BC Epilepsy News and Events

Premature Birth May Increase Risk of Epilepsy Later in Life

Thu, 06 Oct 11 07:00:00 UT

Being born prematurely may increase your risk of developing epilepsy as an adult, according to a new study published in the October 4, 2011, issue of Neurology®, the medical journal of the American Academy of Neurology.

“We found a strong connection between preterm birth and risk of epilepsy and the risk appears to increase dramatically the earlier the birth occurs during pregnancy,” said study author Casey Crump, MD, PhD, of Stanford University in Stanford, California. “More effective prevention of preterm birth is urgently needed to reduce the burden of epilepsy later in life."

For the study, 630,090 adults in Sweden ages 25 to 37 were followed for four years. Participants who developed epilepsy were identified through hospital records as well as monitoring prescriptions for drugs that treat epilepsy. Of the participants, 27,953 had been born prematurely and 922, or 0.15 percent of the total study participants, had been hospitalized for epilepsy during the study.

The study found adults who were born very preterm (23-31 weeks gestational age) were five times more likely to be hospitalized for epilepsy as an adult compared to those adults who were born full-term (37-42 weeks gestational age). Adults who were born between 32-34 weeks of pregnancy were almost twice as likely to be hospitalized for epilepsy and adults who were born between 35 and 36 weeks were one-and-a-half times as likely to be hospitalized for epilepsy compared to those born full-term. The results remained the same regardless of fetal growth, birth order or related disorders that may be associated with preterm birth.

“Other disorders were also more common in people born preterm, including cerebral palsy and other diseases of the central nervous system,” said Crump. “It’s possible that the association between preterm birth and epilepsy may be explained by a decreased flow of oxygen to the brain in the uterus during pregnancy that leads to preterm birth or abnormal brain development resulting from preterm birth itself.”

This study was conducted at the Center for Primary Health Care Research at Lund University in Sweden and was supported by the National Institute of Child Health and Human Development, the Swedish Research Council, the Swedish Council for Working Life and Social Research, and the ALF project grant.

Read more of the research findings here.

Longer Term Older Epilepsy Med Usage Linked to Hardening of Arteries

Mon, 21 Nov 11 08:00:00 UT

According to new research published in Epilepsia, the journal of the International League Against Epilepsy (ILAE), patients with epilepsy who were treated with some antiepileptic drugs (AEDs) for extended periods of time may be at increased risk for developing atherosclerosis.

Atherosclerosis refers to an hardening of the arteries in the body. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques. Over time, these plaques can block the arteries and cause symptoms and problems throughout the body. This is a common disorder, and often occurs with aging.

The study reveals that the risk of developing atherosclerosis is substantially linked to the use of certain AEDs. The medications that were studied are: valproic acid (Depakote, Depakene), phenytoin (Dilantin) carbamazepine (Tegretol, Tegretol XR, Carbatrol), and phenobarbital. This study followed adults who were taking only one of these medications (monotherapy) in addition to a control group of adults without epilepsy who were not taking AEDs.

Dr. Yao-Chung Chuang from Kaohsiung Chang Gung Memorial Hospital in Taiwan and his research team compared the long-term impact of these medications on atherosclerosis development. They enrolled 160 adults with epilepsy who had undergone AED monotherapy for over 2 years, together with 60 healthy controls. In this study they measured and compared participants' common carotid artery (CCA) intima media thickness (IMT).

Dr. Chuang stated: "Our study found patients with epilepsy who were under long-term monotherpy with phenytoin, carbamazepine and valproic acid displayed significantly increased CCA IMT measurements. These altered circulatory markers from prolonged AED therapy may accelerate the atherosclerotic process."

In addition, the researchers also examined particular risk factors linked to types of AED therapy. They found that those taking carbamazepine or phenytoin had different mechanisms that could lead to a hardening of the arties vs. those taking valproic acid.

The authors' strongly recommend that the AED(s) for epilepsy patients in need of long-term treatment must be carefully selected, especially in elderly patients or those at high-risk of atherosclerosis.

If you are one of these medications, it is a good idea to speak to your doctor whether another AED would be better for you, particularly if you have a family history of heart disease.

It is also important to note that anyone can reduce their risk of atherosclerosis, through some simple lifestyle changes. This includes regular exercise, healthy eating, maintaining a healthy weight, and not smoking.

Adapted from an article written by Petra Rattue in Medical News Today

Health Canada Audit Findings

Tue, 22 Nov 11 08:00:00 UT

Findings from an audit of Health Canada have just been released. It brings to attention various problems in the department. In particular, the slow response in issuing warnings about significant negative side-effects from medications. This includes the delay of Health Canada in notifying physicians and patients about the risk of birth defects from Topiramate (Topamax). This medication is often prescribed for people with epilepsy.

Below are excerpts of an article from the Globe and Mail newspaper about these findings.

Ottawa - The public is waiting far too long to be warned of significant risks about the drugs they take, the federal auditor general said Tuesday.

It's only the latest example of risk caused by rampant information mismanagement that is undercutting work in many federal departments, said interim auditor general John Wiersema.

The audit of Health Canada found the department has an archaic system of monitoring that can take years to tell the public that some drugs already on the market come with significant risks.

In one case, a drug that was being prescribed for epilepsy, migraines, psychiatric conditions or weight loss was found to be linked to birth defects. (Note: This medication is Topiramate and the birth defect is cleft palate)

But it took six months for the brand-name drug to include a warning, and almost two years for generic producers to be told they had to change their labels and warnings.

"Health Canada is slow to act on potential safety issues related to drugs already on the market," Wiersema said in a release. "It needs to get safety information out to Canadians more quickly, and address the potential for conflict of interest."

The auditor general also raised concerns about Health Canada failing to say why it rejected certain drugs, or required changes. Since doctors can prescribe drugs for conditions that have not been authorized, they need to have this information to keep their patients safe.

"It is important that they be informed when the department rejects a marketed drug for a new use, so they understand the department's concerns," says the audit, tabled in Parliament on Tuesday.

But the report on Health Canada raises the most disturbing issues. It found there is poor communication about clinical trials, pointing out that Health Canada was not disclosing information about authorized trials — depriving some Canadians with life-threatening diseases of a chance to participate in new treatment options.

The department is also turning a blind eye to unauthorized trials, making it impossible for participants to make informed decisions.

"This increases the risk that Canadians may be unaware of new treatment options or may unknowingly participate in an unauthorized trial."

"It is taking the Harper government years to let health-care providers and the public know of safety risks involving prescription drugs," Liberal health critic Hedy Fry said in a release.

"Furthermore, the government has broken its promise to increase transparency in the drug-approval process. These shortcomings are placing the health and well being of Canadians in serious danger."

The audit shows a department overwhelmed with a mounting pile of information about thousands of drugs that are increasingly central in how Canadians manage their health care.

The department often receives crucial information about adverse reactions by fax or courier, and has to enter the information manually into a database. With the number reports of adverse reactions skyrocketing in the past few years, the backlog is growing and Health Canada has not found a way to prioritize, the audit says.

The department is also falling behind on its inspections of clinical trial sites.

And its reviews of drugs for safety, efficiency and quality drag on, especially for generic drugs, over-the-counter medications and other drugs that are adjusted after they hit the market.

As for conflict-of-interest, the audit says Health Canada should beef up its requirements and actively make sure its employees are in compliance.

Health Canada says it has agreed to all of the auditor general's recommendations, and in some cases has already begun implementing them.

Indeed, Wiersema held out hope that new user fees charged to pharmaceutical companies for Health Canada's approvals will help resolve the government's lack of resources and huge workload.

The drug market in Canada is enormous, as Canadians have become more dependent on pharmaceuticals to treat their ailments. In 2008, there were 13,000 different kinds of prescription and non-prescription drugs sold in Canada for about $28 billion. Prescription drugs are generally 84 per cent of that.

In 2010, doctors issued 505 million prescriptions. Medication is becoming more complex and more diverse, posing a huge burden on regulators around the world, added Jeff Poston, executive director of the Canadian Pharmacists Association.

Written by Heather Scoffield

Watch a Recording of the Epilepsy in Canada Webcast

Thu, 24 Nov 11 08:00:00 UT

You can watch a recording of the lecture: EPILEPSY IN CANADA: What's New and What the Future May Hold on our website. To watch this webcast, please click on this link: http://mediasite.mediagroup.ubc.ca/MediaGroup/Viewer/?peid=0b6f7ab20990460b96bb063afe2c78811d

Below is a list of the speakers and the topics that they spoke about.

Epilepsy in Canada Today: What's New and What the Future Might Hold

Dr. Bernd Pohlmann-Eden: A neurologist from Dalhousie University in Nova Scotia who specializes in the care of people with epilepsy. He spoke about new treatments for people with epilepsy.

Dr. Mano Javidan: The senior neurologist at Vancouver General Hospital Epilepsy Clinic. He spoke about current leading-edge research and developments.

Elvira Balakshin: The Program and Communications Coordinator of the BC Epilepsy Society. She spoke about ways to help overcome the challenges of living with epilepsy.

Andrea Hayes: an Epilepsy Advocate program representative. She spoke about personal aspects of having epilepsy.

Survey on Epilepsy and Intellectual Disability

Wed, 23 Nov 11 08:00:00 UT

Cardiff University in collaboration with Brainwave, the Irish Epilepsy Association is conducting a survey of people who work with, or care for (in a personal or professional capacity) people who have epilepsy and an intellectual disability.

This survey enquires about a range of subjects that affect this community including issues surrounding medication, service access and social life. You will be asked to answer questions about your experiences with epilepsy and intellectual disability in your own words. All of your responses will be anonymous.

A report for the International Bureau for Epilepsy will be written based on the responses. As well, some of this research may be published in scientific journals or presented at conferences.

Click here to complete the survey.

If you have questions or require further information, please contact Dr. Rose Thompson at ThompsonR5@cf.ac.uk

New Blog Post About Living With Epilepsy

Wed, 23 Nov 11 08:00:00 UT

Our new blog post contains excerpts from an autobiographical story about living with epilepsy. The author has led a challenging life, but his stories and reflections show how someone with epilepsy can persevere even with challenges that may seem insurmountable.

Read this blog post here.

In other news, the BC Epilepsy Society blog was recently selected as one of the 35 Best Blogs for Epilepsy Support by Medical Billing and Coding.

If you have topics, stories, or articles that you would like to share with our readers, please contact Elvira Balakshin at 604-875-6704 or at outreach@bcepilepsy.com

We love your feedback!

Seizures Associated with Menstrual Cycle

Mon, 05 Dec 11 08:00:00 UT

Two recent study findings have increased understanding about the relationship between and a potential treatment for seizures that happen in conjunction with the menstrual cycle. This condition is called catamenial epilepsy. Below is information about the studies. One has identified risk factors for catamential seizures and the other one has identified a potential treatment for these.

Seizures May Worsen During Menstrual Cycle

Seizures among women of childbearing age with epilepsy may worsen during menstruation or ovulation, researchers have found. In the study, investigators at the Comprehensive Epilepsy Center at the University of California, Irvine, examined the trend of seizures associated with menstrual cycles (called "catamenial" seizures) among a group of women aged 19 to 50.

The study participants responded to a questionnaire about the worsening of their seizures during their menstrual cycle, and the researchers used these responses as well as the women's monthly seizure calendars to identify those with catamenial seizures.

Among the women with catamenial seizures, the investigators examined the type of epilepsy they had, the frequency of their seizures, their response to medications as well as neuroimaging findings and seizures during pregnancy, according to a news release from the American Epilepsy Society.

Two-thirds of the women with catamenial epilepsy had a diagnosis of partial epilepsy. The rest had primary generalized epilepsy. Meanwhile, about 75 percent of the women with catamenial epilepsy had medically refractory seizures -- which means they're resistant to treatment. The rate was twice that of their peers with epilepsy who did not have catamenial seizures.

A high percentage of women with catamenial epilepsy who had children reported having more seizures during pregnancy, according to the study authors, Avriel Linane and Mona Sazgar.

The study findings were presented on December 4, 2011 at the annual meeting of the American Epilepsy Society in Baltimore. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

This article was adapted from a HealthDay news release.

Progesterone Therapy for Women with Epilepsy Shows Favorable Outcome

Women of childbearing age with epilepsy commonly have seizures that are exacerbated by hormonal changes. Investigators today reported favorable outcomes of a clinical trial of progesterone therapy in reducing these catamenial seizures.

Progesterone is a naturally occurring steroid known to lessen neuronal excitability and seizures. The purpose of the clinical trial was to compare progesterone versus placebo in lessening seizures in women with epilepsy. "We found that progesterone can provide a clinically important benefit for a substantial portion of women with catamenial seizures," said lead investigator, Andrew G. Herzog, M.D., M.Sc., of Harvard University. "And, the level of perimenstrual seizure exacerbation is a significant predictor of women most likely to benefit from this hormonal therapy."

The proportion of women who responded to progesterone therapy increased relative to the increased level of perimentrual seizure exacerbation; whereas, no significant difference in response rate was observed in women with seizures that did not show substantial perimenstrual exacerbation, i.e., three times or greater increase in average daily frequency.

This article was adapted from an Epilepsy Foundation news item.

Click here to read the research abstract.

More information about women and epilepsy is available from the BC Epilepsy Society Women in Mind webpage.

Gamma Knife Surgery Benefits People with Epilepsy

Tue, 13 Dec 11 08:00:00 UT

New research study results have continued to show the potential benefits of a new type of surgery that could reduce the frequency of epileptic seizures. This surgery procedure is applicable for some people who have with seizures caused by lesions in the brain. The procedure is called gamma knife surgery. It uses a type of laser technology to eliminate lesions in the brain that could cause seizures. The latest findings about this procedure are particularly notable in that other positive results have been found. This includes improvements on cognition, mood, and behaviour. Below is a press release from the American Epilepsy Society about these findings.

Gamma Ray Surgery Benefits Epilepsy Patients Beyond Seizure Reduction

Neurosurgeons continue to explore minimally invasive surgery with gamma radiation (gamma knife surgery, GKS) in the treatment of brain lesions causing seizures and epilepsy. Studies of the procedure are showing it to be an effective alternative to invasive microsurgery for hypothalamic hamartomas and other lesions that lie deep within the brain. Prospective research by investigative teams in Canada and France, and presented at the American Epilepsy Society’s 65th annual meeting, reveals that gamma knife surgery in hypothalamic hamartomas has significant benefit in the lives of patients beyond seizure reduction.

The hypothalamus lies near the brain stem and controls a number of functions such as body temperature, circadian cycles, and sleep. Hamartomas are abnormal clumps or masses of normal tissue attached to functional tissue. The lesions are present at birth and may provoke intractable seizures, including laughing seizures, and lead to precocious puberty, and cognitive deficits.

Jean Regis and his team of investigators at Timone University Hospital, France, are studying the long-term results of gamma knife surgery for hypothalamic hamartomas in pediatric patients as young as 3 years of age. Of patients treated between January 1999 and December 2007, 40 have been evaluated for at least 3 years postsurgery. The evaluations include seizure record review, neuropsychogical tests, psychiatric evaluation, endocrinology evaluation, and visual field and acuity analysis.

The number of seizures following gamma knife surgery was dramatically decreased from a median of 92 seizures per month preoperatively to 6 seizures per month after the procedure. Global psychiatric and cognitive comorbidity was improved in 56% of patients, considered to be cured in 28%, remained unchanged in 8%, and continued to worsen in 8% of patients.

“This prospective trial is demonstrating very good safety and efficacy of gamma knife radiosurgery in the long term,” says Regis. “Beyond seizure reduction, the improvement in psychiatric and cognitive domains, school performance, and social integration appears to be a major benefit for children with this frequently catastrophic condition. We will continue to follow these children to observe any changes that might occur in their condition as they age.”

In another study, conducted at the Centre Hospitalier Universitaire de Sherbrooke in Canada, investigators evaluated gamma knife surgery for hypothalamic hamartoma in a small group of older patients 14 to 57 years of age. In this group, 66% of patients were seizure free at the time of evaluation. The mean time to seizure freedom following treatment was 18 months. Patients in whom there was little or no reduction in seizures had larger lesions than in the seizure free cohort.

“We found that when the entire lesion could be targeted, radiosurgery did more than reduce the seizures,” says lead author Pascale Bourgeois. “There also were encouraging effects on cognition and quality of life. While the procedure is ineffective for large lesions, gamma knife surgery should be a first line surgical therapy for small hamartomas.’

Unmet Medical Needs for People with Epilepsy in Canada

Tue, 10 Jan 12 08:00:00 UT

A recently published Canadian study has shown that people with epilepsy do not receive the healthcare services they require.

This study analyzed the number of healthcare utilizations (such as doctor, dentist, and psychologist appointments and/or emergency room visits) as well as feedback from people with epilepsy about their healthcare needs and satisfaction with these services.

It found that people with epilepsy more frequently use healthcare services as compared to the general population and people with asthma, diabetes, and/or migraine. However, even with a higher rate of healthcare service useage it found that people with epilepsy were more likely to report unmet mental health and dental needs. This is disturing as people with epilepsy have a higher risk and prevalence of mental illness and/or gingival overgrowth.

This study was published in Epilepsia, a medical journal that covers medical and psycho-social aspects of epilepsy treatment and care. The research abstract is below. You can also read it online here.

Epilepsy is associated with unmet health care needs compared to the general population despite higher health resource utilization—A Canadian population-based study

Summary
Purpose: (1) To determine whether health resource utilization (HRU) and unmet health care needs differ for individuals with epilepsy compared to the general population or to those with another chronic condition (asthma, diabetes, migraine); and (2) to assess the association among epilepsy status, sociodemographic variables and HRU.

Methods: Data on HRU were assessed using the 2001–2005 Canadian Community Health Surveys, a nationally representative population-based survey. Weighted estimates of association were produced as adjusted odds ratio with 95% confidence intervals, and logistic regression was used to explore the association between sociodemographic variables and HRU in those with epilepsy. All data on disease status, HRU, and unmet health care needs were self-reported.

Key Findings: Individuals with epilepsy had the highest rate of hospitalizations and the highest mean number of consultations with physicians. Despite higher rates of consultation with psychologists and social workers compared to the general population, those with epilepsy were significantly more likely to say they had unmet mental health care needs. People with epilepsy were also less likely to use dental services compared to the general population. Epilepsy was a significant predictor of HRU in logistic regression models.

Significance: Given the prevalence of psychiatric comorbidities in those with epilepsy, it is concerning that this group perceives unmet mental health care needs. It is also troublesome that there was decreased utilization of dental health care resources in those with epilepsy considering that these patients are more likely to have poor oral health. Although individuals with epilepsy use more health care services than the general population, this increase appears to be insufficient to address their health care needs.

Authors:
Aylin Y. Reid¹, Amy Metcalfe^1,2, Scott B. Patten^2,3, Samuel Wiebe^2,3, Sophie Macrodimitris¹, Nathalie Jetté^1,2Author Information:
¹Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
²Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
³ Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada

News Year's Resolutions to Improve Seizure Control

Mon, 16 Jan 12 08:00:00 UT

Happy 2012 everyone!

The arrival of a new year usually coincides with thoughts and plans about making a commitment to new goals, projects and/or habits. If you have epilepsy, there are some potential ways that you can lessen the risk of seizures – as well as improve your health. These can be incorporated into some simple changes into your everyday routine. Below are suggestions for New Year’s resolutions from an epilepsy.com email newsletter. Be sure to include these tips for your resolutions in 2012 and beyond!

1. Keep better track of your seizures. Consider enrolling in epilepsy.com’s my seizure diary for better seizure tracking. This is free, it is simple, it can be accessed via your mobile phone, computer or tablet device. It may help to get a better sense of how frequently your seizures are happening and when sharing it with your doctor may help to improve your seizure control by showing whether you need to make a change in your medication or consider another treatment. (Note, a BC Epilepsy Society blog post covers additional online methods to record seizures)

2. Consider asking your doctor what new treatments are available. Sometimes one needs to remind your physician, particularly if you continue to have seizures, that you are interested in getting better seizure control. Don’t be afraid and ask your doctors what’s new out there. If the doctor doesn’t seem to know then look it up on epilepsy.com or other web sites that might be able to help answer that question.

3. Resolve to take better care of yourself. Not eating, lack of sleep, drinking alcohol can all have bad impact on seizure control. By doing simple things such as exercising, getting sleep, finding new ways to lessen your stress, one may find that their seizure control will improve over time.