Breastfeeding while taking epilepsy medication does not harm infant

Brain development of breastfed infants is not harmed by the mother taking epilepsy medications.

Taking epilepsy drugs while breast-feeding does not appear to harm the developing brains of young children, a new study finds.

There have been concerns that using epilepsy drugs while breast-feeding could pose a threat to youngsters because it's been shown that some epilepsy drugs can cause cell death in young animals' brains.

And in spite of the fact that epilepsy experts recommend breast-feeding, "it is still a sensitive topic among women with epilepsy," noted one expert, Dr. Patricia Dugan, assistant professor of neurology at the Comprehensive Epilepsy Center at NYU Langone Medical Center, New York City.

"Despite reassuring published data, such as this article, patients frequently tell us that they receive contradictory advice from their obstetricians and pediatricians, resulting in a significant amount of distress for the mother," said Dugan, who was not connected to the new research. "Hopefully, papers such as these will encourage everyone involved in the care of women with epilepsy to promote breast-feeding," she said.

The new study included 181 children of mothers who had epilepsy and took drugs to control the condition. Nearly 43 percent of the children were breast-fed for an average of seven months.

IQ tests conducted on the children when they were 6 years old found no differences between those who were breast-fed and those who were not, according to the study published online June 16 in JAMA Pediatrics.

"Our study does not provide a final answer, but we recommend breast-feeding to mothers with epilepsy, informing them of the strength of evidence for risks and benefits," wrote a team led by Dr. Kimford Meador, of Stanford University in California

Another expert said the study offers valuable information.

"The authors controlled for many of the factors that might influence the intellectual outcome of this large number of children," noted Dr. Ian Holzman, chief of the division of newborn medicine at the Kravis Children's Hospital at Mount Sinai in New York City.

"By following these children through age 6, they were able to present information relevant to the important issue of school performance," he said. "This study allows us to counsel mothers who are planning to breast-feed that there doesn't seem to be any harm [in taking epilepsy medications]."

Dugan said the study also hinted at other benefits for breast-fed children.

"It also showed that testing of breast-fed children at 6 years old -- an age when more meticulous testing can be performed -- reflected beneficial effects of breast-feeding, with higher IQ and better verbal abilities than nonbreast-fed children," she said.

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Study: Epilepsy patients who don't take medication may become depressed

A study claims that epilepsy patients who do not take medication may become depressed, which can reduce their quality of life.

A new study led by Alan B. Ettinger, M.D., M.B.A., Director of the Epilepsy Center at Neurological Surgery, P.C. (NSPC), has found that many patients who fail to take their antiseizure medications are suffering from depression. Previous studies by Dr. Ettinger and others have found a high incidence of depression in people with epilepsy, but this is the first research to show a direct link between depression and medication nonadherence. The study will be published in the July 2014 issue of the journal Epilepsy & Behavior, and is available online ahead of publication.

"Our previous studies have shown that there are substantial consequences to missing doses of antiepileptic medications, even occasionally," said Dr. Ettinger. "We have also seen that depression impacts quality of life. Now we see that depression is a significant factor in drug nonadherence. This demonstrates that it is critical for physicians to screen their patients for depression, and to talk with them about the importance of taking all of their medications when scheduled."

Missing even one dose of an antiepileptic drug can cause breakthrough seizures, even in patients whose epilepsy is well controlled by medications. This can have devastating effects -- including hospitalizations, falls and related injuries, and even death. Studies have shown that 30-50% of people with epilepsy don't adhere to their medication regimen.

"Other studies have shown a link between depression and failure to take medications in conditions such as hypertension and HIV, but little was previously known about the potential impact of depression on antiepileptic drug adherence," said Dr. Ettinger.

Among other factors thought to play a role in antiepileptic drug nonadherence are memory difficulties and medication side effects.

In the current study, researchers accessed a nationwide health plan/pharmacy database, and selected a sample of 10,000 epilepsy patients. 2,750 patients were randomly selected from this group and mailed an in-depth survey that included a number of validated questionnaires on medication adherence, depression status, seizure severity and frequency, and quality of life, among other factors. Questionnaires used in the survey included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), which asks questions that are highly specific to epilepsy and is considered highly reliable. 465 patients completed and returned the survey. Claims data were analyzed with the widely used medication possession ratio (MPR), to measure drug adherence. (MPR represents the proportion of time that an individual was theoretically in possession of a medication.)

The researchers conducted a path analysis, a highly reliable and sophisticated type of statistical modeling, to determine the relationships between depression, drug adherence, seizure severity and quality of life. One key finding was that depression, as determined by the NDDI-E, was significantly correlated with an elevated risk of antiepileptic drug nonadherence. Depression, as measured by the NDDI-E and another survey instrument, was also associated with low quality of life scores. In addition, patients with depression were more likely to report having more severe seizures.

"We have known for a while that depression impacts patients' quality of life, and we know that it can be treated; now we know that there is a direct link to patient harm," said Dr. Ettinger, who works on a number of committees through the American Epilepsy Society to educate clinicians on the importance of depression screening.

Dr. Ettinger suggests that neurologists inquire about each patient's mood and quality of life, as well as medication adherence, during office visits. There are also brief questionnaires that patients can complete in the waiting room to indicate potential mental health issues. He also points out that some antiepileptic medications are now available in once-daily formulations (making it easier for patients to remember to take them), and that there are other medication adherence reminders now available, including smartphone alarm apps.

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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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Children with epilepsy at higher risk of injury

A study looks at epileptic children and found that they are at a significantly higher risk of injury than children without epilepsy.

Children and young adults with epilepsy are more likely to suffer broken bones, burns and poisonings compared to those without the neurological disorder, new research has found.

The study, led by academics at The University of Nottingham and funded by the National Institute for Health Research, shows that young people with the condition are at significantly greater risk of being poisoned by medication, leading the authors to call for further research into whether these poisonings are intentional.

The results, taken in tandem with previous research findings, highlight the need for further research into whether young people with the condition are at greater risk from an overdose, accidental or intentional, of their epilepsy drugs or other medication. And the researchers say that doctors and other healthcare professionals should use the results of the study to help warn epilepsy patients of the increased risk associated with their illness.

The study, published in the latest edition of the journal Pediatrics, found that young people with epilepsy were more than twice as likely to be poisoned by medication. This jumped to four times the risk in patients aged between 19 and 24 years old.

The patients, all aged between 12 months and 24 years old at the time of their diagnosis, were also almost one and a half times more likely to suffer a burn-related injury and almost 25 per cnet more at risk of breaking an arm or leg.

Dr Vibhore Prasad, of the University’s Division of Primary Care, said: “More research is needed to understand why people with epilepsy have a greater number of medicine-related poisonings and whether the poisonings are intentional or accidental. This is the first study in the UK population to estimate the risk of fractures, burns and poisonings. The risk of a poisoning in the next five years for 1,000 people with epilepsy is about 20 extra poisonings compared to people who do not have epilepsy.”

Epilepsy is a chronic condition caused by a sudden burst of electrical activity in the brain, causing a temporary interruption in the way the brain normally works and resulting in a seizure. In the UK alone there are more than 600,000 people with epilepsy.

Previous studies into the condition have suggested that these seizures — and the side effects caused by some anti-epilepsy drugs — put patients at a greater risk of accidental injuries.

However, most research may have overestimated this risk because they focused primarily on people with more severe epilepsy, such as institutionalised adults or those being treated in epilepsy clinics.

This latest study is the first to investigate the potential risk of injury exclusively in children and young people with and without epilepsy.

The research, which was carried out in association with academics at the London School of Hygiene and Tropical Medicine, used GP records from almost 12,000 patients with epilepsy to study the incidence of injury over an average of two and a half years and compared it with the records of around 47,000 non-epileptic people.

The authors say that doctors and other healthcare professionals can use the findings of the research to make children and young adults diagnosed with epilepsy, and their parents, more aware of the risk of injury and to inform existing guidelines on treatment. In particular, they cite the need for more information relating to the safe storage of medicines and the supervision of children while taking their medication to be given by doctors at the time of prescribing and by pharmacists when dispensing prescriptions.

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Target enzyme for epilepsy drugs may also cause sleep loss

A study in fruit flies shows that an enzyme that is a target for epilepsy drugs also contributes for sleeplessness. This has many implications for treating both conditions.

A new study in a mutant fruitfly called sleepless (sss) confirmed that the enzyme GABA transaminase, which is the target of some epilepsy drugs, contributes to sleep loss. The findings, published online in Molecular Psychiatry, were led by Amita Sehgal, PhD, head of the Chronobiology Program at the University of Pennsylvania's Perelman School of Medicine. The findings shed light on mechanisms that may be shared between sleep disruption and some neurological disorders. A better understanding of this connection could enable treatments that target both types of symptoms and perhaps provide better therapeutic efficacy.

"Epilepsy is essentially an increase-in-firing disorder of the brain and maybe a decrease in activity of the neurotransmitter GABA, too," says Sehgal, who is also a professor of Neuroscience and an investigator with the Howard Hughes Medical Institute (HHMI). "This connects our work to drugs that inhibit GABA transaminase. Changes in GABA transaminase activity are implicated in epilepsy and some other psychiatric disorders, which may account for some of the associated sleep problems."

The team looked at the proteomics of the sss mutant brain -- a large-scale study of the structure and function of related proteins -- and found that GABA transaminase is increased in the sss brain compared to controls. This enzyme breaks down GABA, so GABA is decreased in the sss brain. Because GABA promotes sleep, there is a decrease in sleep in the sss mutant fly, as the name implies.

The relationship between the SSS protein and GABA is not fully understood. The SSS protein controls neural activity, and its absence results in increased neural firing, which likely uses up a lot of energy, says Sehgal. GABA transaminase works in the mitochondria, the energy-production organelle in the glial cells of the brain, which provide fuel for neurons. The large energy demand created by the increased neural firing in sss brains probably alters mitochondrial metabolism, including GABA transaminase function in glia.

In the sss mutant fly, there is a stream of connections that leads to its signature loss of sleep: The sss mutant has increased neuron firing caused by downregulation of a potassium channel protein called Shaker. Recently, the Sehgal lab showed that SSS also affects activity of acetylcholine receptors. Both of these actions may directly cause an inability to sleep. In addition, increased energy demands on glia, which increase GABA transaminase and decrease GABA, may further contribute to sleep loss. On the other hand, if GABA is increased, then sleep is increased, as in flies that lack GABA transaminase.

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Seizures caused by fevers alleviated by epilepsy drug

A study shows that seizures caused by fevers in children can be alleviated by antiepileptic drugs.

Early treatment with antiepileptic drugs reduces the length of fever-related seizures in children, according to a new study.

Published Feb. 6 in the journal Epilepsia, the study also found that a standard emergency medical services treatment guideline for prolonged fever-related seizures is needed in the United States.

Most fever-related seizures, also called febrile seizures, are brief, but up to 10 percent can last more than 30 minutes. These prolonged seizures can put children at risk for short- and long-term complications, including developing epilepsy, according to a journal news release.

The new study included nearly 200 children, aged 1 month to 6 years, who had one seizure or a group of seizures that lasted more than 30 minutes. The researchers examined the connection between time to treatment and length of the seizure.

About 90 percent of the children were given at least one antiepileptic drug, and the first dose was given by EMS crews or emergency-room staff an average of 30 minutes after the seizure began, the study found.

The average length of seizure was 81 minutes among children who received an antiepileptic drug before they arrived at the emergency room and 95 minutes for those who did not. On average, seizures ended about 38 minutes after a child received the first dose of an antiepileptic drug.

"The time from the start of the seizure to treatment is crucial to improving patient outcomes," study lead author Dr. Syndi Seinfeld, an assistant professor in the division of child neurology at Children's Hospital of Richmond, at Virginia Commonwealth University, said in the news release.

"Our study is the first to examine the treatment of [febrile seizures] by EMS, which currently does not have a standard therapy protocol for prolonged seizures," Seinfeld said.

"Our findings clearly show that early [antiepileptic drug] initiation results in shorter seizure duration," she said. "A standard [prolonged seizure] treatment protocol prior to arrival at the hospital, along with training for EMS staff, is needed across the United States to help improve outcomes for children with prolonged seizures."

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A gene for childhood epilepsy is identified

A study using Zebrafish was used to identify a new gene associated with childhood epilepsy.

A European consortium of epilepsy researchers has reported the discovery of a new gene involved in severe childhood epilepsy. Using a novel combination of technologies, including trio exome sequencing of patient/parental DNA and genetic studies in the tiny larvae of zebrafish, the EuroEPINOMICS RES consortium found that mutations in the gene CHD2 are responsible for a subset of epilepsy patients with symptoms similar to Dravet syndrome -- a severe form of childhood epilepsy that is in many patients resistant to currently available anti-epileptic drugs.

The discovery of CHD2's role in epilepsy offers new diagnostic tools for families and clinicians of children with Dravet syndrome and related genetic epilepsies. In addition, the creation of a zebrafish model for CHD2 encephalopathy may facilitate the discovery of new drugs that can treat patients with this form of epilepsy.

Dravet syndrome is a severe genetic epilepsy with onset during infancy, with initial seizures often triggered by fever. For most Dravet patients these seizures cannot be treated adequately with currently available anti-epileptic drugs, and therefore the syndrome is classified as pharmacoresistant. Dravet patients usually develop moderate to severe cognitive delays and some features of autism, and are at increased risk of SUDEP (sudden unexplained death in epilepsy). Approximately 80% of Dravet patients have mutations in the gene SCN1A which encodes the Nav1.1 sodium channel, however for the remaining 20% of patients the underlying genetic cause has yet to be determined.

To identify novel genes involved in Dravet Syndrome and other genetic epilepsies, epilepsy clinicians and human geneticists across Europe recently initiated the EuroEPINOMICS RES (Rare Epilepsy Syndromes) consortium. In 2011, the EuroEPINOMICS RES consortium was awarded €2,37 million in funding from the national funding agencies participating in the European Science Foundation program to systematically search for novel genes for seizure disorders.

As part of these ongoing research activities, the DNA of Dravet patients without SCN1A mutations was analyzed by trio exome sequencing, which searches across the active parts of the genome for de novo mutations that have arisen in these patients (de novo mutations are DNA copying errors that occur in the parents' gametes or in the fertilized egg or embryo, resulting in the afflicted family member being the first person in their family to have this genetic condition). In a group of 9 such patients, this analysis of their DNA (and the DNA of their parents) resulted in the identification of 2 patients with de novo mutations in CHD2, which stands for chromodomain helicase DNA binding protein 2. A third patient with a CHD2 mutation was subsequently identified as well.

To confirm that mutations in CHD2 cause the epilepsy observed in these patients, the same gene was then functionally analyzed in the tiny larvae of zebrafish, which have emerged in the last decade as a powerful animal model for the study of epilepsy. In the case of CHD2, scientists collaborating with the EuroEPINOMICS RES consortium used antisense technology to rapidly generate zebrafish larvae with a partial loss of function of this gene, and were then able to detect epileptic seizures in these animals using electrographic analysis (this method is very similar to electroencephalography, or EEG, which is used to analyze seizures in humans).

The genetic analysis was led by Peter De Jonghe, head of the Neurogenetics Group of the VIB Department of Molecular Genetics at the University of Antwerp (Antwerp, Belgium) and the epilepsy genetics group in Kiel, headed by Ingo Helbig (Dept. of Neuropediatrics, University of Kiel, Germany). Peter De Jonghe: "This research reinforces our belief that trio sequencing enables us to unravel the genetic background of syndromes which occur spontaneously. Previously, investigations into the genetic causes of syndromes such as Dravet Syndrome were not feasible. These types of investigations were only possible by screening large families and seeing how a disorder was passed along. But in disorders such as Dravet Syndrome, this did not work since the children were so seriously ill that they themselves never went on to have their own children. So this new technology also opens up new perspectives in the search for the genetic background of many disorders."

Ingo Helbig adds that "the epileptic encephalopathies pose a major clinical problem as most children have treatment-resistant epilepsy, intellectual disability and many other medical issues. We hope that identifying the underlying genetic cause will help us find better treatment options for the affected patients. In the past, we were not able to identify the reason why children have severe epilepsy. The discovery of CHD2 as the culprit gene in a subset of children with epileptic encephalopathy is a major step for us."

The zebrafish research was led by Camila Esguerra of the Laboratory for Molecular Biodiscovery of University of Leuven (Leuven, Belgium). She commented: "Our previous research to validate zebrafish as a model for epilepsy put us in a good position to be able to help the EuroEPINOMICS consortium investigate the function of CHD2. The zebrafish larva is an ideal model to study genes involved in epilepsy, and the methods necessary for such studies are now well-established in our laboratory. Looking forward, our zebrafish models of pharmacoresisant epilepsy are well-suited for large-scale pharmacological screens to find new anti-epileptic drugs."

The Dravet Syndrome Foundation EU (DSF-EU, Madrid, Spain) is a patient organization dedicated to finding a cure for Dravet Syndrome, and also works to promote awareness of the disease and to help families of Dravet patients. Julian Isla, Executive Director of DSF-EU, stated: "One of the most important things for patients with genetic disorders and their families is to be able to give a name to the gene causing their disease. When it comes to Dravet syndrome, the genes responsible for up to 20% of the cases are still unknown. The discovery that mutations in CHD2 cause a Dravet-like syndrome means some of these patients will now have access to better genetic diagnosis and therefore provide much-needed answers to these families. Importantly, the development of a new animal model for Dravet syndrome based on reduced CHD2 expression might help to find effective treatments that could improve the lives of thousands of people suffering from Dravet syndrome and perhaps other genetic epilepsies."

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Normal life for a person with epilepsy

This article provides much information on epilepsy and describes what an average day is like for a person who has epilepsy.

The roots of epilepsy have been traced as far as 3000 years ago. Because of its disturbing and dramatic features, back then epilepsy was feared and was thought to be a result of some sort of supernatural force or evil influence.

Today we are in the 21st century, yet people with epilepsy are not free from the social stigma, discrimination and isolation. In many rural parts of the country, it is still believed that people with epilepsy are mentally challenged and cannot be treated or lead a normal life. Women with epilepsy face problems in getting married because of the belief that they cannot have children or if they do their children will also be affected. (Read: World Epilepsy Day 2012: Top myths about epilepsy busted)

This clearly shows a lack of understanding of the disorder. Epilepsy doesn’t mean being mentally challenged or having an abnormal life. A person with epilepsy can lead a normal life, get married and have children as well. All you need is a better understanding of the disorder and ways to treat and prevent it.

What is epilepsy?

Epilepsy is a chronic brain condition having unique characteristics. One of the characteristics of people with epilepsy is the recurrence of seizures. That is why epilepsy is commonly known as seizure disorder.

The brain functions with the help of millions of neurons that transmits and receives signals. Epilepsy is caused when the normal pattern of transmission of signals to and from the brain is disturbed. This results in seizures that affect consciousness, body movements and sensations in the affected person for a short period of time until the electric impulses settle. Physical changes that occur during an epileptic seizure may arise either from disturbance in one part of the brain (partial seizure) or in nerve cells from different parts of the brain (generalized seizures). (Read: Epilepsy patients’ brain activity to be monitored)

What is the difference between seizures and epilepsy?

Seizure is just a sign of epilepsy. All patients with epilepsy have seizures but all people having seizures may not have epilepsy. An episode of a single seizure doesn’t indicate that the person is suffering from epilepsy. Seizures can also be triggered by synchronised activity of neurons in the brain occurring in different conditions like high fever, lack of oxygen supply to the brain and hypoglycaemia. Epilepsy is a condition that makes a person susceptible to seizures.

What happens during an epileptic seizure?

Several physical changes take place during an epileptic seizure. Although nothing can describe what the person going through an epileptic attack feels, but the following signs may be seen during an epileptic seizure:

• Sudden jerking movements or twitches in the arm, legs and facial muscles (clonic movements) 
• Rapid movement of the eye balls and head
• Altered consciousness or complete loss of consciousness
• Abdominal discomfort
• Tendency of tongue biting and incontinence.
• Later the patient may feel confused, drowsy and weak

What causes epilepsy?

The exact cause of epilepsy is not found in most cases. Since epilepsy involves the brain function at the neuronal level, several events or conditions that affect the brain may cause epilepsy.

• Trauma to the brain or head injury
• Lack of oxygen supply to the brain during birth
• Brain tumors
• Infections such as meningitis and encephalitis which affect the brain.
• Stroke caused by damage to a blood vessel in the brain
• Neurological diseases such as Alzheimer disease
• Genetic conditions
• Lead poisoning or carbon monoxide poisoning can cause epilepsy
• Drug addiction and overuse of certain antidepressants

Does epilepsy affect a particular age group? Who is at risk?

Dr Arjun Srivatsa, renowned neurosurgeon and founding trustee of Spine Trust India says, ‘Epilepsy is statistically more prevalent in older population. In children, nearly 30 percent of cases are reported in the first 5 years of age. ‘ ‘There is no particular group of people who have greater chances of getting epilepsy,’ he adds further. 

How is epilepsy diagnosed?

According to the Indian Guidelines of Epilepsy, diagnosis of epilepsy requires a detailed medical history of the patient. Dr Srivatsa mentions that epilepsy is usually well described by an eye witness. Therefore, family members and friends of the patient may be required to describe the event and the physical changes observed. The guidelines suggest video recording of the epileptic event can be useful for correct diagnosis.

The doctor will then examine pulse rate and blood pressure of the patient. Presence of subcutaneous nodules and other neurological signs are also examined.

Confirmation of epilepsy is done through various brain imaging procedures. An electroencephalogram (EEG) is a common diagnostic tool used to detect signals from the neurons in the brain and classify the type of epilepsy. The waves resulting from these signals may show a specific pattern which helps the doctor to confirm epilepsy as the cause of seizures. A CT scan or MRI scan may be taken to detect other conditions that may be causing seizures. A positron emission tomography (PET)  scan may be performed to analyze which centers in the brain are involved in seizures. (Read: World Epilepsy Day: Epilepsy more disabling than acknowledged)

How is epilepsy treated? Are there any advances in treatment?

The aim of treatment in epilepsy is to control seizures through anti-epileptic drug (AED) therapy and surgery.

Anti-epileptic drug (AED) therapy: AED is the most common form of treatment given to patients with epilepsy. A single AED (monotherapy) is first given to the patient. Drugs like phenytoin, oxcarbazepine, valproate, phenobarbitone and carbamazepine are conventional drugs used for monotherapy. A combination of these drugs may be given if monotherapy shows no effect on reduction in seizure events. Complete withdrawal of drugs is considered only when the patient is seizure-free. Usually the dosage of drug is reduced gradually and over a period of 3–6 months (or longer) the patient may be free from seizures. Dr Srivatsa says ‘A small group of patients having seizures may need life long medications because of chances of relapse’ (Read: Scientists cure epilepsy in mice) 

Surgery:

‘There is a small population of patients, who do not respond to drug treatments at all. Such patients are termed as refractive to treatment,’ Dr Srivatsa says. ‘However, in such patients, if appropriate diagnosis is done and the areas of the brain which are prone to seizures are mapped using advanced EEG, surgery can be considered,’ he mentions.  

• Removal of seizure focus:It is the most common type of surgery where a small part of the brain where disturbance in signals is observed is removed.
• Multiple Subpial Transection: Sometimes, when the affected part cannot be removed, the surgeon may introduce series of incisions to prevent the signals from the affected part to reach other parts of the brain. 
• Lesionectomy: Epilepsy caused by the presence of a lesion can be treated by surgical removal of the legion.

‘There are newer methods like Vagus nerve stimulation (VNS) which are considered in patients who are not fit for surgeries,’ says  Dr Srivatsa. In this method, a device called vagus nerve stimulator is implanted under the skin of the patient in the chest. The device remains attached to the vagus nerve that delivers electrical signals to the brain thereby reducing seizures by 20-40 percent. 

Diet:

Researchers believe that diet rich in fats and low in carbohydrates (ketogenic diet) may help to reduce the frequency of seizures.

Can epilepsy be prevented? How?

Because the cause of epilepsy is not known, it cannot be prevented. However, childhood epilepsy can be prevented with good care during pregnancy. Genetic screening may help the mother to identify the chances of epilepsy in her child. Preventing head injuries can be taken as a preventive measures since they can lead to epilepsy.

People with epilepsy can control the frequency of their seizures by:

• Adhering to recommended prescribed medication
• Following a regular sleep cycle
• Avoiding stress
• Modifying diet
• Undergoing regular medical checkups and adhering to their follow-up schedule.

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Type of epilepsy medication during pregnancy affected children differently

 A study shows that different types of epilepsy medication, when taken during pregnancy, affect children differently than the other types of medication.

Women with epilepsy usually need to take medications to treat the condition even while they are pregnant. But how do those medications affect their developing babies?

A recent study found that one epilepsy medication appeared to affect children's development less than another when the children were preschoolers.

The two medications studied were levetiracetam (brand name Keppra) and valproate sodium (brand name Depacon, Depakene or Depakote).

Children whose mothers took levetiracetam during pregnancy scored similarly to children not exposed to medications in the womb.

Children whose mothers took valproate sodium scored lower with motor skills and language skills.

This study, led by R. Shallcross, PhD, of the Department of Clinical Psychology at the University of Liverpool in the United Kingdom, looked at the development of children whose mothers took epilepsy medications while pregnant.

The researchers compared the children of 97 women who took either levetiracetam or valproate sodium while pregnant to the children of 131 women without epilepsy, who took no prescription medications during pregnancy.

The children were aged 3 to 4.5, and their cognitive skills and language development were tested with established scales.

After taking into account other characteristics that differed among the children and/or their mothers, the 53 children whose mothers took levetiracetam did not score any differently than children not exposed to medications during pregnancy.

Differences were seen, however, among the children whose mothers took valproate sodium during pregnancy.

The 44 children exposed to valproate sodium in the womb scored an average 15.8 points lower on gross motor skills than children exposed to levetiracetam in the womb.

The scale used is calculated similarly to an IQ scale, with 100 representing the average for children.

Children of mothers who took valproate sodium also scored an average 6.4 points lower on language comprehension and 9.5 points lower on expressive language skills, compared to children of mothers who took levetiracetam during pregnancy.

The researchers therefore concluded that children whose mothers used levetiracetam to treat their epilepsy during pregnancy fared better in motor skills and language development than children whose mothers used valproate sodium.

However, the researchers cautioned that their findings do not mean that valproate sodium should never be used during pregnancy.

Because this medication is used to treat seizures, which can also be dangerous for an unborn baby, some women may still need to take it while pregnant.

This study was published January 8 in the journal Neurology.

The research was funded by UCB Pharma Ltd., the Epilepsy Research Foundtion, GlaxoSmithKline, Sanofi Aventis, Janssen-Cilag, Novartis, Pfizer, Eisai and Epilepsy Research UK.

Five authors have received travel funds or advisory board honorariums from various pharmaceutical companies, including Sanofi Aventis and UCB Pharma Ltd.

Three of these authors have also given expert testimony in legal cases related to fetal anticonvulsant syndrome or the safety of anticonvulsants during pregnancy.

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