What is the cause of Alzheimer's seizures?

U.S. scientists say an Alzheimer's disease-associated enzyme that disrupts neural activity in the brain might cause seizures in some Alzheimer patients.

The Massachusetts General Hospital researchers said the enzyme involved in the formation of the amyloid-beta protein associated with Alzheimer's can also alter the mechanism by which signals are transmitted between brain cells.

That might explain the increased incidence of seizures seen in some Alzheimer's patients.
The finding also suggests potential treatments that block the enzyme -- called beta-secretase or BACE -- might alleviate seizure occurrence.

The research is available online in the journal Nature Cell Biology.

New drug may treat Epilepsy in children

There is hope children with a certain type of epilepsy could soon be able to cut their rate of seizures by up to two thirds.

Tests have shown a new drug can help those who suffer frequent seizures.

Scientists hope by targetting a particular receptor in the brain with the drug the number of seizures could be significantly reduced.

University of New South Wales researcher Margaret Morris says there are already some drugs out there, but they hope to improve them.

“Some people don’t get much relief and some people have unacceptable side effects like weight gain,” Professor Morris said.

“So the search for better treatments is always important because we hope to be able to treat the seizures and prevent side effects.”

Currently some of those with certain types of epilepsy can suffer up to hundreds of seizures a day.

Can Carbon Dioxide treat Epilepsy?

Recent research shows that carbon dioxide (CO2) can offer a new and completely free way to prevent fever-related epileptic seizures. The discovery was made by the NordForsk-financed Nordic Centre of Excellence on Water Imbalance Related Disorders (WIRED)One of the researchers behind the discovery, Professor Kai Kaila from WIRED estimates that "if our results are confirmed in the clinical tests currently ongoing, CO2 enriched air could prove a simple, safe, effective and practically cost-free way to treat fever-related seizures among small children.

This could have both immediate benefits as the seizures are stopped very quickly as well as more long-term benefits, by reducing the risk of developing epilepsy at an older age."Fever-related epileptic disorders are very common in infants. The experiments carried out by WIRED have shown that epileptic seizures induced by fever can be stopped rapidly (within 20 seconds) and safely by simply adding 5% CO2 to the air inhaled.

Such fever-related seizures only affect children under the age of five, but experimental studies have shown that they could make the brain prone to epilepsy later in life.The therapy will not be limited only to fever-induced seizures, however. Evidence suggests that the treatment can also be effective in stopping some other types of epileptic seizures, potentially offering a welcome treatment to those suffering from epilepsy worldwide.

The impressive research results and their rapid clinical testing were made possible by the unique environment that the Nordic countries offer for research in the field of molecular medicines. Assets include extensive and reliable patient and epidemiological registries, biobanks, uniform high level health care systems, as well as a strong tradition in genetic and biomedical research.

The increased collaboration between the Nordic countries that the Nordic Centre of excellence constellation has made possible have given the associated researchers a mass and impact that have significantly increased the visibility of Nordic research in molecular medicine worldwide.

Olympic Logo triggers seizures!

Organisers of the official website of the 2012 Olympics in London were last night forced to remove animated footage from the site after reports that the use of flash imagery had triggered epileptic seizures.

Organisers said they had removed the footage after the charity Epilepsy Action said it had received calls from people who had suffered seizures after watching it. The charity said the images could be a danger to anyone with photosensitive epilepsy, which affects around 23,000 people in the UK.

According to Professor Graham Harding, who devised the test to ensure television images do not provoke epileptic fits, the piece was in contravention of Ofcom guidelines.

The animated footage was broadcast in television reports covering the launch of the controversial London 2012 logo on Monday. There were reports that the offending animation included the logo. One viewer, Christopher Filmer, told the BBC: "The logo came up on television and I was thinking about the 2012 Olympics and then I was out."

But a spokeswoman for the Olympics insisted that the offending footage related to a five second piece of animation featuring a diver in a swimming pool. "We have taken immediate steps to remove the animation from our website while checks are being conducted," she said. "The concerns are not about the design of the London 2012 logo."

Brain surgery can help with seizure disorders when medication is not enough!

Epilepsy surgery can eliminate seizures for 60 to 85 percent of people with temporal lobe epilepsy who do not respond well to medications. But surgery leads to memory problems in 25 to 40 percent of people. New research helps doctors and patients weigh the risks and benefits of surgery.

The study, published in the June 5, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology, shows that quality of life improves for people after surgery if their seizures are controlled, even if they develop memory problems.

"This is important information that can help people decide whether or not to undergo surgery," said study author John T. Langfitt, PhD, of the University of Rochester in Rochester, N.Y. "It suggests that the benefits of controlling seizures outweigh the downsides of memory problems. It may be that people can learn to compensate for memory problems more easily and effectively, such as by making lists and using an electronic organizer, than they can compensate for the restrictions that seizures can cause, such as not being able to drive."

Langfitt also noted that seizures are probably less socially accepted than these kinds of memory problems, which he says patients sometimes can pass off as everyday forgetfulness.

For the study, 138 people who had surgery for temporal lobe epilepsy were followed for five years after surgery. A total of 56 percent of those were free of seizures after the surgery. Another 26 percent were free of seizures at either two years after surgery or five years after surgery, but not both. The remaining 18 percent still had seizures at both two and five years after the surgery.
The quality of life scores remained stable for those who still had seizures but did not have any memory problems. Quality of life scores declined only for those who had both seizures and memory problems, which was eight percent of the participants.

Because certain risk factors make people more likely to have memory problems after surgery and other risk factors make people more likely to continue to have seizures after surgery, doctors can use these results to help determine who is a good candidate for surgery and also to closely monitor those who are at risk, Langfitt said.

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The study was supported by grants from the National Institute of Neurological Disorders and Stroke and the Agency for Healthcare Research and Quality.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com

Boy recovering from induced coma due to seizures

A 10-year-old Mannville boy is due to go to a rehabilitation facility following a medically induced coma because of seizures he was suffering.Garrett Heward-Hyndman was moved to Glenrose Rehabilitation Hospital after spending several weeks in Stollery Children’s Hospital.Heward-Hyndman’s mother Shannon Hyndman said doctors suspect Rasmussen’s disease, a rare neurological children’s disorder marked by seizures.

Although it will take about two months for an official diagnosis, Garrett is being treated for the disease now, to help it go into remission.Heward-Hyndman was in a coma for two weeks after falling ill at home. After he complained of flu-like symptoms, Hyndman took him to the doctor. The next day, “he’d been napping on the couch when he had a seizure,” she said.

That was the first of hundreds of seizures for Heward-Hyndman and, said Hyndman, “with each seizure, it’s like running a marathon.”After being brought out of the coma, Heward-Hyndman, who is on five anti-seizure medications, has had to relearn tasks such as walking and talking.“To see him start to do things is incredible,” Hyndman noted.

Alice Sheehan of the Mannville Hotel, who organized a recent benefit for Heward-Hyndman’s family, said the members of the community, and others in the area, rallied behind the family, including one person who donated $500 in gas coupons.“They have no problems giving here,” Sheehan commented, adding the money raised helped the family.“You can see the stress lifting from their faces.”Hyndman said the family has “come to discover” that giving spirit.“It’s been much appreciated.”

Can a special diet help to control seizures?

"A diet to ease the trauma of epilepsy", Telegraph, June 4, 2007, Link: http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/06/04/hepilepsy104.xml

Sara and David Garland lost their daughter, Daisy, to epilepsy. They tell Cassandra Jardine how their tragedy grew into a charity helping some of the UK's 59,000 epileptic children Daisy Garland was 18 months old when her mother, Sara, started her on a strange new diet. The first meal consisted of mackerel in olive oil, a little kiwi fruit and goat's cream mixed with water and vegetable oil. " 'This is awful,' I thought as I gave it to her," says Sara.

Three times a day, Daisy ate meals that would make even Atkins dieters feel queasy: omelettes with extra mayonnaise, lots of salmon and avocado, fatty frankfurters, cream, butter and olive oil galore, but very little carbohydrate and protein. The diet was so precise that even her toothpaste and sunscreen were sugar-free. "It was half scary, half exciting," says Sara, 43, who remembers vividly those early days when she would spend six hours calculating menus and weighing everything to the nearest gram. It was worth it.

Within a week of starting the diet, she and her husband David noticed a change in Daisy, who suffered from epilepsy: "It felt like a veil was lifting. Previously she had had as many as 100 seizures, day and night, but her fits became fewer, shorter and less violent." The seizures had begun in October 1998 when Daisy was five months old, a couple of days after her second polio, diptheria and tetanus vaccination.

Indeed a study published last year in Australia on vaccine links to Daisy's form of epilepsy - severe myoclonic epilepsy in infancy - has found an underlying genetic cause, with the first seizure possibly triggered by the rise in temperature following vaccination. Most of Daisy's seizures involved jerky movements, but she had many sorts: screaming seizures, tongue-biting incidents and others where she would stare into space.

"They would come out of the blue - just when you were ready to go out," her mother remembers. "You never knew what state she would be in afterwards. Sometimes she was fine, but after longer ones - her longest was six and a half hours - she had headaches and had to rest. Epilepsy was stealing her childhood; it left her little time to play or learn, and each seizure may have inflicted some brain damage." Penny Fallon, consultant paediatric neurologist at St George's Hospital, South London, tried various anti-convulsant medications and a steroid on Daisy.

The drugs only made her worse. "She was like a little zombie: drowsy and with little appetite. She also became aggressive and would stare into space and dribble," says Sara. It was then she decided to try the ketonic diet she had heard about. "Most doctors don't offer it because it is not a drug," she says. "No one knows exactly how it works and doctors like to understand what they are prescribing." "The NICE [National Institute for Clinical Excellence] guidelines are not to try the ketonic diet until two drugs have proved ineffective," says Fallon, who describes it as "not so much a diet as a treatment".

The idea behind the ketonic diet - which Sara wants to make available to other children with epilepsy - is to mimic starvation. When the body is denied carbohydrates as fuel, it instead burns fat - either body or dietary. This produces ketones, by-products of fat metabolism that can affect the brain. While the exact biochemistry is not yet known, the effect of fasting on seizures was recognised by Hippocrates in the 5th century BC.

It is safe only if prescribed by a dietician, who will devise a diet to put the body into ketosis while providing enough calories in the form of fat, as well as the protein, vitamins and mineral supplements needed for growth. It must be started in hospital, in case the child becomes hypoglycaemic, and under the supervision of a neurologist who can adjust medication and perform EEG (electroencephalogram) tests.

Although Fallon pointed to possible side-effects, including anaemia, high cholesterol and kidney stones, she eventually gave in to the Garlands' pleas and Daisy was put under a dietician who impressed upon them that there could be no cheating. If Daisy had so much as a couple of raisins that weren't on the day's diet sheet, Sara found, the result would be seizures a couple of hours later. It was worth it, however, because over the next few months she became seizure-free, was able to stop taking medication and developed much faster.

Just before she turned four, Daisy had the walking and talking skills of a two-year-old. Sara and David were beginning to have a life again, having formerly had to watch Daisy 24 hours a day. Then they had a tragic setback. After a routine test, Daisy was given antibiotics in hospital because she was thought to have E-coli. She didn't, but by the time that was known, Daisy had had a massive seizure and was so ill that she was not expected to last the weekend. She recovered, but it took a long time for her to become seizure-free again and she never regained either her balance or her speech.

Two years later, she went to bed one evening and never woke up. Sudden death is a feature of severe myoclonic epilepsy, but the Garlands fear her system had been weakened by the antibiotics. They might have dwelt bitterly on the past but they wanted to create a memorial to their daughter, so, a few months after Daisy's death, they set up a charity bearing her name. In just two years - during which time their daughter Grace was born - they have raised £90,000.

As well as creating a website, a support group for parents of children with epilepsy, and a handbook on the ketonic diet, The Daisy Garland charity is funding specialists to make the diet more widely available to some of the more severe cases among the 59,000 children with epilepsy in the UK. Lee-Anne McHarry, a dietician at St George's, was their first part-time appointment in March 2006. She now helps 14 children, which is as many as she can manage because each one requires constant adjustments to their diet to reflect their age, stage and food preferences.

"It's marvellous for their brains to be given a chance to develop," she says. "The diet can produce great changes in them - not just seizure reduction but behavioural changes. One child who was having screaming tantrums is now calmer and more alert." Younger children tend to do better on the diet than older ones, she finds, because parents have more control over what they eat. Some prefer the "classic" ketonic diet, others prefer one that substitutes medium-chain triglycerides (a pharmaceutical alternative) for naturally occurring fats.

Both seem to work equally well, according to studies by the Institute of Child Health attached to Great Ormond Street Hospital. But, despite the growing evidence of their effectiveness, ketonic diets are not generally available to children with epilepsy because dieticians are already overstretched. "Unfortunately," says Dr Helen Cross, who is overseeing the research at the ICH, "there are only a handful of departments in the UK with the expertise and resources to deliver it." The Daisy Garland charity hopes to change that.

The family moved to Totnes in Devon earlier this year, so the Garlands are hoping to place a second ketonic dietitian in a hospital somewhere in the West Country. To their great relief, Grace, who is now 18 months old, shows no sign of epilepsy, but Sara Garland's advice to parents who are going through what she experienced with Daisy is this: "Keep nagging your neurologist to be put in touch with a dietitian. Although the ketogenic diet is hard work, the results are amazing - and it soon becomes a piece of (sugar-free) cake."

Taking a risk with brain surgery can change your life for the better!

During a commencement speech, Alyssa Monroe told fellow Hickman High School graduates to be willing to take chances.

"If you want bigger rewards, take bigger risks," Alyssa challenged 575 graduates during Hickman’s afternoon graduation ceremony at Mizzou Arena.

It’s a lesson one graduating Kewpie has already learned.

In the summer, John Grupe gambled for a chance to live without epileptic seizures, undergoing a dangerous brain operation at St. Luke’s Hospital in St. Louis.

"It was a leap of faith," said his dad, Greg Grupe, who is also Hickman’s senior class principal. "There was a possibility it could have blinded him, or he could have lost his ability to speak."
John has spent the past eight years dealing with epilepsy, a neurological condition that causes seizures.

The seizures usually aren’t severe, he said, but they have prevented him from getting a driver’s license or participating in sports.

"It’s really hard," John said. "It impacts your life a lot. I didn’t get to do the things most high school students get to do."

He decided to wage war on the disability last year after he suffered more than 40 mini-seizures in one day.

Greg Grupe said he and John’s mom, Dixie, a Hickman teacher, left the decision up to their son.
"We didn’t fight him," Grupe said. "We talked a lot with him, but it was his decision. It was a chance to be seizure free, and he had to weigh that against the small possibility there would be problems."
The gamble paid off. While John isn’t completely cured, the seizures are a lot less frequent now. He might even be able to get his driver’s license if he can remain seizure-free over the next few months.

John believes the surgery also has made him a better person.

"It’s great not having as many any more," John said of the seizures.

"I’m happier in my surroundings. I’ve grown to be understanding and patient with everything."
He spent his senior year volunteering in a special needs classroom, saying he is able to relate to students with mental challenges. John is also thinking about pursuing a career in teaching, following the footsteps of his parents and sister Mary, who teaches at Rock Bridge High School.
But like many graduating seniors, John is keeping his options open. He will spend a year in the AmeriCorps before heading to college and deciding where his future will lead.

Other graduates who spoke during commencement said Hickman’s Class of 2007 would achieve greatness. Some could go on to find a cure for cancer or become the next Sam Walton or even the next president of the United States, graduate Thomas Goran said.

"We will make an impact, each one of us," graduate Lauren Fichter said. "We will make a difference in this world."

Greg Grupe is confident of that, not just for John, but for all graduating seniors.

"No matter what challenges arise in your life, if you believe in yourself and have a strong support system and you are a risk taker, you can do anything," Grupe said.

"I believe that about all the kids walking across that stage, but that one in particular."

Don't play hero, get help from the vet if your dog has seizures!

Just a moment ago your dog was nosing around the backyard. Then, suddenly, he is lying on his side, jerking and twitching for what seems like an eternity. Seeing your pet having a seizure can be terrifying, leaving you to wonder what you should do to help him.

The answer is simple: Resist the urge to hold or comfort your pet and just wait for the seizure to end. One thing you don’t need to do is worry about your pet swallowing its tongue or injuring itself. Fortunately, it is not physically possible to swallow a tongue, and I have never actually seen an animal that has injured itself during a seizure. Keep in mind that during a seizure, the muscle contractions in your pet’s jaw are powerful enough to amputate any fingers you might decide to poke in his mouth to protect his tongue.

If your dog bites his tongue, it will heal just fine. If he bites off your fingers, they will probably never work quite the same, even if they can be reattached. As horrible as it looks, it might be small consolation that an animal is unconscious during a seizure, so he will have no memory of it. Afterward, there is a period of time called the post-ictal phase, when the animal is conscious and almost back to normal, but the brain is rebooting and some systems may be a little out of whack for a while. This phase may last five minutes or five hours.

Isolated seizures of a few minutes duration do not cause measurable brain damage, but a prolonged series of closely spaced seizures, or a seizure that lasts more than 10 minutes (as measured by the clock, not just by how long it seems) starts becoming a risk for permanent problems. Those pets need immediate medical intervention at a veterinary hospital. The reasons for seizures in dogs and cats fall into two general categories. The first is known as extracranial, or outside the brain.

Examples would be metabolic problems such as a buildup of toxins from the liver or ill-functioning kidneys, low blood calcium in a nursing mother, or very low blood sugar in a diabetic being treated with insulin or a ferret with a blood sugar-lowering tumor. When presented with an animal that has had a seizure for the first time, a veterinarian will usually run blood work to rule out systemic problems that could lead to seizures. Often the lab work will come back normal, which suggests that the seizures are being caused by the other category: intracranial problems, or problems originating inside the brain itself.

Animals that have their first seizures when they are older than 10 are more likely to have something such as a brain tumor triggering the problem. Animals that have repeated seizures at younger ages are more likely to have epilepsy. Finding out exactly what is causing intracranial seizures usually requires advanced diagnostics, such as a CT scan of the brain. Although that multimillion dollar piece of equipment is not generally available to the average veterinarian, we can refer to specialists. When the expense of a CT scan makes that procedure impractical, we must use our best judgment to choose a treatment plan.

Epilepsy can usually be controlled with antiseizure medications such as phenobarbitol and potassium bromide. Once we start an animal on seizure control medications, it is a lifetime commitment. For that reason, veterinarians will often have an owner note when seizures occur until they reach a frequency that requires treatment. Sometimes an animal will have an isolated seizure and will never have another one; in those situations it would be unfortunate to start them on medication for the rest of their lives without a real need for it.

Some owners are reluctant to control their pets’ seizures with medication because they fear it’s “toxic.” All seizure medications can have side effects, but they tend to be minor and easily dealt with. If I had the choice of having my pet live a normal, happy, seizure-free life with side effects that include weight gain and drinking and urinating more, I would cheerfully choose that over having him eventually seizure to death because I was afraid of the medication that would solve the problem. Anne Pierce is a veterinarian with North Academy Veterinary Hospital. Contact her at anneepierce@hotmail.com.

3-D Imaging makes it easier for brain surgery!

Surgeons like Oren Sagher can use these images in the operating room, and even have them fed digitally into the special eyepiece that they use to perform surgery on very tiny areas of the brain.
From the outside, it may look like a gray lump of tissue, covered with ridges and bumps. But inside, an incredibly complex network of thread-like white fibers carries signals back and forth between areas of the brain and the spinal cord. Each fiber is crucial to a particular aspect of how our mind communicates with our body.

But until now, brain surgeons haven’t been able to see those fibers, called white-matter tracts. Invisible to the naked eye, and impossible to see on normal brain scans, they fall victim to even the most careful surgeon’s hand during operations to remove tumors or calm severe epilepsy. And the result can be permanent, unintended damage to the senses, movement, or thinking ability.
Now, advanced medical imaging is making it possible for surgeons to know where those tracts are – and even to see them in their field of vision while they operate.

A University of Michigan Health System team is one of the first in the world to offer this type of image-guided surgery. Already, it has helped them plan the operations of patients, and reduce their risk of damage. And the technique holds great promise for other uses as it is developed further.

“In the past, we had a pretty good idea of what different parts of the brain do, but we’ve never been able to see the direct connections from one part of the brain to another, or from one part of the brain to the spinal cord,” says one of the team’s leaders, Suresh Mukherji, M.D. “We can see those connections now, by looking at the sub-cellular level to see how the water molecules in the tissue move.”

Mukherji directs the U-M Division of Neuroradiology – a team of brain-imaging specialists. They work closely with U-M neurosurgeons, who perform thousands of brain and spine operations a year, and with neurologists who diagnose and treat brain and nerve disorders ranging from epilepsy and multiple sclerosis to cancer.

Neurosurgeon Oren Sagher, M.D., says this teamwork makes it possible for him to operate with the best possible information about each patient’s brain. “Thoroughly imaging the brain is one of the keys to successful brain surgery. We have to be able to see all the structures that we’re going after, and all the structures that are in our way and need to be avoided,” he says.

That’s what the new imaging technique, called tractography, makes possible for the first time.
The technique relies on powerful MRI (magnetic resonance imaging) scanners, which create images of patients’ brains, one thin slice at a time. U-M has several extremely powerful MRI machines, call 3T scanners.

Then, ultra-fast computers equipped with special software compile all of those slices into a three-dimensional image of the brain. Lastly, the neuroimaging team uses special techniques to see how water molecules are moving inside every area of that virtual 3-D brain.

It’s that water-movement imaging that allows the white-matter tracts to come into view. Inside the tracts, water can only move in a lengthwise direction, back and forth along the length of the thin strand. But in the rest of the brain tissue, the water can move around more freely.

In fact, U-M brain imaging specialists already use this kind of information to tell them if cancer cells are dying in response to chemotherapy or radiation, because water can move faster in dead or dying areas of cancer tissue than it can in healthy brain cells.

In tractography imaging, Mukherji explains, “How the water molecules are oriented, how they move, is something we can now detect, and as a result we can now see parts of the brain that we were never able to see before.”

Add that together with the ability to create 3-D maps of the brain, and the result is spectacular images that just show the entire network of white-matter tracts and the individual nerve fibers that they’re made of.

These images become a roadmap for surgeons like Sagher, especially when they’re superimposed on other images that show the specific areas of “gray matter” where epileptic seizures begin or where tumors lurk.

This cross-registration, as it is called, fuses the information about the areas of the brain that the surgeon needs to remove or destroy in order to treat the patient’s condition, with the information about what that the surgeon needs to avoid in order to preserve a patient’s vision, for instance, or her ability to move her right arm.

Surgeons like Sagher can use these images in the operating room, and even have them fed digitally into the special eyepiece that they use to perform surgery on very tiny areas of the brain.
“The computers can decipher the direction of the fibers, and then assign a color to them so we know that this group of fibers belongs to this tract, which has this function by virtue of where it is,” explains Sagher, who directs the U-M Image-Guided Surgery Program. “It essentially makes the invisible visible.”

He contrasts this kind of imaging with what was used even a decade ago. Back then, the neurosurgeon might be able to have a series of CT (computed tomography) scans showing the structure of the brain in individual slices. These transparent films would be hung on a lightbox in the operating room, and give the surgeon a sense of what to expect when he or she cut into the patient’s head.

Since that time, scanners have gotten better and the computers needed to create 3-D images have gotten more powerful, which has allowed surgeons to see the gray matter better and allow the computer to guide their hands to some extent. But only tractography allows them to see the white-matter tracts.

Now, he and his colleagues use the images to plan their operations ahead of time – for instance, when operating on a patient with epilepsy who has decided to have surgery after medicines have failed to control their seizures.

If the origin of the seizures is in a part of the brain that controls memory or learning, for example, the tracts that lead in and out of that area are key connectors that, if cut, can change the patient’s life forever. And if a tumor is deep within the brain, the operation needed to get to it can cut across many important areas. But the tractography images can let the surgeon see areas where there aren’t any tracts, and plan the route he or she will take to get to the area of the problem.

Mukherji, Sagher and their colleagues predict that tractography will change brain surgery and the way we see the brain’s function forever, just like the first CT and MRI scans of the brain changed the diagnosis and treatment of many disorders. The team is pursuing research to improve the technique and show how it can best be used – and how it helps spare patients from unintended consequences.

“Instead of imaging the brain, we’re essentially able to image the mind,” says Mukherji. “We’re able to image how a person’s thoughts and brain impulses travel, and this is just the beginning.”
One patient’s story about image-guided surgery:

At the age of 25, Kimberly Carothers was tired of having her life limited by her epilepsy. Though she’d been taking medications to control her seizures for over a decade, they weren’t working anymore. After suffering a serious “grand mal” seizure, she lost her right to drive for six months – a crushing blow for a young adult who wants to start life on her own.

So, she decided to explore the idea of surgery. Like the 20 percent of people with epilepsy whose condition resists all attempts at medication, she was a candidate to have a surgeon operate on the tiny area of her brain that was giving rise to the haywire electrical signals that caused her seizures.

She turned to the U-M Comprehensive Epilepsy Program, which includes neurologists and neurosurgeons who help nearly 100 patients each year achieve a cure for their condition through surgery. The fact that U-M offers special brain-imaging techniques that can help reduce the risk of damage to healthy brain tissue during surgery helped put her mind at ease. “The doctors have just made me so confident about it, and never having to take medicine again would be the greatest thing for me.”

The operation, early this spring, was a success. “Since the surgery, I’ve not had any seizures,” Kimberly says. “In the future, I’m looking forward to someday having kids, and going back to school. I feel really good about it.”

Treating Epilepsy!

Epilepsy and seizures affect 2.5 million Americans, and about 450,000 children develop epilepsy each year. Brain injury or infection can cause epilepsy at any age; however, the cause of epilepsy is unknown for about half of all individuals with the disorder. Advances in treatment have improved the quality of life for thousands of adults and children suffering from seizures.

Epilepsy and seizures affect 2.5 million Americans, 181,000 new cases of epilepsy are diagnosed every year, and the disorder incurs an estimated $12.5 billion in annual direct and indirect costs. About 450,000 children ages 15 and younger develop epilepsy each year, and of these, 315,000 are school-aged children. Children and adolescents are more likely to have epilepsy of unknown or genetic origin. The rate of new cases in children is highest before age 2, gradually declines until about age 10, and then stabilizes.

“Brain injury or infection can cause epilepsy at any age; however, the cause of epilepsy is unknown for about half of all individuals with the disorder,” said Howard Weiner, MD, a pediatric epilepsy neurosurgeon at NYU Comprehensive Epilepsy Center, and an American Association of Neurological Surgeons (AANS) spokesperson. 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 cause. In people age 65 and older, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer's disease. Seizures may not begin immediately after a person incurs a brain injury – seizures may occur many months later.

The emotional and physical toll can have a very negative impact on patients with refractory epilepsy. Uncontrolled seizures may cause significant physical injury or accidents, as well as cause cognitive disturbances, poor school or work performance, inability to work, and progressive memory deterioration. People with epilepsy may feel socially isolated and limited, thus diminishing their quality of life. The families of patients may also be significantly impacted emotionally by the disorder.

According to the AANS, tremendous advances have been made in epilepsy treatment over the past decade. Epilepsy may be treated with drug therapy, surgery, biofeedback, vagus nerve stimulation (VNS) or a ketogenic diet. The wide range of antiepileptic drugs (AEDs) remains the cornerstone of treatment.

AEDs treat the symptoms of epilepsy (the seizures), rather than curing the underlying condition. The drugs act on the brain to prevent the seizures from starting by reducing the tendency of the brain cells to send excessive and confused electrical signals. Before any drug is prescribed, it is important to discuss potential benefits, side effects and risks with your doctor.

Brain surgery may be a viable alternative for some people whose seizures cannot be controlled by medication. A person who has been given adequate dosages of several seizure medications, for an appropriate period of time without good results, is unlikely to achieve complete seizure control with any other medication.

Epilepsy surgery can benefit patients who have seizures associated with structural brain abnormalities, such as benign brain tumors and cortical dysplasia, malformations of blood vessels (such as arteriovenous malformations and cavernous angiomas), the genetic disorder tuberous sclerosis, and strokes.

The goal of epilepsy surgery is to identify an abnormal area of brain cortex from which the seizures originate and remove it without causing any major functional impairment.

Surgery is most commonly performed to treat partial epilepsy, since only one area of the brain is involved. After surgery, many patients will be seizure-free, while others will have better controlled seizures. A few patients may not improve and will need to explore further treatment options.
In some cases, a palliative approach is used to stop the spread of seizures, when the actual seizure focus cannot be determined accurately.

One such approach involves cutting the nerve fibers connecting the two sides of the brain through a corpus callosotomy. The corpus callosum is a band of nerve fibers located deep in the brain that connects the two sides (hemispheres) of the brain. It helps the hemispheres share information, but it also contributes to the spread of seizure impulses from one side of the brain to the other.

Some conditions are associated with seizures arising from one entire half of the brain – one hemisphere which is not functioning normally. A functional hemispherectomy is a surgical procedure performed in these cases, in which the epileptic, non-functioning hemisphere is disconnected from the remaining, normal hemisphere in order to stop the seizures.

“Depending on how well the seizure focus can be defined, between 50 and 90 percent of children who have epilepsy surgery stop having seizures entirely or experience a major reduction in the number of seizures. Many people in the field believe that the earlier in a child’s development that surgery is performed, the better the outcome,” stated Dr. Weiner.

For more information on epilepsy and other neurological conditions, please visit: http://www.neurosurgerytoday.org/what/patient_e/epilepsy.asp.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public.

All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain, and peripheral nerves.