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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FDA approves migraine prevention medication for adolescents

The FDA has approved Topamax for migraine prevention in adolescents aged 12 to 17 years old. This is the first approved medication for this purpose in this age group.

Today, the U.S. Food and Drug Administration approved Topamax (topiramate) for prevention (prophylaxis) of migraine headaches in adolescents ages 12 to 17. This is the first FDA approval of a drug for migraine prevention in this age group. The medication is taken on a daily basis to reduce the frequency of migraine headaches.

Topamax was first approved by the FDA in 1996 to prevent seizures. It was approved for migraine prevention in adults in 2004.

“Migraine headaches can impact school performance, social interactions, and family life,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “Adding dosing and safety information for the adolescent age group to the drug’s prescribing information will help to inform health care professionals and patients in making treatment choices.”

About 12 percent of the U.S. population experiences migraine headaches. Migraine headaches are characterized by episodes of throbbing and pulsating pain in the head, and may occur several times per month. Other common symptoms include increased sensitivity to light, noise, and odors, as well as nausea and vomiting. Many patients experience their first migraine attack before reaching adulthood, and migraine can be just as disabling in teens as it is in adults.

The safety and effectiveness of Topamax in preventing migraine headaches in adolescents ages 12 to 17 was established in a clinical trial that enrolled 103 participants. Those treated with Topamax experienced a decrease in the frequency of migraine of approximately 72 percent compared to 44 percent in participants that took an inactive drug (placebo). 

The most common adverse reactions with the approved dose of Topamax (100 milligrams) were paresthesia (a burning or prickling sensation felt in the hands, arms, legs, or feet), upper respiratory infection, anorexia (loss of appetite), and abdominal pain.

Topamax must be dispensed with a Medication Guide that describes important safety information about the drug. Topamax and all anti-epileptic drugs may increase the risk of suicidal thoughts and behavior, and patients should be advised of the need to be alert for the emergence of, or worsening of, the signs and symptoms of depression, or unusual changes in mood or behavior.

Topamax increases the risk of the development of cleft lip and/or cleft palate (oral clefts) in infants born to women who take the drug during pregnancy. The benefits and risks of Topamax should be carefully weighed before using it in women of childbearing age.  If the decision is made to use the medication by a woman of childbearing age, effective birth control should be used.

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Study: Seizure medication may reduce risk for some cancers

A study shows that the seizure medication valproic acid may reduce the risk for certain head and neck cancers.

A drug used to treat seizures may reduce the risk of head and neck cancers, a new study suggests.

Valproic acid (Depakote) is prescribed to prevent seizures and also to control mood, but it is also being investigated for cancer prevention because it inhibits genetic changes that can lead to cancer.

The new study included nearly 440,000 U.S. veterans, including about 27,000 who were taking valproic acid for bipolar disorder, post-traumatic stress disorder (PTSD), migraines and seizures. Overall, veterans who took the drug for at least one year were 34 percent less likely to develop head and neck cancers than those who didn't take the drug, the investigators found.

The risk appeared to be even lower in those who took it in higher doses or for longer periods of time, according to the study published online March 24 in the journal Cancer.

Veterans who took valproic acid did not have a reduced risk for lung, bladder, colon or prostate cancers, said team leader Dr. Johann Christoph Brandes, of the Atlanta Veterans Affairs Medical Center and Emory University in Atlanta, and colleagues.

"A 34 percent risk reduction for the development of head and neck cancer with [valproic acid] use could result in the prevention of up to approximately 16,000 new cases and 3,000 to 4,000 annual deaths in the U.S. alone," Brandes said in a journal news release.

"Head and neck cancer is an important global health crisis, and low cost and low toxicity prevention strategies like [valproic acid] use have a high potential impact on pain, suffering, costs, and [death] associated with this disease," he added.

Although the study found an association between valproic acid use and reduced risk of certain cancers, it did not prove cause-and-effect.

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Researchers find a new way that epilepsy spreads

Researchers found a new way that epileptic activity spreads through the brain, which has implications for seizure treatment.

Researchers in the biomedical engineering department at Case Western Reserve University have found that epileptic activity can spread through a part of the brain in a new way, suggesting a possible novel target for seizure-blocking medicines.

Evidence from a series of experiments and computer modeling strongly suggests individual cells in a part of the brain, known as the hippocampus, use a small electrical field to stimulate and synchronize neighboring cells, spreading the activity layer by layer.

The scientists report the discovery in theJournal of Neuroscience this week.

"We know there are several ways for neurons to talk with one another: chemical and electrical synaptic transmission and diffusion of ions," said Dominique Durand, professor ofbiomedical engineering at Case Western Reserve and the study's senior author. "But this shows a new mechanism. Neurons talk to each other cell to cell using electrical fields, propagating a wave of activity."

Durand worked with graduate students from Case Western Reserve's Neural Engineering Center: Mingming Zhang, Chen Qiu, Rajat J. Shrivacharan and Thomas P. Ladas; and Senior Research Associate Luis E. Gonzales-Reyes to investigate how epileptic seizure activity starts and spreads in the brain.

They inserted a 64-channel microelectrode array in the unfolded hippocampus of a mouse model to monitor its activity. They then injected the hippocampus, which is known to be involved in the most common form of epilepsy, with a drug to make the hippocampus epileptic.

They blocked chemical synapses from transmitting signals between neurons by reducing the calcium ion concentration below the level typically involved in signaling. They then blocked what are called "gap junctions," which electrically transmit signals across synapses, by injecting the antimalarial drug mefloquine, known to hamper the process.

Their tests showed that epileptic activity continued to spread at a speed of about 0.1 meter per second with or without synaptic transmission.

The propagation speed eliminated the third known route of epileptic propagation—signaling by diffusion of sodium and potassium ions across brain cell membranes. Diffusion is too slow to be the method of transmission.

The researchers were left with the fourth known way that neurons communicate: electrical fields. When a group of cells fire together, they can generate currents and electric fields that can be large enough to excite their neighbors.

Computer simulations with a large set of neurons confirmed that a weak electrical field could, by itself, spread epileptic signals at the speed that matched their experimental results. The computer model also predicted that signal transmission would change speeds depending on the distance between neurons.

The researchers verified the prediction by injecting drugs that would either expand or decrease the space between cells. The closer the cells, the faster the transmission. The more distant the cells, the slower the transmission until—at a certain distance—the signal failed to propagate.

For some time, doctors have used diuretics to treat some types of epilepsy.Diuretics are known remove water from cells and but their anticonvulsant properties are not known, Durand said.

As water is removed from cells and enters the extracellular space, it increases the space between cells and may be pushing them beyond the reach of the weak electrical field, he said.

The researchers say that this finding does not diminish the importance of synaptic transmission in epilepsy but points to another synchronizing and propagation mechanism.

But "this discovery has implications for epilepsy," Durand said. "If cells in an excited state can talk to or influence each other, they can synchronize to a seizure-like state, propagate to neighbors thereby generating a full-blown seizure."

The electrical fields and the process of synchronization and propagation may be new targets for medicines or other treatments to prevent or limit seizures.

The researchers are now investigating a way to directly test the effect of electric field on seizure generation and propagation.

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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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Epilepsy drug may help adults learn pitch

Results from a study shows that an epilepsy drug can help adults learn the rare skill of having perfect pitch.

Perfect pitch, also called absolute pitch, is the ability to accurately name any pitch you hear. People with perfect pitch can sing any note of the chromatic scale without hearing reference pitches first.

Until recently, perfect pitch was thought to be an innate ability that very few children possessed. The American Psychological Association estimates that only one in 10,000 Americans have the gift.

But according to a research report published last week, scientists have discovered that Valproate, a drug used to treat epilepsy, can help adults develop perfect pitch.

Research had shown that the drug enabled adult mice to learn habits that were previously only possible for mice to learn during youth.

Harvard researcher Takao Hensch and an international team of scientists, then, decided to give Valproate to a group of adult men who had no prior musical training. They asked the group to complete an online ear-training course that lasted for two weeks.

At the end of the trial, those who took Valproate were significantly better at identifying pitches than those taking a placebo.

Hensch, who is a professor of molecular and cellular biology at Harvard, recently discussed the research team's findings with Linda Wertheimer of NPR. "It's a mood-stabilizing drug, but we found that it also restores the plasticity of the brain to a juvenile state," Hensch said.

In other words, the drug seems to restore the ability to learn certain tasks that were once thought impossible to learn outside of childhood.

Of course, the implications of such a drug are enormous. It could help adults learn a new language and speak that language without an accent, abilities which are thought to peak in early childhood.

For a long time, perfect pitch was thought to be a result of nature, not nurture.

In the NPR interview, Hensch acknowledges that there is a genetic component. But he and many other researchers believe that perfect pitch can be acquired, through early musical training before age seven.

Other researchers disagree, saying that the ability to develop perfect pitch is genetic and can't be taught.

However, there is one point on which researchers tend to agree: It is impossible for adults to develop perfect pitch.

Many musicians regard perfect pitch as the holy grail, the ultimate musical gift. Mozart had perfect pitch, and many experts think Beethoven had it also.

The ability to instantly identify whether any pitch is sharp or flat can help string players play in tune. The ability to sing any pitch can help singers navigate densely chromatic music.

And perfect pitch can help any musician sight-read a difficult score. A drug that could aid adults in developing this ability would probably prove extremely popular among musicians.

But Hensch warns that scientists are only beginning to understand how Valproate affects the brain's ability to learn new things. And the drug is known to have side effects.

So, it may be a long time before Valproate is available to consumers for this purpose. And those who take such a medication may find that perfect pitch has its downside.

Those who have it might not enjoy listening to an orchestra that tunes to a concert "A" that is a little sharp or flat, as some orchestras do. And hearing the out-of-tune pitches of electric appliances, train whistles and other background noises in our environment could become annoying for a whole new reason.

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The effect of anti-epileptic drugs on children's growth

A recent study looked into how the use of anti-epilepsy drugs effects children's growth and health, and results showed that the use of certain drugs to impair the growth of children with epilepsy.

This study investigated whether long–term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan. These results raise serious concerns about the growth of pediatric epilepsy patients who use AEDs, and potentially the need to closely monitor growth in children with epilepsy and adolescents under AED treatment, especially VPA.

Methods

• Children with epilepsy treated with one prescription of AEDs (monotherapy) for at least 1year were selected.
• The AEDs included valproic acid (VPA; Deparkin) in 27 children (11 boys and 16 girls) aged 4-18years, oxcarbazepine (Trileptal) in 30 children (15 boys and 15 girls) aged 5-18years, topiramate (Topamax) in 19 children (10 boys and 9 girls) aged 6-18years, and lamotrigine (Lamicta) in eight children (5 boys and 3 girls) aged 5-13years.
• Patients with a history of febrile convulsions were selected as the controls.

Results

• One year of VPA treatment significantly impaired the statural growth of pediatric patients with epilepsy (p<0.005) compared with the control group.
• The underlying mechanism may have been due to the direct effect of VPA on the proliferation of growth plate chondrocytes rather than alterations of serum calcium.

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Inflammation can be caused by anti-epilepsy drugs

A report claims that anti-epilepsy drugs can cause inflammation and thus may have roots in the immune system.

Physicians at the Ruhr-Universität Bochum (RUB) have been investigating if established anti-epilepsy drugs have anti-inflammatory or pro-inflammatory properties -- an effect for which these pharmaceutical agents are not usually tested. One of the substances tested caused stronger inflammations, while another one inhibited them. As inflammatory reactions in the brain may be the underlying cause for epileptic disorders, it is vital to take the trigger for the disorder under consideration when selecting drugs for treatment, as the researchers concluded. They published their report in the journal Epilepsia.

Glial cells play a crucial role in the nervous system

Hannes Dambach from the Department for Neuroanatomy and Molecular Brain Research, together with a team of colleagues, studied how anti-epilepsy drugs affect the survival of glial cells in cultures. Glial cells are the largest cell group in the brain; they are crucial for supplying neurons with nutrients and affect immune and inflammatory responses. The question of how glial cells are affected by anti-epilepsy drugs had previously not been studied in depth. The RUB work group Clinical Neuroanatomy, headed by Prof Dr Pedro Faustmann, analysed four substances: valproic acid, gabapentin, phenytoin and carbamazepine.

Four anti-epilepsy drugs affect glial cells in different ways

Glial cells treated by the researchers with valproic adic and gabapentin had better survival chances than those treated with phenytoin and carbamazepine. However, carbamazepine had a positive effect, too: it reduced inflammatory responses. Valproic acid, on the other hand, turned out to be pro-inflammatory. In how far the anti-epilepsy drugs affected inflammations was also determined by the applied dose. Consequently, different drugs affected glial cells -- and hence indirectly the neurons -- in different ways.

Inflammatory responses should be taken under consideration in clinical studies

"Clinical studies should focus not only on the question in how far anti-epilepsy drugs affect the severity and frequency of epileptic seizures," says Pedro Faustmann. "It is also necessary to test them with regard to the role they play in inflammatory responses in the central nervous system." Thus, doctors could take the underlying inflammatory condition under consideration when selecting the right anti-epilepsy drug.

Epilepsy may have different causes

In Germany, between 0.5 and 1 percent of the population suffer from epilepsy that requires drug treatment. The disease may have many causes: genetic predisposition, disorders of the central nervous system after meningitis, traumatic brain injury and stroke. Inflammatory responses may also be caused by damage to the brain.

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Research on women, pregnancy, and the effects of epilepsy

Research looks into women, pregnancy and folic acid supplementation, and how valproate, an antiepileptic drug, effects them.

New research pertaining to the latest findings on the effects of epilepsy on both the mother and child were presented at the American Epilepsy Society's 67th Annual Meeting in Washington DC. These studies explore folic acid use, the effect of surgery with intractable focal epilepsy, and antiepileptic drug exposure during breastfeeding.

Researchers from the Harvard Neuroendocrine Unit at Beth Israel Deaconess Medical Center in Boston, Massachusetts investigated the frequency of folic acidsupplement use by women with epilepsy in the community and factors that may predict its use (Platform B.04 / Abstract 1722353). Folic acid deficiency in early pregnancy is known to cause birth defects and increase the risk of miscarriages, which can occur most with enzyme-inducing antiepileptic drugs (AED). Neural tube malformations are most common with the use of Valproate, a folic acid antagonist.

Data for this study was collected through the Epilepsy Birth Control Registry (EBCR), a web-based survey and educational site used to gather key information from 626 women with epilepsy in the community. The study found that 44% of respondents took folic acid.

"Our findings show that only about half of the women surveyed are taking folic acid, despite their high risk of unintended pregnancies. Additionally, we found that many of the respondents who were not taking precaution of neural tube malformation were taking Valproate, a folic acid antagonist," said Andrew G. Herzog, MD, principal investigator of the study. "Overall the women at risk, regardless of antiepileptic drugs or contraceptive use, did not differ significantly from women not at risk and on no antiepileptic drugs."

In a related study, researchers from The Mayo Clinic-Rochester presented evidence to support the importance of early surgery in women with intractable focal epilepsylooking to get pregnant (Poster 3.250 / Abstract 1750307). One hundred and thirteen women were included in this study. An average of 0.93 pregnancies and 0.73 births were identified prior to surgery, compared to a significantly higher success rate of 1.27 pregnancies and 0.96 births post-surgery. A total of 17 women had a total of 35 pregnancies and 25 births after surgery. Those patients who received fewer medications prior to surgery were more likely to have additional children following surgery.

"While the significance of these findings is uncertain, we believe that they support a role for earlier surgical intervention in the management of intractable focal epilepsy and the relationship it has to conceiving and giving birth," said Rachel R. Fabris, MD, the lead author of this study.

A third study was presented as a follow up to previous research determining the effects of antiepileptic drug exposure via breast milk on IQ at age 3 years old. The new data collected was from a cohort of children at the age of 6, which the researchers deemed an age more predictive of school performance and adult abilities (Poster 2.213 / Abstract 1732174). While breastfeeding is known to have beneficial effects for both the child and the mother, there is concern regarding whether breastfeeding while taking antiepileptic drugs could be harmful to the cognitive development of the infant.

Results of the study were analyzed as a function of whether the children had been breastfed or not. Overall, 43% of the children were breastfed, but the results failed to show adverse effects of AED exposure: children who breastfed exhibited higher IQ and Verbal Index scores even though their mothers used AEDs.

"Our results are encouraging in that women with epilepsy can be less fearful of breastfeeding their baby," said the leader of this study, Kimford Meador, MD. "Nevertheless, this is a limited study and additional research is needed."

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Epilepsy myths and facts.

This article looks at nine myths about epilepsy and reveals the truth about these myths.

Epilepsy is the third most common neurological disorder, after stroke and Alzheimer’s, in the United States. Yet it is often presumed to be a rare disease. Those with epilepsy can often feel that, on top of living with seizures, misunderstanding “causes a stigma that makes life more difficult” and recount how, after suffering a seizure at work or school, they’ve experienced discrimination and social isolation.

Epilepsy affects some 2.7 million Americans (about 1 in 26) and some 50 million people around the world. In about 70 percent of cases of epilepsy, medication can help control seizures; in some cases, surgery can provide a “cure” by removing the source of seizures.

As November is Epilepsy Awareness Month, here are some other commonly held misconceptions about epilepsy.

1. People with epilepsy are mentally ill or possessed.

Photo via Wikimedia Commons.

The Ancient Greek medical writer Hippocrates called epilepsy the “sacred disease”; even today, some traditional cultures still see epilepsy as a kind of spirit possession. Epilepsy is now understood to be a chronic medical condition and an umbrella term for some 20 different seizure disorders. It is a disorder of the brain and it is not something you can catch; epilepsy is not contagious.

The prevalence of school, mood, quality of life and cognitive problems is more common among children with epilepsy and your neurologist should be asking and managing these problems.

2. Someone having a seizure is in danger of swallowing their tongue.

They are not; it is impossible to swallow your tongue. Nothing, though, should ever go into a person’s mouth during a seizure as biting down on something at such a time could cause serious dental trauma, contrary to Hollywood depictions of epilepsy. Neither, by the way, does anyone foam at the mouth when having a seizure.

When someone is having a seizure, they are unconscious and not in any pain. They may feel discomfort afterwards due to a fall, muscle aches or a bitter tongue.

3. Epilepsy affects intelligence.

Image via Wikimedia Commons.

People with epilepsy often have the same level of intelligence as those without epilepsy. Frequent seizures may make learning more difficult and medications can have side effects such as excessive fatigue but epilepsy itself does not typically lower intelligence or affect people’s ability to think. (Just ask Leonardo da Vinci, Sir Isaac Newton and Ludwig van Beethoven; they’re just same noteworthy historical figures who had epilepsy).

However, some people can have a decline due to medications, seizures, accidents, sleep problems or mood disorders. If you have concerns, ask your neurologist.

4. Epilepsy is something you’re born with.

Anyone can get epilepsy at any time in their life. Some are born with epilepsy (meaning that it is genetic), but you can also develop it as a result of head trauma, a brain tumor or lesion and stroke. The cause of epilepsy isn’t known in 65 to 70 percent of cases.

Genetics is an important cause of epilepsy.

5. Seizures happen all the time and involve convulsions.

Epilepsy affects each person differently. Seizures can occur frequently (even daily) for some individuals. Some people, thanks to medication, are able to manage their seizures while it’s more difficult for others.

There are actually some 40 different types of seizures, of which convulsions are only one. Seizures can involve a blank stare, an involuntary movement, altered consciousness, a change in sensation or convulsions.

6. Seizures can be predicted.

Photo via Wikimedia Commons

The onset of a seizure can’t yet be predicted. Some people have reported feeling a certain physical sensation prior to a seizure occurring. Some foods and sensations (flashing lights) have been thought  to trigger seizures in some people.

More and more service dogs are being trained to detect the onset of a seizure. A seizure dog for a child can be trained to bark to alert family about a seizure happening. Dogs can also be trained to activate a pre-programmed device that sends out an alert.

7. People with epilepsy can’t have jobs.

People with epilepsy are employed in all kinds of positions in business, government, medicine and many other fields. They can certainly hold high-pressure, demanding jobs including firefighting.

8. A seizure is a medical emergency.

Epilepsy is not a benign disease and uncontrollable seizures that keep occurring can be a serious health risk. Nonetheless, emergency medical attention isn’t always required. Such attention should be sought under these circumstances, when

… a seizure lasts five minutes or longer or repeats one after another without the person regaining consciousness in-between; it is someone’s first seizure; the person is injured during the seizure (through a fall, for example); the seizure happens in water; or the person is pregnant or has diabetes.

9. Only humans have epilepsy.

Epilepsy can occur in animals and has been identified in dogs and cats. Epilepsy in dogs is often inherited and may be higher in some breeds such as Belgian shepherds; it can be treated with medication (though this can lead to weight gain) and changes in diet and environment.

In cats, seizures are thought to be the result of previous damage to the brain. They can be treated with medication, but long term anticonvulsants can put unnecessary stress on a cat’s liver. Consultation with a veterinarian is certainly called for as is careful monitoring. With proper and attentive care, epilepsy is a condition that humans and animals can learn to live with.

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Moms with epilepsy should breastfeed their infants

A study shows that breastfeeding mothers with epilepsy should continue to breastfeed their children regardless of taking antiepileptic drugs while breastfeeding. JR

The study aims to determine whether signs of impaired development appear already during the first months of life in children exposed prenatally to antiepileptic drugs, and to explore potential adverse effects of antiepileptic drug exposure through breastfeeding. Prenatal exposure to antiepileptic drugs was associated with impaired fine motor skills already at age 6 months, especially when the child was exposed to multiple drugs. There were no harmful effects of breastfeeding. Women with epilepsy should be encouraged to breastfeed their children irrespective of antiepileptic drug treatment.

Methods

• Mothers at 13 to 17 weeks of pregnancy were recruited in the population-based, prospective Norwegian Mother and Child Cohort Study from 1999 to 2009.
• The mothers reported on their child’s motor and social skills, language, and behavior using items from standardized screening tools at 6 months (n=78744), 18 months (n=61351), and 36 months (n=44147) of age.
• The mothers also provided detailed information on breastfeeding during the first year.
• The risk of adverse development in children according to maternal or paternal epilepsy was estimated as the odds ratio with corresponding 95% confidence interval, adjusted for maternal age, parity, education, smoking, breastfeeding, depression/anxiety, folate supplementation, and congenital malformation in the child.

Results

• At age 6 months, infants of mothers using antiepileptic drugs (n=223) had a higher risk of impaired fine motor skills compared with the reference group (11.5% vs 4.8%, respectively; odds ratio=2.1; 95% CI, 1.3-3.2).
• Use of multiple antiepileptic drugs compared with the reference group was associated with adverse outcome for both fine motor skills (25.0% vs 4.8%, respectively; odds ratio=4.3; 95% CI, 2.0-9.1) and social skills (22.5% vs 10.2%, respectively; odds ratio=2.6; 95% CI, 1.2-5.5).
• Continuous breastfeeding in children of women using antiepileptic drugs was associated with less impaired development at ages 6 and 18 months compared with those with no breastfeeding or breastfeeding for less than 6 months.
• At 36 months, prenatal antiepileptic drug exposure was associated with adverse development regardless of breastfeeding status during the first year.
• Children of women with epilepsy who did not use antiepileptic drugs and children of fathers with epilepsy had normal development at 6 months.

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Mechanism that valproate uses to block seizures understood

The mechanism by which the anti-epileptic drug valproate works is finally understood 50 years after the discovery of the drug.

50 years after valproate was first discovered, research published today in the journalNeurobiology of Disease, reports how the drug works to block seizure progression.

Valproate (variously labelled worldwide as Epilim, Depacon, Depakene, Depakote, Orlept, Episenta, Orfiril, and Convulex) is one of the world's most highly prescribed treatments for epilepsy. It was first discovered to be an effective treatment for epilepsy, by accident, in 1963 by a group of French scientists. In thousands of subsequent experiments, animals have been used to investigate how valproate blocks seizures, without success. Scientists from Royal Holloway and University College London have now identified how valproate blocks seizures in the brain, by using a simple amoeba.

"The discovery of how valproate blocks seizures, initially using the social amoeba Dictyostelium, and then replicated using accepted seizure models, highlights the successful use of non-animal testing in biomedical research," said Professor Robin Williams from the School of Biological Sciences at Royal Holloway.

"Sodium valproate is one of the most effective antiepileptic drugs in many people with epilepsy, but its use has been limited by side-effects, in particular its effect in pregnant women on the unborn child," said Professor Matthew Walker from the Institute of Neurology at University College London. "Understanding valproate's mechanism of action is a first step to developing even more effective drugs that lack many of valproate's side-effects.

"Our study also found that the decrease of a specific chemical in the brain at the start of the seizure causes even more seizure activity. This holds important implications for identifying underlying causes," added Professor Williams.

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FDA approved marijuana-based CLINICAL TRIAL to treat Epilepsy

PLEASE NOTE: The FDA has recently approved a clinical trial  or an experiment with a marijuana-base to treat epileptic disorders. The agent has not been approved for clinical use. If interested call the study sponsors below.  JR

The US Federal Drug Association approved clinical studies that aim to determine whether purified cannabidiol (CBD) is a viable anti-seizure treatment. Physician investigators will be provided with Epidiolex, a new 98% CBD product made by GW Pharmaceuticals, and conduct Investigational New Drug studies involving epileptic children.

According to O’Shaughnessy, the clinical studies will be sponsored by Orrin Devinsky, MD, at the NYU School of Medicine, and Roberta Cilio, MD, PhD, at University of California, San Francisco. Both are expected to monitor the progress of 25 patients, but they may enroll more with approval from the FDA. Additionally, Cilio will conduct two individual studies as well.

GW Pharmaceuticals, the British company responsible for the cannabis-based spray Sativex, will provide researchers with their latest “pure CBD” product – Epidiolex. The drug will come in the form of a viscous liquid to be dispensed in syringe droppers. Additionally, there will be two strengths available: 25 milligrams per milliliter and 100 mg/ml.

According to GW, Epidiolex contains no tetrahydrocannabinol (THC), the psychotropic component in cannabis. It is said to contain more than 98% cannabidiol (CBD) and trace amounts of other cannabinoids. GW chairman Geoffrey Guy, MD, told O’Shaughnessy, “Our definition of pure is no THC.”

Guy believes the studies will help provide “better understanding and experience in what cannabidiol does in these different children groups, what benefit we can see, and how the results can best be measured.”

Considering anecdotal evidence that cannabis can help treat epileptic seizures, and nearly 5 years of pre-clinical trial data from GW Pharmaceuticals, Guy expects more studies to come in the future.

“In the coming months, if the FDA is comfortable about how things are going, there will be a number of senior epileptologists in major university centers throughout the U.S., each treating a couple of dozen patients with various epilepsies,” he explained.

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