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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Causes, symptoms and treatments for epilepsy

This article gives a great general overview of the causes, symptoms and treatment options for epilepsy.

Epilepsy is usually identified only after the occurrence of more than one seizure in a person and the chances of Epileptic seizures increases with age and leads to abnormal, excessive or hypersynchronous neuronal activity in the brain. Moreover, the condition is also very common among the infants. Presently over 50 million people are victim of Epilepsy globally of which about 80 percent cases are observed in the developing countries. So, in order to avoid Epileptic condition it is very important to know about thecauses, symptoms, treatment and prevention of Epilepsy. Moreover you should also know about the types of seizure as well as diagnosis of Epilepsy.

Types of Seizure

Depending upon the source of seizure, they are primarily classified into two types of which first is called partial or focal onset seizures in which the seizure within the brain is localized. However, in the second type of seizure called generalized seizures, the seizure within the brain is distributed.

Partial seizures depending upon the extent to which alertness is affected is further divided into two types called the simple partial seizure in which the awareness is unaffected, while the second type is called complex partial (psychomotor) seizure.

Generalized seizures are further divided as per the effect on the body but over all involve loss of consciousness and alertness. The types of generalized seizures include absence (petit mal), myoclonic, clonic, tonic, tonic-clonic (grand mal), and atonic seizures.

Causes of Epilepsy

Though, in most of the cases the reason behind Epileptic seizures are not known but the major cause of Epilepsy is injury to the brain due to some reasons. The major causes of Epilepsy can be characterized by:

• Inadequate oxygen during birth.
• Any head injury at the time of birth or as a result of some accident during the adulthood.
• Recovering patients as a consequence of brain surgery.
• Due to brain tumors.
• Central nervous system (CNS) infections and trauma.
• Some of the genetic factors can also result in epileptic condition such as tuberous sclerosis.
• People suffering from meningitis or encephalitis have increased chances of Epilepsy.
• Sudden stroke or brain injury.
• Abnormal levels of substances such as sodium or blood sugar.

However, the major causes for Epileptic condition are mentioned above but these are not restricted to these only. There are some factors, which may also provoke Epileptic seizures. These are:

• Not taking medicines properly.
• Excessive consumption of alcohol.
• Consumption of drugs like cocaine and others.
• Emotional stress, sleep deprivation
• Taking drugs that interfere with seizure medications.

Symptoms of Epilepsy

Symptoms of Epilepsy are seizure and may vary from person to person. While, some people show simple seizure attacks, some are diagnosed by violent seizures leading to loss of alertness. The symptoms of epilepsy depend upon the part of brain affected causing epilepsy. Some of the common symptoms of Epilepsy are:

• Feeling strange and restless.
• Sudden jerk in the arms.
• Twitching and trembling.
• Sudden unconsciousness. You may fall to the ground due to black out.
• Sometimes you may feel stiffness in your muscles or limp.
• You also may get a warning sign, like strange smell before the seizure provokes. These are called auras.
• Lack of sleep is also a common symptom.

Diagnosis of Epilepsy

Diagnosis of Epilepsy is a tedious task as it requires access to various facts and figures about the patients and the cause of seizures due to lack of an absolute diagnostic tool or test. However, it you have suffered two or more seizures, you may be diagnosed with epilepsy. The diagnosis of Epilepsy is based on many factors.

In order to diagnose Epilepsy, it is very essential to know patient's medical history, which also includes if there is any case of family history of seizures, associated medical conditions, and current medications if any.

Some of the common questions asked to the patient in order to diagnose Epilepsy are:

• At what age did you get the first seizures?
• For how long did you felt the seizure and what was the feeling?
• What do you think should be the reason for the seizure?
• What do you feel before, during, and after the seizures?
• Have you undergone for any treatment for epilepsy before?
• What are the medications prescribed to you and in what dosages?
• Was the treatment effective?
• Are you suffering from any illnesses, diseases, injuries or other medical condition?
• Do you have any family history of Epilepsy?

After analyzing and evaluating all your answers to the questions asked by the doctor, the doctor might provide the answer whether you are getting the seizure due to epilepsy or not.

Treatment of Epilepsy

Though, there is not any absolute treatment for Epilepsy yet, but there are certain methods usually used to reduce the severity of Epilepsy from being increasing.

• Ketogenic diet is one of the common practices deployed for the treatment of Epilepsy and has also shown some success in reducing the rate of seizure to certain extent especially among the children.
• Nerve stimulation through Vagus nerve stimulation method is another option. This treatment is mostly for people who cannot have surgery.
• In some cases where medication does not show proper result, surgery proves to be quite effective.

Prevention of Epilepsy

As such the exact reason of Epilepsy is still unknown. There is no stiff treatment for the disease but by keeping certain common things in mind, you can certainly prevent Epilepsy from being occurring. Some of the preventive measures of Epilepsy are:

• Try to prevent any type of head injuries by wearing seat belts and helmets while driving.
• Immediately rush to a doctor after suffering from the first seizure for medical help.
• Start taking proper medication on doctor's advice after the first or second seizure.
• Avoid the consumption of alcohol.
• Avoid the intake of tobacco products and harmful drugs
• If you are suffering from high blood pressure or any other infection, take proper treatment for that.
• Proper diet enriched with vitamins and minerals is recommended.

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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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Early diagnosis of pediatric epilepsy necessary for optimal brain function

This article discusses pediatric epilepsy and how important early diagnosis is to ensure optimal brain function.

Seizure and epilepsy are words that are often used interchangeably and both are frequently misunderstood. A seizure is an action that may or may not occur again; epilepsy, on the other hand, is a medical condition where multiple seizures take place over a period of time. Infants and toddlers who suffer from epilepsy experience repeated seizures, with the frequency varying from patient to patient. Most of the time, these episodes can be avoided or lessened with medication. It is imperative for these children to receive prompt medical assessment because with early and accurate diagnosis, most pediatric cases can be successfully controlled and some cases can eventually be cured. In the most severe situations, surgery can also be a successful treatment solution.

The onset of epilepsy is most common during early childhood and after age 65. Each year 150,000 children and adolescents in the United States will have a newly occurring single seizure and 30,000 will be diagnosed with epilepsy after subsequent seizures occur.The highest incidence of epilepsy is during the first year of life, which is why new parents can often miss or misinterpret physical symptoms. Common misconceptions As a specialist in pediatric epilepsy, I’ve encountered frequent misinformation about this condition and the children who live with it. Let me dispel the most common misconceptions:A large percentage of patients have normal IQ scores, some even above normal intelligence. The majority of children will develop normal motor skills, show positive progress in school and maintain normal social relationships. Unlike other chronic diseases, many children with epilepsy will eventually outgrow the condition. It has been known for some time that prolonged seizures can injure the brain; more recently, we learned that even short seizures, if frequent or repetitive, can harm the brain as well.This is why early diagnosis and treatment is so critical.

Symptoms in infants and children

Epilepsy is caused by abnormal activity in brain cells and seizures can affect any process the brain coordinates. During development, infants often exhibit a variety of physical movements and mannerisms that may not cause immediate concern.As a result, parents and caregivers can mistake a seizure for typical baby behavior. In most cases, a child with epilepsy will tend to have the same type of seizure each time, so symptoms will be similar from episode to episode such as:

 a staring spell

 uncontrollable jerking movements of the arms and legs

 lack of response to verbal stimulation

 shaking, falling or smacking of the lips

Specialty care for children with epilepsy

If you suspect that your child may have experienced even one seizure, contact your pediatrician immediately for an evaluation.Take notes about the duration and symptoms your child exhibited and share this with your doctor. Failure to properly diagnose epilepsy early on can lead to learning and speech disabilities. 

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