Sleep deprived EEG may have be responsible for patient's death!

The Western Australian Coroner is examining the death of a 40 year old epileptic woman after she went without sleep in preparation for a medical test.

Sharon Moss suffered a fatal seizure in February 2005 on the morning she was scheduled to undergo what's called a sleep-deprived E.E.G. at Royal Perth Hospital.

The Coroner's Court has heard that, while a lack of sleep is a trigger for epileptic seizures, it allows doctors to get a more accurate diagnosis of their patient.

Ms Moss' family has expressed concern that she was not kept in hospital the night before the test because sleep deprivation was a trigger for seizures.
The inquest is continuing.

Activity imbalance in neurons can lead to seizures!

Two genes important for human development and implicated in cancer and schizophrenia also help keep a healthy balance between excitation and inhibition of brain cells, researchers say.
Neuregulin-1 and its receptor, ErbB4, promote inhibition at the site of inhibitory synapses in the brain by increasing release of GABA, a major inhibitory neurotransmitter, Medical College of Georgia researchers led by Dr. Lin Mei report in the May 24 issue of Neuron.

In 2000, a research team led by Dr. Mei showed that neuregulin-1 and ErbB4 also are at excitatory synapses, communication points between neurons where the neurotransmitter glutamate excites cells to action. Here, neuregulin-1 and ErbB4 suppress excitation."Right beside the place where the excitatory synapse can be activated, there is also something that can suppress it," says Dr. Mei, chief of developmental neurobiology at MCG. "Now we have identified another novel target of neuregulin-1 which is the inhibitory synapse."Together the findings reveal a check and balance for brain cell activity managed by neuregulin-1 in the brain's prefrontal cortex, where complex reasoning and decisions about appropriate social behavior occur, he says.

They also provide new treatment targets for psychiatric diseases such as schizophrenia and neurological disorders such as epilepsy, researchers say.The genes are both associated with schizophrenia, a disease that affects about 1 percent of the population, but the exact role of malfunctioning neuregulin-1 signaling was unclear. "(Dr. Mei's) findings help explain how a gene that is potentially causative in disorders like schizophrenia and bipolar disorder relate to a neurotransmitter that is critical for explaining the cognitive deficits associated with the illness," says Dr. Daniel R. Weinberger, director of the Genes, Cognition and Psychosis Program at the National Institute of Mental Health in Bethesda, Md.

"What we have found is neuregulin-1 can regulate GABA release from these neurons and if the GABA is released here that may play a role in controlling the output of this neuron," Dr. Mei says, pointing to an illustration of pyramid-shaped neurons that looks like a high-tech switchboard with information coming in from all angles.Pyramidal neurons get information from nearby interneurons, integrate it, then decide what message to move forward. "This pyramidal neuron receives inhibitory input and excitatory input, and neuregulin-1 can regulate both," says Dr. Mei.They nicely balance input in most people, enabling folks to balance their checking accounts and suppress the urge to run naked down the street.In 2006, University of Pennsylvania researchers reported in Nature Medicine an altered signaling pathway for neuregulin-1 and ErbB4 genes in the brains of schizophrenics.

Dr. Mei's findings show that these factors associated with a schizophrenic brain have at least two places to act. "There is a ton of evidence that when inhibitory synapses, such as GABA, go wrong, the symptoms of mice and rats look similar to those of schizophrenia in people," he says.Mounting evidence suggests that problems with the excitatory and inhibitory synapses regulated by neuregulin-1 result in other problems as well: Excess excitation results in mind-rattling seizures and excess inhibition in depression, as examples.

"If this neuron is too excited, people may get manic or have seizures," says Dr. Mei. "Patients with schizophrenia, for example, show symptoms that implicate alterations in inhibitory neurotransmission in addition to excitatory neurotransmission.

"Dr. Mei co-authored a companion paper in Neuron with scientists at Cold Spring Harbor in New York that provides yet another link between neuregulin-1, its receptor ErbB4 and schizophrenia. It shows ErbB4 plays a key role in the maturation and plasticity of excitatory synapses and that normal synapse development is impaired by genetic defects in neuregulin-1 and ErbB4 signaling. The result is impaired function of the excitatory neurotransmitter, glutamate.

Now he wants to study disease processes in a neuregulin-1/ErbB4 knockout mouse and learn more about how neuregulin-1 mediates GABA release. Another key unknown is what regulates neuregulin-1.

Government to research the best options to treat child life-threatening seizures!

When children suffer life-threatening seizures, doctors have minutes to decide which of two drugs to use to try to save them _ with no good research on which works better. Eleven hospitals around the country are beginning a special study to finally answer that question: A computer will randomly assign patients to get either Valium or Ativan within five minutes of arriving in the emergency room.
Because of the time crunch, doctors won't seek parents' permission first. Children brought to those emergency rooms with the unrelenting seizures known as "status epilepticus" will be enrolled in the study automatically. The National Institutes of Health is funding the unusual study, and announced the plans Wednesday. Participants in medical research almost always must give prior consent, a requirement the government waives in special cases such as study of emergency care.

Parents don't normally get a say in treatment of status epilepticus; they're just told that doctors are administering seizure-treating drugs. At the 11 study hospitals _ including Women and Children's Hospital in Buffalo, N.Y., and the University of Rochester (N.Y.) Medical Center _ once a child's seizures stop, parents will be told about the research and asked if they'll continue to participate.

The only difference in care is that children who remain in the study will receive additional medical monitoring, the NIH said. Status epilepticus is a series of continuous, harsh seizures that, if not treated properly, can lead to brain damage or death.

It affects up to 60,000 people a year, mostly children, and can strike anyone. Risks include having a high fever, low blood sugar, a central nervous system infection, or a head injury. For a list of participating hospitals, check: http://www.nichd.nih.gov/news/releases/study_pediatric_seizure_QA_05 2207.cfm

New implanted device could zap seizures away!

An implanted device that detects seizure activity in the brain and shocks it away before it spreads could bring new hope to epilepsy patients. The device is part of a growing trend to treat neurological diseases resistant to traditional medication with small jolts of electricity rather than with drugs. Preliminary studies have shown that the device can stop seizures in some patients, and larger-scale studies are now under way.

A full 30 to 40 percent of epilepsy patients fail to find relief from anticonvulsant medications--a percentage that has not improved as new medications have entered the market over the past decade. Some of those patients can be treated with surgery targeting the part of the brain that triggers seizures. But this is not always effective, and not all patients are eligible: someone whose seizures originate in the part of the brain that generates language, for example, would be ineligible for surgery because it might damage his or her ability to speak.

A new device being developed by Neuropace, based in Mountain View, CA, could help these patients. An electrical stimulator, smaller than a playing card and curved in shape, is inserted into a hollowed-out part of the skull. (The procedure is modeled on that of the cochlear implant.) Two electrodes are then implanted into the troublesome part of the brain that triggers seizures.
Surgeons locate this spot, known as the seizure focus, prior to surgery using a combination of brain imaging and electroencephalogram recordings (EEG), which measure brain activity from surface electrodes on the skull.

The electrodes monitor nearby neurons for signs of abnormal electrical activity. When they detect signs of an impending seizure, they emit an electrical pulse, blocking the hyperactive wave from spreading throughout the brain. "The idea is to stop the seizure before it occurs," says Frank Fischer, chief executive officer at Neuropace.

The device, known as the responsive neurostimulation system is just one of a growing number of electrically based devices in development or already on the market. In 1997, the FDA approved the vagus nerve stimulator for epilepsy, which stimulates a nerve leading to the brain. The medical-device company Medtronic is currently sponsoring a trial of deep brain stimulation for use in epilepsy in which an electrode is implanted into a specific spot in the brain. The device is currently approved to treat Parkinson's disease.

However, the sensing capability of the Neuropace device makes it different than other systems, says Fischer. Other devices deliver a constant stream of electrical pulses, while responsive neurostimulation system zaps the brain only when necessary. "People with a high level of seizure activity would only get a few minutes of therapy a day," Fischer says. And unlike with vagus nerve stimulator, which can trigger a hoarse voice when turned on, with responsive neurostimulation system, patients can't tell when the electrical pulses are delivered.

Febrile seizures vs. young children, an uneven battle!

If you have ever gone through a febrile seizure with your child for the first time, you might know what it feels like to experience the fear of death.

In 1986, when I was a young mother, I took my daughter who was 6 months old to the doctor to check out a high fever that she had for 2 days. The fever was 103 degrees. She was pale looking and had gone through flu-like symptoms.

While waiting in the doctor's office with my baby sleeping in my arms, suddenly, she went limp. I panicked and screamed out "nurse, nurse, my baby!" Prior to that, the nurse had taken her temperature which was now up to 104. The nurse grabbed her swiftly out of my arms. Several nurses ran in at once and then the doctor.

It was like an emergency room setting. They were quickly asking me questions. Realizing her temperature was rising rapidly, they began to administer ice applications to bring her fever down. Frantically as they were working on her I was in shock and wondered if she was going to die.

After examining her, the doctor gave me the diagnose that she had a febrile seizure. He assured me that there was nothing to be concerned about and that she would grow out of this. He explained the causes of the seizure and how this was not like an epileptic seizure. However, he told me she could have it again in the future whenever she would have her next fever.

He gave me baby Tylenol suppositories and told me to administer it whenever I saw a rise in a fever again. I was told to put her in tepid water if this continued not to work. He said it occurs typically with children under the age of 5 and they do grow out of it. So I had to put my faith in the doctor.

Well, 6 months later, she had another seizure. I was lying next to her while she was taking a nap. I turned to look at her. I observed her eyes opening and rolling back in her head. She then started to shake. I tried to recall what the doctor informed me and carried out his instructions. It was so hard because she was also turning blue and wasn't breathing. I was just praying the doctor was providing me correct advice. I quickly took the suppositories and administered it.

Then I went right to the bathtub and submerged her in tepid water as he advised. She wasn't breathing at this point and turning blue. I called the office in panic and as I was talking to them, she fell asleep in my arms with a peaceful look. He then told me to bring her in. Both times the seizures lasted for maybe a minute.

After that last episode, he prescribed for her to take phenol barbital for 6 months. She was walking at 9 months. When she had to take the phenol barbital it was like watching a drunken baby. It is administered for seizures. However, you should be careful getting immunization shots when you know your child is prone to febrile seizures. She never had a seizure again.

Febrile seizures happen in 2-4% of small children when a fever quickly climbs. Even though you're told that there is nothing to be concerned about you should always seek medical help to find out the reason for the fever.

Some of the symptoms of a febrile seizure can range from mild to severe. An example of mild symptoms would be rolling of the eyes and severe symptoms would be shaking or tightening of the muscles.

Some of the other symptoms can be:

A fever over 102 rising quickly

Losing consciousness

Loss of urine

Vomit

They classify the seizures as:

Simple febrile seizure lasting from a few seconds to 15 minutes and it stops on its own. After this the child may cry or just go to sleep.

Complex febrile seizures last longer than 15 minutes and occur more frequently, more than once in 24 hours. It can also be confined to one side of the child.

It was a traumatic experience for a young mother. I didn't have the Internet for researching as we do today. I would encourage all mothers to research any childhood symptoms or concerns. We mothers have to play an important part in the decision making. I had to take the doctor's word at face value.

If I did have the research capabilities I might not have chosen this solution. She didn't have to have the drug because she would have grown out of it. I believe he prescribed it more for me to calm a young mother rather than it being a necessary solution for my baby. It is a strong drug. It relaxes the brain and nervous system. Here are some of the more serious side effects I found on phenobarbital today.

An allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

An irregular or fast heart rate;

or Eye pain

There are mild side effects too. If I knew what it really did and what possible side effects there were, I probably wouldn't have allowed it. This is an excerpt from an a site called Medical Wisdom.
Prolonged daily use of oral anticonvulsants, such as phenobarbital or valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing such seizures.

http://medicalwisdom.com/health/disorders/febrile_seizures.htm
Knowledge is power.

More resources

http://medicalwisdom.com/health/disorders/febrile_seizures.htm

Living with seizures is not an easy task for little Darian!

Two years ago, tiny Darian Falon was in her car seat when she had her first seizure. Within days, more seizures controlled her body, leaving her incoherent and unable to remember what took place. Drop attacks, in which her entire body would go limp, and staring spells followed."She was getting worse by the day, after the first seizure," says her dad, Justin Falon, 35, of Renner.

"Over a few weeks, she went from one seizure per day to a few more, to a point where she was having dozens each day."At first a neurologist diagnosed that Darian had epilepsy, offering hope that medication would control the problem. But in time, doctors found that Darian, now 4, has Lennox-Gastaut syndrome, a difficult to treat form of epilepsy. Usually striking children between the ages of 2 and 6, the syndrome produces a wide range of seizures.

"Darian was a healthy child for the first 21/4 years of her life," says her mother, Shannon, 32. "And then she had a seizure. Then life changed."The Falons hope Darian will reach age 7 without major mental regression. Many children who suffer from Lennox-Gastaut syndrome do not develop abstract thinking skills.

So far, Darian has done well.Through her little girl grit - which her parents say is beyond her years - she willingly sticks to a strict diet that mimics starvation. And more recently, she added Lotus to her arsenal to fight epilepsy, a Siberian husky trained to help predict her seizures."He's her new best friend," says her father, speaking of the service dog Darian received through the Make-A-Wish Foundation.

"He's been a wonderful addition to the family and a fantastic companion for Darian."

A year ago, after numerous medication changes and doctor visits, including a 24-hour observation in St. Paul where she had more than 100 seizures, the Falons began a difficult but rewarding treatment option. They started Darian on a ketogenic diet, a high fat, low carbohydrate diet used to treat epilepsy."She calls it her 'magic diet,' " says Justin Falon, who works as a mental health therapist for the State of South Dakota. "She's a very responsible 4-year-old."

The ketogenic diet mimics starvation and in some ways tricks the brain into reducing the number of seizuresDarian suffers."Today she is doing remarkably well for a kid with her condition," says Shannon Falon, a lawyer with Johnson, Heidepriem, Janklow, Abdallah & Johnson law firm. "And while the diet is helpful in controlling the seizures, her meals are weighed to the gram. She eats at four times per day, and she has supplements, and she has 32 ounces of water, each day, no more, no less."

For the diet to work, Darian must comply to the letter. There are no days off, no slip-ups allowed, no birthday cake. Her mother says even a single Cheerio could, in due time, lead to hundreds of seizures."The components (of the diet) are not very palatable," says Shannon Falon. "It's a high-fat, low carbohydrate diet. She drinks heavy whipping cream four times a day."

The cream is mixed with oil, and Darian must finish her entire meal - every bite - in a set amount of time."When she started the diet, she was having probably 100 seizures a day. Some days, she would have 20; those were good days," she says. "Initially the struggle with the diet was that she was so ketonic - the diet worked so well - that she was nonfunctional."

'Atkins on steroids'

Nausea and hypoglycemia were part of the sickness. In time, Darian's parents found the balance, but they continue to fine-tune as they go.A typical meal in this "Atkins on steroids" style diet, as it is described by Shannon Falon, might include heavy whipping cream, eggs, oil from safflower or flax seed and fruit, such as strawberries.

But there's no one template for patients and their families to follow. Myriad solutions and recipes have to be accounted for, from toothpaste to sunscreen to types of fruit.Justin and Shannon Falon found several canned fruits that were listed with no sugar added actually did have enough glucose to give their daughter seizures. "We are helping her, but she is busy teaching us," Justin says. "The miracle of the diet is the fine-tuning it takes to get the foods just right."He says it's a balance of keeping your child just sick enough to avoid seizures but well enough that she will continue to eat. She takes supplements for better nutrition, and the diet makes her nauseous.

During the initiation period for the diet, the Falons found that Darian's body adapted quickly, switching to burning fat instead of carbohydrates. In two days, the seizures stopped altogether.Dr. Raymund David, a pediatric neurologist with Avera Children's Clinic, says the diet is often a last resort, especially for patients who fail drug treatment.

For 75 percent of epilepsy patients, the disease starts before age 20."Some seizures will be a singular event, and if it is detected early, most can be very well controlled," he says. "With Lennox-Gastaut (syndrome), it is the most difficult form to treat."

Dr. John Freeman, professor of epilepsy emeritus and member of the Johns Hopkins Pediatric Epilepsy Center's department of neurology in Baltimore, says the ketogenic diet not only works, but that children on it are often very compliant.

"The diet can even cure seizures, and that's something you can't say about any of the drugs," Freeman says. "If the child gets rid of some of their seizures, they will comply. Many who stay on the diet can come off it, eventually, and some can come off of medication and remain seizure free."

The guidebook

Freeman wrote a guidebook on the treatment called "The Ketogenic Diet: A Treatment for Epilepsy," which the Falon family used as a template towards helping Darian.Justin Falon says his daughter has made the connection. "She's kind of a spokesperson for the diet," he says. "She says the 'magic food' is working."

Even her 2-year-old sister, Kendall, knows the benefits. When her mother asks her what the food does, she says, "Stops sweezurs."Lotus joined the family, which already has dogs Dante and Diego, about two months ago. With Libby, 8, as her sister's "greatest cheerleader" and her little sister Kendall's love and affection, Darian does not fight the illness alone; the family is united as a team.Through a local Make-A-Wish effort, Darian chose the dog over wishes such as a trip to Disney World or a shopping spree.

Service dogs such as Lotus are able to recognize the minute changes in the body of a person with epilepsy, such as a change in sweating or secretion. Dogs who help people with epilepsy pay close attention to their masters as well.Dr. Bonnie Bunch, a board-certified pediatric neurologist and assistant professor of pediatric and adolescent medicine at Sanford USD Medical Center says service dogs like Lotus are helpful tools for families fighting epilepsy.

"No one knows for sure how the animals know a seizure is coming," she says. "But the use of seizure dogs is growing."The service dog helping Darian will do several things, says Dr. Gregory Barkley, a member of the Epilepsy Foundation Board and a doctor with the Henry Ford Medical Group in Detroit."Dogs, by their genetic make-up, are programmed to do work for humans, so on a simple level, the dogs protect their charges," he says. "They can be trained to activate an alarm. That's straight-forward. But there's lots of evidence that shows strong interpersonal relationships will help the patient."

As the process of wish-granting began, Justin and Shannon Falon never coached Darian to choose a dog. "We had begun research on our own, and I had asked her if she would want a dog to help her," says Shannon Falon. "But that was before the whole wish thing even started. We mentioned a dog once."

When the foundation's staff visited Darian, they spoke with her, but Justin Falon says they came upstairs more than once to say she was fixed on her decision."We were not surprised. We just wanted that wish to be Darian's and Darian's alone," Justin Falon says."We kept telling her to think bigger," he says. "But she said she wanted a dog that'll let her know if she was going to have a seizure." Wells Fargo sponsored the purchase of the dog.

Lotus will have his first birthday soon, and he's still finding his place in the family. Justin says he has not yet predicted a seizure but has shown promise. The only missing element is developing a tighter bond between Lotus and Darian, which is coming, says Justin.Choosing a dog over a fantasy trip is just one of many choices for Darian. Tough decisions are part of her life, and while she keeps her "magic diet" and develops her relationship with Lotus, her family says they have learned from her.

"You get the feeling that while things are hard, every day, she will not give up," says Justin Falon. "She is very sick, but she has willpower like a small army."The diet is a learning process that is helping for now, says Shannon Falon. "We are confident, in this fine-tuning phase, that we'll get her seizure-free."Reach reporter Jarett C. Bies at 977-3925.

Mom saved by her 5 years old son during seizures episode

When Caleb Weeks' mother began having seizures last month, he did exactly what he was taught and called 911.

Caleb: "My mom fell on her bed and she's having seizures."Dispatcher: "We're getting them out there to you. They'll be there shortly."Caleb:" Bye."Dispatcher: "No, don't hang up yet ... You did a good job calling 911."Caleb: "OK, thanks. I know how to do it."Dispatcher: "That's good, that's very good that you know how to do it. It'll help your mom out."

The boy's mom, Marka, said she taught him how to call 911 in case there was ever an emergency, but she didn't know he could really do it.

"What he did was correct. I'm very proud of him," Marka Weeks said. "I was just kind of shocked when I saw rescue people here."

At one point, Caleb did hang up the phone to go check on his mother, but the dispatcher, Lacy Reed, called right back to make sure she had the right address and to make sure everything was still OK.

Reed kept Caleb on the phone for several more minutes until rescuers got to the home.
Marka Weeks was not only grateful for her son, but the dispatcher that kept her son on the line and kept him calm until help arrived.

Reed had only been on the job three months when Caleb and his mother needed help.
"I asked him how old he was and he said 5, and then I was like, 'OK, let me ask you some more questions and really see what was going on,'" Reed said.

She said she knew she had to keep Caleb on the phone and try to get as much information as she could from the 5-year-old.

Dispatcher: "Is she laying on the floor?"Caleb: "She's laying on the bed."Dispatcher: "She's laying on the bed?"Caleb: "Yes."Dispatcher: "OK. Has she had seizures before? Do you know?" Caleb: "Yes."Dispatcher: "Yes she has?"Caleb: "She had them in her sleep."

"He's actually the only kid I talked to on the job," Reed said. "I think it's special that any kid can remember their address and tell you where they are and get help on the way if the adult's having an issue."

Caleb's mother said she taught the boy to call 911 because she has seizures and she wanted him to know what to do in case of an emergency. She said she's proud of her son.

Seizures induced by cocaine gets baby and infant sibling in state custody

An 18-month-old baby hospitalized with strokes caused by cocaine will remain in state custody as will her 9-week-old sister on the order of a juvenile judge in west Georgia.Juvenile Court Judge Warner Kennon Senior in Columbus issued the ruling Wednesday after examining evidence from a Georgia Division of Family and Children Services representative.A criminal case is pending against the children’s mother, 19-year-old Amber Baxley and her 26-year-old boyfriend Jeremiah Linder. The two were arrested in April and charged with cruelty to children.

Police said Baxley’s child was hospitalized April 22 after having two seizures related to cocaine intoxication.Neither adult gave a clear answer about how cocaine got into the baby’s system during their hearing in Columbus Recorder’s Court. Kennon said the child is receiving shots for her seizures as well as occupational and speech therapy.

The baby has problems moving her limbs.Both children had been placed in state care at an initial hearing in late April. Kennon found Wednesday that no suitable relative was available to care for the children and that they would remain under state care in a foster home.D-FACS will develop a case plan, which will be presented to all parties involved. Kennon said it will address the issue of reunifying parent and children.

Teen's surgery free him from seizures and allow to drive

In February, WZZM 13 brought you the story of Paul Wiersma, a young man who suffered from epilepsy most of his life until brain surgery made him seizure free.It's now been 6 months since his last seizure and under Michigan law Paul can now get his driver's license.Paul Wiersma says, "It's like I made it." It's a right of passage for almost every teenager, the day they get their driver's license.For Paul Wiersma that day was delayed for 3 years due to a recurrence of seizures caused by his epilepsy.

Medication no longer worked for Paul and the seizures were becoming more frequent and unpredictable.It was his stay at St. Mary's Epilepsy Clinic that determined he may be a candidate for brain surgery.Epileptologist, Dr. Adriana Tanner says,” Every test pointed to the right temporal lobe so we knew as a group he was a very good candidate for the surgery."Last November Paul made the decision to have part of his brain removed in hopes of ending the seizures.The surgery was similar to the one being performed on Wiersma.

“The thought of someone opening up your head and operating on the most important part of your body basically is kind of a scary thing," says Wiersma.Dr. Tanner says, "I would certainly hope that he would remain seizure free for the rest of his life."Paul has been seizure free for 6 months. Under Michigan law he can now get his driver's license. "Looking back it was like wow, I'm really here."Paul passed both his written test and his road test on the first try.

It's an experience he won't soon forget. "All I've been through and now that I'm here behind the wheel by myself it's just a wow feeling you know. And it's one of the best feelings I've ever felt"And the first place he wanted to drive was to St. Mary's, to show Doctor Tanner and Dr. Luders his driver's license and thank them for giving him his life back. "It's really freeing to just say I'm going to work I'll be back at 10:00p.m. or 11:00p.m. That's the really nice part of it," says Wiersma.

The future is an open road now for Paul and he's already concentrating on his next goal, graduating from Davenport University.

Febrile Seizures: Explained!

Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body.

SYMPTOMS

Most febrile seizures develop within 24 hours of fever. They occur in about 2 to 5 percent of children less than 6 years old. Most occur at 6 to 18 months. Simple febrile seizures last less than 15 minutes and have no focal features. Complex febrile seizures last longer, have focal features or occur in a series. They occur during bacterial or viral infections. Sometimes they occur after vaccinations.

DIAGNOSIS

Seizures are diagnosed as febrile after exclusion of other causes.

TREATMENT

Treatment is supportive for simple seizures. Complex seizures require drugs with careful monitoring of circulatory and respiratory status. Intubation may be necessary if the seizure persists. Drug therapy is usually given intravenously. Maintenance drugs are only given in prolonged episodes.

New technology help to study the variations of Epilepsy

Eminent neurologist, Dr. Syed Irfan Ali, said that modern technology with newly introduced effective medicines brought positive results in controlling the epilepsy at the advance stage.

Epilepsy is a common neurological disorder with psychiatric sequel and complications and mainly affects the children because of genetic factors, he said, adding that with the use of Electroencephalograph (EEG), Magnetic Resonance Imaging (MRI) and Computerized Topography (CT) Scan, the consultants can easily diagnose the stage of epilepsy and suggest the required dosage of medications, which help the patients to live with seizure free life and perform normal chores and social activities.

He said that timely prognosis and targeted prescription could bring complete recovery, however, among the patients between the periods of two to four years.Describing epilepsy, Dr. Irfan informed that there is a marked variation with higher percentage among the young and the elderly. The epilepsy is a nervous system condition that causes electrical signals in the brain to misfire, he said, adding that these disruptions cause temporary communication problems between nerve cells leading to seizures.

To avoid any mishap when the epileptic patients suffer the fits, he advised the attendants to ensure that the patients should not drive vehicles, not to operate machines in factories, nor swim or work at height or near fire till their fits are controlled.He informed that though anyone can get epilepsy at any age, the research revealed that it can prevail among the children. Dr. Irfan said that 50% of the epilepsy cases are idiopathic with unknown cause.

In some of these, there may be a family history of epilepsy or a child who has a parent or other close family member with the condition is likely to have it too, he said and added that the researchers are working to determine what specific genetic factors are responsible.About the fits, commonly known as seizures in medical field, Dr. Irfan informed that seizures vary in severity, frequency and duration, and typically affect the patients for a few seconds to several minutes.

There are many different kinds of seizures, and what occurs during the seizures depends on where, in the brain, the electrical signals are disrupted, he said. He said that there are two main categories of seizures, generalized seizures, which involve the whole brain and partial seizures, which affect only part of the brain. Some epileptic patients may experience both kinds of seizures.

A child might lose consciousness, jerk or thrash violently during these seizures and milder seizures may leave a child confused or unaware of his or her surroundings, he said and added that some seizures are minor and could be detected only with the experienced eye. In such a case, the patient may simply blink or stare into space for a moment before resuming normal activity.During these fits, he said that it is essential for attendants to stay calm and keep the patient safely away from furniture, stairs, or radiators.

The attendant should put something soft on the head of the patient and turn him or her on the side so that the fluid in the mouth can come out. The attendant should avoid pitching a stick in the mouth of the patient and should restrain the patient from doing so as well. If the patient wants to sleep, he or she should be allowed to do so and the attendant should avoid giving extra medication unless the doctor prescribed it.About diagnose, he said that the attendants should contact the consultant if their patients, particularly children, had suffered seizures, staring spells, confusion spells, shaking spells or unexplained deterioration of school performance.

The attendants should explain the symptoms in detail as it helps the consultant to examine the patient accurately and diagnose problems in the brain and the rest of the neuralgic system.He said that although medication often works, it is less likely that subsequent medication will be effective if the patients are unresponsive after the second or third attempts. In some cases, surgery to remove the affected part of the brain becomes necessary.

Epileptic surgery is done on less than ten percent seizure patients, and only after an extensive screening and evaluation process.Dr. Irfan said that with some simple safety precautions, the children can participate in sports or other activities.

Childhood strokes are related to seizures!

While childhood strokes are uncommon, people still need to be aware that they can happen, doctors said.

Tanzera Hall, 12, of Baltimore, started going to Johns Hopkins Children's Center when she was 7 after she was diagnosed with moya moya syndrome, a rare condition that causes seizures and strokes.

Pediatric neurologist Dr. Lori Jordon hasn't seen Tanzera in a year, but said about 3,200 children have strokes a year.

While it's not common, there are important signs to watch for, Jordan said.

She said weaknesses of the face, hands and arms on one side of the body, slurred speech and seizures affecting one side of the body all could be signs of childhood stroke. Children with those symptoms need to seek medical attention immediately, Jordan said.

Tanzera is still recovering from her illness. She said she has trouble reading and remembering things, but she is making progress.

Missing dog has seizures disorder

Her arrival brought happiness and her disappearance has saddened the Jaccard family.
Mia, a 2-year-old Yorkshire terrier, was discovered missing just after noon on Friday from the Jaccard's yard on Cypress Avenue near San Bernardino Avenue, said Dave Jaccard.

The dog the family has had since she was six weeks old has epilepsy and her seizures have become more frequent, he said.

"It's been two days now and she hasn't had her medication," Jaccard said.

The family has canvassed the neighborhood looking for her and called police. They've plastered the area with fliers.

They're also offering a reward - no questions asked.

"We just want her back. My wife and my daughter are just sick,"

Mia, weighing about five pounds with a brown face and black-silverish body, was a birthday present for his daughter when she turned 18.

Jaccard said he was working inside his home when Mia and her sidekick Eddie, a beagle, scratched on the door to go outside.

The pair was outside for about 15 minutes when Jaccard went out to empty a bucket. He noticed the yard gate pushed open. Mia was gone and Eddie was standing in front of the home.

Jaccard said a few people told him they saw a girl with a dog that looked like Mia near Truman Middle School.

But the small dog hasn't returned home.

Anyone with information is asked to call (909) 356-1035 or (951) 313-8288.

Surgery may help control seizures

Lara's Worley's mother thought she was playing when she fell to the floor two years ago, her arm over her eyes. Neva Worley tried to move her daughter's arm. It wouldn't budge and Lara was foaming at the mouth.

Doctors diagnosed the 16-year-old Princeton School sophomore with epilepsy, and in June, she heads for the Cleveland Clinic in Ohio to undergo a rare type of brain surgery. Doctors at the University of North Carolina Medical Center at Chapel Hill said she needs the procedure is only done at two hospitals in the country -- one in Florida and one in Ohio. Lara and her family chose Ohio.

Friends are holding a benefit dinner May 19 to help defray medical expenses for the surgery.
Her mother said she has no idea how much the surgery is going to cost, but she knows it will be a lot.

Doctors have controlled the seizures to the point where they're down to one a week. But they still affect her life.

Her mother, an elementary school teacher, and whenever Lara is finished with her classes, she spends time with her mother in her classroom until it's time to go home. Despite her physical problems, she is still doing well in school and is a member of the Beta Club.

Lara said she has lost some friends because of the onset of the seizures. But others have stuck with her and have learned what to do if a seizure happens.

The seizures last about a minute, two at the most. One friend stays with her while another goes to get her mother.

Lara and her family are hoping things change a lot after the surgery. They leave June 9 for Ohio. The family will stay at the Ronald McDonald House a couple of blocks from the hospital during their stay.

The surgery will be June 13 or 14, and Lara will spend about a day in intensive care. She should be able to come home within a week.

The benefit dinner will be held from 4 until 7 p.m. on May 19 at the Princeton United Methodist Church on the corner of Center and First streets.

Spaghetti will be the fare, with $6 plates available for eat-in or take-out. For information call 936-0468 or 427-6711.

Friends have also set up an account for donations to be sent to the Lara Worley Fund, c/o First Citizens Bank, P.O. Box 1016, Princeton, N.C. 27569-1016.

There also will be a silent auction with items like sport memorabilia, gift cards, flower arrangements, jewelry and baskets.

Those who come to dinner and wish to can sign a quilt, which Lara will take with her to Ohio.

A parent's love and care can do wonders...

Being a mother is exciting.

But sometimes it can be hard, especially when the child has a rare disease.

Janet Trujillo’s journey with her daughter, Sheri Lynn, began 28 years ago.

At first, she didn’t notice the baby’s problems, but at 6-months old Trujillo knew something was wrong.

“I noticed she was having developmental problems,” Trujillo said. “She wasn’t lifting her head, rolling over, crawling or any of the normal developmental phases.”

At 12 months, when Sheri was still in a fetal infant stage, Trujillo took her to the pediatrician, who sent them to a neurologist, but he had no idea what was wrong.

At age 2, Sheri began having grand mall seizures and may have had small ones in her sleep. Trujillo said the hardest part was dealing with the sleep disorder.

“The younger children only sleep two hours over a 24-hour period,” she said. “Sheri was about 8 when she started sleeping six hours a night, and now she’s up to eight hours on a good night.”
Because of this, Trujillo and her husband, Joe, had to work and sleep in shifts because Sheri was so active and screamed because she didn’t want to be alone.

“It was a very frightening stage because she didn’t know what was going on,” she said. “The doctors didn’t either. They said some kind of neurological damage, some kind of severe retardation, some type of seizure problem, but they didn’t know.”

When Sheri was 12, Trujillo was given a magazine article describing the symptoms of what could have been Sheri’s double.

“We took the article and Sheri back to her pediatrician and she had a blood test at Stanford University. They confirmed that she had this chromosome No. 15 deletion,” Trujillo said. “Sheri was born with a genetic disorder called Angelman Syndrome.”

The disease is when a chromosome actually has been deleted. People are born with hundreds of matching pairs of X and Y chromosomes, but when one of them is missing, it causes this condition.

“There are 23 characteristics of Angelman’s,” Trujillo said. “Sheri is atypical. She has all of the conditions. Most individuals only have eight to 10 of the features.”

Over the years, she had seizures and was treated for that, had surgery to correct her lazy eye and spinal fusions to help the scoliosis, Trujillo said.

“She is severely retarded, which is one of the conditions,” Trujillo said. “She has an understanding comprehension of a 3-year-old. She’s nonverbal and cannot speak.”

But she does make pre-speech sounds, such as “mama” or “dada.”

“We communicate by pointing and making sounds,” Trujillo said. “We have a language that only she and I can understand and a few caretakers.”

Angelman Syndrome has become known as the Puppet syndrome because children, who are diagnosed with it, “walk on their toes with their hands in the air trying to hold their balance,” Trujillo said. “They look like puppets on strings, marionettes.”

People with the syndrome have similar characteristics, no matter what their race.

“They all have a round flat face and a flat back of their skull,” Trujillo said. “They all look like they’re related.”

It wasn’t easy when the neurologist saw her once, evaluated her and suggested she be sent to a state institution.

“He said she was hopeless. We should forget about her and start a new family,” Trujillo said. “We decided to keep her at home. I grew up in a medical background family. My husband did, too, and we decided this gentleman just didn’t know what he was talking about even though he was the head of Children’s Hospital in Oakland, Calif.”

The disease was discovered in the 1960s by Dr. Angelman.

“There are less than 1,000 in the United States,” Trujillo said.

In spite of the difficulties, Trujillo said she loves her daughter just the same.

“It’s one of those tough love things when you have to lay down ground rules for her safety,” she said.
Sheri likes to go to the malls and see people. When Trujillo is at home, Sheri enjoys helping her make cookies, color while Trujillo creates crafts and spending one-on-one time with each other while communicating without saying a word.

Sheri is enrolled in a daycare program at Starpoint four days a week 48 hours a week with a caretaker, “so I can continue to do my community service and work she’s a full-time resident at home.”

And this Mother’s Day, Trujillo will celebrate it at home with her daughter, Sheri.

“She’s our social butterfly, she said. “You meet Sheri, and she falls in love with you, and you fall in love with her. She’s very warm and loving.”

Work vs. Epilepsy

In the run up to National Epilepsy Week (20–26 May), Epilepsy Action has criticised what it calls the outdated attitudes of employers who continue to discriminate against people with epilepsy.
The charity is demanding that employers ‘confront their prejudices’ as figures show that unemployment rates among people with the condition are still unacceptably high.

Epilepsy Action’s Epilepsy and Employment Survey found that 14% of respondents were unemployed but actively looking for work, significantly higher than the overall International Labour Organisation unemployment rate of 8.8% for disabled people. It also revealed that almost half (47%) of respondents felt they had been discriminated against when applying for employment. Around a third (32%) of respondents felt that they had been discriminated against by their employer because of their epilepsy within the last two and a half years.

Epilepsy is covered by the Disability Discrimination Act 1995 (DDA); the Act applies even if employees are not currently having seizures or taking medication. Under the DDA discrimination can occur if: a disabled person is treated less favourably than someone else; the treatment is for a reason relating to the person’s disability; and this treatment cannot be justified.

As an employer, this means that you must not treat someone with epilepsy less favourably than another person; the only exception to this would be if there were specific health and safety reasons for the less favourable treatment.

However, despite this legal protection, 30% of respondents to the Epilepsy Action survey did not feel that the DDA had helped them to find and keep a suitable job.

Employers should be aware that under the DDA an employee has no obligation to disclose the nature of their condition to their employer. If an employee does disclose their condition, an employer cannot tell any third party unless they have the employee’s permission. In addition, if an employee does disclose their condition, employers would then need to recognise that that employee is covered by the DDA, as well as carry out a risk assessment to assess the specific risks from their condition.

According to the HSE, any potential risk to safety due to someone having seizures needs to be assessed on an individual basis, because each situation and each workplace will be different. However, Action Epilepsy suggests that a risk assessment might include asking the person the following questions:

What type(s) of seizure do you have?

How often do you have seizures?

How long do your seizures usually last?

What usually happens when you have a seizure?

How long does it usually take you to recover from a seizure?

What time of day do you usually have seizures?

Do you get a warning, also known as an ‘aura’, before you have a seizure?

The answers to these questions may help you to decide whether the person with epilepsy could do a particular job in the same way as other employees or whether some reasonable adjustment may be needed.

The charity suggests that often these adjustments can be simple modifications, like allowing an employee time to recover after seizures; allowing an employee to start and finish later than others if seizures occur a short time after waking; allowing an employee to work regular hours rather than shifts if seizures are aggravated by disrupted sleep patterns; and ensuring that all staff are educated about epilepsy.

Simon Wigglesworth, Epilepsy Action’s Deputy Chief Executive, says: "Epilepsy is an invisible condition and, as such, it is still much misunderstood. A lot of employers and their employees seem to fear the consequences of someone having a seizure at work.

However, many people with epilepsy are completely seizure-free on medication, while others have their seizures well controlled. People whose seizures are uncontrolled could still be a valuable member of staff with just a few minor adjustments in the workplace.”

Surgery gives hope to Epileptic patient!

After 15 years of life-threatening, grand mal epileptic seizures that seemed untreatable, Teresa Farley met her angel of mercy in the form of Greenbrier Valley neurologist Dr. John O. Collins.
Within a year of treatment by Collins, Farley has suffered only a single seizure, a far cry from the sometimes five-a-day epileptic episodes that made her life miserable.

“It’s a blessing from God,” Farley, of Neola, said of the Vagus Nerve Stimulator, which is implanted in her chest and helps prevent her seizures by sending an electrical jolt to the brain. “My entire life has changed.”

Farley’s former life consisted of daily, unconscious-rendering grand mal seizures that struck at all times of the day and night. Sometimes the violent shaking of her body and subsequent muscle tension — which caused her fingernails to cut into her hands — lasted up to 15 minutes and left her exhausted for hours. In a medical oddity, Farley can sometimes predict when a seizure is about to strike because of phenomenon called “auros.”

“It’s a classic temporal lobe syndrome,” Collins explained Wednesday. “Some people smell things before a seizure, some people get panicked, and I’ve known others that just take off running.”
Previously, an aura was the beginning of frightening episode, but now when she smells natural gas, Harry, her husband of four years, jumps into action.

“Right before I have a real bad seizure, I have a strong smell of natural gas,” Farley said. “That’s when my husband swipes me with the magnet.”

The small magnet that Harry has connected to his watchband triggers 1-2 milli-amps of electricity in the VNS device implanted in Teresa’s chest. The device is a bit bigger than a silver dollar. The minor surgery is done on an outpatient basis by an outside surgeon.

Teresa also carries a magnet, in case a seizure strikes while she is in the bathroom, which is all that separates this couple from their daily routine of managing her epilepsy.

“It’s basically a magnetic switch that turns on a pulse generator,” Collins said of the VNS, which is produced by the Houston company Cyberonics. “This electrical impulse stimulates the Vagul nerve and that sends a signal to the brain which disrupts the abnormal behavior in the temporal lobe.”

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Teresa’s life-changing medical procedure came after accompanying her husband to Collins’ office, the Neurology Clinic in Lewisburg, where Harry was being treated after undergoing two back surgeries. During one of Harry’s office visits, Teresa had a seizure in front of Collins.
“When she became a patient of mine, she had been on a number of medications, and at that point I considered her to be a refractory seizure patient (unresponsive to treatment,)” Collins said. “So we started to look at some options, which included VNS.”

As part of Teresa’s seizure management, Collins balances drug prescriptions with VNS therapy, a balance that may be different with each of the 10 to 15 patients who have VNS devices under his treatment. Collins said the cost of visits to his office are covered by most major insurance carriers and the $25,000 implantation procedure is usually covered as well.

The VNS device is also marketed as a treatment for depression, and Teresa believes this has also helped her overall happiness in life.

“The goal is to come up with the right combination which will produce the best quality of life,” the doctor said.

Collins described Teresa as “doing well” in her VNS epilepsy treatment, and an interesting bonus developed after the Farleys began managing their health problems.

“Mr. Farley was so eaten up with his wife’s problems that as we started helping Teresa, he started to get better, too,” Collins said. “He didn’t have to worry about her so much.”

Although Collins admits that VNS therapy doesn’t work for everyone, for the Farleys, it’s been a blessing that’s allowed them to live a fuller life.

“I never let this magnet out of my sight,” Harry, 54, who has been married to Teresa four years, said. “She has had only one grand mal seizure in the last year. The magnet has made a world of difference.”

Inmate suffered fatal seizures during lockup!

A Chicago man found dead in his cell at the Metropolitan Correctional Center early Tuesday was ordered to be taken from the facility for a neurological examination late last year, court records show.Habib Solebo, 23, was discovered by a correctional officer at about 6:30 a.m., and attempts to revive him were unsuccessful, the corrections facility said.

Solebo's attorney, Keri Ambrosio, said her client suffered from seizures and blackouts, and she had had difficulty assuring he had proper medical care since he was arrested early last year."I have a file full of medical care requests," Ambrosio said. "I am very interested and the family is very interested in reading the autopsy results."Solebo, of the 1200 block of West Pratt Boulevard, was awaiting trial on a charge of conspiracy to distribute a controlled substance.U.S. District Judge Ruben Castillo in December had signed an order directing the Bureau of Prisons to transport Solebo out of the corrections center for testing.

"The examination shall include an MRI and any other test that the examiner deems appropriate in determining the cause of Mr. Solebo's seizures and blackouts," the order states.The document also sought a report on the tests and results.Ambrosio said she had been told that Solebo was removed for an examination about a week ago, but she said neither she nor his family had received updated information on his condition.

Vincent Shaw, a spokesman for the Metropolitan Correctional Center, said an investigation into the incident was ongoing, but preliminary indications were that the death was not a suicide or homicide. Shaw said he could not comment on Solebo's medical care.

Surgery puts a stop to toddler's laughing seizures

A 3-year-old New York girl isn't laughing any more, after undergoing delicate surgery -- and her mom said that's a good thing.

Ana Lagalla had a brain tumor that gave her seizures of uncontrollable laughter. The tumor caused a rare form of epilepsy that, untreated, could worsen to the point of mental retardation.
Doctors at Schneider Children's Hospital on Long Island successfully removed the tumor in a four-hour operation March 30. Now, her mother said she has her little girl back.

Her mom said the laughing seizures began in May 2006, with only a few episodes a day. But the frequency of the seizures grew at an alarming rate, and earlier this year physicians determined that a tumor was the culprit.

Since the surgery, the seizures have stopped completely and doctor's are optimistic about Ana's future.

Can Epileptic seizures be affected by Estrogen?

In more than a third of women with epilepsy, seizures fluctuate across the menstrual cycle, due in part to continually fluctuating effects of estrogen on the neural circuitry in the hippocampus, a region of the brain involved in learning and memory - and in epileptic seizures.

Northwestern University scientist Dr. Catherine S. Woolley, a pioneer in understanding the effects of hormones on the structure and function of neural circuitry, says understanding how estrogen contributes to seizure activity could lead to novel and needed therapeutic targets for anti-epileptic drugs.

On April 30, Dr. Woolley told fellow scientists meeting at Experimental Biology 2007 in Washington, DC, that new and unexpected findings in her laboratory suggest where such therapies might intervene. Dr. Woolley had been selected to present this year's C. J. Herrick Award Lecture, a distinguished award presented as part of the scientific program of the American Association of Anatomists.

A decade ago, Dr. Woolley discovered that estrogen increases the number of excitatory synapses on neurons in the hippocampus. Excitatory synapses activate neurons, sending and receiving neurotransmitters, explaining how estrogen could enhance learning and memory consolidation. Beyond the fact that estrogen played this role, her findings surprised the scientific community for two more reasons.

First, based on natural hormone cycles, the synaptic turnover was very rapid, demonstrating remarkable plasticity of the brain. Second, the estrogen-influenced changes were taking place in the hippocampus, outside what were then considered the traditional hormone-sensitive regions of the brain.

Dr. Woolley's research since has focused on these estrogen fluctuations and how they drive synaptic changes. She now has shown that, in addition to their effect on excitatory synapses that turn on neurons, fluctuating levels of estrogen also have an equally dramatic effect on the inhibitory synapses that silence neurons.

Using a combination of electrophysiology to measure synaptic function and nanoscale measurements of synaptic structure, her team has shown that estrogen suppresses the release of inhibitory neurotransmitters, and that this occurs by regulating vesicles at inhibitory synapses (vesicles being the membranes that contain neurotransmitters).

And once again, there was an additional, surprising finding, says Dr. Woolley. Estrogen receptors are typically found in the cell nucleus where they regulate the expression of genes, a relatively slow mechanism to change brain function. Her group found that these receptors also are located on vesicles at inhibitory synapses and that estrogen mobilizes these vesicles toward synapses.

The synaptic location of estrogen receptors shows that the effects of this hormone in the brain can be targeted to individual synapses, fine-tuning how neurons communicate, and on a much more rapid time scale then previously appreciated. The estrogen regulation of neurotransmitter vesicles points to novel targets for anti-epilepsy therapies.