Posts Tagged seizures

[Abstract] The hidden side of travel: Epilepsy and tourism

Highlights

    Reveals how the invisible disability of epilepsy affects the travel experience

    Social stigma of epilepsy is found to have greater impact on travel than seizures.

    Illuminates the plurality of lived experiences of disability in a travel context

    Problematises travel as visible, an escape from normality, independent and authentic

    Challenges the discourse of visibility in the disablist environment of tourism

Abstract

Previous tourism research has examined the barriers and travel experiences of people with physical/mobility and sensory impairments. This paper advances tourism knowledge by revealing the travel experiences of people with the invisible and stigmatising condition of epilepsy. The study employed a phenomenological approach to explore whether, and how, the hidden neurological condition affects the travel experience. Analysis of the data revealed three main themes relating to the experience of travel for individuals with epilepsy: seizure episodesinvisibility of the condition; and managing anxiety. The paper illuminates the hidden side of travel for people with epilepsy and its social stigma, and problematises the socially constructed nature of travel as mostly visible, an escape from normality, independent and authentic.

via The hidden side of travel: Epilepsy and tourism – ScienceDirect

, , ,

Leave a comment

[WEB SITE] The Parts of Epilepsy We Often Don’t Talk About

 

Growing up, my biggest secret was that I had epilepsy. I have had it since I was 5.  Neurologists kept saying, “She’ll grow out of it.” I’ve tried medication after medication, trying to control the seizures and limit the number of side effects.  I’ve tried weaning off medication, only for a seizure to return within one or two days. Life becomes more bearable when my seizures are controlled, but I never feel carefree.  Epilepsy is much more than having seizures.

With my epilepsy comes fear.  I am constantly cautious and afraid.  I am afraid of having a seizure during school, at work or in public.  Although I’ve been seizure-free for over a year, I am afraid of driving down the road and feeling that tingling in my stomach and not being able to pull the car over quickly or safely enough. I am afraid of injuring my brain and body beyond repair. I am afraid of who will see me. I am afraid of waking up from a seizure and being alone. I am afraid of forgetting my medication.

With my epilepsy comes depression. For me, epilepsy has always brought along depression for company. With each anti-seizure medication, the depression waxes and wanes, but it always lingers like a permanent resident in my brain.  When I am honest about my suicidal thoughts, doctors prescribe an antidepressant. We both hope the depression will fade, but I am usually met with a new set of side effects.  Together, both conditions appear invincible, but I always fight back. Depression tells me to die instead of taking the pills from the container. Depression tells me the darkness is here to stay.  Depression steals my energy and my smiles. When I am always outnumbered, and the fight is unfair, I wonder how much of who I have become is due to the medication and how much is truly me.

Too often, with epilepsy comes shame. All through grade school, I heard kids at school make fun of seizures and even pretend to have seizures. I listened and watched. As one of the quietest students in class, my lips felt zippered shut, but my face turned red. They did not know what it feels like to lose control of your body. They didn’t know what it was like to wake up confused and disoriented, not knowing how long the seizure lasted or what was happening before it. I was not brave enough to speak up.

My closest friends didn’t know I had epilepsy. I snuck away at sleepovers to take my medication at 8:00 p.m. I made excuses as to why I couldn’t drive, why I wouldn’t drink alcohol, why I occasionally arrived to school late, why I visited a hospital that was over an hour away rather than the local doctor’s office, or why there was a bruise on my forehead.  When I started telling people outside of my family, they would reply with phrases such as “I didn’t know that you were an epileptic,” “I need to be careful around you,” or “At least it’s not something terminal.” They may not have known their words were insensitive or hurtful, but I have never been met with comfort or acceptance after telling my story. Only shame.

Epilepsy can be somewhat of an invisible illness. Sometimes I can hide it. Other times, I can’t. Epilepsy is much more than having seizures.  For some people, myself included, it’s a lifelong challenge.

Having epilepsy can mean battling depression, anxiety, insomnia, muscle weakness, lethargy, weight gain, and a host of other negative side effects from seizures and medications. It can mean staying home from work or school because of an aura. It can mean keeping secrets from best friends. It can mean refusing to give up regardless of what others think and say, how many medications you’ve tried, and the side effects that never subside. I have often wondered who I would be without epilepsy. While I fight the shame and stigma within myself, I have learned and accepted that epilepsy is a part of who I am.

But only one part.

RESOURCES

If you or someone you know needs help, visit our suicide prevention resources.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.

via Epilepsy Is About More Than Seizures | The Mighty

, , , , ,

Leave a comment

[REVIEW] Epilepsy: A Stigma More than Disease – Full Text PDF

Abstract

Epilepsy is a common neurological disorder that occurs from ancient times and accompanying with convulsions or seizures. Epilepsy has revealed a genetic basis. Epilepsy which is considered as a neurodevelopmental disorder has reduced the life expectancy and associated with various stigmatized attitudes or beliefs. Epilepsy and seizures can develop in any person both in male and female at any age. Head trauma and brain strokes are the major causes of epilepsy in adults. Epilepsy accompanied by changes in behavior, personality, and cognition. Several aspects of epilepsy can affect the brain and behavior. Stigma is a reality for a lot of people with a mental disorder. It is a mark of disgrace which sets a person apart from others. Negative attitudes and beliefs create prejudice which leads to negative actions and discrimination. Stigma and social exclusions are stereotyped characteristics of epilepsy. Someone with a mental illness known to be a dangerous and senseless rather than saying in poor health conditions. There are no effective cures for an epileptic people. Besides, many epileptic therapies or cures are still available for the diagnosis and prevention of people with epilepsy. Epilepsy treatment entails how epilepsy is treated and which techniques and antiepileptic drugs are used.

Full Text PDF

, , , ,

Leave a comment

[Abstract + References] The impact of maternal epilepsy on delivery and neonatal outcomes

Abstract

Purpose

Epilepsy is a common neurological disorder that may complicate reproductive health. Our aim in this study was to provide prospective ascertainment of obstetric and neonatal outcomes in women with epilepsy and investigate whether the risk of pregnancy, delivery, and neonatal complications differed between women with epilepsy and women without epilepsy.

Methods

Pregnant women with epilepsy and women without epilepsy (control group) were prospectively evaluated during the years 2013–2018. They were regularly followed by a neurologist and obstetrician until the end of pregnancy.

Results

Delivery and perinatal outcomes were compared between 112 women diagnosed with epilepsy and 277 women without epilepsy. Epilepsy was a significant risk factor for preterm delivery, cesarean section, fetal hypoxia, and Apgar score ≤ 7 at 5 min in offspring (odds ratio (OR) = 2.83, 95% confidence interval (CI) 1.03–7.76; OR = 5.61, 95% CI 3.44–9.14; OR = 1.81, 95% CI 1.08–3.04; OR = 8.12, 95% CI 4.04–16.35, respectively). Seizures during pregnancy had influence on the preference of cesarean section as a mode of delivery (ОR = 3.39; 95% CI 1.40–8.17). The rate of perinatal hypoxia was significantly higher in children born by cesarean section (ОR = 2.84; 95% CI 1.04–7.76). There was no significant difference between women with epilepsy and controls in malformation rate.

Conclusions

Women with epilepsy had an increased risk of pregnancy and delivery complications. Cesarean section was associated with an increased risk of complications in offspring.

 

References

  1. 1.
    Harden C (2008) Antiepileptic drug teratogenesis: what are the risks for congenital malformations and adverse cognitive outcomes? Int Rev Neurobiol 83:205–213.  https://doi.org/10.1016/S0074-7742(08)00011-1CrossRefPubMedGoogle Scholar
  2. 2.
    Bromley R, Baker G (2017) Fetal antiepileptic drug exposure and cognitive outcomes. Seizure 44:225–231.  https://doi.org/10.1016/j.seizure.2016.10.006CrossRefPubMedGoogle Scholar
  3. 3.
    Leach J, Smith P, Craig J, Bagary M, Cavanagh D, Duncan S et al (2017) Epilepsy and pregnancy: for healthy pregnancies and happy outcomes. Suggestions for service improvements from the Multispecialty UK Epilepsy Mortality Group. Seizure 50:67–72.  https://doi.org/10.1016/j.seizure.2017.05.004CrossRefPubMedGoogle Scholar
  4. 4.
    Borthen I, Eide M, Veiby G, Daltveit A, Gilhus N (2009) Complications during pregnancy in women with epilepsy: population-based cohort study. BJOG 116(13):1736–1742.  https://doi.org/10.1111/j.1471-0528.2009.02354.xCrossRefPubMedGoogle Scholar
  5. 5.
    Artama M, Braumann J, Raitanen J, Uotila J, Gissler M, Isojärvi J et al (2017) Women treated for epilepsy during pregnancy: outcomes from a nationwide population-based cohort study. Acta Obstet Gynaecol Scand 96(7):812–820.  https://doi.org/10.1111/aogs.13109CrossRefGoogle Scholar
  6. 6.
    Borthen I, Eide M, Daltveit A, Gilhus N (2010) Delivery outcome of women with epilepsy: a population-based cohort study. BJOG 117:1537–1543.  https://doi.org/10.1111/j.1471-0528.2010.02694.xCrossRefPubMedGoogle Scholar
  7. 7.
    Borthen I (2015) Obstetrical complications in women with epilepsy. Seizure 28:32–34.  https://doi.org/10.1016/j.seizure.2015.02.018CrossRefPubMedGoogle Scholar
  8. 8.
    Sveberg L, Svalheim S, Taubøll E (2015) The impact of seizures on pregnancy and delivery. Seizure 28:35–38.  https://doi.org/10.1016/j.seizure.2015.02.020CrossRefPubMedGoogle Scholar
  9. 9.
    Razaz N, Tomson T, Wikström A, Cnattingius S (2017) Association between pregnancy and perinatal outcomes among women with epilepsy. JAMA Neurol 74(8):983–991.  https://doi.org/10.1001/jamaneurol.2017.1310CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hiilesmaa V, Bardy A, Teramo K (1985) Obstetric outcome in women with epilepsy. Am J Obstet Gynecol 152(5):499–504CrossRefGoogle Scholar
  11. 11.
    Viinikainen K, Heinonen S, Eriksson K, Kälviäinen R (2006) Community-based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia 47:186–192.  https://doi.org/10.1111/j.1528-1167.2006.00386.xCrossRefPubMedGoogle Scholar
  12. 12.
    Richmond J, Krishnamoorthy P, Andermann E, Benjamin A (2004) Epilepsy and pregnancy: an obstetric perspective. Am J Obstet Gynecol 190(2):371–379CrossRefGoogle Scholar
  13. 13.
    Pilo C, Wide K, Winbladh B (2006) Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs. Acta Obstet Gynecol Scand 85:643–646.  https://doi.org/10.1080/00016340600604625CrossRefPubMedGoogle Scholar
  14. 14.
    Thomas S, Sindhu K, Ajaykumar B, Sulekha D, Sujamol J (2009) Maternal and obstetric outcome on in women with epilepsy. Seizure 18(3):163–166.  https://doi.org/10.1016/j.seizure.2008.08.010CrossRefPubMedGoogle Scholar
  15. 15.
    Hvas C, Henriksen T, Оstergaard J, Mogens D (2000) Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight. Br J Obstet Gynaecol 107:896–902CrossRefGoogle Scholar
  16. 16.
    Yerby MS (2000) Quality of life, epilepsy advances, and the evolving role of anticonvulsants in women with epilepsy. Neurology 55(5 Suppl 1):21–31 discussion S 54-8Google Scholar
  17. 17.
    Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Perucca E, Sabers A, Thomas SV, Vajda F, EURAP Study Group (2015) Antiepileptic drugs and intrauterine death: a prospective observational study from EURAP. Neurology 85(7):580–588.  https://doi.org/10.1212/WNL.0000000000001840CrossRefPubMedGoogle Scholar
  18. 18.
    Kasradze S, Gogatishvili N, Lomidze G, Ediberidze T, Lazariashvili M, Khomeriki K, Mamukadze S, Metreveli M, Gagoshidze T, Tatishvili N, Tomson T (2017) Cognitive functions in children exposed to antiepileptic drugs in utero – study in Georgia. Epilepsy Behav 66:105–112.  https://doi.org/10.1016/j.yebeh.2016.10.014CrossRefPubMedGoogle Scholar
  19. 19.
    Katz O, Levy A, Wiznitzer A, Sheiner E (2006) Pregnancy and perinatal outcome in epileptic women: a population-based study. J Matern Fetal Neonatal Med 19(1):21–25.  https://doi.org/10.1080/14767050500434096CrossRefPubMedGoogle Scholar
  20. 20.
    Shahla M, Hijran B, Sharif M (2018) The course of epilepsy and seizure control in pregnant women. Acta Neurol Belg 118:459–464.  https://doi.org/10.1007/s13760-018-0974-0CrossRefPubMedGoogle Scholar
  21. 21.
    Thomas S, Syam U, Devy J (2012) Predictors of seizures during pregnancy in women with epilepsy. Epilepsia 53(5):e85–e88.  https://doi.org/10.1111/j.1528-1167.2012.03439.xCrossRefGoogle Scholar
  22. 22.
    Ozdemir O, Mustafa E, Aslihan K, Selimova V, Atalay C (2015) Pregnancy outcome of 149 pregnancies in women with epilepsy: experience from a tertiary care hospital. Interv Med Appl Sci 7(3):108–113.  https://doi.org/10.1556/1646.7.2015.3.4CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Vajda F, O’Brien T, Graham J, Hitchcock A, Lander C, Eadie M (2018) Predicting epileptic seizure control during pregnancy. Epilepsy Behav 78:91–95.  https://doi.org/10.1016/j.yebeh.2017.10.017CrossRefPubMedGoogle Scholar
  24. 24.
    Soontornpun A, Choovanichvong T, Tongsong T (2018) Pregnancy outcomes among women with epilepsy: a retrospective cohort study. Epilepsy Behav 82:52–56.  https://doi.org/10.1016/j.yebeh.2018.03.001CrossRefPubMedGoogle Scholar
  25. 25.
    Borthen I, Eide M, Daltveit A, Gilhus N (2011) Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG 118(8):956–965.  https://doi.org/10.1111/j.1471-0528.2011.03004.xCrossRefPubMedGoogle Scholar
  26. 26.
    Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, Mccorry D, Bagary M, EBM CONNECT Collaboration et al (2015) Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 386(10006):1845–1852.  https://doi.org/10.1016/S0140-6736(15)00045-8CrossRefPubMedGoogle Scholar
  27. 27.
    Kusznir Vitturi B, Barreto Cabral F, Mella Cukiert C (2019) Outcomes of pregnant women with refractory epilepsy. Seizure 69:251–257CrossRefGoogle Scholar
  28. 28.
    MacDonald S, Bateman B, McElrath T, Hernández-Díaz S (2015) Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol 72(9):981–988.  https://doi.org/10.1001/jamaneurol.2015.1017CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Vajda F, O’Brien T, Graham J, Hitchcock A, Kuhn Viale L, Allotey JR, Lander C, Eadie M (2018) Cesarean section in Australian women with epilepsy. Epilepsy Behav 89:126–129.  https://doi.org/10.1016/j.yebeh.2018.10.008CrossRefPubMedGoogle Scholar
  30. 30.
    Veiby G, Daltveit A, Engelsen B, Gilhus N (2009) Pregnancy, delivery, and outcome for the child in maternal epilepsy. Epilepsia 50(9):2130–2139.  https://doi.org/10.1111/j.1528-1167.2009.02147.xCrossRefPubMedGoogle Scholar
  31. 31.
    Tollanes M (2009) Increased rate of caesarean sections – causes and consequences. Tidsskr Nor Legeforen 129:1329–1331.  https://doi.org/10.4045/tidsskr.08.0453CrossRefGoogle Scholar
  32. 32.
    Kolas T, Hofoss D, Daltveit A, Nilsen S, Henriksen T, Häger R et al (2003) Indications for cesarean deliveries in Norway. Am J Obstet Gynecol 188:864–870CrossRefGoogle Scholar
  33. 33.
    Othman N, Rahman A (2013) Obstetric and birth outcomes in pregnant women with epilepsy: a hospital-based study. Ann Indian Acad Neurol 16:534–537.  https://doi.org/10.4103/0972-2327.120458CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Chen Y, Chiou H, Lin H, Lin H (2009) Affect of seizures during gestation on pregnancy outcomes in women with epilepsy. Arch Neurol 66(8):979–984.  https://doi.org/10.1001/archneurol.2009.142CrossRefPubMedGoogle Scholar
  35. 35.
    Christensen J, Pedersen H, Kjaersgaard M, Parner E, Vestergaard M, Sørensenet M et al (2015) Apgar-score in children prenatally exposed to antiepileptic drugs: a population-based cohort study. BMJ Open 5:e007425.  https://doi.org/10.1136/bmjopen-2014-007425CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Farmen A, Grundt J, Nakling J, Mowinckel P, Nakken K, Lossius M (2019) Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway. Eur J Neurol 26(4):617–623.  https://doi.org/10.1111/ene.13865CrossRefPubMedGoogle Scholar
  37. 37.
    Liporace J, D’Abreu A (2003) Epilepsy and women’s health: family planning, bone health, menopause, and menstrual-related seizures. Mayo Clin Proc78 78:497–506CrossRefGoogle Scholar
  38. 38.
    Rauchenzauner M, Ehrensberger M, Prieschl M, Kapelari K, Bergmann M, Walser G, Neururer S, Unterberger I, Luef G (2013) Generalized tonic-clonic seizures and antiepileptic drugs during pregnancy – a matter of importance for the baby? J Neurol 260:484–488.  https://doi.org/10.1007/s00415-012-6662-8CrossRefPubMedGoogle Scholar
  39. 39.
    Quiroz L, Chang H, Blomquist J, Okoh Y, Handa V (2008) Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting. Am J Perinatol 26(4):271–277.  https://doi.org/10.1055/s-0028-1103155CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kamath B, Todd J, Glazner J, Lezotte D, Lynch A (2009) Neonatal outcomes after elective cesarean delivery. Obstet Gynecol 113(6):1231–1238.  https://doi.org/10.1097/AOG.0b013e3181a66d57ıCrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Pennell PB (2008) Antiepileptic drugs during pregnancy: what is known and which AEDs seem to be safest? Epilepsia 49(Suppl 9):43–55.  https://doi.org/10.1111/j.1528-1167.2008.01926.xCrossRefPubMedGoogle Scholar
  42. 42.
    Tomson T, Xue H, Battino D (2015) Major congenital malformations in children of women with epilepsy. Seizure 28:46–50.  https://doi.org/10.1016/j.seizure.2015.02.019CrossRefPubMedGoogle Scholar
  43. 43.
    Galappatthy P, Liyanage CK, Lucas MN et al (2018) Obstetric outcomes and effects on babies born to women treated for epilepsy during pregnancy in a resource limited setting: a comparative cohort study. BMC Pregnancy Childbirth 18(1):230.  https://doi.org/10.1186/s12884-018-1857-3CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Battino D, Tomson T, Bonizzon E, Craig J, Lindhout D, Sabers A et al (2013) Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia 54(9):1621–1627.  https://doi.org/10.1111/epi.12302CrossRefPubMedGoogle Scholar
  45. 45.
    Mawhinney E, Craig J, Morrow J, Russell A, Smithson W, Parsons L, Morrison PJ, Liggan B, Irwin B, Delanty N, Hunt SJ (2013) Levetiracetam in pregnancy: results from the UK and Ireland epilepsy and pregnancy registers. Neurology 80(4):400–405.  https://doi.org/10.1212/WNL.0b013e31827f0874CrossRefPubMedGoogle Scholar
  46. 46.
    Kazemi M, Salehi M, Kheirollahi M (2016) Down syndrome: current status, challenges and future perspectives. Int J Mol Cell Med 5(3):125–133PubMedPubMedCentralGoogle Scholar
  47. 47.
    Veiby G, Bjørk M, Engelsen B, Gilhus N (2015) Epilepsy and recommendations for breastfeeding. Seizure 28:57–65.  https://doi.org/10.1016/j.seizure.2015.02.013CrossRefPubMedGoogle Scholar
  48. 48.
    Stephen L, Harden C, Tomson T, Brodie M (2019) Management of epilepsy in women. Lancet Neurol 18(5):481–491.  https://doi.org/10.1016/S1474-4422(18)30495-2CrossRefPubMedGoogle Scholar
  49. 49.
    He S, Zhu H, Qiu X, Zhu X, Peng A, Duan J, Chen L (2017) Pregnancy outcome in women with epilepsy in Western China: a prospective hospital based study. Epilepsy Behav 74:10–14.  https://doi.org/10.1016/j.yebeh.2017.05.034CrossRefPubMedGoogle Scholar
  50. 50.
    Johnson E, Burke A, Wang A, Pennell P (2018) Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy. Neurology 91(11):e1031–e1039.  https://doi.org/10.1212/WNL.0000000000006173CrossRefPubMedGoogle Scholar

via The impact of maternal epilepsy on delivery and neonatal outcomes | SpringerLink

, , , , , ,

Leave a comment

[Review] Ketogenic Diet and Epilepsy – Full Text PDF

Abstract

Currently available pharmacological treatment of epilepsy has limited effectiveness.
In epileptic patients, pharmacological treatment with available anticonvulsants leads to seizure control in <70% of cases. Surgical intervention can lead to control in a selected subset of patients, but still leaves a significant number of patients with uncontrolled seizures. Therefore, in drug-resistant epilepsy, the ketogenic diet proves to be useful. The purpose of this review was to provide a comprehensive overview of what was published about the benefits of ketogenic diet treatment in patients with epilepsy. Clinical data on the benefits of ketogenic diet treatment in terms of clinical symptoms and adverse reactions in patients with epilepsy have been reviewed. Variables that could have influenced the interpretation of the data were also discussed (e.g., gut microbiota). The data in this review contributes to a better understanding of the potential benefits of a ketogenic diet in the treatment of epilepsy and informs scientists, clinicians, and patients—as well as their families and caregivers—about the possibilities of such treatment. Since 1990, the number of publications on attempts to treat drug-resistant epilepsy with a ketogenic diet has grown so rapidly that it has become a challenge to see the overall trajectory and major milestones achieved in this field. In this review, we hope to provide the latest data from randomized clinical trials, practice guidelines, and new research areas over the past 2 years.

[…]

Download Full Text PDF 

, , , , , , ,

Leave a comment

[Abstract] Vagus Nerve Stimulation for the Treatment of Epilepsy

First page of article

Vagus nerve stimulation (VNS) was the first neuromodulation device approved for treatment of epilepsy. In more than 20 years of study, VNS has consistently demonstrated efficacy in treating epilepsy. After 2 years, approximately 50% of patients experience at least 50% reduced seizure frequency. Adverse events with VNS treatment are rare and include surgical adverse events (including infection, vocal cord paresis, and so forth) and stimulation side effects (hoarseness, voice change, and cough). Future developments in VNS, including closed-loop and noninvasive stimulation, may reduce side effects or increase efficacy of VNS.

via Vagus Nerve Stimulation for the Treatment of Epilepsy – Neurosurgery Clinics

, , , ,

Leave a comment

[Infographic] First Seizure Management

 

, ,

Leave a comment

[Infographic] Operational Classification of Seizure Types

, , ,

Leave a comment

[WEB SITE] Stem cell-derived neurons stop seizures and improve cognitive function

People with untreatable epilepsy may one day have a treatment: ‘Convincing’ their own cells to become the neurons they need

IMAGE

IMAGE: THIS IS ASHOK K. SHETTY. 
CREDIT: TEXAS A&M UNIVERSITY HEALTH SCIENCE CENTER.

About 3.4 million Americans, or 1.2 percent of the population, have active epilepsy. Although the majority respond to medication, between 20 and 40 percent of patients with epilepsy continue to have seizures even after trying multiple anti-seizure drugs. Even when the drugs do work, people may develop cognitive and memory problems and depression, likely from the combination of the underlying seizure disorder and the drugs to treat it.

A team led by Ashok K. Shetty, PhD, a professor in the Department of Molecular and Cellular Medicine at the Texas A&M College of Medicine, associate director of the Institute for Regenerative Medicine and a research career scientist at the Olin E. Teague Veterans’ Medical Center, part of the Central Texas Veterans Health Care System, is working on a better and permanent treatment for epilepsy. Their results published this week in the Proceedings of the National Academy of Sciences (PNAS).

Seizures are caused when the excitatory neurons in the brain fire too much and inhibitory neurons–the ones that tell the excitatory neurons to stop firing–aren’t as abundant or aren’t operating at their optimal level. The main inhibitory neurotransmitter in the brain is called GABA, short for gamma-Aminobutyric acid.

Over the last decade, scientists have learned how to create induced pluripotent stem cells from ordinary adult cells, like a skin cell. These stem cells can then be coaxed to become virtually any type of cells in the body, including neurons that use GABA, called GABAergic interneurons.

“What we did is transplant human induced pluripotent stem cell-derived GABAergic progenitor cells into the hippocampus in an animal model of early temporal lobe epilepsy,” Shetty said. The hippocampus is a region in the brain where seizures originate in temporal lobe epilepsy, which is also important for learning, memory and mood. “It worked very well to suppress seizures and even to improve cognitive and mood function in the chronic phase of epilepsy.”

Further testing showed that these transplanted human neurons formed synapses, or connections, with the host excitatory neurons. “They were also positive for GABA and other markers of specialized subclasses of inhibitory interneurons, which was the goal,” Shetty said. “Another fascinating aspect of this study is that transplanted human GABAergic neurons were found to be directly involved in controlling seizures, as silencing the transplanted GABAergic neurons resulted in an increased number of seizures.”

“This publication by Dr. Shetty and his colleagues is a major step forward in treating otherwise incurable diseases of the brain,” said Darwin J. Prockop, MD, PhD, the Stearman Chair in Genomic Medicine, director of the Texas A&M Institute for Regenerative Medicine and professor at the Texas A&M College of Medicine. “One important aspect of the work is that the same cells can be obtained from a patient.” This type of process, called autologous transplant, is patient specific, meaning that there would be no risk of rejection of the new neurons, and the person wouldn’t need anti-rejection medication.

“We will need to make sure that we’re doing more good than harm,” Shetty said. “Going forward, we need to make sure that all of the cells transplanted have turned into neurons, because putting undifferentiated pluripotent stem cells into the body could lead to tumors and other problems.”

The development of epilepsy often happens after a head injury, which is why the Department of Defense is interested in funding the development of better treatment and prevention options.

“A great deal of research is required before patients can be safely treated,” Prockop said. “But this publication shows a way in which patients can someday be treated with their own cells for the devastating effects of epilepsy but perhaps also other diseases such as Parkinsonism and Alzheimer’s disease.”

Shetty cautioned that these tests were early interventions after the initial brain injury induced by status epilepticus, which is a state of continuous seizures lasting more than five minutes in humans. The next step is to see if similar transplants would work for cases of chronic epilepsy, particularly drug-resistant epilepsy. “Currently, there is no effective treatment for drug-resistant epilepsy accompanying with depression, memory problems, and a death rate five to 10 times that of the general population,” he said. “Our results suggest that induced pluripotent stem cell-derived GABAergic cell therapy has the promise for providing a long-lasting seizure control and relieving co-morbidities associated with epilepsy.”

 

via Stem cell-derived neurons stop seizures and improve cognitive function | EurekAlert! Science News

, , , , ,

Leave a comment

[Editorial] New Directions in the Management of Status Epilepticus – Neurology

Status Epilepticus (SE) is a neurological emergency and has high morbidity and mortality. The International League Against Epilepsy (ILAE) recently updated their definition to specify that, “SE is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures.” Such phenomena can lead to long-term neurological complications due to neuronal death, glia, neurological injury, aberrant neuroplasticity, oxidative stress and inflammation, and alteration of neuronal networks. Depending upon the type and duration of SE, these mechanisms are quite variable. Therefore, in response to the updated definition of SE, novel avenues of research are required to address the specified involvement of the underlying mechanisms and pathophysiology resulting in the development of and outcomes from SE.

Improving the basic science understanding of SE will facilitate essential clinical trials. One can envision such experiments to include device and compound-based technological interventions directed at aborting the seizure activity and improving clinical outcomes. Benzodiazepines remain one of the cornerstones of treatment, and studies are underway to study new delivery options, including intranasal, buccal, and intramuscular midazolam, in addition to rectal diazepam, with the goal of aborting the seizure activity outside the hospitals, as rapidly as possible. Approved and off-label anticonvulsants, such as phenytoin, phenobarbital, valproate, topiramate, levetiracetam, lacosamide, steroids, immunosuppressants, and neuroprotective compounds, have also shown some efficacy at treating SE. However, substantial challenges remain in optimally managing SE and minimizing the short- and long-term complications. Such difficulties can be overcome by innovative approaches targeting the underlying mechanisms of neuronal excitability, glia, neuronal death, neuroplasticity, oxidative stress, inflammation, and neuroinflammation.

The book comprises six original research articles and four reviews. Collectively, the materials provide insights into the pathophysiology, clinical presentation, treatment, recent advances and future directions in the management of SE, with the goal of providing an in-depth view and advancing the field to improve management of SE.

The book opens with an original research article by Kristin Phillips et al. which showed the role of hypothermia as a neuroprotective agent for preventing the development of calcium plateau against SE-induced delayed hippocampal injury. Hypothermia-mediated neuroprotection after pilocarpine-induced SE was evident from decreased Fluoro-Jade C+ neurons in the hippocampus. The second original article by Matos et al. described SE-induced changes in spontaneous locomotor activity and the temporal expression of genes related to circadian rhythms (Clock, Bmal1, Cry1, Cry2, Per1, Per2, and Per3) in the hippocampus at both early post-SE and chronic epilepsy phases. Authors propose that seizures can act as a non-photic cue and altered temporal expression of clock genes likely contributes to the pathogenesis of mesial temporal lobe epilepsy. The third original article by Hutson et al. presented an interesting case study which showed evidence of brain dynamics resetting after successful anticonvulsant treatment following SE utilizing stereo encephalography (SEEG) data.

A review by Kirmani et al. conferred the current literature about autoimmune SE including therapeutic options and future directions. An original research article by Wyatt-Johnson et al. reported that SE-induced morphological alterations in microglia at different time-points and discussed the role of such changes on epileptogenesis. Another research article by Kortland et al. addressed the socioeconomic outcome and quality of life outcome in adults after status epilepticus in their original article. The authors conducted a multicenter, longitudinal, matched case-control analysis and concluded that relatively favorable outcomes seen in patients with refractory and super refractory SE as compared to non-refractory SE cases underlying the need of effective therapeutic choices.

An original research article by Bertoglio et al. compared the effects of two different protocols of kainate-induced SE in two strains of rats on neurodegeneration and chronic epilepsy development. The findings revealed that severe neuron loss after SE does not necessarily correlate with a higher seizure rate in the chronic phase after SE. In a review article, Castro et al. discussed the efficacy and promise of resveratrol, a phytoalexin found in the skin of red grapes, for easing SE-induced neurodegeneration, neuroinflammation, aberrant neurogenesis and for restraining the evolution of SE-induced brain injury into a chronic epileptic state. Sharma et al. by reviewing methods of induction and characterization of behavioral SE and EEG correlates in mice and rats, highlighted the advantages of a repeated low dose of kainate protocol for minimizing the variability in the initial SE severity and reducing the mortality rate. The last original article by Lucchi et al. described the role peroxisome proliferator-activated receptor gamma in the anticonvulsant properties of EP-80317, a Ghrelin receptor antagonist in pilocarpine-induced SE rat model and repeated 6 Hz corneal stimulation model in mice.

via Frontiers | Editorial: New Directions in the Management of Status Epilepticus | Neurology

, , , ,

Leave a comment

%d bloggers like this: