Researchers Develop Wearable Device for Predicting Epileptic Seizures

Article, originally posted on MedicalXPress.com

Ben-Gurion University of the Negev researchers have developed Epiness, a device for detecting and predicting epileptic seizures based on machine-learning algorithms. The wearable device can generate an advanced warning about an upcoming seizure that will be sent to a smartphone up to an hour prior to its onset. The system was out-licensed for further development and commercialization to NeuroHelp, a startup company that was recently founded by BGN Technologies, the technology transfer company of BGU and Dr. Oren Shriki, of BGU’s Department of Cognitive and Brain Sciences and NeuroHelp’s scientific founder.

Epiness is a seizure prediction and detection device that is based on a new, ground-breaking combination of EEG-based monitoring of brain activity together with proprietary machine-learning algorithms. The device combines a wearable EEG device with state-of-the-art software that minimizes the number of necessary EEG electrodes and optimizes electrode placement on the scalp. The sophisticated machine-learning algorithms are designed to filter noise that is not related to brain activity, extract informative measures of the underlying brain dynamics, and distinguish between brain activity before an expected epileptic seizure and brain activity when a seizure is not expected to occur.

Controlling Seizure Effects Using a New Potassium Channel Activator

Article, originally posted on News-Medical.net

A group from The Mount Sinai Hospital / Mount Sinai School of Medicine have identified and characterized a novel potassium-channel activator, GiGA1, capable of selectively opening a subset of potassium channels to produce an antiseizure effect in animal models.

This study presents an integrated approach to GIRK1-specific activators, employing both computational modeling and subsequent biochemical and physiological studies. The resultant seizure mitigation produced in an acute epilepsy mouse model demonstrates a potential role for this compound in the treatment of brain disorders.

Mortality Implications and Factors Associated With Nonengagement in a Public Epilepsy Care Initiative in a Transient Population

Abstract, published in Epilepsy & Behavior

Background: Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs.

Aims: The aim of the study was to describe factors associated with and mortality consequences of nonacceptance of a public epilepsy care initiative.

Methods: In this cross-sectional study, we contacted 207 (36%) people out of 575 who screened positive for epilepsy during a population-based survey of 59,509 people. They were invited for neurological evaluation and care provision (including antiseizure medications (ASMs)) but chose not to engage. Structured questionnaires and qualitative interviews were conducted to determine reason for their nonengagement. Factors associated with nonengagement were evaluated by univariate and multivariate analysis. We conducted verbal autopsies for those who had died.

Results: Ten (5%) of the 207 individuals died since the initial screening; six with epilepsy-related causes. Of those who could be contacted (n = 48), 40 (19%) were confirmed to have epilepsy. Nonengaging individuals were likely to be older (odds ratio (OR): 1.02; 95% confidence interval (CI), 1.01, 1.11), locals (OR: 4.32; 95% CI, 1.55, 12.03), and earn less than US$ 78/month (OR: 3.6; 95% CI, 1.62, 8.06). Reasons for not engaging included a belief that epilepsy is inconsequential, loss of daily wages owing to healthcare facility visit and physical infirmity.

Conclusions: Nonacceptance of a community-based public epilepsy care initiative is associated with high premature mortality, mostly attributed to epilepsy-related causes. Older age, ethnic status, and economic deprivation are factors associated with nonacceptance, though the underlying reasons may be varied.

The Perceived Health of Children With Epilepsy, Sense of Control, and Support for Their Families

Abstract, published in Epilepsy & Behavior

Aim: The aim of this study was to evaluate the perceived health of children with epilepsy as experienced by the respondents to a questionnaire, to assess the sense of control over their child’s epilepsy, and how much support they feel they received in various environments.

Methods: In this observational study, the data were collected using a questionnaire that was sent to families of children with epilepsy, who were treated at University Children’s Hospital in Ljubljana, Slovenia from January to September 2016. The questionnaire consisted of 29 questions related to their epilepsy.

Results: There were 1198 patients who met the entry criteria for the study and were sent the questionnaire, of which 181 (15.1%) responded. The diagnosis of epilepsy was established in 91.2% of patients (8.8% were patients after a first unprovoked seizure), of which drug-resistant epilepsy was reported in 33.3%. Patients had epilepsy diagnosed for a mean of 4.9 ± 4.4 years. Of all patients, 82.4% of patients were taking antiepileptic drugs (AEDs) at the time of inquiry. The longer the patient had epilepsy diagnosed, the lower was the perceived health (p = 0.004). Patients with pharmacoresistant epilepsy, those who had seizures, and those who were receiving AEDs had significantly lower scores of perceived health compared with those who did not (p < 0.001; p < 0.001; and p = 0.016, respectively). Of all responders, 79.8% responded that they feel that they have their child’s condition under control. The child’s condition was considered under control more often if the child had no reported seizures (p < 0.001) and if the family had enough support in the health system (p = 0.002) or psychological support (p = 0.005). Patients with pharmacoresistant epilepsy more often replied that they do not have enough support in the health system (p = 0.006).

Conclusions: Our study suggests that the presence of seizures, pharmacoresistant epilepsy, years of epilepsy diagnosis, and prescription of AEDs have a significant negative effect on the perceived health of children with epilepsy. Enhancement of the support families received in different environments can offer an opportunity to improve the sense of caregivers’ control over child’s epilepsy.

People With 1 Kind of Epilepsy Have Higher Sleep Apnea Risk

Article, published in Futurity

People with generalized epilepsy who have seizures arising from both sides of the brain simultaneously have a higher risk of obstructive sleep apnea than patients who have focal epilepsy where seizures emanate from one area of the brain, according to a new study.

The findings will help physicians better understand who is most at risk for obstructive sleep apnea (OSA) and therefore, who will benefit most from treatment. Treatment of OSA may help patients feel better and maintain better health. OSA treatment may also be an important part of epilepsy treatment.

“OSA is common in patients with epilepsy and treatment may improve seizure control. However, this condition is often undiagnosed in patients with epilepsy, and understanding of the risk profile for OSA is important,” says Matthew Scharf, an assistant professor of medicine and neurology at Rutgers Robert Wood Johnson Medical School and lead author of the paper in Epilepsy & Behavior.

Sex Differences in the Epilepsies and Associated Co-Existing Illnesses: Implications for Use and Development of Drug Therapies

Abstract, published in Pharmacological Reviews

The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated co-existing illnesses as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated co-existing disorders, with emphasis on those aspects most informative for the development of new drug treatments. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic co-existing disorders; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; cellular mechanisms; and catamenial epilepsy in women, a type of epilepsy in which seizures increase during certain phases of the menstrual cycle. Further attention placed on potential sex differences in epilepsies, co-existing disorders, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy.

SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various co-existing disorders. The features of epilepsy and seizure activity as well as concurrent afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated co-existing disorders, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.

Quality of Life in Elderly Patients After Surgery for Drug-Resistant Epilepsy

Abstract, published in Epilepsy & Behavior

Introduction: Health related quality of life (HRQoL) has become a pivotal outcome parameter after surgery for drug-resistant epilepsy. The aim of the study was to investigate HRQoL and its relationship to seizure outcome, neurological deficits, and anxiety after epilepsy surgery in a specific subpopulation of elderly patients.

Methods: A total of 85 elderly patients (older than 50 years) answered a standardized HRQoL questionnaire one year after epilepsy surgery. The questionnaire addressed current self-assessed HRQoL in four areas (physical function, cognitive function, mood, social interaction).

Results: A total of 51 patients (60%) were completely seizure free at last available outcome. Permanent neurological deficits were observed in 8 patients (7%). Analysis confirmed significant association between seizure outcome and overall HRQoL. New permanent neurological deficits showed impact on both HRQoL and cognitive function. Anxiety and subjective assessment of postoperative status were strongly correlated with overall HRQoL and remained as independent predictive factors.

Conclusion: Surgery for drug-resistant epilepsy in elderly improves patients’ HRQoL. Both seizure freedom and new neurological deficits influence overall HRQoL. Interestingly, anxiety and patients’ subjective assessment of postoperative status showed the highest impact on HRQoL in this subpopulation of epilepsy patients.

Cognitive, Behavioral, and Social Functioning in Children and Adults With Dravet Syndrome

Abstract, originally published in Epilepsy & Behavior

Aim: The objective of the study was to describe the cognitive, behavioral, psychological, and social functioning of individuals with Dravet syndrome.

Method: Cognitive, behavioral, and social functioning were assessed in patients with Dravet syndrome by comprehensive, age-appropriate standardized neuropsychological testing. Primary caregivers completed standardized measures regarding participants’ behavior, psychological status, adaptive functioning, and social skills, including their involvement with intervention services.

Results: The cohort comprised 45 patients, aged 2-30 years. Intellectual functioning ranged from average intellect to profound intellectual disability, with a decrease in cognitive and adaptive functioning with age. Only 6 children were able to complete the entire neuropsychological battery and showed a range of cognitive profiles. Twenty-one (58%) participants had deficits in social skills and 18/27 (67%) in social communication, with 10 participants, who did not yet have a diagnosis of autism spectrum disorder (ASD), screening positive for social communication deficits. Behavioral problems were frequently reported, with attention problems in 24 (65%). Despite this, parents reported that psychological services were the least utilized health interventions.

Conclusions: Cognitive functioning varies markedly in individuals with Dravet syndrome, with some patients demonstrating global impairment while others have a discordant neuropsychological profile. Behavioral, psychological, social problems, and ASD are common. Social deficits should be reviewed to identify those who warrant ASD assessment. Early identification of behavioral and psychological disorders and targeted use of psychological intervention are essential components of holistic care in Dravet syndrome.

Study Reveals Seizures During Menstrual Cycle Linked to Drug-Resistant Epilepsy

Summary, originally posted on EurekAlert

More frequent seizures during the menstrual cycle in women with genetic generalized epilepsy have been linked for the first time to drug-resistant epilepsy when anti-seizure medications don’t work, according to a study published in the journal Neurology.

Women with a form of genetic generalized epilepsy called catamenial epilepsy – when seizure frequency increases during their menstrual cycle – were nearly four times more likely to have drug-resistant epilepsy than women who experience no changes in frequency. In generalized epilepsy, seizures begin on both sides of the brain at the same time, while focal seizures start in only one part of the brain.

“Typically, genetic generalized epilepsy is thought to respond better to anti-seizure medications than focal epilepsy. However, previous studies suggest a minority of individuals, between 18 and 36%, with genetic generalized epilepsy, do not respond well to these medications,” said senior author Gary A. Heiman, an associate professor in the Department of Genetics in the School of Arts and Sciences at Rutgers University – New Brunswick. “It is unclear why seizures in these individuals do not respond well, and we sought to investigate why. We found a surprising association between women’s menstrual cycle and these with drug-resistant genetic generalized epilepsy. Understanding the reasons for this association could lead to alternative, personalized treatment options for at least some patients.”

Incidence of Anxiety in Epilepsy During the COVID-19 Pandemic

Abstract, published in Epilepsy & Behavior

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has affected people globally, and people with chronic diseases are suffering more in maintaining their mental and physical health. We thus performed a cross-sectional, case-control study to assess the anxiety level in people with epilepsy compared with the general population.

Results & Conclusions: Data showed that 13.5% of patients had experienced a severe level of anxiety, but the average anxiety level between groups did not show significant difference. Although still many aspects of the pandemic on people with epilepsy are yet to be determined, active investigation of psychological sequels of the pandemic is demanded.