s attitudes towards people with the disease. Generally, people with epilepsy were viewed with fear, suspicion and misunderstanding, and were subjected to enormous social stigma.

They were treated as outcasts and even punished.There was even a belief that epilepsy was contagious and people used to spit at a person with the condition or refuse to use the same utensils as them.

However, despite this stigma and mistreatment, many famous people in history who suffered from the condition went on to achieve great things. These include Julius Caesar, Czar Peter the Great of Russia, Pope Pius IX, the writer Fyodor Dostoevsky and the poet, Lord Byron.

Source: Adapted from “History of Epilepsy” — www.epilepsy.caSidebar

MANAGING A SEIZURE

DO
Stay calm

Make sure the person is in a safe place.

Note the time the seizure starts.

Stay with them.

Cushion their head with something soft

Put them into the recovery position once the seizure has stopped.

Stay with them until they are fully recovered.

Call an ambulance if the seizure lasts more than five minutes.

DON’T
Put anything in their mouth.

Hold them down.

Try to move them unless they are in danger.

Give them anything to eat or drink until they are fully recovered.

Attempt to bring them around.

Sources: www.epilepsysociety.org.uk, ww.epilepsy.com and www.epilepsy.org.uk

Know what to do when someone has a seizure. Picture from: http://www.youtube.com

FACTS ABOUT EPILEPSY
* It isn’t contagious.

* It is one of the most common neurological disorders and affects people of all ages. It is not a rare condition. *It is a spectrum condition with a wide range of seizure types and control varying from person-to-person.

*Most people with epilepsy can do the same things that people without epilepsy can do. However, those with frequent seizures may not be able to work, drive, or may have problems in other parts of their life.

*Epilepsy cannot be cured

* A person can die from epilepsy. While it doesn’t happen frequently, epilepsy is a very serious condition and individuals do die from seizures.

Source: www.epilepsy.com

Those with frequent seizures will be advised not to drive. Picture from: cdldrivingacademy.com

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[WEBINAR] Webinar on Cannabis for Seizures

WEBINAR ON CANNABIS FOR SEIZURES

Location: Online
Description: Spectrum News presents a free webinar with Orrin Devinsky on cannabis compounds for epilepsy. He is professor of neurology, neurosurgery and psychiatry at New York University and director of the NYU Langone Comprehensive Epilepsy Center. Time: 3 p.m. Eastern Time.
IAN Attending: No.
Event Date(s): July 17, 2018

 

via Webinar on Cannabis for Seizures | Interactive Autism Network

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[WEB SITE] Researchers develop new prediction method for epileptic seizures

Epileptic seizures strike with little warning and nearly one third of people living with epilepsy are resistant to treatment that controls these attacks. More than 65 million people worldwide are living with epilepsy.

Now researchers at the University of Sydney have used advanced artificial intelligence and machine learning to develop a generalized method to predict when seizures will strike that will not require surgical implants.

Dr Omid Kavehei from the Faculty of Engineering and IT and the University of Sydney Nano Institute said: “We are on track to develop an affordable, portable and non-surgical device that will give reliable prediction of seizures for people living with treatment-resistant epilepsy.”

In a paper published this month in Neural Networks, Dr Kavehei and his team have proposed a generalized, patient-specific, seizure-prediction method that can alert epilepsy sufferers within 30 minutes of the likelihood of a seizure.

Dr Kavehei said there had been remarkable advances in artificial intelligence as well as micro- and nano-electronics that have allowed the development of such systems.

“Just four years ago, you couldn’t process sophisticated AI through small electronic chips. Now it is completely accessible. In five years, the possibilities will be enormous,” Dr Kavehei said.

The study uses three data sets from Europe and the United States. Using that data, the team has developed a predictive algorithm with sensitivity of up to 81.4 percent and false prediction rate as low as 0.06 an hour.

“While this still leaves some uncertainty, we expect that as our access to seizure data increases, our sensitivity rates will improve,” Dr Kavehei said.

Carol Ireland, chief executive of Epilepsy Action Australia, said: “Living with constant uncertainty significantly contributes to increased anxiety in people with epilepsy and their families, never knowing when the next seizure may occur.

“Even people with well controlled epilepsy have expressed their constant concern, not knowing if or when they will experience a seizure at work, school, traveling or out with friends.

“Any progress toward reliable seizure prediction will significantly impact the quality of life and freedom of choice for people living with epilepsy.”

Dr Kavehei and lead author of the study, Nhan Duy Truong, used deep machine learning and data-mining techniques to develop a dynamic analytical tool that can read a patient’s electroencephalogram, or EEG, data from a wearable cap or other portable device to gather EEG data.

Wearable technology could be attached to an affordable device based on the readily available Raspberry Pi technology that could give a patient a 30-minute warning and percentage likelihood of a seizure.

An alarm would be triggered between 30 and five minutes before a seizure onset, giving patients time to find a safe place, reduce stress or initiate an intervention strategy to prevent or control the seizure.

Dr Kavehei said an advantage of their system is that is unlikely to require regulatory approval, and could easily work with existing implanted systems or medical treatments.

The algorithm that Dr Kavehei and team have developed can generate optimized features for each patient. They do this using what is known as a ‘convolutional neural network’, that is highly attuned to noticing changes in brain activity based on EEG readings.

Other technologies being developed typically require surgical implants or rely on high levels of feature engineering for each patient. Such engineering requires an expert to develop optimized features for each prediction task.

An advantage of Dr Kavehei’s methodology is that the system learns as brain patterns change, requiring minimum feature engineering. This allows for faster and more frequent updates of the information, giving patients maximum benefit from the seizure prediction algorithm.

The next step for the team is to apply the neural networks across much larger data sets of seizure information, improving sensitivity. They are also planning to develop a physical prototype to test the system clinically with partners at the University of Sydney’s Westmead medical campus.

 

via Researchers develop new prediction method for epileptic seizures

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[Slideshow] Epilepsy & CBD

H Andre, O Danna, W Emma
… Scharfman and MacLusky, 2006 Page 34. Inhibition – Ledgerwood et al., 2010 ● CBD
is shown to inhibit synaptic transmission in hippocampal slices ○ In many forms of epilepsyseizures originate in the medial temporal lobe, an area that includes the hippocampus …

 

The Epilepsy & CBD Slideshow PDF file

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[Abstract] Pharmacotherapy of epilepsy

Pharmacotherapy of epilepsy is usually initiated after two or more unprovoked seizures, a decision that should be made after assessment of the individual risk of further seizures. Antiepileptic drugs (AEDs) are selected based on documented efficacy for the type of seizures, the epilepsy and possible epilepsy syndrome of the patient, taking potential adverse effects and comorbidity into account. For many AEDs, the mechanisms of action are incompletely understood. More than half of patients with newly diagnosed epilepsy achieve sustained seizure freedom with their first or second drug trials. After a prolonged time of seizure freedom discontinuation of therapy may be considered; the risk of relapse after drug withdrawal can be estimated on the basis of a number of clinical factors. The informed patient’s attitude is essential in all therapy decisions. Treatment is still largely symptomatic, but the future may involve a greater degree of disease-modifying precision medicine.

via [Pharmacotherapy of epilepsy]. – Abstract – Europe PMC

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[WEB SITE] Health Beat: Slowing down seizures

MIAMI – Mark Weinberg has trouble remembering the car accident that changed his life at 16.

“My parents say I was in a coma for four days,” he shared.

Weinberg survived but suffered a severe brain injury and started having seizures every week.

“I’ll go up to someone and say, ‘Can you hold my hand? I think I’m having a seizure,'” he said.

Dr. Andres Kanner, the chief of the epilepsy division at the University of Miami’s Miller School of Medicine, said a seizure is like a short circuit in the brain.

“They can lose awareness of their surroundings and be unresponsive and they don’t know what’s happening around them,” Kanner explained.

Kanner said medication can control seizures in 70 percent of patients, but for Weinberg, that wasn’t the case.

“I think I’ve been on almost every medicine,” Weinberg said.

Now, new technology is helping patients like Weinberg. It’s called responsive neuro stimulation, or the RNS system.

“Imagine a pacemaker, which has a computer chip in it,” Kanner said.

The device made by Neuropace is implanted under the scalp and connected to the areas in the brain causing seizure activity.

“As it detects that abnormal pattern, it sends an electrical stimulation,” Kanner continued.

That stimulation prevents the seizure from happening. Since having the device implanted, Weinberg’s seizures have been cut in half.

“Even if I do have them, they’re shorter, so I’m not as scared as I used to be,” Weinberg said.

Now, he’s going to college, living a life with fewer seizures.

Kanner said studies show the device is safe and does not affect cognitive function. Kanner said in the first year, 30 to 40 percent of patients notice their seizure frequency may be cut in half.

via Health Beat: Slowing down seizures – WFMZ

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[WEB SITE] What Modern Day Challenges Affect Epilepsy Treatment?

epilepsy

Researchers recently published an article in The Lancet Neurology discussing the difficulties facing seizure detection in patients with epilepsy.

Epilepsy is a neurological disorder that is characterised by short repetitive epileptic seizures.  These seizures can be harmful to the individual depending on the circumstances in which they occur, such as a seizure while driving. This disorder is set apart from other neurological disorders since there is a broad range of different physiological changes that can cause it, leading to a large variation in symptoms and making it difficult to treat. While 70% of sufferers can be treated with pharmacological agents, 30% have no reliable anti-epileptic drugs that are effective for their particular type of epilepsy.

In a recent study, Christian Elger and Christian Hoppe determined that a key challenge facing patients is that over 50% of patients under-report the number of seizures they experience, which has a serious impact on how well doctors are able to determine what treatments are most suitable for them. This also calls into question many of the previously published research on epilepsy treatments. They recently published this report in The Lancet Neurology.

Why are Epileptic Seizures Difficult to Detect?

In this personal view, the writers determined that the cause of under-reporting is primarily due to patients, or their caregivers, being unable to identify when seizures are occurring. Seizures can impair consciousness, may occur at night, or the physical symptoms may be so subtle that they are not easily noticed unless professionally trained to do so.

Technologies for Epilepsy DetectionThe gold standard for epilepsy detection is video-electroencephalography (VEEG), where patients have their brain activity monitored for epilepsy-specific activity and trained technicians can test for impairments to consciousness, cognition, language, and memory. Video footage from the VEEG can also be viewed at a later time to spot slight body movements indicative of a seizure. The limitation of this method is that it requires a hospital visit, increasing associated costs, and is only suitable for identifying how frequent a person has a seizure over a given time, it does not address the issue of a person (or their caregiver) being aware they are having a seizure in real time.

Automated System Required

It is clear that the future of seizure detection requires an automated system,  preferably one that patients can wear over the long-term and that will notify them or a nearby center when a seizure occurs. The main barriers to this technology is that a number of the current ambulatory systems for monitoring brain activity can be limited in monitoring time (72 hours) or require labor-intensive analysis of data, although as algorithms for analyzing brain activity improve this limitation will also decrease.

An analysis of movement via home-based video systems, or of various physical data outputs (i.e. accelerometry, magnetometry, gyroscopy, or pressure data) derived from worn sensors have some promise but so far the results have not been consistent.

Surface Electromyography

It appears that one of the most promising methods, which is also viewed favorably by patients, is surface electromyography (SEMG). This method involves self-adhesive sensors that are attached to muscles in areas of the body affected by seizures. Furthermore, multi-modal approaches that combine SEMG, EEG, and electrocardiography have a detection rate over 85% for the majority of seizure types.

Improved Seizure Detection Necessary

It is clear that improved seizure detection is necessary for ensuring that doctors provide the most appropriate treatment to individual patients, as well as ensuring that patients are protected from life-threatening seizures. Improving wearable, ambulatory technologies and advancements in algorithms for the analysis of seizure data will help provide comprehensive support to both physicians and to the patients that they monitor.

Written by Michael Healy, BSc, MSc

Reference: Elger C.E., Hoppe C. Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection. Lancet Neurol 2018; 17: 279–88.

via What Modern Day Challenges Affect Epilepsy Treatment? – Medical News Bulletin | Health News and Medical Research

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