Showing posts with label houston epilepsy specialist. Show all posts
Showing posts with label houston epilepsy specialist. Show all posts

Monday, October 20, 2014

Seizures after Vaccine are Not due to the Vaccine...it might be worse.

Etiologies for Seizures Around the Time of Vaccination found in 65%!!

Its important to have an expedited evaluation by an epilepsy specialist. JR

Post-immunization epilepsy likely not related to vaccine: study

Reuters: HealthSeptember 17, 2014
(Reuters Health) - Children who start having seizures soon after a vaccination and go on to develop epilepsy usually turn out to have an underlying cause of the seizure disorder, according to a new study published in Pediatrics.
"It's reassuring to hear that with follow-up testing, the vast majority of these cases can be identified as coming from a different cause," Dr. Shannon MacDonald told Reuters Health.
..
In the days after receiving a vaccine, compared to other times, children are two to five times more likely to have a febrile seizure, according to the authors of the new study.
"When a child has its first seizure shortly after a vaccination, and continues to have seizures thereafter, parents may think the vaccination has caused the epilepsy. However, in our study the majority of children who developed epilepsy after a vaccination, had a genetic or structural cause of the epilepsy," Dr. Nienke Verbeek, a clinical geneticist at University Medical Centre Utrecht in The Netherlands, told Reuters Health.
"In these children, the vaccination should only be considered a trigger for the first seizure that thereby unmasks the child’s underlying susceptibility for epilepsy," Verbeek added.
Roughly one in every 100 healthy, normally developing children will develop epilepsy after a febrile seizure, according to NINDS, but children with certain conditions, including cerebral palsy and developmental delay, are at greater risk.
To better understand the relationship between febrile seizures and epilepsy, the researchers looked at nearly a thousand children who had a first seizure within several days of being vaccinated. Twenty-six of the children were later diagnosed with epilepsy, and the researchers were able to follow up with 23 of them.
Eight of the children had Dravet syndrome, a rare genetic condition in which seizures may be brought on by fever, infectious disease, or vaccination. Three of the children had developmental delays and structural brain defects that could cause epilepsy. Four other children had gene mutations that could cause epilepsy, brain malformations, or a family history of the disease.
"Although no underlying cause was detected in one-third of children with epilepsy with vaccination-related onset, a genetic basis of epilepsy in these children is still possible: genetic analyses were incomplete, some children had positive family histories for seizures, and molecular defects underlying many genetically determined epilepsies have yet to be discovered," Verbeek and her colleagues write.
"For parents it is important to understand that a genetic cause (a so called DNA-mutation) for epilepsy cannot be induced by vaccinations," Verbeek told Reuters Health. " These mutations are already present in the child before it is born. They may have been transmitted by one of the parents, but more commonly have occurred spontaneously around the time of conception."
The findings “provide a pretty strong case that this was not caused by the vaccination,” Dr. Jorn Olsen told Reuters Health in a telephone interview.
...
SOURCE: Pediatrics, online September 15, 2014.
OBJECTIVES: This study was an assessment of the incidence, course, and etiology of epilepsy with vaccination-related seizure onset in a population-based cohort of children.
METHODS: The medical data of 990 children with seizures after vaccination in the first 2 years of life, reported to the National Institute for Public Health and Environment in the Netherlands in 1997 through 2006, were reviewed. Follow-up data were obtained of children who were subsequently diagnosed with epilepsy and had had seizure onset within 24 hours after administration of an inactivated vaccine or 5 to 12 days after a live attenuated vaccine.
RESULTS: Follow-up was available for 23 of 26 children (median age: 10.6 years) with epilepsy onset after vaccination. Twelve children developed epileptic encephalopathy, 8 had benign epilepsy, and 3 had encephalopathy before seizure onset. Underlying causes were identified in 15 children (65%) and included SCN1A–related Dravet syndrome (formerly severe myoclonic epilepsy of infancy) or genetic epilepsy with febrile seizures plus syndrome (n = 8 and n= 1, respectively), a protocadherin 19 mutation, a 1qter microdeletion, neuronal migration disorders (n = 2), and other monogenic familial epilepsy (n= 2).
CONCLUSIONS: Our results suggest that in most cases, genetic or structural defects are the underlying cause of epilepsy with onset after vaccination, including both cases with preexistent encephalopathy or benign epilepsy with good outcome. These results have significant added value in counseling of parents of children with vaccination-related first seizures, and they might help to support public faith in vaccination programs.

Saturday, September 13, 2014

Fish Oil Might Ease Tough-to-Treat Epilepsy

Interesting potential adjunct with few risks. JR


Fish Oil Might Ease Tough-to-Treat Epilepsy: Study

People taking the low-dose omega-3 supplements had fewer monthly seizures, but more research is needed

By Robert Preidt
HealthDay Reporter
MONDAY, Sept. 8, 2014 (HealthDay News) -- Low doses of fish oil may help reduce the number of seizures experienced by people with a form of tough-to-treat epilepsy that no longer responds to drugs, a small new study suggests.
The research was led by Dr. Christopher DeGiorgio, of the University of California, Los Angeles, and included 24 people with epilepsy that could no longer be controlled using medications.
One expert not connected to the study said many people with epilepsy remain without adequate treatment.
"Although medications remain the primary treatment for newly diagnosed epilepsy, more than 35 percent of patients continue to haveseizures despite taking antiepileptic drugs," said Dr. David Friedman, director of the Comprehensive Epilepsy Center at Winthrop University Hospital in Mineola, N.Y.
Friedman said that in these cases, patients often resort to alternative treatments such as epilepsy surgeries, special diets or brain-stimulating devices. So the new study using a common nutrient is intriguing, he said.
In the study, the UCLA team gave the patients three separate treatments, each lasting 10 weeks and separated by a period of six weeks.
The treatments were: the "low-dose" intervention of three capsules offish oil (about 1,080 milligrams) a day plus three "dummy" capsules containing corn oil only; the "high-dose" involving six capsules of fish oil a day, and a placebo treatment of three capsules of corn oil taken twice a day.
The average number of seizures while taking the low dose of fish oil was about 12 a month, compared with just over 17 when taking a high dose of fish oil, and just over 18 when taking the corn oil only.
Two people were completely free of seizures while taking a low dose of fish oil. This did not occur while patients were taking a high dose of fish oil or corn oil....

Sunday, March 16, 2014

Whole Exome Sequencing Brings Out Novel Genetic Causes of Dravet syndrome

Another reason to ask your epileptologist for genetic exome sequencing if there is no diagnosis. JR

 2014 Mar 12. [Epub ahead of print]

GABRA1 and STXBP1: Novel genetic causes of Dravet syndrome.

Abstract

OBJECTIVE:

To determine the genes underlying Dravet syndrome in patients who do not have an SCN1A mutation on routine testing.

METHODS:

We performed whole-exome sequencing in 13 SCN1A-negative patients with Dravet syndrome and targeted resequencing in 67 additional patients to identify new genes for this disorder.

RESULTS:

We detected disease-causing mutations in 2 novel genes for Dravet syndrome, with mutations in GABRA1 in 4 cases and STXBP1 in 3. Furthermore, we identified 3 patients with previously undetected SCN1A mutations, suggesting that SCN1A mutations occur in even more than the currently accepted ∼75% of cases.

CONCLUSIONS:

We show that GABRA1 and STXBP1 make a significant contribution to Dravet syndrome after SCN1A abnormalities have been excluded. Our results have important implications for diagnostic testing, clinical management, and genetic counseling of patients with this devastating disorder and their families.

Sunday, September 15, 2013

Is it migraine or occipital epilepsy? Panayiotopoulos syndrome (PS) can cause vomiting and headache!

What are the key differences between occipital seizures and migraine? 

Sometimes its hard to tell...JR 
Panayiotopoulos syndrome (PS) 

Fig. 1

Benign childhood focal epilepsies: assessment of established and newly recognized syndromes

  1. Michael Koutroumanidis
+
  1. Department of Clinical Neurophysiology and Epilepsies, St Thomas’ Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK
  1. Correspondence to: Michael Koutroumanidis, MD, Department of Clinical Neurophysiology and Epilepsies, St Thomas’ Hospital, London SE1 7EH, UK E-mail:michael.koutroumanidis@gstt.nhs.uk
  • Received April 14, 2008.
  • Revision received June 30, 2008.
  • Accepted July 1, 2008.

Summary

A big advance in epileptology has been the recognition of syndromes with distinct etiology, clinical and EEG features, treatment and prognosis. A prime and common example of this is Rolandic epilepsy that is well known by the general pediatricians for over 50 years, thus allowing a precise diagnosis that predicts an excellent prognosis.

However, rolandic is not the only benign childhood epileptic syndrome.

Converging evidence from multiple and independent clinical, EEG and magnetoencephalographic studies has documented Panayiotopoulos syndrome (PS) as a model of childhood autonomic epilepsy, which is also common and benign. Despite high prevalence, lengthy and dramatic features, PS as well as autonomic status epilepticus had eluded recognition because emetic and other ictal autonomic manifestations were dismissed as non-epileptic events of other diseases.

Furthermore, PS because of frequent EEG occipital spikes has been erroneously considered as occipital epilepsy and thus confused with the idiopathic childhood occipital epilepsy of Gastaut (ICOE-G), which is another age-related but rarer and of unpredictable prognosis syndrome. Encephalitis is a common misdiagnosis for PS and migraine with visual aura for ICOE-G. Pathophysiologically, the symptomatogenic zone appears to correspond to the epileptogenic zone in rolandic epilepsy (sensory-motor symptomatology of the rolandic cortex) and the ICOE-G (occipital lobe symptomatology), while the autonomic clinical manifestations of PS are likely to be generated by variable and widely spread epileptogenic foci acting upon a temporarily hyperexcitable central autonomic network.

Rolandic epilepsy, PS, ICOE-G and other possible clinical phenotypes of benign childhood focal seizures are likely to be linked together by a genetically determined, functional derangement of the systemic brain maturation that is age related (benign childhood seizure susceptibility syndrome). This is usually mild but exceptionally it may diverge to serious epileptic disorders such as epileptic encephalopathy with continuous spike and wave during sleep.

Links with other benign and age-related seizures in early life such as febrile seizures, benign focal neonatal and infantile seizures is possible. Overlap with idiopathic generalized epilepsies is limited and of uncertain genetic significance.

Taking all these into account, benign childhood focal seizures and related epileptic syndromes would need proper multi-disciplinary re-assessment in an evidence-based manner.


Full article here....

Tuesday, August 20, 2013

Houston Area ISD's Seizure Action Plans for Children With Epilepsy

Make sure your child has an action plan...please contact me with a link if I missed your school. As a child neurologist / specialist in epilepsy, I fill out may of these forms.  Schools should be aware and prepared. JR



Selected Houston Area Seizure ACTION Plans for Schools

Houston ISD Seizure and Asthma action Plans

Katy ISD
Fort Bend ISD ( Sugar Land ) Seizure, Asthma and Allergy ACTION PLAN

Spring Branch ISD ACTION PLAN for seizures, asthma, allergies & Diabetes

Conroe ISD ( The Woodlands)  Seizure information form 

Lamar Consolidated ISD ACTION PLAN

Generic Forms from the EPILEPSY FOUNDATION