Posts Tagged seizures
Epilepsy is a devastating disease which causes recurrent and often frequent seizures. Treatments are available, but even here there are challenges if a patient’s condition does not respond to medication.
Epilepsy is a serious and debilitating neurological disease. It’s also a frightening one, because it can result in frequent seizures which can cause loss of body control and/or consciousness in patients. Anyone whose seizures are poorly controlled faces an increased risk or danger from accidents, or even death.
It’s the thought of losing control unpredictably which makes epilepsy so alarming. Where might you be and what might you be doing when a seizure occurs? Crossing a road? Driving? Patients have to face this kind of worry on a day-to-day basis. Plus, many fear social stigmatisation if they have a seizure in public.
How epilepsy impacts the lives of patients
Epilepsy disrupts the normal balance between excitation and inhibition in the brain, and it’s this which causes seizures. It can start at any age and is usually lifelong and, shockingly, there are more people with the disease than you might think and it’s thought to affect around six million Europeans.1
“This is a condition which can have a significantly negative impact on the lives of patients and their care-givers,” says Mark Altmeyer, CEO of Arvelle Therapeutics International, a biopharmaceutical company focused on bringing innovative treatments to patients suffering from central nervous system disorders. “Because the seizures are so unpredictable, they can disrupt a patient’s ability to drive, work, or live a ‘normal’ life. As it carries a high risk of mortality, its effects cannot be underestimated.”
There is still a high unmet need for patients with drug-resistant focal onset seizures.
A number of anti-seizure medications are available and work effectively for many patients. But even here there are challenges because they don’t work for everybody, notes Ilise Lombardo MD, CMO of Arvelle.
“Unfortunately, between 30% of patients2 don’t respond to current medications,” she says. “We have to do more to find solutions that can help patients with the drug-resistant form of the disease.”
Reducing seizure severity and becoming seizure-free
So, what can drug-resistant epilepsy patients do to try to help their condition? There are actions they can take such as changing their diet and avoiding environmental triggers; but these may not have significant impact. At this point, invasive options, such as surgery, may be a possibility. However, not all patients will be suitable for this type of intervention.
“I believe the goal for any patient with epilepsy — and particularly those who are treatment-resistant — is to reduce their seizure severity,” says Lombardo. “And, ultimately, their goal is to be seizure-free for an extended period of time which will enhance their quality of life. Any innovative medications to help patients get to that point will be welcomed as a big advance.”
Arvelle is focused on finding innovative solutions so that patients with unmet needs are better able to manage their disease.
The power of partnerships
Why a joined-up approach is the best way to achieve better outcomes for people with epilepsy (PWE).
If key stakeholders in the epilepsy field work in partnership, they can achieve great things for patients, says Stuart Mulheron, General Manager of Arvelle.
“A partnership doesn’t have to be a major agreement,” he stresses. “It can be as simple as working locally with clinicians, nurse teams and pharmacists; or, on a larger scale, with patient and professional associations. By working collectively, everyone in the partnership has a chance to make a positive impact on epilepsy awareness, and highlight the challenges faced by patients, such as stigma and exclusion whilst working together on practical solutions to improve patient outcomes.”
“As a young company, we’re in the process of developing relationships with different stakeholders in the epilepsy field,” says Mulheron. “After all, we all want the same thing: to make patients’ lives better.”
1. Baulac M, de Boer H, Elger C, et al. Epilepsia. 2015;56(11):1687-1695
2. Chen Z, Brodie MJ, Liew D, Kwan P. JAMA Neurol. 2018;75(3):279-286;
AuthorTony GreenwayDecember 14, 2020
Experiencing migraines may occur before seizures. If you have a seizure disorder, you are twice as likely to have migraine headaches. Discussing migraine pain is best done alongside others on MyEpliepsyTeam who understand what you are going through.
On MyEpilepsyTeam, the social network and online support group for those living with epilepsy, members talk about a range of personal experiences and struggles. Migraines are one of the top 10 topics most discussed.
Here are a few question-and-answer threads about migraines:
Here are some conversations about migraines:
Have another topic you’d like to discuss or explore? Go to MyEpilepsyTeam today and start the conversation. You’ll be surprised just how many others may share similar stories.
Feel free to ask a question here.
The start-up Neuronostics is using the brain waves of large numbers of people to assess an individual’s risk of seizure disorders more quickly and accurately.
By Eric Bender
Neuronostics is a spin-off from the University of Exeter, UK, and one of the final eight for The Spinoff Prize 2021.
The symptoms that many people associate with someone having an epileptic seizure — losing consciousness, biting the tongue or even briefly ceasing to breathe — would make it seem that diagnosing this condition would be a simple matter.
But diagnosis is a tricky process that usually takes months — and might never be definitive. People with epilepsy describe their diagnostic journey as “long, confusing, unclear and uncertain”, says John Terry, a mathematician at the University of Birmingham, UK.Read more about The Spinoff Prize
Terry is co-founder and managing director of Neuronostics in Bristol, UK, a start-up that aims to shorten this journey. The company’s patented software, BioEP, analyses electroencephalography (EEG) recordings of brain activity that are routinely collected during the first appointment with a neurologist. It can identify epilepsy from a single recording, with a similar sensitivity to that of clinicians who conduct numerous tests over many months, says Terry.
The implications are enormous. More than 65 million people, nearly 1% of the global population, have epilepsy, and the condition has serious associated risks. Quicker and more reliable diagnosis could lead to earlier treatment and could substantially reduce the potentially severe impact on people’s quality of life.
“This technology could be a game changer for epilepsy diagnosis,” says Exeter-based Simon Privett, an epilepsy-awareness advocate at the UK charity Epilepsy Action, who has worked closely with Terry and his team.
Beyond the standard scans
Epileptic seizures are driven by unusual electrical activity in the brain. A diagnosis is made on the basis of clinical history, and EEG and magnetic resonance imaging (MRI) scans help to confirm the diagnosis, says Kathryn Davis, a neurologist specializing in epilepsy at the University of Pennsylvania in Philadelphia.
But Davis emphasizes that those tests aren’t definitive — the scans don’t always show anything unusual in people who do have epilepsy.
Among people who have had a seizure but whose scans don’t show unusual activity, the risk of a second seizure is only around 30%, Davis says. She usually doesn’t prescribe anti-epileptic drugs at that point. “I’m just counselling them to wait and see if you have another potentially life-threatening event,” she says. “And if you do, then we’ll treat you. That’s an extremely common scenario.”
Currently, clinicians examine EEG readouts and look for precursors of seizures such as spikes in activity or brief bursts of unusual pathological activity. They also look for seizures. “The trouble is that these are all quite rare events,” Terry says. So clinicians usually begin a process to eliminate psychological or physical causes of the seizures — monitoring people for progressively longer periods of time, and upping stresses that can trigger seizures, such as lack of sleep, to pick up signals of epilepsy.
Terry and his collaborators at Neuronostics instead use 20 seconds of seizure-free data from a routine EEG scan. Using a database of EEG records from people with and without epilepsy, the researchers have created a computer model that has built a network of interactions between the signals produced by the electrodes placed on the head to measure brain activity, called EEG channels1 (see ‘Simulating seizure risk’). This model, Terry explains, describes “transitions between background states in the brain that are apparently healthy, and seizure-like states that are apparently pathological”. The Neuronostics software uses the model to generate a risk score that can help a clinician to assess an individual’s risk of epilepsy.
With a conventional evaluation of an initial EEG scan, a clinician can correctly diagnose roughly 25% of people with epilepsy, according to Terry. Unpublished research with the Neuronostics model shows that it performs much better, detecting epilepsy in 60% of those who do have the condition, and making the right assessment in 87% of cases.
Accelerating the diagnosis of epilepsy has two major advantages. First, it avoids the need for long-term testing, and the associated disruption for those being examined. Second, it reduces the number of seizures a person is likely to have — delays in diagnosis and treatment mean that seizures will keep happening, and, generally, the more seizures someone has, the more likely they are to have more.
If fully validated, the ability of Neuronostics’ method to outperform clinicians’ interpretations of initial EEGs could prove very helpful for diagnosis, says Davis.
Delivering on diagnostics
Neuronostics’ system has been long in gestation. Terry and his colleagues first reported2 the method in 2012. Terry then discussed the research with a commercial technology specialist at the University of Exeter (where Terry was then based) who was impressed with the technology and its potential impact. The university applied for patent protection and, in 2018, aided the company’s formation. It also helped to secure a series of UK government grants — most recently, two awards totalling £870,000 (US$1.2 million) in September 2020 from the National Institute for Health Research.
In March, the company raised £300,000 in a seed round of financing. It now has four full-time employees and is hiring, among other roles, a head of marketing.
Neuronostics estimates there is a potential market of 3.5 million EEGs annually in the United States and Europe, and it plans to charge a per-use fee of $400 in the United States and the equivalent of $280 in the United Kingdom (the fee is lower in the United Kingdom because of requirements under its government sponsorship). The company received regulatory approval for BioEP in Europe and the United Kingdom in May, with expansion to the United States planned for late 2022.
The diagnosis of epilepsy might not, however, prove to be the software’s most valuable offering. The start-up also sees potential for determining prognosis for people taking epilepsy treatments, says mathematician Wessel Woldman at the University of Birmingham, who is co-founder and scientific director at Neuronostics. Indeed, although some neurologists remain sceptical about EEG analysis for diagnosis, “when it comes to prognosis, there’s a lot more of a realization that computer-assisted methods could really contribute something meaningful”, Woldman says.
About one-third of people diagnosed with epilepsy get no benefit from any available drug. For the remaining two-thirds, finding the right treatment can take months. Neuronostics analyses might allow clinicians to observe the effects of a medication much more quickly, which could cut down on seizures and minimize the use of medications with significant side effects, Woldman says. He is collaborating with clinicians at St Vincent’s Hospital in Fitzroy, Australia, to test the approach. Very early results are encouraging, he says.
Neuronostics is also developing a smartphone app called ConnectEP that works with a new generation of inexpensive, gel-free wireless EEG headsets designed for home use. The resulting data won’t be clinical-grade but could still prove highly useful to neurologists, Terry says. The company hopes to release the app by the end of 2021.
Later generations of ConnectEP could also produce useful short-term forecasts of risk of seizures — an exciting possibility, says Privett, who is involved in testing prototypes. Overall, Privett says, the potential impact of Neuronostics technology for people with epilepsy is huge.
As it commercializes its technology, Neuronostics is maintaining its tight focus on feedback from all the stakeholders in epilepsy treatment — especially those with the condition. “Our ethos”, says Terry, “is to ensure that our models and experiments and clinical work develop very closely together.”
- 1.Schmidt, H. et al. Epilepsia 57, e200–e204 (2016).PubMed Article Google Scholar
- 2.Terry, J. R., Benjamin, O. & Richardson, M. P. Epilepsia 53, e166-e169 (2012).PubMed Article Google Scholar
By Andrée Mayne
Our Support Services Manager, Andrée Mayne, gives some helpful tips for people with epilepsy who are already working or are starting work.
With many employees going back into the office after the hiatus caused by COVID-19 negotiating the world of work might be tricky for many of us, but it can be even trickier if someone has epilepsy. If you have epilepsy and you work, you’re about to start work or you’re thinking of getting back into work, read our top tips below.
Tip 1 – Telling people about your epilepsy
Remember, you don’t have to tell an employer about your epilepsy but for employers to be able to meet health and safety regulations, they need to know whether their employees have any medical conditions that could affect their work.
If your employer knows about your epilepsy they can consider making adjustments to your work or environment for you and organising epilepsy awareness training. If your colleagues know about your epilepsy they can also help if you do have a seizure in the office.
Tip 2 – Find out how the law affects you
Before you start working, make sure you understand your employer’s responsibilities relating to your Health and Safety. As an employee, you are also responsible for your own safety at work and the safety of your colleagues. The Health and Safety at Work Act 1974 says that employers are responsible for making sure that all their employees are safe at work and are protected from possible dangers to their health. However, if you don’t tell them about your epilepsy, you cannot hold them responsible for not making adjustments for you.
People with epilepsy are also covered by the Equality Act which aims to protect people against disability discrimination in the workplace. Because epilepsy is a physical, long-term condition, people with epilepsy are protected under the Equality Act, even if their seizures are controlled or if they don’t consider themselves to be ‘disabled’.
Tip 3 – Help is available
There are organisations out there ready to help you with any questions or issues you have around work. Here are a few of them:
• Jobcentre Plus have Disability Employment Advisers (DEAs) who provide support to people with disabilities
• Access to Work is a government scheme that supports people who are disabled in paid work, or about to start paid work. It can help to fund solutions to help you in your work. For example, if you aren’t able to drive to work due to your epilepsy, and there is no suitable public transport, it may pay for a taxi so that you can get to work.
• Citizens Advice Bureau (CAB) offer free confidential and independent advice to people needing information around employment law
• Advisory, Conciliation and Arbitration Service (ACAS) – advice for employers and employees
• Epilepsy Society helpline – our specialist helpline is here to help anyone affected by epilepsy
You can find further information on work and employment on our website, including types of jobs and information for employers.
Listening to Mozart has a notable impact on seizure reduction in patients with epilepsy — and now researchers believe they know why, new research suggests.
Investigators found that the acoustic characteristics of Mozart’s Sonata for Two Pianos in D Major (K448) suppresses brain activity in patients with epilepsy while a piece by the 18th century classical composer Franz Joseph Haydn did not have this effect.
Listening to this Mozart sonata and perhaps other musical pieces may eventually become a treatment for preventing epileptic seizures, said study investigator Ivan Rektor, MD, CSc, Epilepsy Centre at the Hospital St Anne and professor at the Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
“This research into the impact of listening to music could lead to the development of a music-related type of palliative neurostimulation therapy,” Rektor told Medscape Medical News.
The findings were presented at the virtual Congress of the European Academy of Neurology (EAN) 2021 and published online in the European Journal of Neurology.
Epilepsy affects 6 million people in Europe. Furthermore, estimates show that about 15 million Europeans have had at least one seizure at some time in their lives. In addition, about 30% of patients with epilepsy are not adequately treated with antiseizure medications.
Researchers have been studying the impact of Mozart’s music on brain-wave activity since the 1990s. Various studies report a reduction in epileptiform discharges in patients with epileptic seizures, coma, and refractory nonconvulsive status.
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An epileptic trigger describes anything that can prompt a seizure. A few common epileptic triggers include physical or emotional stress, flashing lights, eating certain foods, and even lack of sleep. But one potential trigger that is confusing for many people with epilepsy involves alcohol.
If you’re living with epilepsy, you might be curious about the relationship between alcohol and seizures. Take this five-question quiz to better understand how alcohol and seizures may be connected.
Share Your Thoughts
On MyEpilepsyTeam, the social network and online support group for people with epilepsy and their loved ones, members have discussed alcohol, epilepsy, and seizure triggers.
What is your experience with alcohol and epilepsy? Join the conversation today to share your experiences and connect with others on MyEpilepsyTeam.
- Seizure Triggers — Epilepsy Society
- Triggers of Seizures — Epilepsy Foundation
- Alcohol as a Seizure Trigger — Epilepsy Foundation
- Drinking Levels Defined — National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- What Is the Impact of Binge Drinking in Patients With Epilepsy? — MDedge Epilepsy Resource Center
- Alcohol Use and Alcohol-Related Seizures in Patients With Epilepsy — Frontiers in Neurology
- Lack of Sleep and Epilepsy — Epilepsy Foundation
- Stress, Mood, and Seizures — Epilepsy Foundation
- Alcohol and Seizures — American Addiction Centers
Epilepsy is the second most common neurological disorder after stroke characterized by seizures of various types which result from episodic neuronal discharges.In Management of epilepsy the main target is to achieve the balance between the factors which alters the excitatory postsynaptic potential and postsynaptic potential.Although several antiepileptic drugs are available to treat epilepsy, the treatment of epilepsy is still far from adequate.Traditionally the herbal drugs can be an alternate source in treatment of epilepsy with improved safety and efficacy.The herbal drugs/remedies can make the anticonvulsant treatment more rationale and patient friendly due to less side effects, toxicity and drug interactions. In addition, more safety, tolerability, efficacy, and fewer expenses especially in long term therapy are other advantages with herbal anticonvulsants. This review article explains about the pathophysiology, management of epilepsy, various herbal drugs used in the treatment of epilepsy and their responsible phytoconstituents for producing significant effect in controlling seizures.
Cyclical patterns of seizure activity have long been recognised in patients with epilepsy, but, until the past decade, were considered a curiosity of little practical value. 1 The advent of implanted systems for epilepsy management, both seizure prediction systems and therapeutic devices such as the Responsive Neurostimulation (RNS) System, have changed this perspective. In particular, implanted systems can harness knowledge of the cycles to generate more accurate prediction strategies. Furthermore, identification of these cycles offers the possibility that cortical stimulation and other therapies might be delivered in a more precise manner, with potentially increased efficacy and fewer side effects.
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- Anxiety and seizures
- PNES (pseudoseizures)
- Panic attacks and seizures
- Panic attack vs. PNES
- PNES symptoms
- PNES diagnosis
- PNES treatment
- Bottom line
Anxiety is a necessary human emotion designed to alert us to potential dangers and protect us from potential threats. For most people, feelings of anxiety are short-lived, but in some people, anxiety can become a chronic condition that greatly impacts quality of life.
Anxiety can cause a wide range of physical and mental symptoms, one of which may include psychogenic nonepileptic seizures (PNES), also called pseudoseizures.
In this article, we’ll explain what PNES are, how they differ from neurological seizures, and everything you need to know about anxiety and PNES.
A seizure is a brief period of uncontrolled electrical activity in the brain that can provoke a wide variety of changes in the body. Epilepsy is a chronic condition that causes unpredictable, recurrent seizures.
Seizures can be caused by a variety of triggers, including increased stress and anxiety. In fact, according to the British Epilepsy AssociationTrusted Source, stress is one of the most commonly self-reported seizure triggers in people with epilepsy.
Research has also shown that even in people without epilepsy, stress and anxiety can trigger what’s known as psychogenic nonepileptic seizures (PNES), or pseudoseizures. PNES are physiologically different from the neurological seizures found in epilepsy.
Pseudoseizures (PNES) aren’t the same type of neurological seizures that are caused by uncontrolled activity in the brain. Instead, PNES are an extreme response to stress and anxiety and are therefore considered psychiatric in nature.
According to the literatureTrusted Source, PNES are classified as a type of functional neurological disorder (FND), or conversion disorder. Conversion disorders are triggered by emotional stress that causes physical symptoms that can’t be explained by other underlying conditions.
PNES most often occur in people who struggle to manage stress, anxiety, or other traumatic emotions through traditional coping strategies. When these emotions become overwhelming enough, the body may shut down as a defense mechanism. In some people, this can present as a PNES.
Sometimes, anxiety symptoms can manifest as a sudden, intense episode called a panic attack. Panic attack symptoms mimic many of the same symptoms you may feel when you’re anxious. However, you may also notice other intense symptoms, such as:
- difficulty breathing or swallowing
- sharp chest pains
- chills or hot flashes
- tingling or numbness in the extremities
- feelings of panic or dread
- feelings of disconnection from yourself or reality
Panic attacks aren’t a known cause of neurological seizures in people without epilepsy. However, there may be a correlation between panic attacks and PNES in people who experience them.
In one meta-analysisTrusted Source from 2018, researchers investigated the link between panic and hyperventilation and PNES. Eighteen studies were analyzed for a potential relationship between panic attacks, hyperventilation episodes, and PNES.
According to the results, up to 83 percent of individuals who had PNES also reported having accompanying panic attacks. In addition, the researchers found that up to 30 percent of individuals with voluntarily induced hyperventilation also experienced PNES.
While these results seem to suggest that panic attacks and panic attack symptoms may be a trigger for PNES, more research is still needed.ADVERTISEMENTExplore new calming exercises with Calm
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Panic attacks and PNES can both happen as a result of stress and anxiety. However, there are differences between the two experiences that distinguish them from each other.
These episodes feature many, if not all, of the classic symptoms of anxiety. Panic attacks come on suddenly and pass within about 10 minutes. Many people who have panic attacks are still able to retain some level of function during the attack. However, symptoms vary from person to person.
These episodes may not feature any symptoms of panic or anxiety at all. PNES tend to come on gradually and last longer than panic attacks. Many people who have PNES also experience panic symptoms, but some don’t.
In some cases, panic attacks can even be used as a diagnostic tool to help differentiate PNES from neurological seizures. In one studyTrusted Source from 2014, researchers found that panic attack symptoms were more likely to appear in a PNES than in an epileptic seizure.
Although PNES and neurological seizures may appear similar, there are some differences in symptoms between the two conditions. For example, PNES may feature some of the symptoms found in neurological seizures, such as:
- lowered awareness
- loss of body control
- flailing or thrashing
- head arching
- tongue biting
In addition to the symptoms above, PNES may also present with symptoms not traditionally found in neurological seizures, such as:
- side to side head movements
- nonsynchronized body movements
- muscle contractions
- closed or fluttering eyes
- crying during the episode
- avoidance behaviors
- memory recall or avoidance
Another distinguishing factor of PNES is that these symptoms tend to appear more gradually and last longer than in neurological seizures.
If you have been experiencing PNES, your doctor will most likely refer you to an inpatient setting for testing. Video-electroencephalography (vEEG) is the most common diagnostic test for pseudoseizures.
During your inpatient stay, you will be connected to an electroencephalography (EEG) machine and a video monitoring system. The EEG machine tracks electrical activity in the brain, while the video monitoring system records any physical symptoms.
Any seizures or PNES that happen during your stay will be analyzed to determine the correct diagnosis. If you appear to have a seizure, but there’s no unusual brain activity, the most likely diagnosis is PNES.
In some cases, further imaging of the brain with a CT scan or MRI scan may be warranted. Your doctor may also want to perform further testing to eliminate any other underlying conditions, such as deficiency or infection.
They may also order additional psychological testing to narrow down any potential causes or triggers for your PNES.
Since PNES are psychological in nature, treatmentTrusted Source of the underlying anxiety is important. Treatment options for anxiety-induced PNES may include:
- Psychotherapy. Cognitive-behavioral therapy (CBT) is the first line of treatment for anxiety disorders. With CBT, an individual can learn how to better cope with stressful or anxious thoughts, feelings, and behaviors. This may help reduce the frequency of pseudoseizures. In addition, trauma-focused therapy may be helpful for individuals with trauma-based disorders who experience pseudoseizures.
- Medications. Anti-epileptic drugs aren’t useful for pseudoseizures because these seizures aren’t neurological. Instead, selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help reduce the symptoms of anxiety that can cause pseudoseizures. SSRIs have been found to be most effectiveTrusted Source when used in conjunction with psychotherapy.
- Lifestyle. Both psychotherapy and medications can help an individual more easily cope with stress and anxiety. In turn, this can reduce the potential for emotionally triggered pseudoseizures. However, lifestyle changes can also help to reduce the symptoms of anxiety. Focusing on good sleep, a balanced diet, daily exercise, and mindfulness practices can further reduce anxiety and greatly improve quality of life.
Ultimately, you and your doctor will work together to come up with the best treatment approach for your personal situation.
While anxiety is unlikely to trigger neurological seizures in people without epilepsy, it can trigger PNES in individuals with underlying mental health conditions. Since these episodes have a psychiatric origin, treatment of the underlying anxiety can help reduce or eliminate these episodes.
If you’re concerned that you have been having PNES, reach out to your doctor for an appropriate diagnosis and treatment.
Last medically reviewed on March 29, 2021