Epilepsy in a Nutshell

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Ketogenic Diet Conference
2008-04-09 16:43:00
Well, I just got back from the 1st International Symposium on the Diet ary Treatment of Epilepsy and Other Neurological Disorders. The conference was held in Phoenix, AZ. I'll admit right off the top that this was the best conference that I've ever attended. The quality of science was stellar and, for a refreshing change, there was a tangible level of emotion that you don't normally get at science conferences.The first morning of the conference we listened to a great intro talk on the History of the Ketogenic Diet (KD). This is a high fat, low carbohydrate diet used to treat drug-resistant seizures. The KD used to be one of the main treatments for epilepsy until the introduction of the anticonvulsant drugs in the late 1930s. In 1994 NBC Dateline ran a story on Charlie Abrahams, the son of the Hollywood movie producer Jim Abrahams, who became seizure free on the KD after many years of uncontrolled seizures. A few years later, Jim Abrahams directed a made-for-tv movie entitled "Firs...
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Epilepsy and Driving
2008-03-25 04:51:00
It has been a long time since my last post. Apologies for my absence. Things are very busy right now as I am wrapping up my thesis. I was in Manitoba this past weekend at a family gathering. We were talking about heart disease and how some individuals with heart disease can be a real risk on the roads (eg, they could faint from poor blood flow or even have a heart attack behind the wheel). This raised the issue of whether or not people with epilepsy should be allowed to operate a motor vehicle. The laws vary from country to country, but in general if you are diagnosed with epilepsy you lose your permit to operate a motor vehicle until you have been seizure free for a set period of time (usually a year or two). My supervisor often mentions that individuals with epilepsy do show an increased risk of motor vehicle accidents. However, the number of accidents for this group is not nearly as high as the accident numbers for individuals with cardiovascular disease. To top it off, neither o...
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Diagnosing Epilepsy
2008-03-08 15:38:00
Some of this information has been presented in various posts below, but I wanted to add it here in the context of diagnosing epilepsy.Epilepsy is diagnosed upon having more than one unprovoked seizure. Identifying the type of seizure is critical in deciding the appropriate treatment. It is a good idea to see an epileptologist to increase the likelihood of accurate diagnosis and treatment. Types of EpilepsySymptomatic EpilepsyApproximately 30-40% of patients with epilepsy have “symptomatic” seizures. These are seizures associated with a specific structural abnormality in the brain. Such abnormalities can include tumours, brain injury, infections, scars, and blood vessel malformations (Browne & Holmes, 2001). Symptomatic epilepsies are the hardest to treat and are often drug-resistant (Kwan & Brodie, 2000).Idiopathic EpilepsySixty to seventy percent of patients with epilepsy have “idiopathic” seizures. These are seizures that occur in an apparently normal brain. Idiopathic sei...

Kids Vaccine Linked to Fever and Seizures
2008-02-28 22:28:00
An recently published study shows a potential link between the ProQuad vaccine and seizures. In brief, the article suggests that kids who got the ProQuad vaccine were twice as likely to develop febrile seizures.Here's a link to a good review of the article.Have a great week,Kirk.
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Parenting a Child With Epilepsy: Part 2
2008-02-24 00:49:00
We are lucky to have a 2nd post by Kristi, who is the mother of a young boy with epilepsy. Here is "Part 2" of her post on parenting a child with epilepsy.-------We have entered a stage of holding with our son’s epilepsy, which we like to call behaviour management. He is mostly seizure- free, with only break through seizures that we have to worry about. They are predominantly myoclonic jerks, which means they are less dangerous than the drop seizures or tonic clonic seizures he has also experienced. That said, we are now in less of a crisis- management stage, and are trying to maximize his developmental potential during this pre- Kindergarten time. We have self- referred to Occupational Therapist, Physical Therapist, Early Child hood Intervention play therapist, Speech and Language pathologist, etc. We had to self- refer because when we see our neurologist, he remarks that Sam is doing really well. And he is, compared to children having many seizures a day. However, the me...
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Good Article
2008-02-19 20:07:00
Here's a link to a nice article that I thought you might enjoy. It's a good summary on epilepsy, current epilepsy research and what the future might hold. You can find the article here.Have a great day.Kirk.
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The Gamma Knife
2008-02-18 15:10:00
Gamma Knife for the Treatment of Epilepsy.I recently attended the 62nd Annual meeting of the Eastern Association of Electroencephalographers. One of the very interesting talks was given on the use of the gamma knife for the treatment of seizures. "Gamma knife", sounds futuristic, right? Well, this technology was actually developed by Lars Leksell (Sweden) in 1967. The technology is pretty expensive and not many centers have a unit. Canada currently has 3 gamma knives country-wide and the USA has about 90. What is the Gamma Knife?The gamma knife does not actually involve a knife. In fact, it is a non-invasive form of surgery insofar as there is no cutting or removal of skull. It is a form of “radiosurgery”. Radiosurgery is basically the use of radioactivity to kill tissue. The gamma knife contains 201 radioactive cobalt sources. Cobalt gives off gamma rays, and these rays are focused toward a common, intersecting point. This point is called the “active zone”, where a very sma...

Parenting a Child with Epilepsy: A Journey
2008-02-10 01:10:00
Today we are lucky to have another guest post. Kristi and her husband are farmers in rural Saskatchewan and proud parents of five wonderful kids. Among her many accomplishments, Kristi instructs a taekwondo club and spends her spare time training for her 5th degree black belt. Three years ago Kristi and her husband learned that their son has epilepsy. It has been a life-changing experience for them and their family. Here is the story of her journey so far. Part 1.Parenting a Child with Epilepsy : A Journey A parent’s job, by definition, is to love, nurture, protect, care and advocate for their children. As a parent of a child with epilepsy, some of those duties become complicated and out of focus. Of course, we love our son. But now, we also love him with lots of time and energy spent on handling his seizure disorder. We love him with trips to the city for appointments: specialists, therapies, regular check-ups, tests; two hours each way, and of course fries on the way home. We love...

Anticonvulsants and Suicide
2008-02-03 18:36:00
Suicide can be a taboo subject, but the purpose of this blog is to provide important information to those living with epilepsy. This means that "taboo" goes out the window. Anticonvulsants May Increase the Risk of Suicide and Suicidal ThoughtOn Jan 31st, 2008 the FDA (Food and Drug Administration) announced that those taking the anticonvulsant medications are twice as likely to have suicidal behavior or thoughts of suicide (0.43%) than those taking placebo (an inert substance; 0.22%). This increase in suicidal thought and behavior seemed to be a general finding that was not specific to a particular age group, race, or gender group.The drugs that were studied are * Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR) * Felbamate (marketed as Felbatol) * Gabapentin (marketed as Neurontin) * Lamotrigine (marketed as Lamictal) * Levetiracetam (marketed as Keppra) [Patient Information Sheet] * Oxcarbazepine (marketed as Trileptal) * Pregabalin (marke...
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What are the Unmet Medical Needs for People with Epilepsy?
2008-01-31 18:27:00
I was recently handed this quarter's copy of "The Brain Wave". On page 5 it has quotes from some of North America's top epileptologists. Here are their thoughts in response to the question: "What are the most important unmet medical needs for people with epilepsy?"."Decreasing stigma and creating environments that optimize learning and employment ...""... a drug, device or procedure that will stop seizures in patients with intractable epilepsy. We have many new drugs available, with many favorable properties, yet no real advance in the number of people who become seizure free. Improvement in seizures is good, but seizure freedom is always our goal.""The hidden toll of epilepsy - identifying the side effects of medication.""... comprehensive care and evaluation for the child with epilepsy and other neurological or school difficulties ... Taking care of the child with seizures who also has ADHD, or migraine, or learning difficulties, or mood disorder, or a sleep disorder requires ap...
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Take Your Omega-3 PUFAs
2008-01-25 16:01:00
What are PUFAs?PUFAs, or polyunsaturated fatty acids, are long-chain fatty acids that have 2 or more "double-bonds". This is a bit of molecular mumbo-jumbo, but essentially it means that these fats are liquid at room temperature (as well as at body temperature). This is in contrast to saturated fatty acids (found in butter and lard, for example), which are more solid at room temperature. Omega -3 PUFAs These are essential fatty acids. This means that, like vitamins, our body doesn't make them on its own so we need to get them from our diet. Examples of Omega-3 PUFAs are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).We can get ALA from some grains, such as flax seed. EPA and DHA, however, are most abundant in cold water fish (eg, salmon, anchovies, mackerel, etc.). Those that don't get a lot of fish in their diet are likely not getting their daily required intake of Omega-3 PUFAs. This realization has led to a boom in the sales of PUFA supp...

Febrile Seizures
2008-01-21 14:25:00
What are febrile seizures?Febrile seizures are seizures that occur as result of a high fever. Fever causes a seizure in about 1/35 children, making it the most common cause of seizures in children. Febrile seizures are very scary, especially to the parents of young children. It is believed, however, that these seizures are not harmful. 30-40% of the time a febrile seizure will reoccur. Who gets febrile seizures?A fever, if serious, can cause a seizure in individuals of any age. Children between the ages of 3 months and 5 years, however, appear to be the most affected by febrile seizures. Febrile seizure first aidThe golden rule for all seizures is: if it lasts longer than 5 minutes, go to the hospital. This applies to febrile seizures too. You may want to try an "antipyretic drug" (ie, a drug that reduces fever), such as acetaminophen (Tylenol®). What causes febrile seizures?It isn't fully understood why a fever causes seizure activity. It probably has to do with the complex, deve...

Epilepsy and Alternative Medicine
2008-01-15 15:52:00
I have asked several friends/colleagues and mentors to help me with blog content this year. So, we'll be having some "guest posters". Today's guest blogger will provide a naturopathic perspective to the treatment of epilepsy.Dr.Sara-Jane White is a Graduate of the Canadian College of Naturopathic Medicine . She has also received an Honors English Degree from Brescia College at the University of Western Ontario and she has completed her medical school prerequisites at the University of Toronto. For more information on the naturopathic treatment of epilepsy, or if you have questions on Rett Syndrome please see Dr.White's webpage: http://www.natdoc.comEpilepsy and Alternative MedicineThis list is not inclusive but provides information on the more commonly used herbs.Approximately 2-5% of the population will suffer from epilepsy during their lifetime. As there is more patient awareness of complementary and alternative medicine, patients with epilepsy are increasingly turning to herbs ...
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Behavioural Autonomy and Seizures
2008-01-11 12:39:00
What is Autonomy ?Autonomy is one of those words that is hard to put your finger on. It comes from the Greek words "nomos" meaning "law" and "auto" meaning "self". So together they literally mean to "make your own laws". More generally, it is often used to mean "independent" or "self-governed". Degrees of AutonomyThere are varying degrees of autonomy. On one extreme you have no autonomy. In my point-of-view, complete loss of autonomy equals death. On the other extreme you have absolute autonomy. This is a bit more theoretical and probably isn't possible. There are always mild disruptions of autonomy. This is both necessary and good. Basically, this keeps things from doing whatever they want to do, whenever you want to do it. Mild disruptions in autonomy usually come in the form of "rules" or "laws"- whether they be laws of physics, parental laws, club rules, etc. Of course, some regions/countries/groups have rules and laws that greatly affect one's autonomy, but this is for another...

SUDEP
2008-01-06 20:14:00
What is SUDEP?SUDEP, or Sudden, Unexplained Death in EPilepsy, occurs when a patient with epilepsy dies suddenly and with no apparent cause. SUDEP occurs in approximately 1/1000 patients with drug-resistant epilepsy. General Risk Factors- Severity of seizures- Skipping drug doses (poor compliance)*- Taking multiple anticonvulsant drugs*- Breathing complications (eg, apnea)- Having a structural brain lesion- Cardiac abnormalities (eg, irregular heart beat)- Being male (males are affected by SUDEP more commonly than females)*These do not appear to be significant risk factors for SUDEP in children.SUDEP PreventionAggressively Pursue Seizure Control This may sound like one of those "duhhhh of course" statements, but many people stop short of exhausting their treatment options. First and foremost, take your anticonvulsant medications as prescribed. If you are unclear about how you should be taking your medications then please talk to your pharmacist. If you have uncontrolled seizures, ma...

New Drugs
2008-01-02 15:53:00
Happy 2008. Let's start off the New Year on a hopeful note. I recently read an article on some new, emerging drugs being developed for the treatment of drug-resistant epilepsy. Approximately 30% of individuals with epilepsy do not achieve adequate seizure control on the existing anticonvulsant drugs. These seizures are said to be "drug-resistant" (note: some might use the cumbersome terms "intractable" or "medically refractory"--but these all mean something similar, that the individual's seizures are not being significantly reduced by the medications currently available). Therefore, there is a real need for new drugs that work in a new way (ie, drugs that have a novel mechanism of anticonvulsant action). The goal of developing such drugs is to one day have 0% drug resistant seizures. A recent review published in European Journal of Neurology reviews drugs currently being tested for the treatment of drug-resistant seizures. Here is a list of some of these potentially exciting new c...
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Merry Christmas and Happy 2008
2007-12-28 17:40:00
I'm away visiting with family and friends I'll post some morewhen my holiday ends.Until thenHappy New Year andhere's to a great 2008 .OK, so the rhyming scheme isn't consistent. In my defense, all my blood is being diverted away from my brain and towards my stomach. I have some exciting posts planned for the New Year, so please stay tuned. And, as always, feel free to post your questions/comments below.All the best,Kirk.
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See An Epileptologist
2007-12-21 16:34:00
I have heard this story too many times: someone has seizures- they go to a family physician- they are misdiagnosed or placed on the wrong drug- they have uncontrolled seizures for years- they don't realize they might be able to optimize their diagnosis and treatment.The Mechanic AllegoryYou get in your car one day to head to work. Upon shifting into reverse you hear a horrific *CLANK*. Being the clever person you are, you have figured out that your car's transmission has just died. So, you need to get your car fixed. You have 3 options: 1) Take your car to the general mechanic around the corner. He doesn't know much about transmissions, but he might get it fixed without too much trouble. 2) Take your car to the "drive-train" specialists down the street. She is a step-up from the general mechanic in terms of expertise, but the drive-train involves many different pieces and you're not sure how much she knows about the transmission itself. 3) Take your car to the transmission speci...

National Walk for Epilepsy
2007-12-18 23:18:00
The 2008 National Walk for Epilepsy Mark your calendars- on March 29th, 2008 the Epilepsy Foundation is hosting its 2nd Annual National Walk for Epilepsy. The Walk takes place in Washington, D.C. during a very beautiful time of year, cherry blossom season. Now is a great time to sign up and start raising funds, both to get there yourself and/or to raise money for the Foundation. This is the American Walk for Epilepsy -- I'll discuss below plans for Canada's First National Walk for Epilepsy.Long Overdue- But Better Late Than NeverFinally, a National event to raise awareness and money for epilepsy. Epilepsy is probably one of the oldest known disorders. Pythagoras and Socrates were said to have suffered from seizures. Why is it that only now (2500 years later) we are seeing National Walks and other great fund-raising initiatives for epilepsy? Better late than never though, right? Right.Speaking of "Better Late Than Never"My wife and I attended the 1st Annual National Walk for Epileps...

The Ketogenic Diet and Friends
2007-12-14 14:53:00
It's Friday and I want to have some fun- so I'm going to post about the ketogenic diet. I'll introduce the concept of dietary treatment of epilepsy now. I'll discuss how these diets might be working in a later post. What is the Ketogenic Diet ?The ketogenic diet is a high fat, low carbohydrate and adequate-protein diet used to treat drug-resistant seizures. The most commonly used "classic" ketogenic diet has a 4:1 ratio. This means that there are 4 parts of fat to every 1 part of combined carbohydrate and protein (by weight). Translation: about 90% of your caloric intake is in the form of fat. Normally our body uses carbohydrate (sugars) as the main energy source. When dietary carbohydrates are severely limited (ie, almost no potatoes, rice, noodles, fruit, or candy) the body goes looking elsewhere for energy. Our bodies have a "backup system" that uses fat for energy. The KD provides a lot of fat for this back-up system to use. Who Goes on the Ketogenic Diet?Approximately 20-30%...
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The Drugs: Wherefore and Whence?
2007-12-12 14:55:00
Anticonvulsant Drugs , Antiseizure Drugs or Antiepileptic Drugs?I am seldom picky over words, but I really dislike the term "antiepileptic drug". It sounds like a pill you take if you don't like people with epilepsy. Some rogue, pill-popping gang wandering the streets with a score to settle against those who have epilepsy. Whoever coined this term obviously didn't eat their Wheaties.Two more acceptable terms are "antiseizure drugs" and "anticonvulsant drugs". Strictly speaking, a seizure is an electrographic event. It is the disruption of brain activity that we can measure using an EEG (see "What is a Seizure" below). A seizure may or may not be associated with a convulsion. A convulsion is the movement/behavior caused by a seizure. For example, tonic-clonic* (formerly called grand mal) seizures cause tonic-clonic movements therefore it is a convulsive seizure. Other seizures, however, do not cause convulsions. For example, simple partial seizures that do not affect motor areas of ...

Seizure First Aid
2007-12-10 02:55:00
Don't We Already Know What To Do?There is probably very little point in even writing this- cause we all know that when you witness a seizure, you try and open the person's mouth so that they don't swallow their tongue. Then you call them an ambulance. Right?WRONG!If you were reading the above paragraph to yourself thinking "yup, yup, right, exactly!" ... then please read below in great detail. Then re-read it.Witnessing a Seizure.Witnessing a seizure for the first time is difficult. It is important to know that the person having a generalized seizure is not in pain and is not conscious. Many people feel scared when they witness a seizure. This is OK. Take a deep breath and know that you can be a significant help to the person having the seizure by following a few simple steps.What To Do.- Stay calm. - Ensure your own safety. If you can't safely approach the individual, then simply stand back. - If possible, make sure the individual having the seizure is not in harm's way (eg, s...

What is Epilepsy? What is a Seizure?
2007-12-09 18:14:00
Some simplified terms.Neuron: Also called brain cells. These are the basic building blocks of our brain. They signal (both chemically and electrically) to one another, resulting in our behaviors. Behavior: What we do.What is epilepsy? Epilepsy is a disorder characterized by a wide spectrum of seizures. I will describe the seizure types later, but they range from very brief staring spells to the much stereotyped jerking and flexing of the arms and legs. A diagnosis of epilepsy is made after more than one unprovoked seizure. About 1% of the population has epilepsy.What is a seizure? The definition of "seizure" is not completely agreed upon. What we do know is that a seizure consists of a change in brain activity that results in a disruption of our normal behavior. If you give any more detail than that, then people start to argue. Generally speaking, however, people agree that a seizure has elements of "synchrony" and "hyper-excitation". Normally, brain activity is "chaotic". When you...

Why Start a Blog on Epilepsy?
2007-12-09 16:35:00
Welcome to the "Epilepsy in a Nutshell" blog!Why start a blog on Epilepsy? The answer is fairly simple. We are entering a new age in health care where patients (and family/friends of patients) want to empower themselves with information. The flow of knowledge from clinical and basic science realms- especially as it pertains to epilepsy- is not readily accessible. Therefore, the purpose of this blog is to distill and relay important information to those of you living with epilepsy.The title "Epilepsy in a Nutshell" harkens back to my grade 9 science class where my teacher used to tell us "it's all up there in a nutshell grade 9". This was his way of empowering us to use our brains and sort through the problems. The title isn't meant to suggest that epilepsy is a simple subject. On the contrary- there is nothing more challenging than trying to understand how the brain works, or why it isn't working the way we want it to. As you probably already know, there are no easy answers in th...
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