Epilepsy can affect anyone. In the US approximately 3.4 million people have epilepsy and 1 in 10 people will have a seizure in their lifetime. Join us and the Epilepsy Foundation to raise awareness about epilepsy this month!

onein26.org

endepilepsy.org

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What is epilepsy?
Dr. James White, Minnesota Epilepsy Group

Lessening the burden of epilepsy.
Dr. James White, Minnesota Epilepsy Group

How epilepsy is treated.
Dr. James White, Minnesota Epilepsy Group

Pregnancy and epilepsy.
Dr. Julie Hanna, Minnesota Epilepsy Group

Visit www.allinahealth.org/epilepsy for more info.

The post Common Questions About Epilepsy – Video Series appeared first on Minnesota Epilepsy Group.

The Epilepsy Foundation of Minnesota supports the 60,000 Minnesotans & North Dakotans living with epilepsy.

Visit www.efmn.org/awareness to find out get involved with Epilepsy Awareness and help those with epilepsy.

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John Bryson, Secretary of Commerce

A headline topping the news earlier this week:

“Commerce Dept. says Sec. Bryson suffered seizure.”

The U.S. Commerce Department Secretary was involved in two motor vehicle crashes over last weekend.  The accidents appear to be due to seizure activity. Secretary Bryson is 68 years-old.

This major news story brings up (at least) three important issues:

1)      The highest achievers in our society can have seizures/epilepsy.

2)      New onset-seizure activity in people over 60 years of age is associated with an increased risk of stroke (note- we have limited details on Secretary Bryson’s case).

3)      A seizure while driving can be dangerous.

Important/famous people and epilepsy

I think it is very important to point out how epilepsy can affect a wide range of people in our society.  Part of the stigma associated with epilepsy is the misconception by some that people with epilepsy cannot have high intelligence or great abilities.  That is absolutely wrong! People with epilepsy are well known to be among the best and the brightest.  Patients who have epilepsy are business leaders, musicians, doctors, lawyers, teachers and politicians.  For example:

• Coach Kill is the University of Minnesota head football coach-his seizure activity on the sidelines of football games has been the subject of recent national news.
• Supreme Court Justice John Roberts has had documented seizure activity (Time Magazine, 2007).

Epilepsy is relatively common- affecting 1-2% of the population.  Most people with epilepsy have well controlled seizures.  Thus, people do not usually know who has seizures and are often not aware of the accomplishments of a person with epilepsy.  I think that educating the general population about epilepsy is an important way to combat the stigma associated with the word “epilepsy.”

Dr. Robert Fisher, MD, PhD wrote an excellent review about famous people with seizures for Epilepsy.com (https://www.epilepsy.com/epilepsy/newsletter/Jan10_people). Did you know that the following people have been either suggested to have seizures or have clear documentation of epilepsy/seizures:

• Julius Caesar
• Napolean
• Vincent Van Gogh
• Leo Tolstoy
• Dostoevsky

Epilepsy as a warning sign for stroke

Having the first seizure of a person’s life after the age of 60 years of age is a real shock to the patient. They have lived their whole life without having a seizure, so it can be quite a surprise.  Not only is having a seizure a big deal for the patient, the patient also needs to contend with the following information:

• The onset of seizure activity after the age of 60 years is associated with a striking increase in the risk of stroke. The risk of stroke increases three-fold in patients who have their first seizure after the age of 60 years (Cleary et al, Late-onset Seizures as a Predictor of Subsequent Stroke, Lancet 2004;363:1184-1186).

The take home message of the study: if you have the first seizure of your life after the age of 60 years, you need to be evaluated for stroke risk factors and appropriate treatment given.  The last thing a patient needs is a stroke! The seizure activity may be a warning sign that may help prevent the stroke.

Driving and seizures

Patients with epilepsy list driving restrictions as one of their top concerns (Krumholz A, Driving issues in epilepsy: past, present and future. Epilepsy Currents 2009;9:31-35).  This of course makes sense- employment, taking care of family, seeing friends all are significantly limited if a person cannot drive.  Although driving is extremely important for quality of life, driving with uncontrolled seizures that could impair a person’s driving ability is high risk behavior—for the patient and for others on the road.  In the US, each state has its own driving rules as they pertain to epilepsy.  The Epilepsy Foundation has a very useful website to search for driving information by state: (https://www.epilepsyfoundation.org/resources/drivingandtravel.cfm)

Several studies confirm that epilepsy poses some risk for motor vehicle accidents, but that risk seems small, especially compared to alcohol.  For example, one study estimated that the percentage of fatal driver crashes caused by a seizure is only 0.2% as compared with 30% caused by alcohol (Sheth SG, Krauss G, Krumholz A. Neurology 2004;63:1002–1007). It has been reported that only 11% of all car crashes involving individuals with epilepsy are due to seizures.  The majority of car accidents involving patients with epilepsy are not due to seizures—but rather due to driver error.

Latest Update: 6/13/2012

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1-2% of the world’s population has epilepsy

9% of people will have at least one seizure in their lifetime

If you have a first seizure in your life, what is the chance you will have a second seizure in the next two years?

• If neurological exam, EEG and MRI brain are normal: 25%
• If  neurological exam, EEG and/or MRI are abnormal: may be > 40-50%

If you have had 2 or more seizures in your life, what is the chance that you will have more seizures?

• 70%

Percentage of patients with epilepsy who do NOT  have an identified reason for their seizures (unknown category):

• 50 %

If you have the first seizure in your life, what is the percent chance your seizures will be completely controlled?

• First seizure medication: 50%
• Second seizure medication: 10%
• Third seizure medication and combination therapy: 3%
• Total percentage of patients who continue to have seizures despite > 3 seizure medication trials: 30%

The typical seizure lasts 30-60 seconds.

30 minutes: This is the duration of essentially continuous seizure activity required to meet criteria for status epilepticus. Status epilepticus is prolonged seizure activity that can be severe and even life-threatening.

Approximately 50 million people have epilepsy, worldwide.

3/4 of people in developing countries do not get the treatment that they need.

Dates are numbers (of course!).  Here are some dates that are very important in the history of epilepsy:

• 11^th century BC: Approximate date that the oldest known medical reference to epilepsy was written. It was written on two clay tablets found separately in Turkey and Iraq. The translation provides a clear description of seizure activity.
• 400 BC: Date Hippocrates wrote The Sacred Disease. This medical text was the first to describe seizures as coming from the brain. It should be noted that there is some controversy as to whether or not Hippocrates was the author of this important text
• 1857: Potassium bromide is introduced to treat seizures. This is the first scientifically validated seizure medication
• 1886: Modern era of epilepsy surgery begins: Sir Victor Horsley successfully performs brain surgery on a patient with focal seizures due to a depressed skull fracture.
• 1929: First EEG was used to record human brain waves.

LATEST UPDATE: 6/6/2011

Seizures By The Numbers - Infographic

Seizures By The Numbers Infographic on Visual.ly

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Two new antiepileptic drugs (AEDs) have had recent FDA approval. The first medication to be discussed is clobazam (band name = Onfi). This drug is currently available. The second AED is ezogabine (brand name = Potiga). Ezogabine is not yet available in pharmacies, but should be available soon.

The purpose of this article is to provide educational information on these medications. Please note- for specific treatment with these AEDs, please discuss with your clinician.

CLOBAZAM (BRAND NAME = ONFI)

What kind of medication is Onfi?

Onfi is an AED. It works by binding to GABA receptors in the brain. By binding to GABA receptors, seizure activity is reduced. Onfi fits into the class of drugs known as benzodiazepines. Other benzodiazepines that you may have heard of: lorazepam (brand name = Ativan) and diazepam(brand name =valium).

What types of seizures does Onfi help?

Works on seizures seen in patients with Lennox-Gastaut Syndrome (LGS). LGS seizures can be very severe. Seizure types associated with LGS:

• Generalized tonic-clonic seizure: Old terminology is “grand mal seizure.” This is probably the most recognizable seizure type- patient will collapse to the ground, body will stiffen, full body shaking activity is seen.
• Atypical absence seizure: Old terminology is “petit mal seizure.” Patient will stare and be unresponsive.
• Myoclonic seizures: brief jerks of parts of body. For example, brief, sudden and fast jerk of an arm or leg. Can be a single jerk or a series of jerks.
• Atonic seizures: Muscles lose tone- as if all strength in muscles is lost. Can be very sudden in onset. Can result in falls with injury. The reason for the injuries makes sense. If I fall to the ground, I can protect myself by bracing my fall with my arms. With atonic seizures, patients can fall on their face-unable to protect themselves because their muscles are not responding.
• Tonic seizures: Muscles suddenly increase in tone—muscles go stiff. This can be very intense and sudden.This can also result in falling and injury.

Important side effects: sedation/sleepiness, coordination problems, breathing problems, slurred speech, change in behavior- such as aggressive behavior,  and nausea. There are other side effects- this is a brief list of some the more common or more important side effects. It is hoped that with slow increases in the medication, side effects can be minimized or not occur.

What happens if I stop Onfi abruptly?

This can lead to withdrawal symptoms. Symptoms of withdrawal include tremor, feeling anxious and possibly seizures.

Common dosing of Onfi:

Start at 5mg once or twice per day. Starting dose and titration depends on weight (children vs adult) and other clinical factors. Can be titrated up to 20mg twice per day in some patients.

EZOGABINE (BRAND NAME = POTIGA)

What kind of medication is Potiga?

Potiga is an AED. It improves seizure control by increasing the current through potassium channels in the brain’s neurons. The increase in flow through this channel reduces the excitability of the brain- this can reduce seizure activity (remember, a seizure is often due to abnormal electricity coming from the brain).

What types of seizures does Potiga help?

It has been approved for use in focal onset seizures. These are seizures that start in one part of the brain, and then propagate. For example, a seizure starting in the temporal lobe would be a focal seizure. Such a seizure may start with an aura- a feeling of nausea, for example. The seizure could then spread to cause confusion and unresponsiveness.

Important side effects: dizziness, sleepiness, inability to empty the bladder, change in cardiac conduction (QT interval lengthening), and change in behavior- including hallucinations. There are other side effects. These are just a sampling of some the important side effects. It is hoped that with slow increases in the medication, side effects can be minimal or not noted at all.

Common dosing of Potiga:

The medication is to be taken three times per day. The goal is to titrate up to a dose of 600mg to 1200mg per day (total daily dose).

References

Introduction to Potiga via [Epilepsy.com]

The post New Antiepileptic Drugs appeared first on Minnesota Epilepsy Group.

ARTICLE HIGHLIGHTS

• Stem cell therapy for epilepsy is a possible treatment option in the future.
• Stem cell therapy may prove useful for:
  • Improving seizure control
  • Improving memory issues
  • Stem cell therapy is not yet approved for the treatment of epilepsy- the safety and effectiveness of such treatment has to be thoroughly studied and approved by the FDA.

INTRODUCTION

There are many exciting areas in epilepsy research. One topic of great interest is the use of stem cells to treat seizures. Although stem cell research related to epilepsy is in its early stages, preliminary data would suggest promise for this treatment option. The writing of this article has been prompted by several people in clinic and on our Facebook page asking for information on stem cell therapy for epilepsy. The goals of this article are to: 1) provide a basic understanding of stem cell therapy; and 2) to review stem cell therapy in epilepsy.

WHAT IS A STEM CELL? HOW DO STEM CELLS STOP SEIZURES?

When an organism (a human, mouse, etc) is developing, the organism will start as a single fertilized cell. This cell will begin dividing. As the cells divide, groups of cells are programmed to form parts of the body- heart, lungs, skin and brain, for example. These early dividing cells are called stem cells. Stem cells are cells that have the ability to develop into a wide variety of cell types. Some stem cells have the potential to become any cell type in the body. Cell types include muscle cells, skin cells or brain cells, such as neurons. In addition, stem cells have the special ability to renew themselves for long periods of time.

It has been shown that stem cells can be transplanted into the brain and produce functioning neurons. One strategy for the use of stem cells in neurological conditions is to transplant stem cells into abnormally functioning brain tissue—this will allow the stem cells to develop into normally functioning brain cells and produce normal brain function.

Illustrative case: Consider a patient with a small area of scarring in her left temporal lobe. Her seizures are coming from that area of scarring. This area of scarring has very abnormally functioning neurons. Properly functioning neurons are supposed to have a nice normal flow of electricity, from one neuron to the next. In our patient’s area of scarring, the neurons are electrically abnormal—the electrical charge is way too high. This abnormal electrical activity can lead to spreading electrical charge that results in a seizure (see our article “What is a seizure?” for details). Now, imagine that you could place stem cells in her brain in the area of scarring. This would result in relatively normal cells replacing the abnormal cells. Instead of excessive electrical activity, you would have normal electrical activity. Because the neurons are now functioning properly and not causing excessive electricity, the seizures are stopped! That is the hope of how stem cells could work.

TYPES OF STEM CELLS

Photo credit: digitalart @ freedigitalphotos.net

Embryonic stem cells: Cells derived from embryos. An embryo is defined as a young animal (human, mouse, etc), early in the stages of development within the womb.

Adult stem cells: The study of adult stem cells for clinical use has been prompted for several reasons, including the ethical issues related to the use of embryonic stem cells. In 2006/2007, researchers identified conditions that would allow some specialized adult skin cells to be “reprogrammed” into stem cells. This is almost like turning the clock back in time—adult cells are reverted to an early stage in cell development—the stem cell. The stem cell could then be used to create a variety of different types of cells (heart cells, brain cells, etc).

This discovery leads to a great hope! Imagine this futuristic treatment plan: 1) patients could have some of their own skin cells removed; 2) skin cells are reverted to stem cells; 3) these stem cells are placed into the patient’s brain – they become normally functioning brain cells and replace the neurons that caused seizures; 4) seizures are stopped! Obviously, this is not reality at this time—but the potential is very exciting!

POSSIBLE WAYS THAT STEM CELLS COULD HELP PEOPLE WITH EPILEPSY (Shetty, Stem Cells, 2007):

• Replace neurons that are lost or dysfunctional- to stop seizures: It has been shown that patients with chronic epilepsy can have a reduced number of neurons in the area where their seizures originate (= the seizure focus). Also, the neurons in the region of the seizure focus may not function correctly – for example, they may be overly electrically active. This abnormally high electrical activity is what can produce seizure activity. Stem cells could be transplanted into the area of the seizure focus and replace the lost or abnormal neurons. The stem cells could be programmed to become normally functioning neurons. By replacing the abnormal function with the normal function, the potential for seizure activity could be potentially erased. This method to use stem cells is similar to the example described above (see above section: Illustrative case).
• Replace neurons that are lost or dysfunctional- to help memory: Some patients with epilepsy have memory complaints. There are a multitude of possible reasons for people with seizures to have memory issues- medication side effects, seizure activity, and mood problems are commonly identified causes. Some patients have memory problems related to losing neurons or  dysfunctional neurons in the area of the seizure focus. By replacing the lost or dysfunctional neurons with normally functioning neurons derived from stem cells, memory problems could be potentially significantly improved.
• Transplant stem cells that have the ability to produce a chemical to stop seizures: Stem cells can be programmed to become neurons that produce a neurotransmitter called GABA. This is a chemical which can stop the overly active neuronal function that can produce seizures. GABA results in inhibition of neurons (opposes the excitation of dysfunctional neurons). If stem cell derived neurons could produce a high quantity of GABA and were placed in the area where seizures started (seizure focus), the seizures could be stopped before they started!

SAFETY ISSUES AND STEM CELLS (Naegele, Neuropharmacology, 2010)

There are several challenges that need to be worked out before stem cell therapy will be widely considered as safe:

• Stem cells can lead to the development of tumors. As noted above, stem cells have the ability to renew themselves for a long-term. This is a good thing- by continuously dividing, stem cells can produce a supply of new cells for therapy. An important negative- the long-term dividing process can lead to the development of tumors, in some cases. This issue is being studied. This issue needs to be considered safe before widespread clinical use will be possible.
• Stem cells can lead to rejection by the body’s defense system. When stem cells are placed into the brain, there is the potential for the body’s immune system to have a reaction to the stem cells- as if the stem cells are an infection that the body needs to get rid of. This can lead to the stem cells being cleared away by the body’s immune system. Obviously, the stem cells will not be able to provide therapy if this occurs. Again, this issue is being studied.

CAN CLINICIANS PRESCRIBE STEM CELL THERAPY FOR EPILEPSY NOW?

The answer is no. Essentially all the research on stem cell therapy for epilepsy has been carried out in animal models (rodents, for example). There are currently no FDA approved stem cell therapies for epilepsy. In the coming years, large scale human studies using stem cell therapy for the treatment of epilepsy will hopefully be carried out. Such studies will look at the safety and effectiveness of such treatment. These studies will be necessary to obtain FDA approval- so that patients can receive stem cell therapy in the clinic setting. An important question is- when will stem cell therapy be approved by the FDA? The answer to this question is unknown, although experts in the field are hopeful for significant advances in the next 10 years.

CONCLUSIONS

Stem cell therapy is a promising treatment for patients with epilepsy. More studies need to be performed to determine the safety and effectiveness of this treatment. Hopefully, in the not too distant future, stem cell therapy could be offered as a treatment for our patients.

References

Naegele J, Maisano Xu, Yang Jia, Royston S, Ribeiro E. Recent advancements in stem cell and gene therapies for neurological disorders and intractable epilepsy. Neuropharmacology 2010;58:855-864.

Riban V, Fitzsimons HL, During MJ. Gene therapy in epilepsy. Epilepsia 2009;50:24-32.

Shetty AK, Hattiangady B. Concise review:prospects of stem cell therapy for temporal lobe epilepsy. Stem Cells 2007;25:2396-2407.

Stem Cell Information: NIH resource for stem cell research https://stemcells.nih.gov

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