Home testing and monitoring for epilepsy - Available in the Houston Area ..and now in London.

A hospital in London is pioneering a home diagnosis test and monitoring for epilepsy. This is described as a first of its kind. 

But, as an epilepsy specialist, I noted the value and convenience of such a service. My pediatric neurology practice has been offering home EEG service for the Houston area a number of years. 

-JR

A London hospital is the first in Britain to pioneer home testing for epilepsy patients.

The brain-scanning service rolled out by King’s College Hospital NHS Foundation Trust will benefit hundreds of people who suffer devastating seizures, and improve treatment.

Home monitoring allows patients to carry on with daily life without the disruption of days in hospital — it is also thought to be a more accurate method.

The service is called Home Video Telemetry and the patient wears a special head device fitted with electrodes which records brain activity over several days.

A video camera also captures the physical seizures. A technician visits the patient’s home and collects the data on a daily basis which is analysed by a consultant.  Epilepsy affects about 600,000 people in the UK including more than 60,000 children. The condition affects the brain and causes multiple seizure attacks in severe cases. Brain scanning is crucial for doctors to diagnose patients with suspected epilepsy correctly and provide them with tailored treatment.

Hospital checks have been the gold standard until now for those who suffer multiple attacks. However, other NHS trusts are now expected to adopt home testing following the success of pilots by King’s. It comes as new research reveals that testing epilepsy patients in hospital may produce biased results. Dr Franz Brunnhuber at King’s has carried out work revealing that people are about half as likely to experience seizures in hospital than at home.

The consultant clinical neurophysiologist said this can make it difficult for doctors to determine the exact nature of a patient’s condition.

He added: “Misdiagnosis is a major problem with epilepsy because there are lots of conditions which mimic the disorder so it’s crucial to capture seizure attacks accurately. The home service is more convenient for patients. Hospital is a huge stress factor for them. Home testing means patients can lead a normal life.”

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Study claims exercise reduces epilepsy risk in men

Consistent and vigorous exercise, such as during military training, is shown to reduce risk of later developing epilepsy for men.

New research suggests that men who exercise vigorously as young adults may reduce their risk of developing epilepsy later in life. The study is published in the September 4, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology. Epilepsy is a brain disease that causes repeated seizures over time.

"There are a host of ways exercise has been shown to benefit the brain and reduce the risk of brain diseases," said study author Elinor Ben-Menachem, PhD, MD, with the University of Gothenburg in Sweden and an associate member of the American Academy of Neurology. "This is the first study in humans to show that exercise may also reduce the risk of epilepsy, which can be disabling and life-threatening."

For the study, 1.17 million Swedish men were given cycle tests that measured cardiovascular fitness when they enlisted for mandatory military service at age 18. The participants were then assessed for epilepsy for an average of 25 years. During follow-up, 6,796 men were diagnosed with epilepsy.

The study found that men who had a high level of fitness were 79 percent less likely to develop epilepsy than those with low fitness levels and 36 percent less likely to develop epilepsy than those with medium fitness levels.

The proportion of men with high fitness who developed epilepsy in the study was 0.48% (2,381 out of 496,973 with high fitness). The proportion of men with medium fitness who developed epilepsy was 0.62 percent (3,913 out of 629,876 with medium fitness). The proportion of men with low fitness who developed epilepsy was 1.09 percent (502 out of 46,230 with low fitness).

The results were lessened only slightly after considering genetic factors and a prior history of traumatic brain injury, stroke or diabetes.

"Exercise may affect epilepsy risk in two ways. It may protect the brain and create stronger brain reserve, or it may simply be that people who are fit early in life tend to also be fit later in life, which in turn affects disease risk," Ben-Menachem said.

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NICE Quality Standards for Epilepsy Diagnosis, Management and Care

NICE (the National Institute for Health and Clinical Excellence) published their quality standards for the diagnosis, management and care for people with epilepsy. This is intended to improve the quality of care for people with epilepsy.

The National Institute for Health and Clinical Excellence (NICE) has published quality standards for the management and care of patients with epilepsy, a central theme of which is improving diagnosis of the condition.

The new quality standards contain a prioritised set of specific statements that, if delivered across the whole care pathway, should help boost the effectiveness, quality, safety and experience of care for people with the condition, NICE said.

For example, adults being investigated for epilepsy should be tested within four weeks, and those diagnosed with the condition should be seen by an epilepsy specialist nurse who is contactable between scheduled reviews.

Children and young people with a suspected seizure should be seen by a specialist in the diagnosis and management of epilepsies within two weeks, while those with a history of prolonged or repeated seizures must have an agreed written emergency care plan, the quality standards advise.

Epilepsy is the most common serious neurological disorder in the UK, affecting around 600,000 people. More than 40 different types of epilepsy, with 40 different associated seizure types, have been identified, and the nature of the condition makes it hard to diagnose accurately, leaving patients without access to treatment.

"Therefore, a key part of these new quality standards is focused on improving this, and ensuring that diagnosis and treatment are confirmed and reviewed as necessary," explained Gillian Leng, the Institute's Deputy Chief Executive and Director of Health and Social Care.

According to Simon Wigglesworth, Deputy Chief Executive at Epilepsy Action, many people with epilepsy are simply not getting the care they should, and "if the new standards are implemented consistently and effectively, care for people with epilepsy will be vastly improved".

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