Diet changes to help tough-to-treat epilepsy

This article explains low-carb high-fat diets and how they help tough-to-treat epilepsy.

Diets high in fat and low in carbohydrates, such as the ketogenic or modified Atkins diet, may reduce seizures in adults with tough-to-treat epilepsy, according to a review of the research published in the October 29, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Epilepsy is a nervous system disorder in which the nerve cells in the brain work abnormally, causing seizures. About 50 million people have epilepsy worldwide, according to the World Health Organization.

"We need new treatments for the 35 percent of people with epilepsy whose seizures are not stopped by medications," said study author Pavel Klein, M.B.,B. Chir., of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Md., and a member of the American Academy of Neurology. "The ketogenic diet is often used in children, but little research has been done on how effective it is in adults."

The ketogenic and modified Atkins diets include items such as bacon, eggs, heavy cream, butter, leafy green vegetables and fish. The ketogenic diet consists of a ratio of fat to protein/carbohydrates of three or four to one by weight. The modified Atkins diet has a one-to-one fat to carbohydrate/protein ratio by weight.

Scientists reviewed five studies on the ketogenic diet with a total of 47 people included in the analysis and five studies on the modified Atkins diet with 85 people included.

Researchers found that across all studies, 32 percent of people treated with the ketogenic diet and 29 percent of those treated with the modified Atkins diet experienced a 50 percent or better reduction in their seizures. Nine percent in the ketogenic treatment group and 5 percent in the modified Atkins group had a greater than 90 percent reduction in seizures.

The positive results occurred quickly with both diets, within days to weeks. The effect persisted long-term, but, unlike in children, the results did not continue after participants stopped following the diet. Side effects of both diets were similar and not serious, with weight loss the most common side effect.

Fifty-one percent of the ketogenic diet group and 42 percent of the modified Atkins group stopped the diet before the study was completed.

"Unfortunately, long-term use of these diets is low because they are so limited and complicated. Most people eventually stop the diet because of the culinary and social restrictions," said Klein. "However, these studies show the diets are moderately to very effective as another option for people with epilepsy."

Read more here

Difficulties of treating epilepsy while pregnant

This article explains the difficulties of pregnant mothers with epilepsy treating the condition while pregnant.

A new study published in The Cochrane Library, highlights the difficult decisions women with epilepsy have to face when they become pregnant. Taking certain drugs used to control epilepsy during pregnancy may be linked to developmental problems in children. The authors of the study say evidence on the safety of anti-epileptic drugs is limited and that more research is needed to ensure women and their doctors make the most informed choices.

Studies on children born to women with epilepsy increasingly suggest that some anti-epileptic medications affect development in the womb. However, most women with epilepsy rely on these medications to control seizures during pregnancy.

To assess the safety of taking anti-epileptics during pregnancy, the researchers drew together evidence from 28 studies. They measured children's global cognitive ability using either intelligence quotient (IQ), for school aged children, or developmental quotient (DQ), for younger children, to provide a summary of development across a range of cognitive skills. The researchers looked at DQ and IQ scores in the children of three groups of women: those with epilepsy who took anti-epilepsy medication, those with epilepsy who did not take epilepsy medication and those without epilepsy.

The children of women who took one drug, sodium valproate, had lower DQs and IQs than the children of women in the other groups. Higher doses of this drug were linked to larger effects on IQ or DQ. However another drug, carbamazepine, did not appear to have any significant effects on DQ or IQ. Younger children born to women who took carbamazepine did have lower DQs but the researchers concluded that this effect was due to random variation between the results of studies.

"This review highlights the need for preconception counselling in women with epilepsy," said Rebecca Bromley, lead researcher of the study based at the Institute of Human Development at the University of Manchester in Manchester, UK. "Counselling should take account of the fact that many pregnancies are unplanned and cover the risks of anti-epileptic drugs, whilst considering how well they control epileptic seizures."

"The review also highlights the need to counsel patients about risks and benefits of treatment alternatives at the time of epilepsy diagnosis and treatment initiation, so that informed decisions can be made. This is particularly important for women with idiopathic generalised epilepsy for whom valproate is the most effective treatment. Some women may choose to initiate valproate as they have no plans to conceive, while others may choose to avoid valproate and try a less effective drug accepting the associated risk of further seizures." Tony Marson, Coordinating Editor Cochrane Epilepsy Group, University of Liverpool.

Some studies made comparisons between different drugs. The children of women who took valproate had lower IQs than children exposed to carbamazepine or lamotrigine in the womb. They also had lower DQs and IQs than children born to women who took phenytoin. There were no differences between the IQs of children exposed to either carbamazepine, phenytoin or lamotrigine.

Only a few studies analysed the effects of newer anti-epileptic drugs like lamotrigine, levetiracetam and topiramate. "Data was not available for all anti-epileptic drugs that are in use today and data on newer anti-epileptic drugs was especially scarce," said Bromley. "This makes it difficult for women and their doctors to know which medications are safe to use during childbearing years. Future research needs to be carried out in a timelier manner to ensure that when prescribing decisions are being made the risks are already established. Women should however not stop or make alterations to their medication without first seeking medical advice."

Read more here

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.

Read more here

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.

Read more here

Zebrafish research promises new epilepsy treatment

Research on zebrafish shows compounds that help suppress seizures showing promise for future epilepsy treatment.

The prospect of developing new treatments for epilepsy sufferers has been given a boost by a pioneering discovery at a leading international centre of research into human disease in the University of Sheffield.

Researchers at the University’s Medical Research Council Centre for Developmental and Biomedical Genetics (CDBG), in the Department of Biomedical Science, screened a collection of 2,000 biologically active compounds to identify molecules that suppressed epileptic seizures in two day old epileptic zebrafish.

Within this collection, 46 compounds – including some which are used to treat infectious, psychiatric and inflammatory disorders – were found to exhibit anticonvulsant activity and could represent starting points for the development of new drugs for treating epilepsy.

Approximately one out of every 140 people in the UK has epilepsy – more than 400,000 people – of which about 30 per cent do not respond favourably to the available anti-epileptic drugs.

Consequently, many patients live with the disruptive and often devastating effects of untreatable seizures in their daily lives, whilst other patients who receive medication for their seizures experience side-effects that can result from taking some of these drugs.

The University of Sheffield team’s innovative approach to identifying small molecules with potential as anti-epileptic therapies offers new prospects of reducing the burden of suffering from this devastating illness.

Dr Vincent Cunliffe of the University of Sheffield’s Department of Biomedical Science, who led the project, said: “We took advantage of a unique set of features of the zebrafish to look for new anticonvulsant agents within a library of many different types of compounds with a wide range of known biological activities.

“We found that a small number of them had previously-unknown anti-convulsant effects. Some of the identified compounds already have a variety of different medical uses in treating conditions such as fungal infections, as well as psychiatric and inflammatory disorders.”

The research, published in the journal Disease Models & Mechanisms, suggests that some of these existing drugs could be re-purposed for treatment of epilepsy.

Nerve cells communicate with one another by passing electrical impulses along their lengths, leading to the release of a variety of chemical signals known as neurotransmitters at nerve endings, which may then stimulate or inhibit neighboring cells.

Epileptic seizures occur as a result of imbalances in the types of neurotransmitters produced within the brain, causing the simultaneous activation of abnormally large numbers of nerve cells, some of which may then stimulate body muscles to contract vigorously, resulting in convulsions.

Observing these processes at the level of individual nerve cells and molecules is especially difficult because the brains of mammals such as humans and mice, are so large, complex and relatively inaccessible.

However, the three milimetre-long, microscopic zebrafish larva develops rapidly, independently of its parents, and it is structurally simple, transparent and accessible, which allows the behaviours of nerve cells within the brain to be easily viewed in a remarkable level of detail. To study the effects of drugs on the zebrafish brain, they are simply diluted into the water in which the zebrafish develop, which then allows them to be readily absorbed by the body.

Dr Cunliffe added: “The zebrafish is proving to be a remarkably powerful in vivo system for gene function analysis and drug discovery. Over the last ten years our zebrafish research has helped us to understand how the nervous system is built and how faults in this construction process may cause neurological and psychiatric diseases.

“Three years ago we began to explore the usefulness of the zebrafish for drug discovery and we have been surprised by the success we have had in a relatively short period of time.”

More traditional approaches to identifying and developing new pharmaceuticals are slower and more costly, so adopting the zebrafish – a small tropical fish of the minnow family – for this type of research, could help to shorten the timescales and reduce the overall costs of drug development.

Read more here

New technologies utilized for epilepsy treatment

This article claims that developing new technologies is the best way to treat epilepsy. It also goes over a few of the technologies currently utilized for epilepsy treatment.

Speaking in the lead up to Purple Day for Epilepsy Awareness (Tuesday 26 March), geneticist Professor Jozef Gecz says advances in DNA sequencing have been a huge leap forward in understanding epilepsy. 

This, combined with the use of stem cells in laboratory research, will lead to further advances in epilepsy treatment, he says. 

However, he cautions that the same technology has also helped to reveal that epilepsy is a far more complex condition than previously thought. 

"Scientists used to believe that epilepsy was just one condition, possibly with one main cause. But now we know it is a very complex series of neurological disorders – it is many epilepsies, instead of just one epilepsy, with multiple causes and various symptoms," says Professor Gecz, from the University of Adelaide's School of Paediatrics and Reproductive Health. 

Epilepsy is common, with up to 3% of the Australian population experiencing epilepsy at some stage in their lives. Genetic and environmental factors, and trauma, can all play a role in the development of epilepsy. Most (but not all) forms cause sufferers to experience seizures, which vary in severity. 

Research in Adelaide has played an important role in the understanding of epilepsy in recent years. 

"It's really thanks to the pioneering work of Dr John Mulley (Women's and Children's Hospital and University of Adelaide), who discovered the first gene for idiopathic epilepsy almost 20 years ago. Since then, almost 40 idiopathic epilepsy genes have been discovered, many of them by researchers here in Adelaide," Professor Gecz says. 

"There are more than 300 genes known today in which DNA mutations can give rise to some form of epilepsy, in addition to other problems like intellectual disability, autism or psychiatric problems. 

"Thanks to genetic sequencing technology, in most cases we are now able to solve the mystery about what kind of epilepsy a patient has, and we can do this very quickly, very accurately, and cost effectively. 

"Molecular diagnosis is making a huge impact on treatment – it's really taken off in the last few years, and it has the potential to be even more effectively used in the future. Clinicians can now be guided by genetic information when considering treatment of patients with specific epilepsies." 

Professor Gecz and colleagues are currently involved in a major national study of epilepsy, with his lab focusing on the "genetic architecture" of the condition.

Read more here

Greater Costs, Morbidity Among Uncontrolled Epilepsy Patients

An intersting article about the costs of poorly controlled epilepsy - JR

Greater Costs, Morbidity Among Uncontrolled Epilepsy Patients

By: TARA HAELLE, Clinical Neurology News Digital Network

10/23/12 

VITALS

Major Finding: Compared with patients with well-controlled epilepsy, patients with uncontrolled epilepsy have 1.9-2.2 times more fractures and head injuries, receive 1.3-1.9 times more prescriptions, are hospitalized 5.4-6.7 times more often, are admitted to emergency departments 3.7-5 times more often, and incur $12,258-$14,582 greater annual health care costs.

Patients whose epilepsy was uncontrolled had more injuries, spent more time in the hospital, received more prescriptions, and incurred greater health care resource usage and costs than did patients whose epilepsy was under control in a retrospective, longitudinal matched-cohort study.

Additionally, uncontrolled epilepsy in private insurance patients incurred nearly $2,900 more in work time lost for disability and sick leave, comprising about one-fifth of these patients’ total direct health care costs.

Lead author Ranjani Manjunath of GlaxoSmithKline and her associates analyzed public and private insurance claims to determine how health care resource utilization and costs and epilepsy-related injuries differed between patients with uncontrolled epilepsy and those with well-controlled epilepsy. The findings were reported online Oct. 17 (Neurology 2012;79:1908-16).

The researchers defined patients with uncontrolled epilepsy as those who had at least two consecutive changes in their antiepileptic drug (AED) regimen (at least a month apart) and at least one subsequent hospitalization or emergency department visit within the next year. Patients taking AEDs but who had no changes in their therapy as well as no hospitalizations or ED visits were defined as having well-controlled epilepsy.

A total of 3,454 Medicaid patients and 602 private insurance patients with uncontrolled epilepsy were matched 1:1 with well-controlled epileptic patients for the study. Propensity score matching was used to reduce sample selection bias, and adjusted risk ratios for outcomes took into account age, sex, state or region, baseline AED use, use of other drugs known to increase seizure risk, baseline costs, and psychiatric conditions or epilepsy-related comorbidities (Alzheimer’s disease, brain tumor, meningitis, migraine, and stroke). A lower percentage of uncontrolled epilepsy patients were using AEDs at baseline: 48.1% of uncontrolled Medicaid patients, compared with 52.6% of well-controlled Medicaid patients (P less than .001), and 40% of uncontrolled private patients, compared with 45.5% of well-controlled private patients (Pless than .05).

...

The researchers selected only adult patients who had a prescription for an AED and who had been diagnosed with epilepsy or diagnosed with two nonfebrile seizures more than a month apart. All patients had been enrolled in their insurance plan for at least a year, and baseline included the 180 days before the patient’s first AED prescription. Patients were tracked until death, the end of continuous enrollment, or the end of the period for which data were available.

The study found that Medicaid and private patients with uncontrolled epilepsy had similarly higher incidence rate ratios (incidence rate defined as events divided by patient-years) of injury with 1.9-2.2 times more fractures and head injuries. 

Medicaid patients had 2.45 times more car accident injuries and 10 times more status epilepticus episodes.

Compared with patients who had well-controlled epilepsy, Medicaid patients had 1.94 times more AED prescriptions, 1.47 times more non-AED prescriptions, 6.65 times more hospitalizations, 7.72 times more days in the hospital, 3.67 times more ED visits, 1.66 times more outpatient services, and 3.09 times more neurologist visits. 

Likewise, private patients received 1.75 times more AED prescriptions, 1.34 times more non-AED prescriptions, 5.37 times more hospitalizations, 7.27 times more days in the hospital, 5.05 times more ED visits, 1.41 times more outpatient services, and 2.28 times more neurologist visits. (All P values were less than .05.)

Overall, Medicaid patients with uncontrolled epilepsy incurred an average $12,258 more in costs than Medicaid patients with well-controlled epilepsy, and uncontrolled epileptic private patients’ total extra cost was $14,582. 

Most of these costs came from hospitalization; outpatient services and prescription drugs comprised the next largest share. Private patients also missed 2.5 times more workdays, including 61% more sick days.

Article here

Seizure Alert Dog Placement in Texas

Seizure Alert Dog Placement  in Texas

 

My name is Cindy and I train Seizure Alert Dogs for people around the San Antonio area. 

 I'm looking to place this dog in the picture.  She is a lab, boarder collie mix.  She needs a very specific environment so please don't apply for her if you do not meet all requirements. 

 She was temporarily placed with someone with seizures and has proven to alert.  She can not be in a house with any dogs, cats or free roaming animals.  She can not be placed with a child or in a home where there is children under the age of 11.  She loves kids but they are too much of a distraction for her in the home.  She has to go everywhere with the person she is placed with.  You must have a fenced yard but she is never outside by herself.  You have to be available for training.  If you do not live in the San Antonio area, you must be able to come for training or fly me to you.  You must be financially capable to pay for all vet/equipment bills.  You will be responsible for fees that she has accumulated during her training and her equipment, approx. $800.  You will also be responsible for fees during the training.  This will depend on where you live.  You can send a one page letter to me at my email address buechner1@aol.com explaining your desire to have Lily.  Please put the word Lily in the Subject box or it could get deleted. 

 

I have another dog that is service trained that needs to be placed.  She is a blonde lab.  She is currently a breeder for a guide dog facility.  She has very specific needs as well.  She has to be placed in the San Antonio area.  The guide dog facility has agreed to let me place Ava while she is still in the breeding program.  She is slated to have two litters of puppies.  She will have to be under my care during the delivery and 6 weeks after she has the puppies.   She has to be placed with an older child that doesn't go to school or a young adult an older.  She needs to be the only dog in the house but cats are ok.  She has to go everywhere with the person she is placed with. You must have a fenced yard but she is never outside by herself. You have to be available for training.  You must be financially capable to pay for all vet/equipment bills. You will be responsible for a rehoming fee of $600 plus equipment costs and costs during the your training. You can send a one page letter to me at my email address buechner1@aol.com explaining your desire to have Ava. Please put the word Ava in the Subject box or it could get deleted.   It will be some challenges with her since you have to give her back during delivery but she is well worth the trouble.  She is being bred because she is really a special and hard working dog.  We will have to spend a lot of hours training the alert with you but she is a quick learner. 

Epilepsy & Global Health - A New Priority

An article from BBC discusses how epilepsy is turning into a global health issue.

Epilepsy is twice as common in low and middle-income countries as it is in the developed world, according to an international team of researchers.

They say the higher incidence is linked to increased risk factors, including head injuries and infections such as pork tapeworm and river blindness.

And more than 60% of sufferers in those countries receive no appropriate treatment, they say in the Lancet.

A Lancet editorial said epilepsy had to be a global health priority.

Epilepsy is a condition in which disturbances to the brain's normal electrical activity cause recurring seizures or brief episodes of altered consciousness.

There are about 40 different types. Epilepsy is not a mental illness, but can develop after injury or damage to the brain.

About 85% of the global burden of epilepsy occurs in low and middle-income countries.

'Bewitched'

Writing in the Lancet, researchers led by Prof Charles Newton, of the University of Oxford, say the death rate in developing countries is much higher than in developed ones - and that the reason for this is likely to be a failure to treat people with the condition.

Continue reading the main story

Prof Newton said: "The burden of epilepsy in these regions is at least double that found in high-income countries, and sadly, adequate facilities for diagnosis, treatment and ongoing management of epilepsy are virtually non-existent in many of the world's poorest regions."

He added: "Many people with epilepsy or their families do not even know that they have a disorder that can be controlled with biomedical treatment, so it is vitally important that awareness is raised and medical care improved in these regions."

Medications are available - but there can be problems distributing them, especially to remote areas.

The researchers say there are low-cost ways of improving the situation and of reducing the stigma often faced by people with epilepsy and their families - such as working with traditional healers and awareness campaigns to increase understanding of the condition.

In some countries, traditional beliefs about the causes of the condition, including bewitchment, spiritual causes and curses, lead to stigma and increase the chance that a person with epilepsy will not get the treatment they need.

A Lancet editorial adds: "Given the prevalence of epilepsy globally, it should be included as a priority on the public health agenda, and access to treatment should be greatly improved in developing countries.

"It is time for all governments to take epilepsy more seriously."

Read more here

Dr. Rotenberg to speak at Houston Epilepsy Foundation Conference

  

2012 Family Conference

November 10, 2012

Toyota Center

Houston, Texas

Registration

2:00 p.m.

Session I

3:00 p.m.

Parent Track: Dr. Rotenberg- Seizures and Sleep

Adult Track: Maria Palacios- Living Well with Epilepsy

Session II

4:00 p.m.

Parent Track: Mary Jane Williams- IEP and ARD Overview

Adult Track: Dr. Hartshorn- Medical Management

Session III

5:00 p.m.

Parent Track: Dr. Wilfong- New Treatment & Surgery Options

 

Adult Track: Dr. Kalamagalam- 

New Treatment & Surgery Options

Dinner

6:00 p.m.

Houston Rockets vs. Detroit Pistons

7:00 p.m.

Activities will be provided for children 

ages 6-13 years during the conference

**Parking is not included in the ticket price. 

Participants are responsible for their own parking 

at the Toyota Center**

Contact Heather at hpena@eftx.org

buy tickets here 

or 888-548-9716 or 713-789-6295 with any questions. 

 link to full flyer here

Effect of Treatment of Obstructive Sleep Apnea on Seizure Outcomes in Children With Epilepsy

Besides medicine, what else can you do to reduce seizures in children? Check their sleep! JR

Effect of Treatment of Obstructive Sleep Apnea on Seizure Outcomes in Children With Epilepsy

• Eric Segal, MD
, 
• Martina Vendrame, MD, PhD
, 
• Matthew Gregas, PhD
, 
• Tobias Loddenkemper, MD
, 
• Sanjeev V. Kothare, MD

Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

Received 22 October 2011; accepted 8 March 2012.

• Abstract
• Full Text
• PDF
• References

Abstract 

A retrospective review of children with epilepsy and obstructive sleep apnea, treated surgically for their obstructive sleepapnea from January 2008-October 2010, was performed for age, sex, type of epilepsy, antiseizure medications, sleep-study data, and changes in seizure frequency. Twenty-seven subjects (median age, 5 years) with no adjustment to their medications around their time of surgery were identified. Three months after surgery, 10 (37%) patients became seizure-free, three (11%) demonstrated >50% seizure-reduction, and six (22%) exhibited an amelioration of seizure frequency. Two (7%) demonstrated unchanged seizure-frequency, and six (22%) manifested a worsening of seizure frequency. Median seizure frequency before surgery was 8.5 (interquartile range, 2-90), and after surgery, three (interquartile range, 0-75), with a 53% median seizure reduction. Multivariate analysis demonstrated a trend toward seizure freedom with each percentile increase in body mass index and early age of surgery. We conclude that obstructive sleep apnea surgery may decrease seizure frequency, especially in children with elevated body mass index scores and younger age at time of surgery.

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Obstructive sleep apnea, seizures, and childhood apraxia of speech. Pediatric Neurology - Volume 38, Issue 6 (June 2008) (MEDLINE® is the source for the citation and abstract of this record)  - About This Journal  DOI: 10.1016/j.pediatrneurol.2008.03.002

Abstract:

Associations between obstructive sleep apnea and motor speech disorders in adults have been suggested, though little has been written about possible effects of sleep apnea on speech acquisition in children with motor speech disorders. This report details the medical and speech history of a nonverbal child with seizures and severe apraxia of speech. For 6 years, he made no functional gains in speech production, despite intensive speech therapy. After tonsillectomy for obstructive sleep apnea at age 6 years, he experienced a reduction in seizures and rapid growth in speech production. The findings support a relationship between obstructive sleep apnea and childhood apraxia of speech. The rather late diagnosis and treatment of obstructive sleep apnea, especially in light of what was such a life-altering outcome (gaining functional speech), has significant implications. Most speech sounds develop during ages 2-5 years, which is also the peak time of occurrence of adenotonsillar hypertrophy and childhood obstructive sleep apnea. Hence it is important to establish definitive diagnoses, and to consider early and more aggressive treatments for obstructive sleep apnea, in children with motor speech disorders.

Citation:

Obstructive sleep apnea, seizures, and childhood apraxia of speech.
Caspari SS - Pediatr Neurol - 01-JUN-2008; 38(6): 422-5
MEDLINE® is the source for the citation and abstract of this record 

NLM Citation ID:
18486825 (PubMed ID)

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