Ativan may be the best drug to treat Epilepsy

The drug Ativan is better than Valium or Dilantin for controlling severe epileptic seizures, according to a new review of studies.Ativan, or lorazepam, and Valium, or diazepam, are both benzodiazepines, the currently preferred class of drugs for treating severe epileptic seizures. Dilantin, or phenytoin, is an anticonvulsant long used for the treatment of epileptic seizures.The review also finds that a 30-mg diazepam gel is better than the 20-mg gel for treating the milder epileptic seizures that lead up to the medical emergency of full-blown, continuing or repetitive seizures.

Researchers Kameshwar Prasad of All India Institute of Medical Science and colleagues analyzed 11 randomized studies involving 2,017 patients. Patients in the studies experienced either or both status epilepticus (SE), a condition in which a person experiences more than 30 minutes of continuous seizure activity or two or more sequential seizures without regaining full consciousness, and premonitory seizures, shorter events that generally occur with increasing frequency and severity before an SE emergency.

The studies involved the use of the anesthetic Versed, or midazolam, and phenobarbitone, a barbiturate, as well as lorazepam, diazepam, and phenytoin.The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

A Cochrane review of anticonvulsant therapy for SE was published in 2002. It focused on children and did not include several studies involving adults. The new review closes this gap, and studies involving both convulsive as well as non-convulsive SE are included.Gregory L. Barkley, the chair of the Professional Advisory Board of the Epilepsy Foundation of American and a neurologist at the Henry Ford Hospital in Detroit, said the review is not surprising in its findings: “Lorazepam and diazepam do offer the best means for stopping SE abruptly, but it should be noted that phenytoin is important as a follow-up drug.”

Barkley said he hopes the review will change treatment behaviors. Diazepam often is the only anticonvulsant available outside hospital settings because such drugs are not frequently used, and many require refrigeration, unlike diazepam. In addition, Barkley noted that midazolam, which was assessed in three of the studies, “is an emerging treatment under active investigation.” However, he said that “not enough data has yet been generated about the drug for an evidence-based recommendation for its use.”

A number of conditions may precipitate SE, including toxic or metabolic causes and anything that might cause cortical structural damage like stroke, hypoxic injury, tumors, hemorrhages, trauma, toxicologic sources (such as cocaine or alcohol withdrawal), electrolyte abnormalities and infections (such as meningitis and encephalitis).Among children who experience SE, 8 percent die. Among adults, the death rate is 30 percent. Another 5 percent to 10 percent are permanently left in a vegetative state or with cognitive difficulties.

Other outcomes include disabilities severe enough to require dependence on others for activities of daily living, ranging from bathing to dressing to eating and walking; the need for ventilatory support; and incomplete recovery.Between 50,000 and 200,000 cases of SE occur each year in the United States.The review identifies several areas requiring attention in future SE research, such as agreed-on definitions for different types of seizures.

It also says “agreement on the definition of outcomes and method of data presentation [are] also desirable.”Finally, the review notes a practical difficulty in conducting randomized controlled trials in SE. Obtaining the consent of participants is impossible when they are unconscious or not in a state where they can provide consent. Gaining such consent from next of kin is an option highlighted in the review.

New therapy may control seizures

UCB today announced positive clinical trial results from a study evaluating Keppra(R) (levetiracetam) as adjunctive treatment in adult and paediatric patients (4-65 years of age) suffering from idiopathic generalised epilepsy (IGE), with primary generalised tonic-clonic (PGTC) seizures.

The results of this phase III, double-blind, multicentre, randomised, placebo-controlled study in 164 patients demonstrated that Keppra(R) significantly reduced the frequency of PGTC seizures when compared with placebo. Seizures were previously uncontrolled despite treatment with one or two concomitant anti-epileptic drugs.

"Tonic-clonic seizures are the most debilitating seizure type within the generalised epilepsies." said Dr. Robert Leroy, Neurological Institute of Texas. "Historically referred to as 'grand mal', these seizures can have a significant negative impact on quality of life. Epidemiological studies[1] indicate that generalised tonic-clonic seizures are common. Their incidence is almost one in four (23%) of all cases of epilepsy."

According to Peter Verdru, MD, Vice-President Clinical Research, Head of Neurology/Psychiatry Clinical Development, UCB, "The positive clinical trial results in generalised tonic-clonic seizures represent a further milestone in the development of Keppra(R). These results add to the clinical trial data with Keppra(R) as an adjunctive therapy in myoclonic seizures, as well as, its established profile as an adjunctive treatment in partial seizures."

Regulatory Filings Submitted to FDA and EMEA for Keppra(R) as AdjunctiveTreatment for Myoclonic Seizures in Juvenile Myoclonic Epilepsy

UCB also announced that it has filed a variation application with the European Medicines Agency (EMEA) and a supplemental new drug application (sNDA) with the U.S. Food and Drug Administration (FDA) for the use of Keppra(R) as adjunctive therapy in the treatment of myoclonic seizures in patients, 12 years of age and older with juvenile myoclonic epilepsy. This application for a new indication is based on a phase III, double-blind, randomized, placebo-controlled study evaluating the efficacy and safety of Keppra(R) as adjunctive therapy in the treatment of myoclonic seizures in patients with idiopathic generalized epilepsy. Positive results of this study were presented at the 26th International Epilepsy Congress in Paris in August 2005.

Notes to Editors

About Myoclonic Seizures and Juvenile Myoclonic Epilepsy Myoclonic seizures are short, jerky muscle spasms that can occur singly or repetitively on one or both side of the body. They occur in a variety of epilepsy syndromes that have different characteristics. Myoclonic seizures are the hallmark symptom of Juvenile Myoclonic Epilepsy (JME). JME is classified as a type of idiopathic generalised epilepsy (IGE). In IGE seizures result from excessive electrical activity in the whole brain. JME requires lifelong treatment with anti-epileptic drugs (AEDs) and accounts for about 10% of all cases of epilepsy.

About Generalised Tonic-Clonic Seizures Generalised tonic-clonic seizures begin with a sudden loss of consciousness and stiffening of the muscles, followed by rapid rhythmic jerking of the arms and legs. Other symptoms such as a change in heart rate and blood pressure, increased production of saliva and an increase in bladder pressure that often causes incontinence can also occur. About Keppra(R) In the U.S. and Europe, Keppra(R) (levetiracetam) is indicated as adjunctive therapy in the treatment of partial onset seizures in adults and children with epilepsy, aged four years and above.

In adults, the use of Keppra(R) is associated with the occurrence of central nervous system adverse events including somnolence and fatigue, coordination difficulties, and behavioral abnormalities, as well as hematological abnormalities. In paediatric patients 4 to 16 years of age, Keppra(R) is associated with somnolence, fatigue and behavioural abnormalities, as well as hematological abnormalities. In adults, the most common adverse events associated with Keppra(R) in combination with other AEDs are somnolence, asthenia, infection, and dizziness. Of these, most appeared to occur predominantly during the first 4 weeks of treatment.

In pediatric patients 4 to 16 years of age, the most common adverse events associated with Keppra(R) in combination with other AEDs are somnolence, accidental injury, hostility, nervousness, and asthenia.

Suddenly victim of seizures, coach welcomes support

Southern Illinois coach Jerry Kill says he doesn't remember the seizure that caused him to collapse and convulse during a game nearly two weeks ago - or the six other seizures he suffered in the days after.

But the 44-year-old coach, back on the sidelines after being released from the hospital last week, said he embraces all the support he's gotten from his players, family and friends since then. And he's confident he now has the right medicine to handle the unspecified condition, which occasionally manifests itself with seizures but is not considered life-threatening.

Kill has declined to detail that health issue, telling Southern's athletic director Paul Kowalczyk simply that "the brain is misfiring once in a while."

"Life's very precious. I enjoy life," Kill told the St. Louis Post-Dispatch this week after a practice session with the Salukis (5-2, 3-1 Gateway) ahead of their game Thursday night at Western Kentucky, ranked No. 1 in Division I-AA. "I figure I'm ornery enough that the good Lord isn't ready for me, anyway.

"It doesn't matter if we win another damned game or not. What matters is I think we've got a unique bunch of kids and coaches who truly care about one another."

After collapsing during the closing seconds of Southern's 61-35 home loss Oct. 15 to Illinois State, Kill said he doesn't remember his wife scurrying to his side and telling him, "I love you." He doesn't recall the opposing coach assembling players from both teams to take a knee and each other's hands to pray as Kill was loaded into an ambulance.

Kill also doesn't remember his half-dozen other seizures in the days afterward, or how he suffered what he believes are two broken ribs in the process. But he remembers much of the support he got, including from a player who came to his office this week to wish him well - the same player Kill kicked off the team last summer for at least a season but who stayed in school at Southern.

"He could say, `The hell with Coach Kill,'" Kill said, adding, "I've suspended the kid for a year, I've taken a year off his career because he screwed up. (And) I had a whole different human being in my office.

"Jiminy Christmas, that meant a lot."

Kill was on the sidelines during the Salukis' 42-20 victory last Saturday at Indiana State but served largely as an adviser, a day after being released from the hospital.

Kill also had a seizure in November 2001 shortly after the Salukis lost to then-Southwest Missouri State, the school said. Kill returned to coach the next week.

Epileptic and special needs patients lose their home

A date has been set for the closing of the Fort Wayne State Developmental Center.
Today's announcement has huge ramifications for patients and the center's employees.
Come July 2007, all the developmentally disabled patients at the center will have to be moved into a different living arrangement.

It's being sold as a cheaper, more effective way to care for those patients, with a significant negative impact on jobs for this area.

The roughly 1,000 employees on the payroll are guaranteed jobs for about five months, and then all positions will be phased out through June of 2007.

The decision was no shock to employee Christopher Brown, who says, "They've been talking about it for probably months to almost years, so, so it's just one of those things that was inevitable."
Employee Greg Lewis says, "They have to do what they have to do, they are trying to save money and they have to do what they have to do."

The center cared for 679 patients in 1987, the number now…208.

Nearly all of the remaining patients, quite a number of whom are profoundly developmentally disabled, will be moved to homes or apartments where they're supposed to get more personalized attention.

The State Developmental Center has a history of patients being abused and neglected…the Secretary of Family and Social Services referring to it as a checkered past.

But Mitch Roob made it clear, that's not why this place is being closed, that it's about cost savings and better client care.

It costs taxpayers 860 dollars per day, per patient to house someone here, and between 150 and 400 dollars a day to serve them in group homes or assisted living settings.

This woman's daughter, who suffers from epileptic seizures, was moved from an institution to assisted living.

Nanette Whightsel, a patient’s parent says, "She's so much calmer, she's quieter, her seizures are under control better. Her whole life is so much better."

And the cost savings is being pledged to reduce a mammoth waiting list for services.
But officials concede at least a dozen of the center's patients can't make it in assisted living.
There's also the question, where will a thousand people go to find new jobs?

Rob Young, with the Economic Development Alliance says, "It's significant, but you're also in a metropolitan statistical area that has a labor force of about 250,000."

Late today, leaders of a union that represents workers at the facility, blasted Governor Mitch Daniels’ administration for this decision, saying that moving patients like these into community settings raises the risk of suicide attempts and incidents of arson.

The head of AFSCME says there's a real danger this could also result in the mistreatment or inadequate treatment of patients with mental illness.

Surgery ended seizures and changed his life

Brain pace maker: Implanted device can help control seizures, mood

Now that he is seizure-free, Ian Sinclair of Quincy can play with with his nieces and nephew without risk.

When his nephews were babies, Ian Sinclair, 30, couldn’t hold them because they’d fall if he had one of his frequent, sudden seizures. So he was delighted to cradle his infant niece recently, nearly two years since a surgical implant ended the seizures that began when he himself was a baby.
‘‘I was not expecting complete relief,’’ said Sinclair of Quincy. ‘‘Even to this day I and members of my family can’t believe it. I have the option now to get my life back on track. It’s a blessing where I can take a few steps toward my goal of independence.’’

The breakthrough epilepsy treatment is called Vagus Nerve Stimulation (VNS) therapy. But it’s popularly called ‘‘a pacemaker for the brain,’’ since a pacemaker-like device is implanted in the patient’s left chest. From there, it sends mild, intermittent doses of electrical stimulation through thread-thin wires to the left vagus nerve in the neck, which connects to the brain. In ways not totally understood by researchers, the electrical discharge effects parts of the brain involved in seizures and mood disorders.

In Ian’s case, the result has been a complete cessation of seizures since December, 2003. More typically, patients still have seizures, only less frequently and less severely, said Sinclair’s neurologist Dr. Georgia Montouris, co-director of Epilepsy Services at Boston Medical Center and assistant professor of neurology at Boston University School of Medicine.

What’s more, they recover from those seizures more quickly, and they need less medication, which reduces the side effects of osteoporosis, lethargy, weight gain and confusion.

‘‘I’m not trying to say that this is the best thing since sliced bread, but for a lot of people, it has made a major difference,’’ Montouris said.

Montouris has had about 130 patients receive the device, which weighs about an ounce and is the size of a pocket watch. More than 75 percent improved significantly, she said.

Since the Federal Drug Administration approved VNS for epilepsy in 1997, 30,000 patients worldwide have received it, according to the manufacturer, Cypertonics. And it’s application is growing, since the FDA just approved it in July for treatment of depression, which affects about 40 percent of patients with epilepsy. VNS clinical trials now are under way to study its usefulness in treating anxiety disorders, Alzheimer’s disease, bulimia and chronic headache/migraine.

In contrast to VNS’s impact on seizures, it appears to be less effective for severe depression, but nonetheless offers possibilities when other treatments have failed.

‘‘I see many (depressed) patients for whom nothing works,’’ said psychiatrist Linda Carpenter, who conducted the clinical trial at Butler Hospital, affiliated with Brown University Medical School in Providence. ‘‘I feel for many patients it offers hope. There’s a good chance they will feel a little better and a smaller chance they’ll feel somewhat better.’’

A year after implant, 30 percent of patients had a 50 percent reduction in symptoms based on the Hamilton Depression Rating Score, compared to 13 percent on medication only, according to Cypertonics.

‘‘Some patients will say, ‘It’s not for me,’’’ Carpenter said. ‘‘Others will say ‘those are sort of low numbers, but I’ll take any alternative.’’’

That was Sinclair’s viewpoint when he decided on VNS.

‘‘I was biting my tongue and my body would contort and several times I cracked my skull when I fell,’’ he said. ‘‘Afterwards, I wouldn’t be able to move for 24 hours. I was having seizures sometime five times a week, and I was willing to try anything.’’

Sinclair still faces challenges, coping with the memory and learning deficits caused by so many seizures that began when he was 18 months old and worsened following a head injury during an attempted robbery outside a Burger King he managed. But he doesn’t expect these to stop him from getting his driver’s license and returning to work.

Head trauma, in fact, is one of the major causes of epilepsy, along with congenital defects and compromised blood flow in the brain. The two peak times for onset are in children under age 10 and adults over age 60.

As common as diabetes, epilepsy is the second leading neurological disorder. About one percent of the population, or 2.4 million Americans, has epilepsy and about 181,000 new cases are diagnosed each year, according to the Epilepsy Foundation of America. Of these, about 30 percent are not helped by anti-epileptic drug therapy and become candidates for VNS.

VNS, though, is not without risks, since it is a surgical procedure, Montouris said. Although it is performed outpatient and takes 45-60 minutes, risks include infection, blood clot and vocal chord damage. The most common side effects are a wispy voice, which Sinclair experiences, as well as tickling in the throat and shortness of breath occurring during the electrical charge. These typically diminish over time.

Once the implant is complete, the doctor programs the timing and duration of the electrical charge, simply by waving over the device a wand that is connected to a palm pilot size computer. Sinclair, for example, receives 30 seconds of stimulation every five minutes, though the dose is different for every patient. It also can easily be adjusted by the physician during a patient’s follow-up visits.

VNS therapy costs about $20,000 to $25,000, reimbursed by most third party payors as well as Medicare and Medicaid in most states. So far, it is more difficult to get insurance coverage for VNS therapy in the treatment of depression, although that could change as more studies are conducted, Carpenter said.

Currently, psychiatrists haven’t widely endorsed VNS therapy because its has not undergone the same type of clinical trials the FDA requires before approving medications, Carpenter said.
‘‘The FDA has a different standard of approval for devices and there is a huge number of psychiatrists who ask whether the level of proof is good enough,’’ she said. ‘‘Some doctors want to wait until there is more data.’’

In the meantime, Sinclair has a new sense of security. Clipped to his belt is a small magnet that he can pass over the implant to produce extra stimulation if he feels a seizure developing. His relatives also have magnets.

‘‘If they feel it coming on, they can abort or shorten the seizure,’’ Montouris. ‘‘It’s very empowering for patients.’’

DEFINITIONS

—EPILEPSY: an illness characterized by recurrent seizures.

—SEIZURE: a disturbance in the electrical activity of the brain. It can symptoms ranging from twitching fingers, unrecognizable speech, convulsions and even unconsciousness.

—VAGUS NERVE: the body's ‘‘information super highway,’’ connecting the brain and many major organs.

US Navy may face legal action for stranding-sonar effects

The US Navy is facing legal action from environmentalists over its use of sonar in routine training, according to reports. The Natural Defense Resources Council (NRDC) argues in a federal lawsuit that the sonar can cause injury and death to many marine mammals, and that the Navy is violating environmental law with its sonar use.
The NRDC says that mid-frequency sonar is behind mass strandings of whales and dolphins, and can cause internal bleeding in these mammals, Reuters reports. It also accuses the Navy of failing to take proper precautions to prevent injuring these animals.
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The Navy, while not commenting specifically on the lawsuit, says its sonar use is critical to national defence, and is a vital part of its training programme. It added that it employs "scientifically-based protective measures" as part of a "comprehensive strategy for assessing the potential effects of its use of mid-range active sonar on marine mammals".

But the coalition of environmental groups would like the Navy to be more judicious in its use of the technology. In the suit, it asks the court to force the Navy to avoid migration routes, and to gradually increase the volume of radar, which it says would give animals in the area time to swim away.

"Military sonar needlessly threatens whole populations of whales and other marine animals," NRDC lawyer Joel Reynolds told Reuters. "In violation of our environmental laws, the Navy refuses to take basic precautions that could spare these majestic creatures. Now we're asking the courts to enforce those laws."

Special diet and medication to control seizures?

Recently a parent brought their child to a neurologist because of concerns of a possible seizure disorder. After an overnight EEG, which is a test in which electrodes are placed on the head to measure electrical activity produced by the brain, the neurologist determined there were some irregularities and that seizures were possible in the future.

The parent asked a few questions including whether there was anything they could do with diet to prevent that possibility. The neurologist replied that aside from the Ketogenic diet, which would only be considered in extreme cases, that there wasn’t anything that could be done. I decided to see what information I could find on seizures and epilepsy.

According to the website epilepsy.com: “There is a fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighboring cells at once. This linkage of electrical discharges creates a "storm" of electrical activity in the brain.

This is a seizure. When a person has had at least two of these seizures, that's called epilepsy.” They also note that essentially many times the cause was unknown: “The reasons why epilepsy begins are different for people of different ages. But what's true for every age is that the cause is unknown for about half of everyone with epilepsy. Children may be born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes their epilepsy.

Severe head injury is the most common known cause in young adults. In middle age, strokes, tumors, and injuries are more frequent. In people over 65, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer's disease.” According to the website that apart from the Ketogenic diet there wasn’t much that anyone could do to prevent seizures.

I decided to take a trip to a local medical library to start my own research to see what I could come up with. I spent quite a few hours the first night searching and sifting through studies from a large number of medical journals. I did that over a number of weeks and accumulated a large number of studies that provided some amazing information. Omega-3 Fatty Acids One of the first studies I discovered was from the journal Epilepsia (1).

The authors described that omega-3 fatty acids (or n-3 PUFAs) are essential for normal brain development and that a deficiency in these fatty acids can “contribute to the emergence of neurologic dysfunctions”. With respect to epilepsy, “recent studies in animal models have shown that n-3 PUFAs can raise the threshold of epileptic seizures.” Based on this knowledge the study authors provided a spread of 65% n-3 PUFAs (46% DHA, 18% EPA, 1% alpha-linolenic acid) plus 100 IU of vitamin E to 5 patients with severe seizure disorders.

The spread (about 5 grams) was eaten at breakfast by 5 patients each day for 6 months. Although this was a small study, the results were nothing short of dramatic. The frequency of grand mal seizures (grand mal seizures are characterized by sudden loss of consciousness followed by violent full-body convulsions lasting several minutes) before the omega-3 diet and after were as follows: Patient 1 – Grand mal seizures before were 2-3 per week and after zero.Patient 2 – Grand mal seizures before were 6-8 per week and after zero.Patient 3 – Grand mal seizures before were 1-2 per week and after 1 per month.Patient 4 – Grand mal seizures before were 1-2 per week and after zero.

Patient 5 – Grand mal seizures before were 14 per week and after 3 per week. The authors conclude in their study that, “All five [epileptic] patients exhibited substantial improvement and alleviation in frequency and strength of both GM [Grand mal] and PM [Petit mal] seizures. No adverse affects were noticed in any of them. Our study shows that n-3 PUFAs [omega-3 polyunsaturated fatty acids] can alleviate symptoms of human epilepsy.”

In another journal, Seizure (2), two authors discussed epilepsy and sudden unexpected death in epilepsy or SUDEP that claims the lives of approximately 500 people each year in the UK. Although epidemiological studies indicate that 70% to 80% of people who develop epilepsy eventually go into remission there are those that continue to have seizures. The authors note the importance of omega-3 fatty acids in brain health.

Key omega-3 fatty acids that are found in large amounts in fish are eicosapentaeonic acid (EPA) and docosahexaenoic acid (DHA). “Nutrition is likely to be one of these factors [contributing to seizures] and, in particular, deficiency in omega-3 fatty acids might be an important factor. Nutritional studies suggest that the Western diet is deficient in omega-3 fatty acids, which is an essential nutrient.

Hence people with epilepsy in the UK, like those in the general population are likely to be deficient in omega-3 fatty acids. Omega-3 fatty acids have important roles in determining the structural and functional properties of neuronal membranes, affecting membrane functions such as electrical signaling, receptor sensitivity, and neurotransmitter release.” Vitamin E Vitamin E (or α–tocopherol / alpha-tocopherol) prevents the damaging effects of oxidation in brain tissues. Free radical scavengers, such as vitamin E, have been implicated in prolonged seizure activity.

Vitamin E is a natural nutrient that works to stabilize the membranes of cells and has no known toxic effects. Early animal studies, published in the Annals of Internal Medicine (3), found that rats and mice that were exposed to 100% oxygen had seizures. However, the authors found that they could prevent the seizures if they administered vitamin E before the experiment. “Seizures occurred in 100% of the vitamin E deficient rats and in 50% of those fed a normal diet, but none developed in rats fed a diet containing an α–tocopherol supplement.”

In the journal Epilepsia (4), the authors of a study examined the effect of vitamin E supplementation on 24 patients. The study was a double-blind and placebo-controlled using 400 IUs of vitamin E for 3 months. At the end of the three months the authors found a dramatic decrease in seizure activity in the patients taking the vitamin E supplement. “Of the 12 subject receiving active drug [vitamin E], 10 were considered responders (> 60% reduction in seizure frequency), 6 had 90-100% reduction of seizure frequency, and 4 had 60-90% reduction. Two were considered failures (<>

Not only was there a dramatic decrease in seizure activity, there was even improvement in some of the patients’ EEG measurements. “The EEG findings, however, appeared to have improved in > 50% (four of seven patients) of the responders who had EEG performed before and after trial of add-on vitamin E.” After the 3 months, the 12 patients receiving the placebo were placed on the vitamin E supplementation. Those 12 patients also showed dramatic improvements by a “reduction in seizure frequency between 70 and 100% in all patients.” Also, those patients that continued the vitamin E protocol after the first 3 months continued to show improvement. “[The] response of six subjects continuing vitamin E after beneficial effects in the first phase [of the study] showed continued improvement.”

This study followed an older study published in Canadian Journal of Neurological Sciences (5), where the author examined 100 children that had grand mal seizures versus 100 healthy children. The author found that those with the seizures had a much lower blood level of vitamin E (632 μg/dl [micrograms per deciliter) than those that did not have seizures (822 μg/dl). Here the author concluded that, “supplements of α–tocopherol might improve seizure control in such patients.” Vitamin B1 Thiamine, also known as vitamin B1, is essential for the functioning of the heart, muscles, and nervous system.

A deficiency of thiamine can cause weakness, fatigue, psychosis, and nerve damage. There is no known toxicity associated with thiamine and studies have documented a relationship between thiamine deficiency and epilepsy. At the neurotransmitter level, thiamine deficiency may be accompanied in a lowering in the concentrations of γ–aminobutyric acid (gamma aminobutyric acid) or GABA. GABA is a neurotransmitter that is inhibitory, that is, it helps quiet the brain. Low levels of GABA are also associated with epilepsy or seizure disorders. Studies of elderly populations show that 10% are deficient in thiamine, and an even larger amount of 23% of nursing home residents were also deficient.

This indicates the relatively high rate of thiamine deficiency occurring especially in the elderly. Thiamine deficiency appears to exist in 25-30% of epileptic patients. A study in the journal of European Neurology (6), examined 50 patients who were diagnosed with a vitamin B1 deficiency. Out of the 50 patients 16 of them had shown epileptic manifestations, where 11 of them had severe vitamin B1 deficiency. They patients were provided with thiamine supplements. In 10 of the patients epileptic seizures were completely “abolished”. The authors conclude that, “patients with late-onset epilepsy thiamine deficiency may be considered as one of several possible causes and that a search for thiamine deficiency should not be neglected as it many give a clue towards simple and effective treatment.”

Another study in Epilepsy Research (7) involved 72 adult epileptic patients receiving a supplement of 50 mg of thiamine and 5 mg of folic acid. The 6 month, double-blind, placebo-controlled study measured the improvement in verbal and non-verbal IQ. At the end of the study the authors found there was an improvement in verbal and non-verbal IQ scores as well as in other neuropsychological functions. The authors conclude that, “the search for thiamine deficiency should not be neglected in chronic epileptics; empirically – if thiamine assessment is not available – we suggest 50 mg of thiamine supplementation daily for 1-3 months in chronic epileptics to prevent organic cerebral damage.”

Vitamin B6 Vitamin B6, also know as pyridoxine, is needed for protein metabolism, red blood cell metabolism, and proper functioning of the nervous and immune systems. Vitamin B6 is also involved in forming GABA, which mentioned before is a major inhibitory neurotransmitter in the brain. Impaired creation of GABA can lead to seizures. Vitamin B6 deficiency has been known to produce neuritis (nerve inflammation), dermatitis, anemia, and convulsions in infants. A report in the journal Epilepsy Research (8), discusses the case of an 8-day-old boy that had developed seizures.

A variety of antiepileptic medications that were tried, such as diazepam and phenobarbital, did not block the seizures. An injection of 80 mg of vitamin B6 did “abolish the seizure immediately.” In subsequent weeks the child got 40 mg of vitamin B6 daily and “several EEGs were normal and no further convulsions were observed.” Analysis showed that the boy’s GABA levels were only at 13 pmol/ml (picomoles per milliliter) before the vitamin B6 and after had increased to 124 pmol/ml after vitamin B6 treatment.

Children without any neurologic disease have a GABA level at 174 pmol/ml. In the journal Pediatrics (9) several cases of children with seizures are discussed. The first case was of a 4 year old girl that had seizures since she was 2 months old. Despite antiseizure medications she still had daily seizures. She received 50 mg of vitamin B6 twice a day and within 24 hours she was seizure free. After a month her legal guardians stopped the vitamin treatment on their own and her seizures started again within 2 days.

After restarting the vitamin B6 she again became seizure free. The second case was of a boy who had been normal until 19 months old when he started having seizures. Despite antiseizure treatment he had between 2 to 6 seizures per day. He was given 100 mg of vitamin B6 intravenously followed by 100 mg of vitamin B6 orally by mouth and the seizures suddenly stopped. “The pyridoxine was stopped; 1 week later seizures recurred. The EEG showed runs of central spikes and sharp slow waves.

Pyridoxine was restarted. A subsequent EEG was normal.” Despite the boy being seizure free for 3 months the parents stopped the treatment believing it was “dangerous”. Within 3 days he started to have 5 to 10 seizures per day. Vitamin B6 was restarted and again the seizures completely stopped. A third case of a 4-month-old boy showed similar results. Despite large amounts of antiseizure medications his seizures continued. He was given 100 mg of vitamin B6 and “seizures stopped in less than 5 minutes”.

Two years later he has not had any further seizures and is receiving 50 mg of vitamin B6 twice daily. The authors conclude that, “the recommendations for pyridoxine treatment should be extended to include all children with seizure disorders with onset at any age who are poorly responsive to medical therapy. The upper limit to the age of onset of pyridoxine-dependent seizures is unknown; no one has studied this question.”

Selenium Selenium is a structural component of and a co-factor for the antioxidant glutathione peroxidase. Glutathione peroxidase is part of the defense mechanism of the body against oxidation. If there were selenium depletion this would lower glutathione levels, which would cause a higher susceptibility of the delicate fats that are part of cell membranes causing membrane and brain cell damage. The failure of protection against oxidative stress due to selenium depletion increases the oxidative stress on important firing neurons in the brain.

A study in the journal Neuropediatrics (10) discusses the cases of 2 children with severe seizures. The first patient has suffered from seizures from 4 days old until the visit to the study authors’ hospital at 5 1/2 months. The second patient had seizures from 11 months until the visit to the hospital at 3 years and 9 months old. The first patient showed an abnormal EEG pattern with “large slow activities mixed with smaller amplitude polyspikes and marked asymmetry.”

The child was started on oral selenium supplements and within two weeks, “the daily number of seizures was reduced by 75% while the duration of seizures regressed dramatically from more than 30 minutes duration to less than 5 minutes. The focal sharp waves and spike-wave activity on the EEG recordings disappeared.” The authors note that the patient’s condition may have been aggravated by the low selenium content of the infant formula he was using.

The second patient had recurrent petite mal seizures that “recurred and became uncontrollable despite benzodiazepine drips or high doses of dexamethasone.” He was started on an oral supplementation of selenium rich lactobacillus (a probiotic bacteria) referred to as “Se-Lb”. After two weeks on this supplement his glutathione levels became nearly normal and “petit mal status and mycolonic seizures together with generalized spike-wave activity in the EEG stopped completely.”

After selenium treatment was stopped his glutathione levels dropped and seizures started again. Selenium treatment was restarted which resulted in “marked clinical improvement with virtually complete cessation of myoclonic seizures and petit mal.” The authors conclude that, “we think that children with epilepsy who develop intractable seizures should be screened for the possibility of selenium deficiency as a trigger of neuronal membrane damage and instability.

Inborn errors of selenium uptake or metabolism could be involved in the pathogenesis of intractable epilepsy, Alpers disease (a progressive degenerative disease of the central nervous system that occurs in infants and children) or progressive neuronal degeneration of childhood.” Carnosine Carnosine (β-alanyl-L-histidine) is a dipeptide, which is a combination of two amino acids of alanine and histidine.

Carnosine is an antioxidant that stabilizes cellular membranes protecting them from damage by free radicals and is found in large amounts in the muscle and brain of mammals. Carnosine also appears to help to modulate zinc and copper into neuronal cells near GABA receptor sites potentially helping with the epileptic inhibition effect of GABA. Carnosine appears to be non-toxic and studies involving carnosine have shown no side effects.

A study in the journal Neuroscience (11) examined the effects of carnosine on seizures in rats. In that study the authors found that carnosine decreased seizure duration as well as the amount of time between seizures. “Carnosine could easily penetrate across the BBB [Blood Brain Barrier] and has few side effects. Therefore, it is likely that carnosine might be a new potential anticonvulsant drug for clinical therapy of human complex partial epilepsy in the future.” Past research has shown that there is an association between EEGs and autism.

One in three children with autism suffer one or more seizures by adolescence. A double-blind, placebo-controlled study in the Journal of Child Neurology (12) examines the effect of L-carnonsine supplements in children with autism. They studied 31 children with autistic spectrum disorders over 8 weeks using 800 mg daily of L-carnosine.

The authors of the study found that, “the results of this study suggest that supplementation with carnosine can significantly improve receptive speech, socialization, and behavior in children with autistic spectrum disorders.” In addition, “if, indeed, carnosine acts to affect GABA bioavailabilty, it may likely alter the seizure threshold or GABA function.” Diet During a previous study that analyzed the effect of an oligoantigenic diet to treat migraine and hyperactive behavior in children the authors noted those children with epilepsy often had their seizures stop during the study.

An oligoantigenic is a “few foods” diet in an attempt to eliminate foods that might be causing a reaction in a person. A study based on this observation in Journal of Pediatrics (13) examined the role of diet in 63 children with epilepsy. All the patients were put on a restricted diet for 4 weeks. Normal daily helpings of excluded foods were reintroduced one at a time at the rate of one per week. If symptoms reoccurred that had disappeared in the initial stages of the diet, then it was eliminated, otherwise it was incorporated back into the diet.

Although none of the 18 patients with epilepsy alone improved, 40 of the 45 patients with migraine and epilepsy did improve in one or more symptoms. All patients, except for one, reacted to at least two foods. “During follow-up of 7 months to 3 years on diet, 25 of these patients achieved complete control of seizures, four other had seizures only with upper respiratory tract infections, and seven had seizures less than half as frequently as formerly; in all these patients other symptoms also improved.

In four other patients, other symptoms improved but seizures did not.” Also, “19 of the 25 patients whose seizures stopped have phased out anticonvulsant therapy, and five are still doing so.” A large number of foods caused reactions in the different patients. The foods that caused the most seizures and symptoms were: cow milk (seizures: 37%, other symptoms: 63%), cow cheese (seizures: 36%, other symptoms: 55%), citrus fruits (seizures: 29%, other symptoms: 50%), wheat (seizures: 29%, other symptoms: 49%), and food additives (seizures: 25%, other symptoms: 58%).

In 16 of the patients EEG was repeated at least 1 month after the study started. “There was no change in five of six patients who previously had had multifocal discharges, whereas normalization of the EEG occurred in one. The EEG improved markedly in there of six patients whose previous EEGs had displayed unilateral epileptic activity.

The EEG of one of the two with moderate abnormalities became normal.” NutraSweet or Aspartame The artificial sweetener aspartame or NutraSweet was introduced to the market in July 1983 and has become pervasive in the food supply. Although some studies have shown it to be safe, large numbers of adverse reactions are still reported.

According to a report in 1984, two-thirds of reactions involve neurologic or behavioral symptoms, particularly headaches. A study in the journal Biological Psychiatry (14) examined the effect of aspartame on 40 patients with unipolar depression along with 40 patients without a psychiatric history. The study was double-blinded and placebo controlled. Patients either received a placebo or aspartame capsules roughly equivalent to 10-12 cans of diet soda.

The study was halted early by the Institutional Review Board [IRB] because of the severity of reactions within the group of patients with a history of depression. During the study 3 of the patients reported they felt that had been “poisoned”. One of the three to use the term “poisoned” experienced “a conjunctival hemorrhage for the first time in her life during the aspartame week. These events led the Chairman of the IRB to halt the project.”

Some of the more severe symptoms noted are as follows: headache (placebo: 63%, aspartame: 88%), nervousness (placebo: 25%, aspartame: 63%), trouble remembering (placebo: 0%, aspartame: 63%), nausea (placebo: 25%, aspartame: 100%), depression (placebo: 38%, aspartame: 75%), insomnia (placebo: 38%, aspartame: 50%), and temper (placebo: 0%, aspartame: 25%).

The authors concluded that, “a significant pattern of reactions to aspartame emerged in patients with a history of major depression. It would appear that individuals with mood disorders are particularly sensitive to this artificial sweetener; its use in this population should be discouraged.” A study in Environmental Health Perspectives (15) also examined the effects of aspartame on the brain.

The authors note that “doses of aspartame which are within the range actually consumed by some people can affect the chemical composition of the brain, and may thereby contribute to particular CNS [Central Nervous System] side effects, including headaches, inappropriate behavior responses, and seizures.” The authors performed a study on rats to determine the effects that aspartame might have on the human brain.

They pretreated the animals with various doses of aspartame 1 hour before exposing them to a seizure inducing treatment. At 1000 mg/kg [milligrams per kilogram] 78% of the animals had seizures, at 2000 mg/kg 100% of the animals had seizures. Only 50% of the animals that were pretreated with water had seizures.

The authors note that, “it is possible that doses of the sweetener [aspartame] that cause a sufficient increase in brain phenylalanine might increase seizure frequency among susceptible humans, or might allow seizures to occur in people who are vulnerable but without prior episodes.” Pesticides Pesticides include various agents devised to control a wide number of pests. A 1997 report by the Environmental Protection Agency (EPA) estimates annual usage of 975 million pounds of pesticide active ingredients.

Because the calorie and fluid intake of children are much higher relative to body weight than adults, small amounts of pesticides considered safe for adults could result in unsafe exposures in children. A study in Pediatric Clinics of North America (16) discusses the effects of various pesticides on children. Cholinesterase-inhibiting insecticides are the most commonly used pesticides. “Central nervous system toxic signs and symptoms include headache; nausea and vomiting; dizziness; respiratory depression; mental status changes, including coma; and seizures.”

Several studies have provided evidence that children display different symptoms than adults. “In these studies, children were more likely to present with mental status changes, including coma. They were also more likely to present initially with seizures.” Organophosphates produce toxicity by inhibition of the cholinesterase enzyme. The result is an accumulation of the neurotransmitter acetylcholine. This causes a prolonged firing of neurons in the brain.

There is a wide range of toxicity for organophosphates and many of the more toxic ones are absorbed right through the skin. “Organophosphates have been thought for many years to be associated with subtle, long-term neurologic effects years after acute and sub acute exposure. Individual case reports first documented patients with reported headaches, blurred vision, memory, depression, irritability, and problems with concentration.”

A case history of a child in the journal Pediatric Emergency Care (17) discusses organophosphates. “Organophosphate poisoning continues to be a relatively common occurrence, especially in rural areas of the United States. Insecticides fall into four classes: organophosphates, carbamates, organochlorines, and pyrethroids. All compounds can precipitate seizures except for carbamates, which have poor central nervous system (CNS) penetration.” Organically grown foods reduce the amount of pesticides on food and in the environment.

A recent study, reported in Medical News Today (18), by researches at Emory University examined the effects of an organic diet on children. “Immediately after substituting organic food items for the children’s normal diets, the concentration of organophosphorous pesticides found in their bodies decreased substantially to non-detectable levels until the conventional diets were re-introduced.” Wrap Up Omega-3 fatty acids are extremely important in a properly working brain.

These omega-3 fatty acids through EPA and DHA supplementation appear to have anti-epileptic effects in animal studies and in a dramatic but small clinical trial. Vitamin E protects the membranes of brain cells dramatically reversing seizures. The B vitamins (B1 and B6) are important in the formation of GABA, a brain “quieting” neurotransmitter, also with dramatic results. Selenium is important in the formation of glutathione, which also helps protect the brain from oxidation.

Carnosine also plays a role in the GABA story. A diet free of certain items (often dairy, wheat, food additives, and citrus) is important in controlling seizures. Aspartame causes neurologic problems in certain individuals and may be a contributing factor in seizures. Pesticides, which are pervasive in our environment and in our bodies, are also a piece of the puzzle. Other factors, such as lead, mercury from the environment and vaccines, quercetin (a bioflavinoid), vitamin C, and more also play a role in the health of the human brain and can also have an effect on seizures.

These studies mentioned here and many more are all important pieces of the puzzle. Each study was designed and executed by a large number of dedicated and thoughtful scientists. But what is often lacking is a synthesis of these pieces of information. Combining all the mentioned approaches into a comprehensive protocol: omega-3, vitamin E, vitamin B1, vitamin B6, selenium, carnosine, proper diet, avoidance of aspartame, pesticides, and more could only produce spectacular results.

Febrile seizures...a nightmare for parents!

MEDIA speculation about Romeo Beckham, who is reported to have recently had two febrile convulsions, has been fuelled by father David's comments that news of Romeo's condition was "not that positive".

Although extremely unnerving to parents, febrile convulsions - an epileptic-type seizure that can sometimes accompany high temperatures in children under five - rarely indicate a serious underlying problem or have any impact on long-term health.

Around one in 30 children will have at least one febrile convulsion before they reach their fifth birthday, and 10 per cent of them will, like Romeo, have three or more (he had a previous one last year). But even in children who have more than one, long-term complications are unusual - the lifetime risk of developing epilepsy for a child who has had recurrent febrile convulsions is roughly double that of a child who has never had one, but is still less than one in 100.

The link between fever and seizures isn't that well understood, but is thought to be related to a build-up of inflammatory chemicals produced in response to infection.

Febrile convulsions are normally associated with relatively minor infections - coughs, colds, tonsillitis and earache - but can occasionally be a sign of more sinister types, including meningitis.
Because of this small risk of serious underlying infection, every child who has had a febrile convulsion should be medically assessed, but, whatever the cause, prevention remains the key. This is what you should do:

• Resist the temptation to wrap a feverish, shivering child, and strip them down to their nappy or underwear instead.

• Paracetamol and ibuprofen should lower their temperature, but if, despite the combination of stripping and drugs, it remains above 39, then gently sponge them in a shallow bath of tepid water.
• If the worst does happen and your child has a convulsion, don't panic. Do not attempt to restrain them or put anything in their mouth. Lay them in the recovery position (on the left side) if possible and call for medical advice.

• If the convulsion lasts longer than five minutes (which is very unusual) dial 999. Witnessing a febrile convulsion may take years off your life, but it's most unlikely to have any significant effect on your child.

Ease the pressure

A RECENT edition of the medical newspaper Pulse provides a useful reminder that drugs aren't the only way to reduce high blood pressure - lifestyle changes can be just as effective.
A review into the latest management of the condition, now thought to affect as many as one in five adults, concludes that restricting salt intake to the maximum daily recommended amount (six grams or two-thirds of a teaspoon a day) is roughly as effective as prescribing a drug.

And that cutting back on alcohol and starting an exercise programme can double that benefit (giving a combined reduction of between 10 and 20mmHg - normal being anything less than 140/90).

Interestingly, stopping smoking seems to have little effect on blood pressure (although it has major benefits elsewhere), but losing weight does help - expect a 1mmHg fall in blood pressure for every kilo (2lb approx) lost.

Driving versus seizures

While shopping with her daughter last summer at a drugstore in Chicago, Stefanie London abruptly experienced blurred vision."The next thing I knew, I woke up at the emergency room," said London, a lawyer from Clayton who had suffered a seizure similar to the spells that afflict people with epilepsy.

Doctors quickly discovered a benign tumor in the lining of her brain.Because she had been rendered completely unconscious, it was half a year before London could legally get behind the wheel of her car, even though she had surgery to remove the tumor within a month of her seizure and never had another problem.

Strict prohibitions, such as a mandatory six-month freeze on driving that Missouri puts on people who've lost consciousness, have helped make traffic deaths because of epilepsy extremely rare.

In Illinois, the restrictions are not so clear cut, although drivers who lose consciousness behind the wheel immediately lose their licenses.But even these tight restrictions can't prevent fatalities.On Monday, Lisa Domer of Mascoutah and her 2-year-old son, Dagan, were killed when her car rolled into a pond in O'Fallon, Ill.

Authorities believe that Domer, who had epilepsy, suffered a seizure and was unaware that her car was idling toward the pond.Domer had told relatives and co-workers that with medication she had been seizure-free for two or three years. But she complained to friends that a new medication unrelated to epilepsy had made her feel "dizzy."

Epilepsy can cause a total blackout and convulsions, although more commonly, people may remain standing still during a seizure."They lose consciousness, they lose contact with the world," said Dr. James Willmore, professor of neurology at St. Louis University School of Medicine. "It may last between one and five minutes."According to a study provided by the Epilepsy Foundation, epileptic seizures cause about 90 traffic deaths each year in the United States.

That's less than one percent of the approximately 42,000 traffic deaths each year. In comparison, alcohol leads to about 13,000 of those deaths.Still, states feel it's important to ensure that drivers who may lose consciousness aren't behind the wheel when it happens.States' restrictions"Anyone with a medical condition that would impair their ability to drive has 10 days to notify us," said Beth Kaufman, a spokeswoman for the Illinois secretary of state.

Doctors are also supposed to notify authorities but aren't bound by the same 10-day timeline, she said.A medical board then reviews the driver's case, unless a doctor says the medical condition has been under control for at least six months. If someone passes out behind the wheel, his or her license is revoked until the board decides to reissue it, Kaufman said.

The board evaluates about 43,000 cases each year and may restrict licenses or decide to reinstate them.Kaufman confirmed that Domer had a valid Illinois drivers license.In Missouri, drivers aren't required to report at all. Doctors inform people who have lost consciousness because of a seizure that they can't drive until they've been seizure-free for six months.

Some states go further, requiring doctors to report their patients' seizures to appropriate authorities, said Willmore.At any given time, about 2 percent of the population - or about 6 million people - has epilepsy, he said. Epileptic seizures are caused by a rhythmic pulsing of electrical activity in the brain that shuts down consciousness.

The pulsing occurs from an imbalance in the brain between substances that stimulate and those that inhibit brain activity.Willmore compared the imbalance to a gymnast walking on a balance beam - too much energy can throw a person off, as can too little.Epilepsy may be inherent or the result of brain trauma, Willmore said. More than half of people with the disorder can control it using drugs, and many others get relief through surgery, he said.Help from friendsAlthough Domer made statements about her new medication less than a week before her death, medical authorities won't speculate on her case, including what might have triggered the seizure.

But authorities say that drug interactions are concerns for epileptics and for others."Something taken alongside epilepsy drugs could affect the drug's ability to control seizures," said Kimberli Meadows, spokeswoman for the Epilepsy Foundation, based in Landover, Md.The loss of driving privileges for those who've had a seizure can be eased by aid from friends and family, said London, the lawyer from Clayton.

While she was barred from driving, her husband took her to work and added additional driving duties to accommodate their three children, and she got rides from friends whenever possible, she said. London, 51, a long-distance runner and cyclist, often walked the three miles from her office to her home at night.

Once she started driving again, she stayed off the highways for an additional six months in fear of a recurrence, she said."People need to be aware that they need family support in a case like this," she said. "They can't be afraid to share it if they're having a problem."

Epilepsy guidelines urge doctors to treat patients faster

Guidelines still under development for the treatment of status epilepticus will suggest more rapid drug treatment of seizures in a pediatric setting, according to a presentation at the American Academy of Pediatrics (AAP) National Conference and Exhibition.James Riviello Jr., MD, Professor of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States, presented highlights of the guidelines here on October 10th.

The Epilepsy Foundation of American is updating its 1993 guidelines for the treatment of status epilepticus and the American Academy of Neurology and Child Neurology Society are working on guidelines for diagnostic assessment of children with the condition.Taken together, Dr. Riviello said the two sets of recommendations should shift clinical practice. "We're recommending treatment sooner," he said, "and we'll say that there's little evidence that any one [diagnostic] test needs to be done."

According to the 1993 guidelines, treatment with diazepam or lorazepam should be initiated if the seizures continue for 10 minutes; the new recommendations will push the threshold for drug treatment to 5 minutes, he said.The shortened interval between onset of seizure and medical treatment continues a decades-long trend of shortening the length of time needed to define and treat status epilepticus -- prolonged or repeated seizures that signify an enduring epileptic condition.In 1970, 1 hour of seizure was considered necessary to show evidence of status epilepticus.

By 1989, that duration was down to 30 minutes, dropping again in the 1990s to 10 minutes.Now, doctors are urged to move to phenytoin doctors after diazepam or lorazepam, then to Phenobarbital, Dr. Riviello said. He did not say, however, whether recommendations for treatment with those agents would be modified when the guidelines are published.

The diagnostic recommendations are likely to underscore the difficulty of relying on any one measure to assess seizures. Few tests are highly sensitive in detecting problems, and Dr. Riviello underscored the fact that no single test appeared to be definitive. Even magnetic resonance imaging, the most powerful and most expensive tool, only returns abnormal findings in 78% of cases, he said.

Depression and Epilepsy may share a link

The same brain dysfunction that underlies epilepsy may also influence suicide risk, researchers report.

The study findings also suggest that suicide and depression may have different brain mechanisms.
"For reasons that are not understood, depression both increases the risk for developing epilepsy and is also common among people with epilepsy who experience many seizures," lead researcher Dale C. Hesdorffer of Columbia University, New York City, said in a prepared statement.

"One question we had was whether some symptoms of depression were more important than others for increasing the risk for developing epilepsy. Suicidal thoughts and suicide attempt were possibilities, because people with epilepsy seem to be more likely to commit suicide than the general population. But we looked at all symptoms of depression," Hesdorffer said.

Published online October 10 in the journal Annals of Neurology, the study included 324 people with epilepsy and 647 people without the disorder. The researchers found that a history of depression was associated with an increase in the risk of epilepsy.

They were also surprised to find that people with epilepsy were four times more likely to have attempted suicide before ever having an epileptic seizure. This was true even after the researchers accounted for other factors such as alcohol consumption, age, gender and depression.

The researchers also found that the presence of specific depression symptoms didn't predict a greater likelihood of later epileptic seizures.

The findings suggest that there's a common underlying brain mechanism for epilepsy and suicidal behavior and that depression and suicidal behavior may be related to different brain mechanisms, the study authors wrote.

"Increasingly, clinicians treating people with epilepsy ask about current depression, but they may not ask about past suicide attempt or suicidal thoughts," Hesdorffer said. "Our results may alert clinicians to the need to ask this question and offer any needed counseling to prevent the occurrence of later completed suicide."

Service dogs to be trained by inmates

Service dogs to be trained by inmates, for the visually impaired, the hearing impaired or to detect seizures.

Inmate to train service dogs that detect seizures

Some prison inmates will soon become dog trainers.

The Department of Corrections says 20 male inmates will be chosen to train dogs for people with sight and hearing problems. They also will train dogs to help people with balance problems and those who suffer from seizures.

The dogs will stay with their trainers and sleep in their cells, department spokesman Jeff Lyons said.

A community group, Pathways to Hope, will provide the dogs, instructors, and other services and supplies.

Similar training programs already operate in other states, including Massachusetts and Maine.

Dog suffering from seizures...another sad condition

I read with sadness the letter from Mary Dionne (Sept. 25), who shared her experience on the loss of her dog, Millie.

As many know by reading these letters, I have shared my experiences with local veterinarians, especially regarding my chocolate lab, Moose. Most do not know, however, what caused me to be so cynical.

On Christmas Eve 2000, Moose was having cluster seizures. I called my vet, whose service advised me to call the vet "on call." I was stunned when told "they didn't know the case" and, "We know it's scary, but dogs don't die from seizures." I hung up in disbelief. We raced to Portland at midnight in a snowstorm, Moose seizing in my arms the entire time.

After a five-day stay, it was determined that he was undermedicated for his condition. My husband eventually uncovered that a technician made an error when filling his last script. The same clinic that had made the decision that triggered his epilepsy had given the wrong medication and was unavailable when its mistake was wreaking havoc on our family.

Our tragic experiences finally led us down the right path -- to Dr. Matthew C. Townsend, his colleagues and staff at Kennebec Veterinary Services Inc. in Waterville. Moose passed on April 21. The people at Kennebec Veterinary are still helping us through the grief as well as caring for our other two boys.

If you're a patient at their clinic, they are there for you when you need them most.

Call for action made by Epilepsy Foundation

Today, the Epilepsy Foundation issued a Call to Action to women of childbearing age who take anticonvulsant medications for conditions that include epilepsy, migraine headaches, and certain psychiatric disorders, urging them to talk to their healthcare providers about treatment options. The Call to Action was created in cooperation with medical experts and representatives from leading medical professional and voluntary health organizations.

Anticonvulsants are used to control seizures in people with epilepsy, but are more frequently prescribed for the treatment of non-epileptic neurological pain symptoms, such as migraine headaches and tremors, and for psychiatric conditions, such as mood and bipolar disorders. According to experts, there were more than 56 million prescriptions written last year making anticonvulsants the fifth most prescribed class of medications.

"The Epilepsy Foundation began its outreach about the effects of anticonvulsants on women in the mid-1990s with an initiative to educate women with epilepsy and their physicians about emerging links between seizures, menstrual cycles and other interrelationships in women's reproductive health. The Call to Action issued today places a sense of urgency for all women of childbearing age to re-evaluate their current drug treatment," said Eric Hargis, president of the Epilepsy Foundation.

The risks to the fetus from anticonvulsant drug use occurs very early in the pregnancy and is compounded by the fact that nearly 50 percent of pregnancies in the United States are unplanned, leaving women unaware and unprepared for the potential risks.

The Epilepsy Foundation, through an unrestricted education grant from GlaxoSmithKline, convened a meeting with medical experts and leading medical professional and voluntary health organizations to develop the following Action Steps to empower women to reduce the risks associated with anticonvulsant drugs, and establish a more successful partnership with their healthcare providers:

1. Work with your healthcare provider to find the medication that works best for you.

2. Talk with your healthcare provider about specific risks and benefits, both short and long term.

3. If you are planning a pregnancy or you are pregnant, talk with your healthcare provider as soon as possible.

4. Do NOT stop or reduce your medication for any reason without advice from your healthcare provider.

5. Take a multivitamin containing folic acid before and after conception

6. If you become pregnant, enroll in the North American Pregnancy Registry (888-233-2334 or www.aedpregnancyregistry.org) as soon as your pregnancy is confirmed.

7. Make sure that your anticonvulsant blood levels are monitored during pregnancy, and that your dose is changed as needed to prevent seizures or worsening of your condition.

8. Ask about ways to prevent long-term effects such as osteoporosis.

9. If weight change occurs, ask your health care provider about diet options, medication alternatives and lifestyle adjustments that may help.

10. Stay on top of emerging information about anticonvulsant drugs.

Mosquitoes causing more than a bite

The health department is warning residents to protect themselves from mosquitoes after a horse tested positive for Eastern Equine Encephalitis.Equine encephalitis is one of three mosquito-borne diseases monitored by health officials. Symptoms include headache, fever and dizziness. In rare cases, it can also cause victims to have seizures, fall into a coma and die.Tips to avoid mosquito bites include limiting outdoors activities at night, wearing long-sleeved shirts and long pants, and using insect repellant.

Four years old affected by seizures condition caused by mosquitoes

Christopher ''C.J." Burke wears a diaper. His mother says he can't walk, talk, move his hands, or sit up without help.

Two months ago, the 4-year-old from Goffstown, N.H., was running around his backyard with his 11 brothers and sisters, playing soccer and riding his bicycle, his parents said. Then one night in mid-August the seizures began, followed by vomiting, high fevers, and a week in a coma.

Now, about a month after C.J. was diagnosed with the mosquito-borne illness Eastern equine encephalitis, physicians say he will never be the same and could have severe disabilities for the rest of his life.

''He has to relearn his whole four years of life again," his mother -- Linda Burke, 39, who is seven months pregnant with her 13th child -- said yesterday in a telephone interview. ''We know he is here with us today. He is going to live, but it's going to be a lifelong struggle for C.J."

C.J. is now at a rehabilitation center in Boston, where he is slowly learning to speak again. He is fed through a tube. For the most part, he recognizes his parents, but he occasionally forgets the name of one of his siblings, said his mother.

Described by his parents as a thin, quiet boy who loves SpongeBob SquarePants and playing with his siblings, C.J. will probably have to use a wheelchair once he is released from the center, they said.
C.J. was admitted to Elliot Hospital in Manchester, N.H., when he had his first seizure on Aug. 16. After doctors were unable to diagnosis him, he was airlifted two days later to Dartmouth-Hitchcock Medical Center in Lebanon, N.H., Linda Burke said. The next day, C.J. was clenching his teeth in severe pain. He didn't recognize his parents, and by nightfall he had slipped into a coma, his mother said.

''Every range of emotion that you can imagine went through my mind," said his father, Christopher Burke, 42, a customer service representative for Car Componet Technologies in Bedford, N.H. ''We kept thinking, if he survives, what kind of little boy are we going to have."

The Burkes finally got some answers on Aug. 26, but his diagnosis of EEE brought little relief. There is no cure or medical treatment for the virus, which kills 30 percent of its victims and causes permanent disability in many who survive.

C.J. is one of seven New Hampshire residents diagnosed with EEE this year. Two have died, a 20-year-old woman and an 80-year-old man, according to the state Department of Health and Human Services.

Massachusetts has had four victims this year, all from Plymouth County. Two of those infected, an 83-year-old man and a 5-year-old girl, have died, said Donna Rheaume, spokeswoman for the Massachusetts Department of Public Health.

''We certainly are recommending people take precautions against mosquitoes," Rheaume said.
''Don't go outside in peak mosquito hours, which is dusk and dawn. Remove standing water in your yard, which are breeding grounds for mosquitos. . . . Wear protective clothing, such as socks, pants, and shirts with long sleeves."

The first symptoms of EEE usually appear three to 10 days after infection and include high fever, stiff neck, headache, and lack of energy, according to the department. Swelling of the brain is the most dangerous symptom.

The family has set up a C.J. Fund at Service Credit Union to help with medical costs their insurance doesn't cover, Linda Burke said.

C.J. will most likely have to undergo physical therapy as an outpatient for the rest of his life, the Burkes said.

They said they pray he will be home for the holidays, just in time to greet his new baby sister.
''You always think it will never happen to your child," Linda Burke said. ''It's a miracle that he pulled through this. It's amazing."

Mother charged with attempted murder of her son who is suffering from seizures

A North Carolina woman who tried to kill her terminally ill son and herself before changing her mind has been charged with attempted murder.

Alice Stennett`s son, 5-year-old Robert, suffers from a genetic disorder that causes muscular degeneration and seizures, the Charlotte Observer reported. Most victims die between the ages of 8 and 12.

Stennett allegedly gave her son an overdose of medication Friday and then took one herself. But she then dialed 911 and summoned medical help.

Neighbors told the newspaper they seldom saw Robert Stennett except when he had a medical emergency and was taken to the hospital.

Mosquitoes causes seizures condition

A 4-year-old boy has survived a monthlong battle with Eastern equine encephalitis, but his family says recovery may take a lifetime.

Christopher "C.J." Burke is one of seven New Hampshire residents to contract the mosquito-borne illness. Two people have died, a 20-year-old Newton woman and an 80-year-old Hooksett man.
Burke's parents say their son was hospitalized with seizures Aug. 16 and it took doctors 10 days to diagnose him. But because there is no cure for the disease, little could be done for him.

"There is no specific treatment (for encephalitis). Physicians are unable to directly fight the virus; care is considered supportive," said Elizabeth Talbot, deputy epidemiologist for the state.
Hospitals provide food and water, try to control the fever and cure any unrelated infections, Talbot said.

One-third of patients who develop the disease die and another third suffer significant side effects, Talbot said.

The Goffstown boy was hospitalized for nearly 30 days. At one point he was in a coma. He's now at a Boston rehabilitation center. His father, also Christopher Burke, says the boy remains on anti-seizure medicine and likely will come home in a wheelchair.

He anticipates a lifelong struggle for his son, but he's grateful that his boy is no longer in the intensive care unit, jerking in convulsions.

"The scariest thing in the world is to see a 4-year-old go through that," Burke said. "It's an absolute miracle he's alive and can do what he can do today."

The family said a "C.J. Fund" has been set up at Service Credit Union to help with expenses.