Drug mix-up to treat Epilepsy may cause heart failure

The three drugs are: Toprol-XL, also known as Metoprolol succinate; Topamax, also known as Topiramate; and Tegretol, also known as Carbamazepine. Toprol-XL is used to treat hypertension, chest pain and some kinds of heart failure; Topamax is used to treat epilepsy and to prevent migraines; and Tegretol is used to treat certain kinds of seizures and a nerve disorder than causes severe head pain.
The letter from drug maker AstraZeneca asks doctors and pharmacists to take extra care in prescribing the three drugs, the Associated Press reported.
Patients who've received the wrong drugs have suffered recurrences of seizures, hallucinations and hypertension, the letter states. At least one patient who mistakenly received Toprol-XL suffered a dangerous drop in heart rate and at least one suicide attempt was possibly linked to a prescription mix-up, the AP reported.
The letter urges doctors to write legible prescriptions that include both the brand and generic names of the drugs. It also asks that pharmacist double-check drug names against prescriptions.

Six years old girl succombs to an Epilepsy related condition

Daisy Garland was being treated at St George's Hospital, Tooting, but died in her sleep in April last year.

Parents David and Sara, from Raynes Park, set up a charity - which raised £24,000 - enough to pay for an epilepsy dietician at St George's for a year.

The family held events such as quiz evenings and a black-tie function on a river boat to raise the cash, Daisy's parents claim a special high-fat diet, called the ketogenic diet, lengthened her life and want to help other sufferers receive it.

Dad David said: "Medication was clearly ineffective for Daisy, and from the age of 18 months her seizures were managed by the ketogenic diet.

"We truly believe this diet prolonged Daisy's life and rescued us as a family."

Nicole de Santos, chief paediatric dietician at St George's Hospital, said: "A large proportion of children with epilepsy have seizures that are resistant to medication.

"This can impair their ability to learn and reach their full potential.

"The ketogenic diet is an accepted therapy for children with hard-to-control seizures.
"We would like to thank the Garlands for their kind and very generous donation."
The nurse's post is due to be advertised shortly.

Sony's new handheld video game causes seizures

SONY'S new handheld video game can cause paralysing seizures in youngsters,medics warned yesterday.

The world's leading expert in photosensitivity said flashing lights and the flickering screen on the £180 PlayStation Portable can cause attacks similar to epileptic fits.

Graham Harding, professor in clinical neurophysiology at Birmingham's Aston University, said: "Any video game has flashing images but it's the proximity to the screen that can induce the seizures.

"And people hold handheld consoles, such as the PSP, very close to their faces.

"The most likely seizure will be photosensitive - it's basically the same as an epileptic attack in children.They are twice as likely to occur in girls than boys. We don't know why this is."
One case per 100,000 people is reported each year in the UK - but in people aged seven to 20, the frequency rises to 5.7 per 100,000.

PET Scan helps for planning surgery for patients suffering from Epilepsy

Positron emission tomography (PET) brain scans may be sensitive enough to help plan brain surgery for epilepsy, based on the results of a new study.

Researchers from the National Institutes of Neurological Disorders and Stroke in Bethesda, Md., say, "Our preliminary data suggest that PET imaging with a marker that shows deficits in signaling for the neurotransmitter serotonin is more sensitive than the traditional PET measurement of brain glucose."

Patients with epilepsy often need brain surgery when medication does not work. The researchers say about 30 percent of patients with epilepsy have seizures that cannot be controlled with drugs.
Surgery performed on the areas of the brain where seizures start can be safe and effective.

However, identifying the correct spot for surgery has traditionally required a separate preliminary surgery that sometimes poses risks. Researchers say localizing the epileptic focus is crucial.
In addition to PET scanning, magnetic resonance imaging (MRI) is also under study as a tool to determine brain origins of epileptic seizures.

Drugs mix-up can affect seizures disorder

Leading pharmaceutical company, AstraZeneca, in letters released by the Food and Drug Administration, warn doctors and pharmacists that mix-ups in prescriptions of three drugs with similar names, but vastly different effects can lead to serious health problems.

The drugs are Toprol-XL, Topamax, and Tegretol.

Toprol-XL, generic name metoprolol succinate, treats hypertension, chest pain, and some kinds of heart failure. It is manufactured by AstraZeneca.

Topamax, also known as topiramate, is used to treat epilepsy and prevent migraines. It is made by Ortho-McNeil Neurologics Inc.

Tegretol, known as carbamazepine, treats some kinds of seizures and trigeminal neuralgia, a nerve disorder that causes stabbing head pain. It is manufactured by Novartis.

According to letters from AstraZeneca’s chief medical officer, Glenn J. Gormley, patients who received the wrong drugs reported recurrences of seizures, hallucinations, and hypertension.
At least one suicide attempt is possibly linked to such a mix-up, and at least one patient who mistakenly received Toprol-XL experienced a dangerous drop in heart rate.

Gormley asked doctors to write legible prescriptions that include both the brand and generic names of the drugs, and asked pharmacists to double-check drug names against prescriptions.

Man suffering from seizures is missing

Kurtis Palmquist has been missing since Sept. 19. Authorities searched the Lake Goodview, Airport Lake and the Mississippi River shoreline last week but turned up nothing.

Winona County Sheriff Dave Brand said another search of the Lake Goodview and Mississippi River areas was conducted Monday using two cadaver dogs. Brand said Palmquist suffered from seizures prior to his disappearance. He was last seen at a Goodview residence a judge had ordered him to stay away from as part of a domestic assault case.

Brain imaging shows epilepsy's deficit in serotonin

Positron emission tomography (PET) brain scans of a brain chemical messenger system may prove sensitive enough to help plan brain surgery for epilepsy, according to a study presented at the 130th annual meeting of the American Neurological Association in San Diego.

"Our preliminary data suggest that PET imaging with a marker that shows deficits in signaling for the neurotransmitter serotonin is more sensitive than the traditional PET measurement of brain glucose," said senior author William H. Theodore MD, chief of the Clinical Epilepsy Section at the National Institutes of Neurological Disorders and Stroke. When drugs fail to control epilepsy, brain surgery is often the only remaining therapeutic option.

However, identifying the correct spot for surgery has traditionally required a separate preliminary -- and inherently risky -- surgical procedure. Epilepsy is a chronic illness of the brain that is estimated to affect almost one percent of the U.S. population. During an epileptic seizure, nerve cells in the brain fire electrical impulses much faster than normal, often leading to loss of consciousness.and convulsionsIn a subset of cases, the seizures always begin the same, identifiable area of the brain, then spread to other areas.

Surgery to remove the area where seizures start can be safe and effective. "About 30% of patients with epilepsy, or approximately 600,000 people in the U.S., have seizures that are not controlled by antiepileptic drugs. Surgery may be an option for some of these, and localizing the epileptic focus is crucial," said Theodore. Both PET and magnetic resonance imaging (MRI) are under investigation as tools to guide neurosurgeons to areas of the brain where epileptic seizures originate.

Theodore and colleagues at NINDS have found, in their pilot study, that a marker for serotonin systems was able to identify epilepsy-generating brain areas even in a patient with a normal MRI. In related studies, the researchers have found that these deficits in serotonin correlate with the likelihood that patients with epilepsy will also suffer from depression.

Theodore cautions that this is a preliminary study of a procedure that is still in the research stages. However, he suggests that physicians should not hesitate to treat patients with epilepsy and depression with effective antidepressant drugs, and to refer patients for surgical evaluation if seizures are not controlled by antiepileptic drugs.

Serotonin 1A receptor imaging and temporal lobectomy. Robert Bonwetsch, MD, Giampiero Giovacchini, MD, Richard Carson, PhD, Patricia Reeves-Tyer, Kathy Kelley, MA, Peter Herscovitch, MD and William H Theodore, MD. Bethesda, Maryland. Positron emission tomography (PET) may provide supportive data for detecting epileptogenic zones in patients with temporal lobe epilepsy (TLE), helping to reduce the need for invasive EEG studies.

Serotonin (5HT) 1A receptor binding has been shown to be decreased in TLE. We used PET to compare 5HT-1A binding measured with the silent antagonist 18FCWAY, to glucose metabolism measured with 18FDG, in 19 patients who had temporal lobectomy for uncontrolled epilepsy, and a mean follow-up of 31 months. We analyzed PET data with co-registered MRI and partial volume correction, computing an asymmetry index (AI) using the formula [2] x [ipsilateral contralateral]/[ipsilateral + contralateral] for anatomic regions drawn on each patient s co-registered MRI scan.

Mean FDG asymmetry in the resected region was 0.25 0.18, versus 0.47 0.20 for FCWAY (P<0.001).>

New anti-seizures drug approved

Today UCB announced that the European Commission has approved the use of Keppra(R) (levetiracetam) in the European Union, as adjunctive therapy in the treatment of partial-onset seizures, with or without secondary generalisation, in children from four to sixteen years of age.
Approval was based on a pivotal paediatric clinical trial, the results of which were most recently(a) reported at the 6th European Paediatric Neurology Society Congress (14th-17th September 2005), in Sweden(1).

"More than 25% of children with epilepsy experience treatment resistant seizures or intolerable side effects from medication" said Tracy Glauser, M.D., director of the Comprehensive Epilepsy Program, Cincinnati Children's Hospital and principal investigator of the study. "Keppra(R) was effective and well-tolerated by children in the study, many of whom had tried multiple anti-epileptic drugs prior to trying Keppra(R)."

The trial was a multicentre, double-blind, randomized, placebo-controlled study in 198 children (4-16 years old), with partial onset seizures with or without secondary generalisation uncontrolled by standard AEDs. Results show that 45% of those who received levetiracetam at a target dose of 60 mg/kg/day for 14 weeks had at least a 50% reduction in seizure frequency, and 7% became seizure free(1).

This compared with 19% (p=0.0002) and 1% respectively in placebo-treated patients. Prior to treatment with levetiracetam, the children enrolled in the study were experiencing approximately five seizures per week (median = 4.7 and 5.3 for the levetiracetam and placebo group respectively)(1).

Levetiracetam was well tolerated, and fewer children withdrew from treatment with levetiracetam because of adverse events compared to the placebo group (5% and 9% withdrawal for the levetiracetam and placebo group, respectively)(1). With the exception of somnolence (22.8% and 11.3% for the levetiracetam and placebo group, respectively), the incidence of treatment related adverse events was similar between patients in the levetiracetam and placebo groups with the most commonly reported treatment adverse events being somnolence, infection, accidental injury, vomiting and headache(1).

Guidelines to prevent video games induced seizures

For the first time in the United States, the Epilepsy Foundation has released guidelines for families with epileptic children. Based on an expert review of photosensivity research, the recommendations specify parameters for lighting and flicker to help prevent the triggering of epileptic episodes in photosensitive individuals.

According to experts for the Foundation, flashing light and repeating patterns don’t cause epilepsy, but can trigger latent epilepsy in individuals with the photosensitive trait. The Foundation also issued a second set of recommendations for industry, so that manufacturers can develop electronic devices that are less likely to trigger a seizure.

As the father of an epileptic child, The Epilepsy Foundations gets my quiet yet sincere “thank you”.

New drug to control nerve pain and seizures

After a 6-month delay, Pfizer Inc. is selling a new drug that could help millions of people with chronic nerve pain and seizures and be a billion-dollar blockbuster for the world's largest drug maker.

Developed at Pfizer's Ann Arbor research facilities, Lyrica is approved by federal regulators to treat three specific ailments: the nerve pain associated with diabetic neuropathy, nerve pain that often accompanies shingles, and for partial onset seizures, the most common type of epileptic seizure.

"These three indications will meet the needs of potentially millions of patients," Toni Hoover, who has led the Lyrica development team since 1998, said Monday.

Lyrica won federal approval to treat diabetics and shingles sufferers in early January, and Pfizer said it would be available by the end of March.

But, according to Hoover, release of the drug was delayed when it was classified by the federal Food and Drug Administration as a low-level controlled substance. That triggered a subsequent review, including a comment period, by the Drug Enforcement Agency.

"We thought we would go through that process more quickly," said Hoover, vice president of development for Pfizer Global Research and Development.

In the meantime, Pfizer received approval for the third use of Lyrica, to treat epileptic seizures.
The delay enabled the company to complete the labeling process and train a 2,500-person sales staff to educate doctors, pharmacists and health professionals on all three applications for the drug.

Lyrica's Class 5 classification -- lowest of all for controlled substances -- puts it in the same category as some cough medicines with codeine, for example. Physicians and pharmacists will follow slightly different procedures in prescribing and tracking the medication, but "patients should not experience any difference," Hoover said.

Nearly half of the 18 million American with diabetes will develop some form of diabetic neuropathy and about 3 million will experience painful neuropathy in their feet, legs, hands or arms. An estimated 50,000 Americans develop nerve pain from shingles, a skin disease caused by reaction to the same virus that causes chicken pox.

The market for nerve pain treatment alone could generate $1 billion in sales, estimated Trevor Polischuk, a pharmaceutical analyst with money manager OrbiMed Advisors in New York. He estimates the market for treating epileptic seizures could be a $500-million market.

Lyrica is the next generation drug in a class developed and controlled exclusively by Pfizer -- alpha-2 delta ligands. Lyrica works like a blanket, dampening hyper-excitable nerve endings that cause not only pain and seizures, but also psychiatric disorders such as anxiety.

One application -- to treat general anxiety disorder -- initially was rejected by the FDA. Pfizer continues to work with regulators, but has not resubmitted an application.

However, Pfizer has filed an application in Europe seeking approval for the use of Lyrica to treat general anxiety disorder. The approval process is expected to take about a year.

The use of Lyrica to treat anxiety disorder could present the most lucrative market because of the potentially huge demand. Polischuk estimated it could be upward of $2-billion, raising it to mega-blockbuster status.

Developed from a chemical acquired from Northwestern University in 1992, Lyrica has been created almost entirely in Ann Arbor -- first in the research and development labs of Parke-Davis, then Warner-Lambert, then Pfizer, as each was swallowed by its successor.

Given the potential uses for alpha 2 delta ligands, the Ann Arbor research facility, which employs 2,500 people, is poised to play a key role in the development of future Pfizer products.

Tips to avoid seizures caused by tv and video games

The Epilepsy Foundation has issued new guidelines to help avoid rare cases of seizures triggered by flickering lights from TV and video games.
The guidelines are particularly important for people who are sensitive to light, but "the suggestions are valid for everybody," Giuseppe Erba, MD, tells WebMD.
Erba is a professor of neurology and pediatrics at the University of Rochester. He helped write the guidelines, which include:

TV Viewing

Watch TV in a well-lit room.
Reduce the screen's brightness.
Keep as far back from the screen as possible.
Use the remote control to change channels.
Avoid watching TV for long periods of time.
Wear polarized sunglasses while viewing TV to reduce the glare.

Video Games

Sit at least 2 feet away from the screen in a well-lit room.
Reduce the screen's brightness.
Don't let children play video games if they are tired.
Take frequent breaks and look away from the screen every once in a while.
Cover one eye while playing and regularly change which eye is covered.
Turn the game off if strange or unusual feelings develop.

Computer Screens

Use a flicker-free monitor (LCD display or flat screen).
Use a monitor glare guard.
Wear nonglare glasses to reduce glare from the screen.
Take frequent breaks from tasks involving the computer.

Strong Environmental Lights

Cover one eye (either one) with one hand until the stimulus is over.
Closing both eyes or turning your eyes away from the stimulus will not be effective.

TV, Video Games Don't Cause Epilepsy

Video games and TV don't cause epilepsy, Erba and the Epilepsy Foundation stress.
"It's quite clear that the exposure to video games does not make you become an epileptic," says Erba.

There are various factors, even in people who are predisposed to seizures, that contribute to the seizure activity triggered by lights. The Epilepsy Foundation also stresses that the frequency or the speed of flashing lights most likely to cause seizures can vary from person to person.

"It's not clear what percentage of people has this particular vulnerability," he says.

Past studies of healthy children have shown that 4% to 9% of the general public is sensitive to light, says Erba. An even smaller number is highly sensitive to light, and a fraction of that group may have seizures from rapidly flashing lights or fast-changing colors on a screen.

According to the Epilepsy Foundation, photosensitivity epilepsy is more common in children and adolescents, especially those with generalized seizures, and becomes less frequent with age.
"The risk of having a seizure if you are sensitive is only one out of 17,000 viewers if you are young," says Erba. "If you are older, it's even less. It's one out of 90,000," he says.

Those numbers came from studies done in England a decade ago, Erba notes. "It doesn't reflect today's situation, with all these new video games that are coming on the market," he says.

Expert's Advice for Parents

An electroencephalogram (EEG) test is needed to check for light sensitivity, says Erba. EEG tests can monitor the electrical activity of the brain during light stimulation; an abnormal response can indicate light sensitivity.

Should parents ask for that test for kids who play video games?

Erba says it might be worth consulting a doctor about that if kids are "very, very engaged in video game playing and so forth" and if a family member is known to be sensitive to light or has certain types of epilepsy that are more likely to be associated with the problem.

Under those circumstances, Erba says his suggestion for parents is to talk to a doctor "and figure out whether it might be worthwhile to get [the child] to have an EEG."

If the child is not sensitive, "there is no danger. But if they are sensitive, they should probably take precautions," says Erba.

"To have seizures, you have to be sensitive and you have to be exposed to a combination of factors that will bring you over the brink," he says.

American Advantage?

The same issue has come up in the U.K. and Japan, says Erba. In the journal Epilepsia, Erba and colleagues note nearly 700 hospital admissions in Japan -- mostly for seizures -- after a December 1997 episode of a Pokemon cartoon.

America's TV system has a slightly higher frequency than those in the U.K. and Japan. That offers "a little bit" of protection against the effects of rapidly flickering lights but not against quickly changing colors, says Erba.

He adds that the new flat-screen TVs have "no problem" with flickering but have much brighter colors.

"Video games and TV programs should not have flashes higher than three per second," says Erba. "You can have perfectly attractive programs flickering at three per second. You don't have to go to nine or 10 per second."

Video Game Group Responds

WebMD emailed the Epilepsy Foundation's recommendations and Erba's report in Epilepsia to Jason Della Rocca, the executive director of the International Game Developers Association.
In an email, Della Rocca says this is the first time he has seen this particular research.

"Video game[s] form an important part of the media and entertainment mix of millions people on a daily basis. And, I'd say that the maxim of all things in moderation will always apply," writes Della Rocca.

"Ironically, gamers -- young and old -- usually have no shortage of 'encouragement' to maintain that balance," writes Della Rocca.

How to avoid seizures caused by visuals

The Epilepsy Foundation revised its guidelines to limit the risk of seizures triggered by flashing images and some patterns on computers, TVs and videogames.

The guidelines, based on standards in place in Britain and Japan, are based on research into photosensitivity- - or susceptibility to visual stimulation.

Children and young adults from age 7 to 19 are five times as susceptible as the general public to visually stimulated epileptic seizures. Such seizures gained worldwide attention in 1997 when nearly 700 children were hospitalized in Japan while watching a Pokemon cartoon episode, the foundation said.

The Epilepsy Foundation recommends that people sit at least 2 feet away from game, computer or TV screens; keep rooms well lit; and take frequent breaks to look away from the screens.

New medication for seizures

Valeant Pharmaceuticals International (NYSE:VRX) today announced the approval of Diastat(R) AcuDial (diazepam rectal gel) -- the only FDA approved at-home treatment for the safe and immediate management of emergency seizures. Diastat AcuDial is an exclusive proprietary drug delivery system that gives physicians and pharmacists greater ability to adapt dosage based on individual patient needs. Diastat AcuDial will be available in pharmacies nationwide in early October 2005.

Timothy C. Tyson, Valeant's president and chief executive officer, said, "Diastat is a unique product that provides caregivers with a fast and safe treatment for epilepsy patients. As the only product approved for treating emergency seizures outside of a hospital, Diastat AcuDial takes these benefits to a new level with a flexible, easy-to-use delivery system that enables immediate treatment of seizures by a non-medically trained caregiver.

This product was designed with input from physicians, pharmacists and patients and we believe that it will be very well received."

"When a patient begins to have prolonged or recurrent seizures outside of their normal patterns, it's a medical emergency that needs to be treated immediately," said Dr. James W. Wheless, professor and chief of pediatric neurology at the University of Tennessee Health Sciences Center. "In the United States, the amount of time that typically elapses between the onset of a seizure and a patient receiving treatment at a hospital can exceed one hour.

That's too long for this type of emergency. AcuDial is a safe, effective treatment, which is a significant patient advantage."

The Diastat AcuDial delivery system incorporates the ability to dial, set and lock specific doses in two configurations delivering doses ranging from 5 to 20 mg, and is easily administered by any non-medical caregiver. The system requires no refrigeration or special handling, so it can be stored in the home, office or taken along when traveling.

Valeant's neurosciences business has gained significant momentum over the past year, beginning with the U.S. re-launch of Tasmar in July 2004 and the anticipated launch of Zelapar in late 2005. The company's growth continued with the acquisition of Xcel Pharmaceuticals earlier this year.

About Epilepsy

The Epilepsy Foundation of America estimates that 2.5 million Americans suffer from epilepsy(1) and that approximately 30 percent of those who suffer from this difficult condition are not able to control their seizures with existing maintenance therapies(2). Approximately 42,000 deaths occur annually due to epilepsy(3).

Of the 181,000 new cases diagnosed each year, 58 percent are treated in an emergency room in the first year and 40 percent are hospitalized at least once(1). Studies have shown that prolonged or repetitive seizures can cause neurological damage. Prolonged seizures can dramatically increase the risk of death, mental handicap, memory loss and changes in neuropsychological function.

Important Diastat (diazepam rectal gel) Information

Diastat (diazepam rectal gel) is a gel formulation of diazepam intended for rectal administration in the management of selected, refractory, patients with epilepsy, on stable regimens of anti-epileptic drugs (AEDs), who require intermittent use of diazepam to control bouts of increased seizure activity for patients two years and older. Diastat AcuDial is supplied in a twin pack of pre-filled configurations:

-- 10 mg delivery system with a 4.4 cm tip delivers doses of 5, 7.5, and 10 mg

-- 20 mg delivery system with a 6.0 cm tip delivers doses of 10, 12.5, 15, 17.5, and 20 mg

Important Safety Information

In pivotal trials with Diastat, the most frequent adverse event reported was somnolence (23%). Less frequent adverse events reported were dizziness, headache pain, vasodilatation, diarrhea, ataxia, euphoria, incoordination, asthma, rash, abdominal pain, nervousness and rhinitis (1%-5%).

About Valeant Pharmaceuticals

Valeant Pharmaceuticals International (NYSE:VRX) is a global, publicly traded, research-based specialty pharmaceutical company that discovers, develops, manufactures and markets products primarily in the areas of neurology, infectious disease and dermatology.

Kids at risk of video game and tv seizures

The Epilepsy Foundation today issued new recommendations for families on how to limit the risk of seizures triggered by flashing images and certain patterns on television, videogames, computers and other video screens. The recommendations are based upon guidelines in the UK and Japan and are the first published in the U.S. to be based on an expert review of research on photosensitivity (the susceptibility to visual stimulation). The report by Graham Harding of the Clinical Neurophysiology Unit, Aston University, Birmingham, England, and his colleagues, appears in the September issue of the journal Epilepsia, the official journal of the International League Against Epilepsy.

The consensus recommendations, which are published in full on the Epilepsy Foundation Web site, cover factors such as light intensity, flicker, contrast, duration and pattern, and the technical parameters within these factors that are most likely to provoke seizures in susceptible individuals. Accompanying the report in Epilepsia is an article on the literature and data review conducted for the working group as part of its analysis and recommendations development.

No one knows how many people have had seizures while watching television, surfing the Internet, or playing videogames. But some epileptologists (doctors who treat seizures) have noticed an increase in the number of young people coming to them following these incidents. The Epilepsy Foundation, which has been watching this trend, believes that seizures from visual stimulation are a significant national health problem.

Physicians on the Epilepsy Foundation's Task Force on Photosensitivity advise that children and young adults 7 to 19 years of age are especially susceptible to visually induced seizures. They report the annual incidence in this age group to be one in 17,500, compared to one in 91,000 in the overall US population. This five-fold increased risk to youth was dramatically highlighted in December 1997 when nearly 700 children were hospitalized in Japan for symptoms that developed while watching a televised Pokemon episode. About 500 of these children had seizures.

Exposure to flashing light and repetitive patterns does not cause epilepsy, the tendency to recurring seizures, according to the experts. Giuseppe Erba, MD, from the Departments of Neurology and Pediatrics at the University of Rochester Medical Center, who led development of the recommendations, said "Children with undetected epilepsy may have a first recognized seizure while playing or soon after playing a videogame.

Some children will have a seizure when exposed to a specific videogame and will not have another seizure unless again exposed to the same stimulus. This doesn't mean that the videogame caused the epilepsy, but it reveals the vulnerability of individuals who carry the photosensitive trait when they are exposed to visual stimuli capable of triggering the abnormal response. The same increased risk exists for children with known epilepsy who can be photosensitive, as well."

In a separate report also released today, the Epilepsy Foundation has issued recommendation for industry concerning technical characteristics of light and patterns that might pose a risk to people who are photosensitive. There is no known method to eliminate the risk of visually provoked seizures entirely because of the great variability of what triggers seizures in different individuals. Controlling these factors in videogames is especially difficult.

The photosensitive recommendations for parents are available on the Epilepsy Foundation's Web site epilepsyfoundation.org or by calling 800-332-1000.

For more information on the recommendations and the report, contact Peter Van Haverbeke, director of public relations, Epilepsy Foundation at 301-918-3772 or Kimberli Meadows at 301-918-3747.

About Epilepsia

Epilepsia is the leading, most authoritative source for current clinical and research results on all aspects of epilepsy. As the journal of the International League Against Epilepsy, Epilepsia presents subscribers with scientific evidence and clinical methodology in: clinical neurology, neurophysiology, molecular biology, neuroimaging, neurochemistry, neurosurgery, pharmacology, neuroepidemiology, and therapeutic trials. Each monthly issue features original peer reviewed articles, progress in epilepsy research, brief communications, editorial commentaries, special supplements, meeting reports, book reviews, and announcements.

About the International League Against Epilepsy

The International League Against Epilepsy (ILAE) is the world's preeminent association of physicians and other health professionals working towards a world where no persons' life is limited by Epilepsy. Its mission is to provide the highest quality of care and well-being for those afflicted with the condition and other related seizure disorders. The League aims: 1. To advance and disseminate knowledge about epilepsy; 2. To promote research, education and training; 3. To improve services and care for patients, especially by prevention, diagnosis and treatment. For more information on the ILAE.

About the Epilepsy Foundation

The Epilepsy Foundation, with national offices in metropolitan Washington, D.C., and 55 affiliates in 39 states, is the leading voluntary health organization with programs and services for nearly 3 million people in the United States with seizures. The organization's goals are increased research, more effective treatment, the elimination of social barriers, and access to quality care, so not another moment will be lost to seizures.

About Blackwell Publishing

Blackwell Publishing is the world's leading society publisher, partnering with more than 600 academic and professional societies. Blackwell publishes over 750 journals annually and, to date has published close to 6,000 text and reference books, across a wide range of academic, medical, and professional subjects.

Football player goes back in the game following seizures

Whoever said you can't keep a "Goodman" down must have been watching a Myrtle Beach High football game.

And whoever said a "Goodman" is hard to find must have played on the Carolina Forest defense.
Myrtle Beach tailback Joe Goodman ran for one touchdown, caught a pass for another, had two more called back on penalities and tallied 117 yards in total offense in the Seahawks' 31-12 victory over Carolina Forest on Friday night at Doug Shaw Stadium.

But more impressive than the numbers he put up was the fact that he played at all. After suffering a bout with seizures earlier this season, Goodman sustained bruised ribs early in the second half but returned to help lead his team to victory.

"[The] dude just sideswiped me real hard and it started swelling up and throbbing," Goodman said, "but I wasn't going to let it keep me out. I had to come back.

"I just love the way my team thrives on it. When somebody does something big, it's like the whole team gets motivated."

The 5-foot-6, 150-pound Goodman already has his teammates' respect after he began experiencing seizures in preseason practice. On the ride back from Conway earlier this month, he had another one that seemed to spell a premature end to his senior season.

"It was something I had when I was younger that just came back up all of a sudden," Goodman said. "I didn't take medication for it when I was young, but now that I'm taking medication for it it's no problem."

Goodman was a serious problem for the Panthers, breaking a 10-yard touchdown run and hauling in a 27-yard touchdown pass from quarterback Andrew Ellis to cap a 21-unanswered-point explosion in a six-minute span during the second period.

After having two more scores erased by penalties, one on a 75-yard touchdown strike from Ellis, Goodman was drilled in the ribs and fumbled deep in Seahawks' territory to give the Panthers a ray of hope. But the Myrtle Beach defense held the Panthers to a field goal with back-to-back goal-line stands.

"We had our backs against the wall down there a few times and they came away with [three points]," said Myrtle Beach coach Scott Earley. "Just a tremendous job on defense."

Meanwhile, Goodman lay prone on the sidelines before strapping on a flak jacket and returning to the game. He carried the ball five straight times to set up the Seahawks' final, game-clinching score.

"It scared us because he took a big hit," Earley said. "We thought, 'Oh Lord, here we go again.' We tried to play Dillon without him [due to the seizures]. They cleared him of all that, but he took a lick tonight.

"But I've had him for four years. When he comes up and says, 'I'm ready,' he's ready. He's just a tough, tough kid."

The victory over their rival was sweet revenge for the Seahawks, who lost last year at Carolina Forest on a field that can best be described as pig slop. Mr. Football quarterback J.D. Melton had a hard time passing in the slop and the Panthers prevailed 21-14.

One sign at Friday's game read, "Got Mud?" And Earley quipped after the game, "There ain't no mud at the beach."

Despite the fact that Hurricane Ophelia dumped five inches of rain earlier this week, the Seahawks had no trouble with footing on a dry field Friday night, especially with the hard running and determination of one Goodman.

"I never say die," Goodman said. "I never let anybody think they put me out of the game."

Stroke may increase risk of Epilepsy

The results of a study conducted in Norway indicate that stroke patients appear to be at increased risk for developing epileptic seizures. The study also shows that the severity of the stroke is a statistically significant predictor for epilepsy.

Health care professionals need to be aware of the risk of epilepsy after stroke since anti-epileptic drugs may be effective in preventing additional seizures, lead investigator Dr. Morten I. Lossius told Reuters Health.

Lossius, of the National Center for Epilepsy, Sandvika and colleagues conducted a long-term, follow-up study of 484 patients who had an ischemic stroke, a stroke resulting from an interruption of blood flow to the brain. The findings are published in the medical journal Epilepsia.

The investigators found that 12 (2.5 percent) patients developed epilepsy within one year of the stroke and 15 (3.1 percent) developed post-stroke epilepsy 7 to 8 years after the event. Post-stroke epilepsy was defined as having two or more unprovoked epileptic seizures one week or longer after a stroke.

Treatment in a specialized stroke unit versus a medical ward, age at the time of the stroke, and the location of the brain area damaged by the stroke, did not seem to influence the risk of developing epilepsy.

In an analysis that accounted for potential factors that may have increased the risk of epilepsy, stroke patients with a Scandinavian Stroke Scale score of less than 30 on admission, indicating a severe stroke, had an almost five-times greater risk of developing post-stroke epilepsy compared with those with less severe strokes.

It is important, Lossius concluded, to conduct more studies to find out if newer treatments, such as drugs that help break up the blood clots implicated in this type of stroke, can reduce the risk of epilepsy in these patients.

Beaten student goes into seizures

Sandalwood High School is a campus of more than 3,200 students. That makes it the largest school in Duval County.If you ask Darlene, who has asked us not to use her last name, she says the school is one of the most dangerous in the area."I'm just appalled," says Darlene.Her grandson goes to Sandalwood.

Last week, she says her grandson witnessed something that caused her to pull him out of school at Sandalwood permanently."Seeing his best friend beaten unconscious and falling to the floor in a seizure."The school and its resource officers say the student was sent to the hospital and two others students were later arrested.

The First Coast News I-Team has learned eleven students have been arrested at Sandalwood in the last two days. The charges vary from causing disturbances to battery. One student was even arrested for making a weapon in shop class."Number one, you're gonna get arrested. Number two, were gonna recommend you go the alternative school," says principal Victoria Schultz.Schultz says she is enforcing a zero tolerance policy.JSO is also looking at what is causing the problem."We've had some detectives from our gang unit come out and do interviews and we can't verify there are gangs here at Sandalwood," says Lt. Joe Medlen.Schultz calls them cliques.

Lt. Medlen says some of those cliques have adopted gang terms and monikers, but they are not organized.Right now, there are two school resource officers and a team of security guards who patrol the school and its grounds trying to stop a problem before it starts."Our goal here is to make Sandalwood safe," says Schultz.Darlene says she isn't taking any chances. She's pulled her grandson from Sandalwood and plans to enroll him somewhere else."I believe the school is too large and it's gonna take a lot more than what they are doing to get it under control."Since school began, 27 students from Sandalwood have been arrested.

New drug to treat epileptic seizures

Eisai Medical ResearchInc. (Headquarters: Ridgefield Park, President Mindell Seidlin, M.D.) hassubmitted a new drug application (NDA) to the U.S. Food and DrugAdministration (FDA) for the anti-epileptic drug (AED) rufinamide. Eisai isseeking approval for two indications for rufinamide, as adjunctive therapy forLennox-Gastaut syndrome (LGS) in children ages four and over and as adjunctivetherapy for partial-onset seizures with and without secondary generalizationin adults and adolescents (12 years of age and over).

Rufinamide is a triazole derivative, a compound structurally distinct fromcurrently approved AEDs. In a multicenter, double-blind, placebo-controlledclinical trial, rufinamide was shown to have clinical benefit in the treatmentof seizures associated with LGS, a severe form of epilepsy that develops inearly childhood, and was designated as an orphan drug for this indication bythe FDA in October 2004.

Based on key findings of two double-blind, placebo-controlled trials, rufinamide will also be filed with the FDA as adjunctivetherapy in adults and adolescents, 12 years of age and over, with partial-onset seizures with and without secondary generalization. "Rufinamide may be an important breakthrough for Lennox-Gastaut syndrome,"said Santiago Arroyo, MD, PhD, Medical Director CNS, Eisai Medical ResearchInc. "LGS is a serious condition that is difficult to manage with currentlyapproved treatments, and the epilepsy community needs new options."

Lennox-Gastaut syndrome is a severe form of epilepsy. Seizures usuallybegin before four years of age, and children with LGS often suffer fromseveral types of seizures. An estimated 1,400 to 4,500 new cases of LGS arediagnosed each year in the U.S., and complete recovery, including freedom fromseizures and normal development, is very unusual. There is no known cure forthe disorder.

Rufinamide also was shown to have clinical benefit as adjunctive therapyin treating adults and adolescents (12 years of age and over) with partial-onset seizures with or without secondary generalization. Partial seizuresaffect only one area of the brain and are the most common type of seizureexperienced by people with epilepsy.

Eisai acquired exclusive North American and European manufacturing andmarketing rights to rufinamide from Novartis Pharma AG in 2004. With thefiling of rufinamide, Eisai plans to strengthen its neurology franchise andcontinue to fulfill its human health care (hhc) mission to satisfy unmetmedical needs and increase benefits to patients and their families.

In double-blind studies, the most commonly observed adverse experiencesseen in association with rufinamide and at a higher frequency (greater than orequal to 10%) than in placebo-treated patients were headache, dizziness,fatigue, somnolence and nausea.

About Eisai Medical Research Inc. Eisai Medical Research Inc. is a U.S. pharmaceutical subsidiary of EisaiCo., Ltd. Eisai Medical Research Inc. was established to focus solely onclinical research and to expedite clinical drug development of new chemicalentities and of new indications for marketed products.

Blood test may detect seizures

A blood test that measures levels of the hormone prolactin may help determine whether a seizure was caused by epilepsy or some other disorder, according to new guidelines.

Researchers reviewed all of the published studies on the prolactin blood test and found it may be useful in certain situations in determining whether an epileptic seizure occurred in adults and older children with unexplained seizures.

The test, which must be used within 10 to 20 minutes after a seizure, measures levels of the hormone prolactin in the blood. Prolactin is produced by the pituitary gland, but an area of the brain called the hypothalamus controls its release.

Researchers say epileptic seizures are thought to affect the hypothalamus and may alter the release of prolactin, causing levels of the hormone to rise.

New Test for Epileptic Seizures

In the study, which appears in the journal Neurology, researchers evaluated eight studies on the prolactin blood test.

The results showed that the test could accurately identify seizures in adults and older children and distinguish them from nonseizure type episodes. Levels of prolactin in the blood increase after seizures but not during nonseizure activity.

Researchers found the test was useful at differentiating epileptic seizures from those caused by mental problems. But they say the test cannot distinguish epileptic seizures from those caused by a fainting episode because prolactin levels also rise after these types of seizures.

Therefore, the guidelines say the test may be appropriate as a secondary test, especially in cases when EEG (electroencephalography, a technology used to analyze seizures) is not available.
More research is also needed to determine whether the prolactin blood test is suitable for young children.

Medication for epileptic seizures, a positive move

Analysis of studies of two widely-used epilepsy drugs indicates that fosphenytoin provides effective, rapid treatment of life-threatening continuous seizures, with a lower risk of adverse effects.

The review of fosphenytoin in the treatment of the condition known as status epilepticus appears in the premier issue of the journal Core Evidence, the first international peer-reviewed publication to assess medications by critically evaluating evidence on clinical effectiveness and outcomes.

Status epilepticus, in which epileptic seizures occur continuously or in rapid succession, is a significant public health problem, with about 150,000 new cases in the United States each year and about 40,000 deaths annually; a mortality rate of about 22%. The condition requires swift emergency treatment, usually through administration of drugs intravenously.

Both phenytoin and fosphenytoin are among the drugs approved for this use by the U.S. Food and Drug Administration (FDA). However, rapid intravenous administration of phenytoin, required for quick termination of seizures, can lead to severe venous adverse effects.

“One of the most poorly understood and potentially serious local complications of intravenous phenytoin administration is the purple glove syndrome, which is characterized by progressive limb swelling, discoloration and pain,” said Andrew Thomson, PhD, who authored the review. “While it is clear that phenytoin is effective for treatment of status epilepticus, the way it is formulated limits how fast it can be infused and influences its tolerability,” Dr Thomson said.

Fosphenytoin, manufactured by Pfizer Inc. and marketed in the United States by Eisai Inc. under the trade name Cerebyx®, is a precursor of phenytoin and was developed to overcome the often severe venous adverse effects that can occur after giving phenytoin intravenously.

The Core Evidence review concludes that there is now evidence that use of intravenous fosphenytoin leads to rapid achievement of therapeutic blood levels, with fewer side effects compared with phenytoin. “Fosphenytoin is a valuable treatment option for the rapid treatment of SE [status epilepticus]; the risk of venous adverse events is lower than with phenytoin…” the review concluded.

The article noted that the higher acquisition cost of fosphenytoin compared with phenytoin is an issue. The article observed that, “Nevertheless there is evidence that when fosphenytoin is administered as recommended the incidence of adverse effects is lower than with phenytoin, thereby avoiding costly management and treatment of these events,…”

The review also noted, however, that although there are some patients for which fosphenytoin may be the preferred option, such children, the elderly and others with poor access to veins, “there is very limited evidence to confirm this benefit.”

Teen suffering from grand mal seizures gets medication after leaving New Orleans

Two local families are safe, and out of New Orleans.Terri and Ron Bryant and their children, Courtney, 16, and Spencer, 11, who have been trapped in New Orleans since hurricane Katrina struck the Gulf Coast last week, are in Arlington, Texas, waiting to complete the final leg of their journey home to Klamath Falls.

The family's final night in New Orleans was difficult."They spent the night at the Louis Armstrong Airport and they had no food or water," said Vicki Olin, Terri's sister. "They were just out on the walkway, the street you might say, all night."Saturday morning the family traveled to Lackland Air Force Base in Texas. A friend from Arlington, Texas, bought them clothes, picked them up and took them to his home where they were to spend the night Saturday.

Terri's supervisor, David Chabner, director of information services at Merle West Medical Center, is arranging flight plans to return the family to Klamath Falls, Olin said.Terri Bryant and her family were in New Orleans so Terri could attend a Medical Users Software Exchange conference. She is regional president of the group and is financial coordinator for information systems at Merle West Medical Center.More good news came about another Klamath Falls family.

Wanda Thomas' family, who had been missing in New Orleans for nearly a week, phoned her from the Astrodome in Houston.

"My kids are fine, and they're all in the Astrodome," Thomas said.Thomas's two daughters, Latasha, 26, and Shannel, 29, and their families had been in New Orleans for a few months while they sought neurological treatment for Thomas' 12-year-old granddaughter, Linika, who suffers from grand mal seizures.Since reaching Houston, Linika has been seen by a doctor and was able to get medication to control her seizures. Thomas's month-old granddaughter, who has Down syndrome, was taken to a hospital for observation.

But Thomas is still waiting for more news about other family members. She still has three sisters, nieces and nephews she hasn't heard from yet.

Dog to detect and warn teen of seizures in advance

Lindsay Mead's best friend is a yellow Labrador puppy with expressive brown eyes, an uncanny gift and the power to change the Ahwatukee teen's life. Lindsay, 14, has a rare form of epilepsy that causes frequent seizures. Through most of her life, the threat posed by these sudden and violent falls has severely curtailed her freedom.

In late May, Lindsay and her father, former state Sen. Slade Mead, traveled to the tiny town of Jud, N.D., to meet Gracie, a specially trained Labrador who may be able to sense the change in Lindsay's body chemistry just before she seizes and alert the eighth-grader.Though critics point to a lack of research confirming this capability in dogs, Gracie is among growing number of animals trained to help people with epilepsy control the effects of their condition.Lindsay's family believes the dog could change life for the shy young woman with a smile full of pink braces."If the seizure detection works, that just opens up her whole world," Slade Mead said.

Dangerous dropsSince the age of 3, Lindsay has suffered from Lennox-Gastaut syndrome, a form of epilepsy that causes her to seize roughly every 70 seconds.Some of these seizures are atonic, or "drop" seizures, which can occur anywhere from once every few weeks to several times a day. The seizures bring on an abrupt loss of consciousness and muscle tone, causing her 110-pound frame to crash to the ground with punishing force. The petite teen is on her third set of false front teeth, having knocked out previous incisors during falls. She has broken her arm and her shoulder and has required stitches several times. Unlike many people with epilepsy, Lindsay is unable to sense the onset of her seizures. With the threat of one of these falls always present, activities like playing outside alone, walking on an errand and even household chores are prohibitively dangerous. At home or at Kyrene del Pueblo Middle School, where she attends special-education classes, an adult leads her by the arm everywhere she walks. With Gracie by her side, that may soon change.

PhenomenonThough anecdotal reports have circulated for years from dog owners with epilepsy who noticed reactions in their pets before their seizures, scant scientific research supports the claim that dogs are capable of reliably detecting such attacks."We tell people, go at their own risk," said Laura Linam, program coordinator with the Epilepsy Foundation of Arizona.There are no state or federal standards for the training or certification of seizure dogs.

A notice on the Web site of the Epilepsy Institute, a New York-based non-profit, says that despite "sensational" media reports, no scientific evidence supporting this ability in dogs exists, and the group does not recommend any trainers. "Even if this ability is confirmed, it is not known that this apparent ability can be acquired through training and/or what kind of training is effective," the site states. Gracie was reared at the Great Plains Assistance Dogs Foundation, a privately funded group in North Dakota that trains dogs to aid people with disabilities.

Like other assistance dog trainers, Great Plains set its own training guidelines and certification for dogs and their owners. Clients pay $15,000 for the dog and its training, although the center offers financial aid for those in need.The group has placed 32 dogs with epileptic people since 1992. Lindsay arrived at the center in May to meet 2-year-old Gracie and undergo a three-week training period."Those two clicked basically off the bat," Goehring said.

When Gracie picks up on the smell, largely imperceptible to humans, that Lindsay gives off before she seizes, the dog is to pull the cord on a small alarm that Lindsay wears on a belt. That's the signal for Lindsay to sit or lie down so that she won't hurt herself during a fall, and for adults nearby who hear the alarm to come to her aid. When Lindsay comes to, she snaps a metal clicker and gives Gracie doggie treats from the pink fanny pack she wears all the time - the signal, in dog language, that Gracie did a good job that she should repeat next time.

It may take up to six months to a year before Gracie learns to reliably pull the alarm before every seizure, and it's possible that the dog may never fully adapt to the task.

Growing appealOf the 12 dogs the group usually trains each year, about half are specifically seizure alert dogs, Goehring said, and more people are contacting the center about such animals. Already, the unconditional love and responsibility that Gracie gives has made a noticeable difference in Lindsay, those closest to her say. "Her self-esteem has improved tremendously, and her confidence," said Michele Ferber, Lindsay's teacher at Kyrene del Pueblo. "She's definitely striving to be more independent."

New implanted nerve stimulator seems to help kids with Epilepsy

Stimulation of a cranial nerve through an implant can effectively treat some children with epilepsy, according to the results of a new two-year study.

In a study of more than 75 young patients, doctors found that 59 percent of those implanted with a vagus nerve stimulator did not suffer from localization-related epilepsy, or seizures occurring in one part of the brain.

Hospital visits for epilepsy-related conditions also decreased by 41 percent, the researchers reported Wednesday at the International League Against Epilepsy Congress in Paris.

The nerve stimulator is implanted in the left side of a patient's neck and works by sending signals to the brain to decrease the electrical activity that leads to seizures. It was approved by the U.S. Food and Drug Administration in 1997 for the treatment of epilepsy unresponsive to medication.

The research was conducted at the Comprehensive Epilepsy Clinic at Columbus Children's
Hospital, one of the first institutions to begin using the nerve stimulator in children.

Epilepsy Foundation sends information for special care

Following a series of recent news reports from the afflicted Gulf Coast, the Epilepsy Foundation today recommended the following steps for people with epilepsy requiring daily medication to prevent seizures and who have been dislocated from areas hard-hit by Hurricane Katrina.

Family, friends and relatives are urged to sharethe vital information below: * Access to medication can be a life-and-death issue for people with epilepsy due to the potential for breakthrough seizures when drug levels in the blood fall below therapeutic levels. Breakthrough seizures can take the form of non-stop seizures, called status epilepticus, and can result in neurological damage and disability, and even death.

Many dislocated individuals in the region have neither access to critically needed seizure medications nor information on how to obtain them. * The Red Cross, through its local chapters and emergency shelters, is a primary source of medication assistance. They can help provide access to medications to meet the immediate needs of affected persons.

In some localities, the Red Cross has arrangements with local clinics where people can be referred to doctors who will provide needed prescriptions. If available, individuals should provide the Red Cross disaster health representatives with prescriptions, physician contact information and other medical documentation.

* The Centers for Medicare and Medicaid Services is preparing special instructions for access to emergency medications. We will provide the instructions as soon as they are released. * The pharmaceutical industry, which plans to donate and ship desperately-needed medicines, asked the Federal government earlier this week to do a public health assessment.

* The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible.

* Medco, a major mail order supplier of medications, has made arrangements with local pharmacies nationwide that will make it easier for its members who may be dislocated to obtain medication. Medco members with questions should call the customer service number on the back of their membership identification card. Dislocated individuals with memberships in other mail order services should check with their medications service and area pharmacies to see if there are similar arrangements in place.

* If a dislocated individual has purchased medications through a drugstore chain, the person should go to another location of that chain to find out if the prescription information is available through the drugstore's computer database. If it is, the prescription can be filled at the new location.The Epilepsy Foundation, a national non-profit with affiliated organizations throughout the United States, has led the fight against epilepsy since 1968.

The Foundation's goals are to ensure that people with seizures are able to participate in all life experiences; and to prevent, control and cure epilepsy through research, education, advocacy and services.

Baby victim of shaken baby syndrome suffers from seizures

Doctors say the child allegedly suffering from shaken baby syndrome was admitted to East Tennessee Children's Hospital with non-accidental injuries.

That was the conclusion of Dr. Matt Hill, a critical-care physician at the Knoxville hospital.
Hill testified Wednesday in Blount County Circuit Court during the aggravated child abuse trial of Michael Lewis Mgrdichian, 29.

Mgrdichian is accused of shaking his daughter Hanna, then not quite 3, on March 30, 2003, while the family lived on Glendale Lane in Louisville.

On the second day of testimony two doctors were called to testify.

Mgrdichian lived at the time with his two daughters, Hanna and Olivia, who was almost 5, and his live-in girlfriend/fiancee Stephanie Brindisi and her daughter, Nina, 10.

Stephanie Brindisi testified that, after Mgrdichian picked her up from work in Knoxville then went to work at 3 p.m., Hanna ``kept telling me she was tired and wanted to sleep.'' Brindisi said this was unusual because Hanna ``is never tired. She's always on the go.''

She also said that later, about 7 or 7:30 p.m., Hanna began having seizures. ``Her eyes were rolling in her head. Her feet and hands were drawing in.''

Her father came home and 911 was called. An ambulance transported the baby to the hospital.
`Essentially a stroke'

Dr. Hill testified that after Hanna was admitted at 8 p.m. four medications had to be used before doctors were finally able to get the seizures stopped.

``She had essentially a stroke involving both sides of the brain,'' Hill said.

Dr. Mary Campbell, an emergency room pediatrician, and Hill both testified that Hanna had numerous retinal hemorrhages. ``You have to have a substantial amount of force to cause numerous hemorrhages,'' Campbell said.

``Hanna was the victim of significant closed head injury,'' she said. This is caused by shaking of her head or hitting of her head.

Defense counsel contends that Stephanie Brindisi picked up Hanna by her ankles and dropped the child on her head. Brindisi flatly denied this.

Both doctors said it is very unlikely that this could cause the extensive injuries Hanna sustained.
Hanna and the other two girls in the Mgrdichian home were placed in state custody March 30, 2003, and put in foster homes.

Hanna's foster mother testified Wednesday that when brought home from the hospital the little girl didn't move, had a feeding tube in her stomach, didn't walk or talk.

For six to eight months she never slept through the night without waking up screaming.
The feeding tube was removed in May 2004.

Still has seizures

Now she can walk with the help of Dofo braces on both feet and say simple sentences. She must wear a helmet because she still suffers from a minimum of four and up to 20 seizures a day. The helmet protects her head when she falls down.

She can't use her left arm or lift her left foot.

She can sit and play with a toy or watch a movie, but she has to have assistance with everyday living.

In other testimony, the former manager of the restaurant where Brindisi worked, Sherrie Eastridge, testified that a few days after the incident she was at the Mgrdichian home. He came out of the bedroom sat at the kitchen table and made a ``comment about not meaning to hurt her,'' Eastridge said.

The state rested its case at 3:45 p.m. Wednesday and the defense will continue calling witnesses at 9 a.m. today.

Treatment for Epilepsy seems to be effective

An epilepsy treatment used to help control seizures in adult patients has shown to be effective in treating children.

Nearly 2 million Americans are affected by epilepsy, a brain disorder that occurs when electrical signals in the brain are disrupted. For most patients, medications can help minimize symptoms. However, in approximately 25 percent to 30 percent of patients, medications don't work.

As an alternative to medications, an FDA-approved implanted device called a vagus nerve stimulator is sometimes used to help control or reduce epilepsy seizures in adults. Vagus nerve stimulation works by sending signals to the brain to decrease the electrical activity leading to seizures.

Now, researchers from Columbus Children's Hospital in Ohio have demonstrated vagus nerve stimulation is an effective treatment for children. In a study of more than 75 patients between the ages 1 and 17, seizures discontinued in 59 percent of the patients implanted with vagus nerve stimulation.

Furthermore, hospital visits from epilepsy-related conditions decreased by 41 percent.
As part of the next phase of this study, researchers will further analyze the data to look for patterns in children with different types of epilepsy. They will examine whether the outcomes differ by age and whether vagus nerve stimulation impacts the duration of epilepsy depending on when implantation occurs.

New treatment for kids who do not respond to medication

When kids with epilepsy don't respond to epilepsy medications, does another treatment called vagus nerve stimulation help?

Researchers including Juliann Paolicchi, MD, are studying that question. Their findings were presented in Paris at the 26th International Epilepsy Congress.

Paolicchi directs the Comprehensive Epilepsy Center at Columbus Children's Hospital in Columbus, Ohio. She is also an associate professor at the Ohio State University College of Medicine and Public Health.

About Vagus Nerve Stimulation

In vagus nerve stimulationvagus nerve stimulation doctors implant a stimulator in the chest, which is attached to wires under the skin to the vagus nerve, a large nerve in the patient's neck. The stimulator sends electrical impulses to the brain to help reduce or stop seizures.

Vagus nerve stimulation was approved in 1997 for people aged 12 and older who have intractable partial epilepsy (focal seizures that don't respond to medication).

But it's often offered as an option for younger patients and those with different types of epilepsy that don't respond to medicine, write Paolicchi and colleagues.

The researchers studied data on vagus nerve stimulation in about 75 kids younger than age 18. All of the kids had the procedure done at the Comprehensive Epilepsy Center.

Study's Findings

Epilepsy-related hospital visits fell by 41% in kids who got vagus nerve stimulation.
The kids were about 9.5 years old, on average, when the implantation was done.
More than half (59%) of the children in the database didn't have partial epilepsy (focal seizures activity in one part of the brain).

Only four patients had side effects that required stopping the therapy. Those side effects were gastroesophageal reflux disease (GERD), vomiting, infection at the implantation site, and worsening of seizure. Each of the four affected patients had one of those conditions.

The frequency of all seizure types combined didn't drop notably over time, but the researchers plan to analyze different types of seizures to get more specific results.

"For families of children with intractable epilepsy, less time spent in the hospital has a significant, positive impact socially and financially by reducing the loss of parental working time, the patients' school absences, and family stressors relating to caring for a hospitalized child," write the researchers.