Could a baby have a seizure? Review the signs and what you can do...

Signs of Seizures in Babies

Is your baby having a seizure? Find out the signs of seizures in babies and what to do if your child has one.

By Jeannette Moninger

Good review of the signs of seizures in babies and what you can do if you think your child may be having them. -JR

About 5 percent of Americans will experience a seizure at some point in their lives, with newborns and very young children at highest risk. Seizures happen when cells in the brain have abnormal electrical activity, temporarily disrupting the brain's normal electrical signals. "It's like a short circuit in the brain," says Adam Hartman, M.D., assistant professor of Neurology and Pediatrics at the Johns Hopkins Children's Center in Baltimore. Epilepsy is the most common cause of seizures, but many things, including birth trauma, brain disorders, and chemical imbalances, can trigger them. Often, doctors can't determine the reason for a seizure.

When you picture someone having a seizure, you probably envision a jerking, shaking body and a temporary loss of consciousness. But signs of seizures often are subtler in babies, Dr. Hartman notes. "At first, you might not notice that anything is wrong." Because the types of seizures that affect infants are different than those affecting adults, it is important to know these signs.

Signs of Seizures in Babies

• Febrile seizures. Your baby may roll her eyes, and her limbs may either stiffen or twitch and jerk. Up to 4 out of every 100 children age 6 months to 5 years have one of these seizures, which are triggered by high fevers, usually above 102°.
• Infantile spasms. This rare type of seizure occurs during an infant's first year (typically between 4 and 8 months). Your baby may bend forward or arch her back as her arms and legs stiffen. These spasms tend to occur when a child is waking up or going to sleep, or after a feeding. Infants can have hundreds of these seizures a day.
• Focal seizures. Your baby may sweat, vomit, become pale, and experience spasms or rigidity in one muscle group, such as fingers, arms, or legs. You may also observe gagging, lip smacking, screaming, crying, and loss of consciousness.
• Absence (petit mal) seizures. Your baby appears to be staring into space or daydreaming. She may blink rapidly or appear to be chewing. These episodes typically last less than 30 seconds and may occur several times a day.
• Atonic (drop attack) seizures. Your baby experiences a sudden loss of muscle tone that makes her go limp and unresponsive. Her head may drop suddenly, or if she is crawling or walking she might fall to the floor.
• Tonic seizures. Parts of your baby's body (arms, legs) or her entire body suddenly stiffen.
• Myoclonic seizures. A group of muscles, usually in the baby's neck, shoulders, or upper arms, starts to jerk. These seizures usually occur in clusters, several times a day and several days in a row.

What to do if Your Baby Has a Seizure

See your pediatrician if you think your baby is having seizures. "If possible, take a video of the episode on your smartphone to show to your doctor," suggests Dr. Hartman, who is also a member of the American Academy of Pediatrics' (AAP) Section on Neurology. It's important to pay attention to these things:

• How long the seizure lasts
• Where the seizure started (arms, legs, eyes) and whether it spread to other body parts
• What the movement looked like (staring, jerking, stiffening)
• What your baby was doing right before the episode (waking up, eating)

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What is the best medicine for children with seizures?

This article discusses what is the best medication for children with seizures.

A recently published clinical study in the Journal of the American Medical Association has answered an urgent question that long puzzled ER pediatricians: Is the drug lorazepam really safer and more effective than diazepam – the U.S. Food and Drug Administration-approved medication as first line therapy most often used by emergency room doctors to control major epileptic seizures in children?

The answer to that question – based on a double-blind, randomized clinical trial that compared outcomes in 273 seizure patients, about half of whom were given lorazepam – is a clear-cut "no," said Prashant V. Mahajan, M.D., M.P.H., M.B.A, one of the authors of the study.

"The results of our clinical trial were very convincing, and they showed clearly that the two medications are just about equally effective and equally safe when it comes to treating status epilepticus [major epileptic brain seizures in children]," Dr. Mahajan said. "This is an important step forward for all of us who frequently treat kids in the ER for [epilepsy-related] seizures, since it answers the question about the best medication to use in ending the convulsions and getting these patients back to normal brain functioning."

Describing the brain convulsions that were targeted by the study, its authors pointed out that status epilepticus occurs when an epilepsy-related seizure lasts more than 30 minutes. Such seizures – which occur in more than 10,000 U.S. pediatric epilepsy patients every year – can cause permanent brain damage or even death, if allowed to persist.

Published in JAMA, the study, "Lorazepam vs Diazepam for Pediatric Status Epilepticus: A Randomized Clinical Trial," was designed to test earlier assertions by many clinicians that lorazepam was more effective at controlling pediatric seizures. The study-authors wrote, "Potential advantages proposed in some studies of lorazepam include improved effectiveness in terminating convulsions, longer duration of action compared with diazepam, and lower incidence of respiratory depression. Specific pediatric data comparing diazepam with lorazepam suggest that lorazepam might be superior, but they are limited to reports from single institutions or retrospective studies with small sample sizes, thus limiting generalizability."

Based on data collected over four years at 11 different U.S. pediatric emergency departments, the new study found that "treatment with lorazepam [among pediatric patients with convulsive status epilepticus] did not result in improved efficacy or safety, compared with diazepam."

That determination led the study authors to conclude: "These findings do not support the preferential use of lorazepam for this condition."

Dr. Mahajan, a nationally recognized researcher in pediatric emergency medicine and a Wayne State University School of Medicine pediatrics professor recently appointed chair of the American Academy of Pediatrics Executive Committee of the Section on Emergency Medicine, said the JAMA study provides "a compelling example of how effective research in pediatric medicine, based on treatment of patients right in the clinical setting, can play a major role in improving outcomes."

Children's Hospital of Michigan Chief of Pediatrics Steven E. Lipshultz, M.D., said this recent breakthrough will "undoubtedly result in better care for pediatric patients who present in the emergency room with seizures related to epilepsy.

"There's no doubt that combining excellent research with excellent treatment is the key to achieving the highest-quality outcomes for patients – and Dr. Mahajan's cutting-edge study is a terrific example of how kids are benefiting from the research that goes on here at Children's every single day," said Dr. Lipshultz.

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How a child's fever can turn into a seizure

This article discusses how a child's fever can turn into a seizure, and explains the different types of seizures.

When a child has a fever, their body can ache. They are restless and they just don’t feel well. While a fever is a part of our natural response to infection, the fever itself can lead to complications. One rare complication is a febrile seizure. A febrile seizure is when your child (ages six months to six years of age) experiences convulsions that occur in the setting of a fever.

Parents can’t imagine too many things more distressing than seeing their already-ill child suffer through a seizure, but febrile seizures are usually not life threatening.

During a febrile seizure, a child:

• Will lose consciousness
• Experience body stiffness
• Have full-body shaking

A seizure lasts only a minute or two, but can go on longer. Febrile seizures rarely require medication. The majority of the cases physicians see do not require hospital admission.

Facts about febrile seizures

• Majority of seizures occur between 12 and 18 months of age.
• The most common type of childhood seizure, affecting 2 to 5 percent of children.
• The exact cause in which a fever can provoke a seizure in this age group is not fully understood, genetic predisposition is a factor.
• Children who suffer a febrile seizure do not have epilepsy. That diagnosis requires the presence of two or more seizures that were not caused by a fever.
• Seizures due to an infection of the brain and its protective lining (meninges) or seizures associated with metabolic problems are not febrile seizures.

Two categories of febrile seizures

Febrile seizures are divided into two categories: simple and complex febrile seizures.

1. Simple

These types of seizures are more common. They involve full-body shaking and last less than 15 minutes. Studies show that simple febrile seizures do not affect future school performance or intelligence.

2. Complex

A febrile seizure is considered complex if it affects only a part of the body, lasts longer than 15 minutes or recurs within 24 hours. Complex febrile seizures have a slightly higher rate of future complications.

Is there a connection between epilepsy and febrile seizures?

The chances of epilepsy developing in a healthy developmentally typical child who has had a simple febrile seizure are estimated to be 2 to 4 percent, while the rate in the general population is about 1 to 2 percent. Although febrile seizures are scary, they are usually not associated with significant health problems. Short febrile seizures do not cause brain damage.

Four Steps: What you can do if your child has a seizure

If your child has a seizure, febrile or otherwise, it is important to stay calm. While you’re remaining calm, follow these four steps:

1. Your child should be placed on his or her side to prevent choking. There is no need to restrain or try to stop the shaking; the seizure will run its course regardless.
2. Never put anything in your child’s mouth. This can lead to chipped teeth, damaged gums or even a blocked airway.
3. Time the seizure. If your child’s seizure lasts more than five minutes, call 911. Medication may be needed to end the seizure.
4. Have your child evaluated that day. While brief seizures don’t require emergency services, the evaluation is mainly to check for the cause of your child’s fever.

Follow up care after a seizure

Treatment of febrile seizures is usually limited to fever-lowering agents such as acetaminophen or ibuprofen. These will not decrease the chance of having another febrile seizure, but will make your child more comfortable. Daily anti-seizure drugs are not recommended. Even though your child will be evaluated on the day of their seizure (step 4 above), certain situations require further diagnostic testing. If your child experiences a simple febrile seizure, he or she may not need to be hospitalized once their fever evaluation is complete. Blood and urine tests are only performed if needed to evaluate the fever.

If your child has a prolonged febrile seizure, they’ll be given a medication to use only if they have another long seizure. The chance of recurrence is generally 30 to 35 percent. Factors such as young age (less than 12 months) or a family history of seizures can increase the recurrence rate.

Seizures are scary, but knowing what to do if one occurs is important. If your child has a febrile seizure, make sure he or she sees your pediatrician or an emergency department physician as soon as possible. While simple febrile seizures are not harmful, we need to make sure they are not a symptom of a more serious illness. Talk with your pediatrician to determine if a consultation with apediatric neurology specialist is appropriate for your child.

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What to do if a child has a seizure

This article details what action to take if your child has a seizure.

Seeing a child suffer a seizure can terrify a parent. As part of Epilepsy Awareness Month in November, an expert offered some advice on how to deal with such a situation.

All first seizures in children require a medical evaluation, said Dr. Adam Hartman, a pediatric neurologist and epilepsy expert at Johns Hopkins Children's Center in Baltimore.

"If this is the first time your child is having a seizure, seek emergency medical care," he said in a Johns Hopkins news release.

Children with known epilepsy who have a breakthrough seizure -- one that occurs despite treatment -- do not typically require urgent medical attention unless:

• The seizure lasts more than five minutes.
• The seizure looks different from previous seizures.
• Several seizures occur in a cluster.
• The child remains unconscious for a few minutes following the seizure.
• The child struggles for air and is not getting enough oxygen, signaled by bluish lips or complexion.

The symptoms listed above may mean that the child is going into status epilepticus, a persistent, severe and life-threatening seizure that always requires emergency treatment, Hartman said.

During a seizure, don't put anything in the child's mouth and don't try to hold the child down. Clear the surrounding area and have the child lie on one side, rather than flat on their back, Hartman said. You can put a small pillow under the child's head.

After the seizure ends, allow the child to rest and check for injuries. Do not give the child anything to eat or drink until fully alert. Note the length of the seizure and the date and time it occurred.

Keep a seizure diary and inform the child's neurologist or primary-care pediatrician about all seizures. Pay attention to what might have triggered the seizure. Sleep deprivation, high fever, illness, and emotional or physical stress increase seizure risk among children with epilepsy.

"Children respond individually to stressors, so it's important to notice the factors that precipitate a seizure in your child and avoid them when and if possible," Hartman said.

Epilepsy, an umbrella term that encompasses more than 40 seizure disorders, affects nearly 3 million people in the United States. More than 320,000 of them are children under 15, according to the Epilepsy Foundation. About 45,000 children in the United States develop epilepsy each year.

More information

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The Epilepsy Foundation has more about epilepsy.

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Zebrafish help find model to treat childhood epilepsy

A study by the National Institute of Health (NIH) shows that zebrafish may help model a treatment for Dravet syndrome, a severe childhood epilepsy.

According to new research on epilepsy, zebrafish have certainly earned their stripes. Results of a study in Nature Communications suggest that zebrafish carrying a specific mutation may help researchers discover treatments for Dravet syndrome (DS), a severe form of pediatric epilepsy that results in drug-resistant seizures and developmental delays.

Scott C. Baraban, Ph.D., and his colleagues at the University of California, San Francisco (UCSF), carefully assessed whether the mutated zebrafish could serve as a model for DS, and then developed a new screening method to quickly identify potential treatments for DS using these fish. This study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health and builds on pioneering epilepsy zebrafish models first described by the Baraban laboratory in 2005.

Dravet syndrome is commonly caused by a mutation in the Scn1a gene, which encodes for Nav1.1, a specific sodium ion channel found in the brain. Sodium ion channels are critical for communication between brain cells and proper brain functioning.

The researchers found that the zebrafish that were engineered to have the Scn1a mutation that causes DS in humans exhibited some of the same characteristics, such as spontaneous seizures, commonly seen in children with DS. Unprovoked seizure activity in the mutant fish resulted in hyperactivity and whole-body convulsions associated with very fast swimming. These types of behaviors are not seen in normal healthy zebrafish.

“We were also surprised at how similar the mutant zebrafish drug profile was to that of Dravet patients,” said Dr. Baraban. “Antiepileptic drugs shown to have some benefits in patients (such as benzodiazepines or stiripentol) also exhibited some antiepileptic activity in these mutants. Conversely, many of the antiepileptic drugs that do not reduce seizures in these patients showed no effect in the mutant zebrafish.”

In this study, the researchers developed a fast and automated drug screen to quickly test the effectiveness of various compounds in mutant zebrafish. The researchers tracked behavior and measured brain activity in the mutant zebrafish to determine if the compounds had an impact on seizures.

“Scn1a mutants seize often, so it is relatively easy to monitor their seizure behavior at baseline and then again after a drug application,” said Dr. Baraban. “Using zebrafish placed individually in a 96-part petri dish we can accurately quantify this seizure behavior. In this way, we can test almost 100 fish at one time and quickly determine whether a drug candidate has any effect on these spontaneous seizures.”

In the first such application of this approach, UCSF researchers screened 320 compounds and found that clemizole was most effective in inhibiting seizure activity. Clemizole is approved by the U.S. Food and Drug Administration and has a safe toxicology profile. “This finding was completely unexpected. Based on what is currently known about clemizole, we did not predict that it would have antiepileptic effects,” said Dr. Baraban.

These findings suggest that Scn1a mutant zebrafish may serve as a good model of DS and that the drug screen may be effective in quickly identifying novel therapies for epilepsy.

Dr. Baraban also noted that someday these experiments can be “personalized,” by looking at mutated zebrafish that use genetic information from individual patients.

This research was funded by the Exceptional, Unconventional Research Enabling Knowledge Acceleration (EUREKA) program at NIH that supports innovative research with the potential for big impact in biomedical science.

“The goal of the EUREKA program is to provide a means to test high-risk ideas to see if they are worth pursuing further. These kinds of ideas often come from left field and are very creative. Since they are so unique, however, there may not be any existing preliminary data to support the hypothesis or demonstrate feasibility. EUREKA grants provide an opportunity to gather this information,” said Brandy Fureman, Ph.D., program director at NINDS.

This particular study was chosen in response to a request by NINDS to help spur novel research on epilepsy. “This research was selected for a EUREKA grant because it proposed a well-designed, inventive model of genetic epilepsy that could accelerate the pace of drug-screening for this devastating form of pediatric epilepsy” said Dr. Fureman.

Dr. Fureman noted that these findings not only describe a novel model of Dravet syndrome, but the positive results with an unexpected FDA-approved drug may lead to new therapeutic avenues. “There is more work to be done, but I am very pleased to see these initial results. These kinds of new directions are exactly what we hoped to stimulate with the EUREKA program,” she said.

For more information about Dravet syndrome and epilepsy, please visit:

• http://www.ninds.nih.gov/disorders/dravet_syndrome/dravet_syndrome.htm
• http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm

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Status Epilepticus

This article discusses Status Epilepticus, an extreme condition when seizures are close together and do not seem to stop. This is a serious condition that requires immediate attention.

Status epilepticus (SE)—persistent, continuous, unremitting seizure or rapidly recurring seizures—represents seizure activity at the extreme. While most seizures terminate spontaneously in fewer than 5 minutes, no one knows why normal mechanisms sometimes fail and allow SE to develop. SE is common, with an incidence of up to 41 per 100,000 people annually, and also life-threatening, with an estimated mortality of about 20%.^1-4 We tend to think of SE as a prolonged seizure of the clonictonic variety, but in actuality, SE occurs in a number of presentations.

SE may be the initial presentation of epilepsy in patients with no history of seizure, or an illness exacerbation in patients with documented epilepsy. Epilepsy and its complications are the cause in fewer than half of all cases of SE; it occurs pursuant to one of any number of neurologic insults, including infection, trauma, or stroke.³

Self-Sustaining Seizures

SE is generally defined as a state of persistent, continuous, unremitting seizure or rapidly recurring seizures that lasts more than 5 minutes or longer. Quick intervention is needed; 5 to 10 minutes is the threshold at which seizure activity is considered a medical emergency.⁵ At that point, neurologic damage begins to occur and the seizure is unlikely to resolve spontaneously. SE becomes epileptogenic (seizure sustaining) by enhancing hyperexcitable networks; the seizure becomes self-sustaining.^6-9 The longer the SE continues, the more likely that excitatory neurotransmitters will damage neurons and the poorer the prognosis.^10-12

SE may be convulsive or nonconvulsive. In both types, changes in electroencephalography (EEG) accompany SE. Usually, the patient loses consciousness or develops an altered sense of awareness. Coma may develop. Generalized convulsive SE is more common than nonconvulsive SE, accounting for 37% to 70% of cases.¹³ Convulsive SE is easily recognized by its sequential motor convulsions, and is associated with significant physiologic changes (Table 1^14,15).

Nonconvulsive SE, a more difficult condition to recognize, may involve altered or reduced consciousness up to and including coma, or exacerbations of the patient’s usual seizure pattern and sensations. Otherwise inexplicable behavioral abnormalities like coma, fugue states (an amnesia-like condition), sleepwalking, aphasia, or paranoia can occur.¹⁶

Among patients who have preexisting epilepsy diagnoses, approximately 15% will experience at least 1 episode of SE in their lifetimes. The most common cause of SE is a medication change or medication nonadherence. In these common cases, the prognosis for full recovery is good. Approximately 12% of patients with epilepsy learn that they have a seizure disorder when SE occurs as the presenting manifestation.^17,18

When epilepsy is absent, central nervous system (CNS) insult is often SE’s cause, with about one-fourth to one-third of cases falling into this category. Stroke is the most common cause of acute SE unrelated to epilepsy. In children, fever and infection are the most common causes. In older adults, cardiovascular disease is more important.^17-19Table 2^3,20 lists other conditions associated with SE.

Prognosis

Each patient’s prognosis depends on the etiology, the duration of seizure activity, and age.²¹ If the seizure is due to inadequate serum concentrations in a previously diagnosed epileptic patient, prognosis is good once serum levels are restored to normal. Similarly, if the SE is a presenting manifestation of epilepsy, prognosis is also good once the condition is managed with anticonvulsants.

If the etiology is one listed in Table 2, prognosis is directly correlated with the condition. More rapid diagnosis and better treatments have decreased mortality over the past 50 years. The old and the very old are more likely to die after experiencing SE, usually from the underlying cause.²²

Treatment

Although SE occurs in a range of presentations with some being more life-threatening than others, it always requires aggressive action. Emergency care is needed, with supportive care until the patient can be transported to a hospital. Emergency medical system personnel may administer anticonvulsants upon arrival if the seizure continues beyond 5 minutes. Rectal diazepam or midazolam given via the buccal or intranasal route are usually the first drugs tried at home or in the ambulance. Maintenance of respiratory function is critical.²³

Once the patient arrives at the hospital, the medical team will establish intravenous access for medication administration. Intravenous lorazepam is the first-line benzodiazepine. Emergency department personnel usually give a bolus dose of dextrose 50% with thiamine to prevent Wernicke’s encephalopathy in patients at risk for this complication. If drug intoxication is the probable cause, they may use naltrexone. Benzodiazepines followed by phenytoin, fosphenytoin, valproate, levetiracetam, or other antiepileptic drugs (AEDs) are the next step. If necessary, hospital personnel will intubate. Usual monitoring is supplemented with electroencephalogram.²³

Concurrently, the emergency team will use any medical history available from family or observers to determine the most reasonable approach. If the patient is epileptic, they will draw blood to determine if subtherapeutic levels are the cause. With all patients, they also perform diagnostic studies to identify a cause and treat it appropriately.

The Far End of the Spectrum

Refractory SE poses a treatment dilemma. When SE patients fail to respond to benzodiazepines or other AEDs, clinicians administer anesthesia to try to cease seizure activity. If SE continues for 24 hours or more after anesthesia begins or recurs when anesthesia is reduced or withdrawn, the patient is diagnosed with super-refractory status epilepticus (SRSE). SRSE occurs in about 10% to 15% of patients hospitalized with SE, and approximately 35% of these patients die.^9,21,22

Poorly understood and difficult to treat, SRSE is an enigma. Anesthesia with thiopental/pentobarbital, midazolam, or propofol is the best treatment choice, but clinicians must administer AEDs concurrently. No single AED has been proved significantly better than any other, and if polytherapy is selected, limiting the AEDs to 2 is prudent. Prescribers should avoid drugs that potentiate gamma aminobutyric acid.^9,21,24

Possible second-line therapies if anesthetics and AEDS fail include hypothermia; magnesium sulfate infusion; pyridoxine infusion; immunotherapy with steroids, intravenous immunoglobulin, or plasma exchange; or neurosurgery; and if the episode can be resolved, adherence to a ketogenic diet (high fat, moderate protein, low carbohydrate). Last-resort therapies include electroconvulsive therapy or cerebrospinal drainage.^9,21

Conclusion

Drug treatment’s exact role in SE remains unclear and evolving. The ideal intervention will be available as an intravenous agent, have few adverse effects, allow high CNS penetrance, be easily monitored, and provide rapid relief.

Until the ideal agent is found and tested, pharmacists can help choose the best agents among the many available.

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Minimal resections equally effective as larger resections in some epileptic children

This article discusses how minimal resections are shown to be equally as effective as larger resections in some children who have epilepsy.

Smaller lesionectomy resections in the surgical treatment of seizures appear to be just as effective as larger resections in select children, sparing patients the functional and developmental deficits associated with the larger resections, a new study suggests.

Lesionectomy, or removal of abnormal lesions seen on MRI, has been well documented to control seizures for the majority of patients with epilepsy; however, when patients with intractable epilepsy have normal MRI findings, the procedure is more complicated, lead author Prasanna Jayakar, MD, director of the Neuroscience Center and chairman of the Brain Institute at Miami Children's Hospital in Florida, told Medscape Medical News.

"In children with normal MRIs, surgeries are guided by functional abnormalities that are often diffuse and lead to large resections involving an entire lobe or multiple lobes," he said. Although large resections are better for controlling seizures, they may involve critical regions and risk functional outcomes.

To determine whether such large resections can be safely avoided, Dr. Jayakar and his team developed a minimally resective strategy, dubbed "functional lesionectomy," in which integrated data from various modalities helps identify the "epicenter" of functional abnormalities for removal.

Their early findings with this novel technique offer important evidence suggesting that the approach does not compromise outcomes.

"Generally most centers believe that children with normal MRI require large resections in order to achieve seizure control," he said. "To our knowledge this is the first such report of restricted resections in this patient population."

Their findings were presented here at the American Epilepsy Society (AES) 66th Annual Meeting.

Intractable Partial Epilepsy

The researchers reported on the outcomes of 25 children with MRI-negative, intractable partial epilepsy who underwent focal corticectomies at Miami Children's Hospital between 2005 and 2011.

The modalities used to identify the epileptogenic region included 3-dimensional electroencephalography (EEG) source localization, single-photon emission computed tomography (SPECT), positron emission tomography (PET), and invasive EEG data that used co-registration software.

The results showed seizure freedom in 3 of 7 (43%) children with type I focal cortical dysplasia, 7 of 12 (58%) children with type II focal cortical dysplasia, and 3 of 6 (50%) with mild malformations of cortical development.

Resections were considered complete in 7 patients and incomplete in 18; however, the outcomes were unrelated to completeness of resection, suggesting that smaller resections did not worsen outcomes.

A greater number of convergent functional modalities was associated with improved outcome, and all 3 of the histopathologic classes were seen in each Engel outcome class.

Most children with Engel class IV outcomes showed data convergence of fewer functional modalities than that seen in almost all children in more favorable outcome classes.

In all cases, the corticectomies were convergent with scalp EEG, and 11 of 12 cases used 3-dimensional EEG for the localization of scalp interictal data.

Ictal SPECT scans showed convergent, focal hyperfusion in 10 of 15 patients, and 12 of 17 patients who underwent PET had convergent regions of hypometabolism. Two had highly localized, convergent hypermetabolic areas.

Intraoperative electrocorticography showed convergent interictal or ictal discharges in 23 children, and 24 experienced ictal onset in corresponding regions in extraoperative subdural monitoring.

Spark Interest

According to epilepsy expert Sanjeev Kothare, MD, the functional lesionectomy concept is indeed in its early stages, but the approach's potential should spark interest.

"As of now, small is not good because we believe that one should resection the entire epileptogenic zone for seizure freedom, [but] there may be a role for this approach in select cases," said Dr. Kothare, senior epileptologist at Boston Children's Hospital and associate professor at Harvard Medical School in Massachusetts.

"If proved by other centers and by a larger series of patients, it would mean that minimal resection of the seizure onset zone could help in reduction of seizure burden, and improved quality of life, without irreversible damage to eloquent cortex and irreversible loss of function, such as vision, language, motor and memory."

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Study Shows Children's Seizures Not Always Damaging

A study claims that seizures in children caused by fevers do not cause long-term damage.

Not all prolonged seizures permanently hurt children with epilepsy, according to preliminary findings from a long-term follow-up study.

The study included 74 children with epilepsy who underwent an evaluation of brain health and mental skills within 10 years of initial enrollment.

The tests showed that those who had experienced prolonged febrile seizures (convulsions triggered by a fever) were normal, the American and British researchers said.

The study authors said they were surprised to discover that only one child had mesial temporal sclerosis, a type of brain damage that is most common in temporal lobe epilepsy. This suggests that the connection between febrile seizures and this condition is weaker than previously believed.

The study was scheduled for presentation Monday at the annual meeting of the American Epilepsy Society in San Diego.

"We have good reason to be confident that children with childhood status epilepticus can have good long-term outcomes, based on these preliminary results," Dr. Richard Chin, one of the researchers, said in a society news release.

The study team includes researchers from University College London's Institute of Child Health, Young Epilepsy in Lingfield, U.K., Edinburgh University, Dartmouth Medical School, Hanover, N.H., and Great Ormond Street Hospital for Children, London.

The data and conclusions of research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

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Scientists Discover Biological Mechanism That Triggers Epileptic Seizures

Scientists have found a biological mechanism that is capable of causing seizures. This is an important discovery for both therapies and future research.

Scientists have discovered the first direct evidence that a biological mechanism long suspected in epilepsy is capable of triggering the brain seizures -- opening the door for studies to seek improved treatments or even preventative therapies.

Researchers at Cincinnati Children's Hospital Medical Center report Sept. 19 in Neuron that molecular disruptions in small neurons called granule cells -- located in the dentate gyrus region of the brain -- caused brain seizures in mice similar to those seen in human temporal lobe epilepsy. The dentate gyrus is in the hippocampus of the temporal lobe, and temporal lobe epilepsy is one of the most common forms of the disorder.

"Epilepsy is one of those rare disorders where we have no real preventative therapies, and current treatments after diagnosis can have significant side effects," said Steven Danzer, PhD, principal investigator on the study and a neuroscientist in the Department of Anesthesia at Cincinnati Children's. "Establishing which cells and mechanisms are responsible for the seizures allows us to begin working on ways to control or eliminate the problem therapeutically, and in a more precise manner."

Epilepsy can develop from a wide range of causes, including birth defects in children that disrupt normal brain development. It can also surface in children and adults who suffer serious brain injuries. These individuals can have high risk of developing some form of epilepsy, depending on the location and severity of their injury, Danzer said.

Technical advances in genetically altering laboratory mice to mimic human disease made it possible for the scientists to generate animals with a specific molecular disruption in dentate gyrus granule cells (DGCs). DGCs are one of only two populations of neural cells that continue to form in significant numbers in the mature brain -- the other being olfactory neurons. This is beneficial considering the hippocampus is responsible for learning and memory, and the dentate gyrus acts as a gate for excitatory signals in the brain that can lead to seizures if not properly regulated.

The presence of abnormal DGCs in epilepsy has been observed for decades, although evidence linking them to seizures was lacking until the current study. Danzer and his colleagues were able to delete a gene called PTEN from mouse DGCs that formed after birth. This caused hyper-activation of a molecular pathway called mTOR (mammalian target of rapamycin), which regulates cell growth and is also linked to tumor formation and cancer when hyper-activated under certain circumstances.

In tests by Danzer and his colleagues, hyper-activation of mTOR caused mice to develop abnormal neural connections among their DGCs -- similar to that observed in human temporal lobe epilepsy -- and the animals experienced seizures. Abnormal neural connections and seizures occurred even in mice that had the PTEN gene deleted in less than 10 percent of their total DGC population, strengthening the link between biological disruption of DGCs and seizures.

When researchers treated epileptic mice with a drug that blocks the mTOR pathway -- rapamycin -- the seizures stopped, solidifying the link to the PTEN-mTOR pathway. Rapamycin has been tested successfully at Cincinnati Children's in the treatment of a disease called tuberous sclerosis, in which benign but still dangerous tumors can form around critical organs. Interestingly, people with tuberous sclerosis are also at risk for developing epilepsy, Danzer said. Newer mTOR inhibitors are also being tested at Cincinnati Children's for the treatment of epilepsy.

Danzer is following up the current study by trying to eliminate abnormal DGCs from the brains of mice that already have epilepsy and to see if this will stop the seizures. Researchers are attempting this by treating mice systemically with diphtheria toxin.

Although diphtheria toxin is not normally toxic to mouse cells, in their experiments the researchers will add a molecule to abnormal mouse DGCs that binds with the toxin. In theory, this should allow the toxin to kill off abnormal DGCs. If treatment stops the seizures, it would further verify the connection between abnormal DGCs and the onset of epilepsy, Danzer said. This would also allow researchers to begin laboratory testing of prospective therapeutic strategies for treatment and prevention.

Mutations involving PTEN and the mTOR pathway have also been identified in other neurological conditions, such as autism and schizophrenia. Danzer said findings in the current study will likely attract the interest of researchers studying these diseases and others involving abnormal granule neurons generated after birth.

"The profound impact of disrupting this pathway in just a small number of granule cells suggests the dentate may be a critical target for mTOR pathway mutations in other neurological diseases," Danzer said. "We believe neuroscientists will be surprised by the huge neurological impact of granule cell disruption and interested in the demonstration of a potentially novel disease mechanism."

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New Brain Pacemaker that can Detect Epilepsy and Treat Seizures in Rats

A brain pacemaker has been invented that can detect epilepsy in rats and even help treat their seizures.

Scientists have created a "brain pacemaker" that controls epilepsy in rats by responding only to abnormal electrical patterns in the brain associated with seizures.

The skull implant is similar to an implantable defibrillator and is inserted in the brain and reacts only when a seizure starts to occur by terminating the seizure's electrical activity.

Results from the study, published in the journal Science, showed that the self-adjusting device delivered therapeutic electrical impulses to the brain at the beginning of a short but frequent type of seizure in rats, reducing the length of epileptic seizure by 60 percent in rats with a ‘petit mal’ form of epilepsy, and then automatically shuts itself off.

Most electrical stimulation devices, like ones that deliver deep-brain stimulation to treat Parkinson’s disease and depression, continuously deliver electrical impulses regardless of the patient's brain activity and can cause a range of side effects like headaches.

While other newer seizure-responsive types of deep brain stimulation devices don't continuously operate, these devices also use electrodes that are implanted in the brain and can pose certain risks like worsening epilepsy symptoms.

Lead researcher György Buzsáki, a neuroscientist at the New York University School of Medicine, and his colleagues, used a less invasive treatment method that involved transcranial electrical stimulation (TES) of neurons using electrodes implanted in the skull rather than in brain tissue.

The device is described as a simple, closed-loop system. Additionally, because the device is only activated in response to seizures, researchers said that the risk of causing brain changing side effects is significantly smaller compared to the effects of continuously stimulating devices.

Epilepsy, a brain disorder that triggers repeated seizures over time, affects nearly 3 million people in the U.S., according to the Epilepsy Foundation, making it third most prevalent neurological disorder in the country after Alzheimer's disease and stroke.

Seizures are episodes of disturbed brain activity that leads to changes in attention or behavior. In a seizure, brain cells keep firing instead of acting in an organized way. The brain's faulty electrical system and sudden chaotic neuronal activity triggers an overflow of energy that can cause unconsciousness and involuntary muscle contractions.

Epilepsy patients can suffer from two different kinds of seizures like petit mal seizures and grand mal seizures. Petit mal seizures occur frequently and often last for just a few seconds whereas grand mal seizures are rarer but involve more violent muscle contractions and a loss of consciousness.

Buzsáki and his team tested the new device against petit mal seizures in laboratory rats because this type of seizure can happen hundreds of times a day, allowing the scientists to effectively test the system they designed.

Researchers noted that patients with petit mal seizures are effectively treated with drugs, so the device would not be used to treat that type of seizure and instead by used to treat seizure in drug-resistant patients.

While the device does not prevent seizure, it treats them right away and reduces the length of the seizure by about 60 percent.

Researchers explained that in people, two plates about the size of a pocket watch could be inserted into the skill in a position that targets the affected area of the brain. The electrodes will sit right on top of the brain and be powered by ultra-light electrical circuits implanted in the skull.

Buzsáki and his team hope to replicate their findings on people with complex partial seizures or epileptic seizures that affect both sides of the brain and cause patients to lose consciousness and can occur simultaneously with head injuries, brain infection and stroke.

There is no cure for complex partial seizures, and the cause of the condition is unknown. An estimated 20 percent to 40 percent of people who have complex partial seizures do not respond to medication.

Dr. Orrin Devinsky, director of the epilepsy program at New York University and who was not associated with the study, told HealthDay that the recent findings have great potential for treating epilepsy and other neurological problems like tremors, Parkinson's disease and even serious depression.

"What's unique about this technique is that it's a sophisticated way to identify the rhythmicity of the seizure itself and interrupt the cycle with precision," he said, according to HealthDay. "Existing [deep brain stimulation] devices don't finesse the timing this way."

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New Technology: Tiny Microchip that can Detect an Epileptic Seizure

A new microchip is being developed that could result in epileptic patients staying in the hospital less. It would be especially useful for children.


A hi-tech medical patch being developed in Abu Dhabi should soon help epileptics avoid long stays in hospital.

The 50fil adhesive microchip, the work of a researcher at the Masdar Institute, monitors epileptic seizures.

It will allow doctors to keep a close eye on patients for up to two weeks without the need for them to stay in hospital attached to a cumbersome and uncomfortable electroencephalograph (EEG) machine.

It would be applied to the forehead and is expected to be smaller in size than three grains of rice.

Currently, doctors often have to rely on patients' own descriptions of their seizures. But their recollections of events under such circumstances are notoriously unreliable.

The chip, which detects rapid eye movements - the early sign of an epileptic seizure - will give doctors a far more accurate picture of what happened, from the length of an attack to its severity.

The patch is the work of Dr Jerald Yoo, a circuit designer at the Masdar Institute, jointly funded by the Massachusetts Institute of Technology in the United States.

About 50 million people worldwide suffer from epilepsy. While no exact figure exists for the UAE, it is believed to be about 2 to 3 per cent of the population - more than 100,000 people.

Dr Yoo said the patch would be especially useful for children or babies, who cannot express what they have suffered.

The chip can also record seizures while asleep, of which patients might not even be aware.

"Doctors need to see raw information and data with their own eyes so they can make the right decisions, diagnoses and treatments.

"You need to learn the patient's seizure traits as they usually have one or two, which allows a more thorough diagnosis and treatment."

The Taiwan Semiconductor Manufacturing Company and the Abu Dhabi-owned Mubadala - which owns most of the chipmaker, Global Foundries - are looking to start making the chip by the end of this year.

Dr Sarmad Al Shamma, a neurologist at the Neuro Spinal Hospital in Dubai, said home monitoring would be good for doctors and patients alike.

"In addition to the discomfort of being in a hospital for more than 24 hours, there is a reduced possibility of an attack in the hospital because patients are lying in bed the entire time," he said.

"This often means they have to stay in the hospital for an even longer time. By monitoring them outside the hospital, we can learn what is triggering the attacks."

Epileptic seizures can be triggered in different patients by lack of sleep, stress, low blood sugar and flashing lights.

Dr Taoufik Al Sadi, the head of neurology at Sheikh Khalifa Medical City, said the chip could help fill "gaps in knowledge" about the condition.

"If this proves to be scientifically solid it would be an excellent addition to better understand the frequency and severity of the seizures, their duration," he said.

"It will allow better options for treatment based on solid, objective data, rather than relying on a patient's history and recollection."

He added that the chip could help reduce the stigma associated with epilepsy.

"Many sufferers feel deprived from basic privileges, such as driving a car and in some cases, going to school," said Dr Al Sadi.

"They find it difficult to be in social situations because they never know when they're going to have the next attack.

"But what they need to know is that after six months of treatment they can drive and resume their normal life."

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