Tag Archives: epilepsy

What is epilepsy: the brain’s thunderstorm

Credit: Pixabay.

Epilepsy is a brain disease that involves recurrent episodes of involuntary movements known as seizures. Seizures may involve a part of the body or the entire body, and are sometimes accompanied by loss of consciousness, as well as loss of bowel or bladder control.

Epilepsy affects people of all ages. An estimated 50 million people worldwide have epilepsy, making it one of the most common neurological diseases.

What causes epileptic seizures?

Seizures are the hallmark of epilepsy. However, you need to experience at least two unprovoked seizures to be diagnosed with epilepsy. A single seizure does not signify epilepsy. In fact, up to 1 in 10 people worldwide will have a seizure during their lifetime.

Epileptic seizures are caused by abnormal brain activity, specifically surges of electricity in the brain. Most seizures happen suddenly without warning, last a short time (a few seconds or minutes) and stop by themselves.

During a seizure, a large number of nerve cells in the brain fire excessively and in synchrony, and this hyperactivity may lead to uncontrollable shaking of the body and periods of loss of consciousness. Imagine a thunderstorm causing the outage of an electrical network, temporarily disrupting connections, likewise electrical activity in brain cells can be prevented from working normally.

Seizure symptoms can vary greatly since abnormal brain activity can affect coordination. Some epilepsy patients simply stare blankly for a few seconds during their seizure, while others repeatedly twitch their arms or legs.

A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness, whereas a strong seizure can last several minutes.

The most common epilepsy symptoms may include:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Psychic symptoms such as fear, anxiety or deja vu

Many people with epilepsy have more than one type of seizure and may even have symptoms of other neurological disorders. For the most part, an epilepsy patient will tend to have the same kind of seizures each time, meaning the symptoms should be similar from episode to episode.

What causes epilepsy?

Epilepsy is a complex neurological condition that can be triggered by a number of different underlying causes, leading to different types of seizures.

A person might start having seizures due to:

  • A genetic inheritance from one or both parents. If you have a family history of epilepsy, you may be at risk of developing a seizure disorder.
  • A structural change in the brain due to either poor brain development because of a childhood disease or damage to the brain. Head injuries, infections like meningitis, a stroke, or a tumor can also cause epilepsy in some people.
  • Structural changes caused by genetic conditions such as tuberous sclerosis, or neurofibromatosis, which tend to cause growths affecting the brain and nervous system.
  • Dementia, which can increase the risk of epilepsy in older adults.

Types of seizures

There are over 40 different types of seizures, each with its different symptoms and patterns.

In order to diagnose a person’s type of epilepsy, a doctor will typically perform an electroencephalogram (EEG) or magnetic resonance imaging (MRI) test to look for certain patterns in the recorded brain waves.

Doctors classify epilepsy as:

  • Generalized epilepsy
  • Focal epilepsy
  • Unknown if generalized or focal epilepsy

Generalized epilepsy

Generalized epilepsy involves seizures that affect all areas of the brain. There are six subtypes of generalized seizures.

  • Absence seizures. Previously known as petit mal seizures, these often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip-smacking. These seizures may occur in clusters and cause a brief loss of awareness.
  • Tonic seizures. These seizures cause stiffening in the muscles and may cause a person to fall to the ground.
  • Atonic seizures. Also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
  • Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face, and arms.
  • Myoclonic seizures. Myoclonic seizures are characterized by sudden brief jerks or twitches of the arms and legs.
  • Tonic-clonic seizures. Previously known as grand mal seizures, these are the most dramatic type of epileptic seizure because they can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

Focal epilepsy

Seizures that result from abnormal activity in a single area of the brain are called focal seizures. These fall into two subcategories:

  • Focal seizures without loss of consciousness. Previously known as simple partial seizures, these seizures don’t cause a loss of consciousness. They may result in involuntary jerking of a body part, such as the arm or leg, as well as spontaneous sensory symptoms such as dizziness or tingling.
  • Focal seizures with impaired awareness. Previously known as complex partial seizures, these seizures involve a change or loss of consciousness or awareness. Patients affected by this type of focal seizure may stare into space and not respond normally to the environment or perform repetitive movements, such as walking in circles or hand rubbing.

How are seizures triggered?

https://www.youtube.com/watch?v=zOmLPQ3WIGs

Some patients find that certain factors may trigger a seizure. These include:

  • Missing medication. Some people with epilepsy are so sensitive that missing a dose of their antiepileptic medication can dramatically increase their risk of having seizures. The longer the break between doses, the greater the chance of having a seizure.
  • Stress. High stress may lower the seizure threshold and trigger seizures. This is why it’s important to recognize signs of harmful levels of stress early in order to manage it.
  • Lack of sleep. This is one of the most common triggers of seizures.
  • Alcohol. For most people with epilepsy, moderate alcohol intake (no more than two standard drinks in a day) should be fine. However, some are very sensitive to even small amounts of alcohol. Alcohol also reduces the effectiveness of the antiepileptic medication, making seizures more likely.
  • Certain drugs and supplements. Like alcohol, some sedative and hypnotic drugs, such as sleeping pills and certain illegal drugs, can trigger seizures when combined with antiepileptic medication. This is why it’s very important that you always share with your doctor all the substances that you use on a regular basis.
  • Diet. What food or drink you consume can have a profound effect on the incidence of seizures. Caffeine, for instance, can trigger seizures. Others become sensitive to seizures when they miss meals and have a low blood sugar level.
  • Photosensitivity. Footage with flickering strobe lights is often accompanied by a warning advising against viewing for those with epilepsy. However, photosensitive epilepsy is quite rare, affecting only a small fraction of those suffering from epilepsy.
  • Menstruation. Some women with epilepsy find that their seizures happen just before or during their menstrual period. This may be due to a combination of changes in hormonal levels, fluid retention, and the amount of antiepileptic medications in the blood.

Since each person can have their seizures induced by different factors, doctors recommend keeping a seizure diary. The diary should include:

  • Date and time of seizures  
  • If you were asleep or awake  
  • Description or type of seizure  
  • What happened before, during and after the seizure, if known 
  • Medication taken or missed that day, including medication for other conditions 
  • Any possible seizure triggers  
  • General health and energy level leading up to the seizures  
  • Menstrual cycle for women 

Treatments

It’s believed that up to 70% of people with epilepsy can live seizure-free if properly diagnosed and treated with the right medication. However, out of the 50 million people worldwide who suffer from this brain disorder, three-quarters live in low-income countries where they do not get the treatment they need.

While about two-thirds of patients respond to anti-epileptic medication, the remainder is resistant to current medical treatment. But new research may also address this group of patients that are drug-resistant.

Anti-epileptic drugs target nerve cells, but researchers in Germany and Japan went a different route. Rather than neurons, they devised a new drug that targets a class of glial cells known as astrocytes.

Astrocytes control the local environment and are responsible for the ion balance in the brain, but also play an important role in signal transmission between neurons. In a study published in early 2021, the researchers led by Dr. Christine Rose from Heinrich-Heine University Duesseldorf found that epileptic discharges lead to a rise in the pH of astrocytes.

In experiments, researchers also found that drugs that suppress changes in astrocytic pH  caused mice to suffer less severely from epileptic hyperexcitability than untreated animals.

“This observation is very intriguing. But it still needs to be established whether or not it can be transferred to humans. And it will take a very long time before any potential drug can be developed and be really used in the clinics,” Rose said.

In the future, treatments such as these and better coverage of existing antiepileptic medication may provide a seizure-free life to all epilepsy patients.

Some epileptic seizures could be triggered by autoantibodies

Epilepsy can have many origins such as a result of a brain injury or a stroke, it can be triggered by a tumor or even passed down along family lines. Now a new study published in the scientific journal Annals of Neurology by researchers at the University of Bonn has found another mechanism that might cause seizures.

Epilepsy is a disorder in which nerve cell activity in the brain is disturbed, causing seizures. (Image: Pixabay)

While it has been known that some forms of epilepsy are accompanied by inflammation of certain brain regions, the link between these inflammations and the seizures themselves hasn’t always been clear.

It is particularly dangerous when inflammatory reactions affect the hippocampus — a brain structure that plays an important role in memory processes as well as the development of emotions. This causes a condition coined limbic encephalitis, but it is still unclear exactly what processes trigger the condition. The scientists at Bonn have now found that autoantibodies are playing an important role.

Unlike normal antibodies, these autoantibodies are not directed against molecules that have entered the organism from outside, but against the body’s own structures (the prefix “auto” can be translated as “self”).

The Bonn study found these autoantibodies in the spinal fluid of epilepsy patients suffering from acute inflammation of the hippocampus. The autoantibody is directed against the protein drebrin. Drebrin ensures that the contact points (synapses) between nerve cells function correctly.

The problem with autoantibodies is that they act somewhat like a trojan horse.

Information processed in the brain is electrical, however, these synapses communicate via chemical messengers — the previously mentioned neurotransmitters. In response to an electrical pulse, the transmitter synapse emits transmitters that then dock to certain receptors of the receiver synapse, where they in turn also generate electrical pulses. The synaptic vesicles (the “packaging” of the neurotransmitters) are once again absorbed and then are recycled.

In experiments with cell cultures, the Bonn group was able to show that shortly after the addition of the autoantibody to the Petri dish, the neurons began to fire machine-gun-like rapid bursts of electrical impulses. In the human brain, this would then most likely result in an epileptic seizure.

“The autoantibody seems to use this route to sneak into the cell, as with a Trojan horse,” explains Becker’s colleague Prof. Dr. Susanne Schoch McGovern. “We know that this form of electrical excitation is contagious, so to speak. With nerve cells, which are interconnected to form a network, all the nerve cells involved suddenly start firing wildly.”

Besides learning about this new method of potential seizures, these results also give hope for new therapeutic approaches for epilepsy. As an example, active substances such as cortisone can suppress the immune system and thereby possibly also prevent the massive production of autoantibodies.

The researchers also elude that it may also be possible to intercept and incapacitate them specifically with certain drugs. However, they also believe there is still a long way to go before treatment becomes available.

Epilepsy affects both males and females of all races, and according to the Centers for Disease Control and Prevention, as of 2015, almost 40 million people globally suffered. According to a 2016 Lancet publication, the year prior resulted in 125,000 deaths from the condition, an increase from 112,000 in 1990. There are over 150,000 new cases every year and one-in-26 people in the U.S. will develop the disease at some point in their lives. Alexander the Great, Theodore Roosevelt, Napoleon Bonaparte, Neil Young, and Prince are some of the most well-known sufferers of epilepsy.

Scientists find ‘epilepsy demon’ in 2,700-year-old clay tablet

The horned demon can be seen at the bottom of this picture of the clay tablet. Credit: Troels Pank Arbøll.

Danish Assyriologist Troels Pank Arbøll was studying cuneiform tablets discussing ancient medicine in a Berlin museum when he stumbled across a peculiar image. Etched on the corner of one of the tablets was a horned demon with a tail and a snake’s tongue — no one had noticed it before. According to the adjoining cuneiform text, the demon was the cause of epilepsy, or what the Assyrians and Babylonians called “Bennu”.

“We have known for a long time that the Assyrians and Babylonians regarded diseases as phenomena that were caused by gods, demons or witchcraft. And healers were responsible for expelling these supernatural forces and the medical symptoms they caused with drugs, rituals or incantations. But this is the first time that we have managed to connect one of the very rare illustrations of demons in the medical texts with the specific disease epilepsy,” Arbøll said in a statement.

In ancient texts such as these, Bennu-epilepsy was regarded as a dreaded disease whose symptoms included seizures, loss of consciousness or sanity, and peculiar behavior — in some cases, the text describes patients who cried out like goats.

The tablet analyzed by Arbøll claims that the epilepsy demon was acting on behalf of Sîn, the lunar god. By the scholar’s interpretation of the text, Assyrians and Babylonians believed that there was a connection between the moon, epilepsy, and insanity.

Credit: Olaf M. Teßmer.

This idea spread wide and fast — thousands of years later you can still find it in western cultures. The English word ‘lunacy’, for instance, is a remnant of this interpretation.

Many cultures regard epilepsy as a “sacred disease”. People who had it were either considered “divine and religiously inspired” or “possessed by a demon or unclean spirit”. For instance, the Jewish Talmud refers to a person with epilepsy as “nikhpe”, meaning “one of writhes”.

Today, the term “epilepsy” is medically defined as “a neurological disorder with recurrent sensory disturbances, loss of consciousness or convulsions; associated with abnormal electrical activity in the brain.”

“In other words, the views on illness, diagnoses and treatments in the earliest civilisations have had a significant impact on later perceptions of illness, even in recent history, “said Arbøll, who is an Assyriologist at the University of Copenhagen.

The Danish scholar’s findings were described in the Journal des Médecines Cunéiformes.

November is Epilepsy Awareness Month

There are many misconceptions of what to do when someone is having a seizure. (Image: Epilepsy Foundation)

As Hippocrates once said “People think that epilepsy is divine simply because they don’t have any idea what causes epilepsy. But I believe that someday we will understand what causes epilepsy, and at that moment, we will cease to believe that it’s divine.”

Four of the hardest words to process are “you’ve had a seizure.” Once you have finally comprehended them, you still haven’t grasped the fact that they will change the course of your life. Those SCUBA diving lessons you had planned for next year? Forget them. The military? Nope. Even driving could be chancy.

According to the Centers for Disease Control and Prevention, as of 2015, 1.2 percent of the total United States population suffered from epilepsy. That’s 3.4 million people. Globally, it’s almost 40 million, with nearly 80 percent of cases occur in the developing world. According to a 2016 Lancet publication, the year prior resulted in 125,000 deaths, an increase from 112,000 in 1990. There are 150,000 new cases every year and one-in-26 people in the U.S. will develop the disease at some point in their lives. Alexander the Great, Theodore Roosevelt, Napoleon Bonaparte, Neil Young, and Prince are some of the most well-known epileptics.

We are the blessed, the cursed, the chosen, and the possessed. History has dictated the angels or demons that possess our bodies. The oldest detailed account of epilepsy comes from a Babylonian textbook of medicine comprising 40 tablets that date as far back as 2000 BC.  This actually records many of the different seizure types we see in the present day. It emphasizes the supernatural nature of epilepsy, with each seizure type associated with the name of a spirit or god – usually evil. Treatment was, therefore, largely a spiritual matter.

In reality, epilepsy is a set of neurological disorders which can vary from unnoticeable periods of staring to the public’s perception which includes periods of vigorous shaking. Causes can stem from disruptions at the cellular level to dramatic brain injuries. Oh, and anyone who can discover what causes the cellular disruptions should book their plane ticket to Oslo, Norway. That Nobel prize for medicine is theirs.

There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures. All involve loss of consciousness and will typically happen without warning.

Sixty percent of seizures are convulsive. One-third of these begin as generalized seizures, affecting both hemispheres of the brain. The other two-thirds begin as focal seizures (that which affects only one hemisphere of the brain) which could then progress to a generalized seizure.

The remaining 40 percent of seizures are non-convulsive, such as the absence seizure, which is presented as a decreased level of consciousness and usually lasts about 10 seconds.

November, which is National Epilepsy Awareness Month, brings attention to the condition, and hopes to educate the public and dispel any myths. Probably two of the greatest myths (and most dangerous) are the ones you hear about putting something in the mouth of someone having a seizure and holding someone down who is having a seizure.

Contrary to popular belief, you cannot swallow your tongue. The only thing you’re going to do there is hurt the person you are trying to help. Tissue around the tongue prevents it from going back into the mouth, and any blood you might see comes from the person biting it. But that comes with the territory. Put something in an epileptic’s mouth you risk choking them or even breaking their teeth.

One of the worst misconceptions is that you should hold the person down. This action basically sends signals to the brain to fire even more uncontrollably, resulting in even more harm. The best course of action is to turn them over on their side, put something soft under their head and make sure that they are kept out of harm’s way. It’s as scary as hell to see, but make sure to stay calm and wait for the seizure to stop on its own.

A simple run-down of what to do in the event you see someone having a seizure is listed on the National Epilepsy Foundation’s website.

1) Stay with the person and start timing the seizure. Remain calm and check for a medical ID.

2) Keep the person safe. Move or guide away from harmful objects.

3) Turn the person onto their side if they are not awake and aware. Put something small and soft under the head and loosen tight clothes around neck.

4) Do NOT put anything in their mouth.

5) Do NOT restrain them.

6) Stay with the person until they are awake and alert after the seizure. Most seizures end in a few minutes.

There is no need to call emergency services unless the seizure lasts longer than five minutes, there are repeated seizures; the person has difficulty breathing; the seizure occurs in water; the person is injured, pregnant, or sick; they do not return to their usual state; or if it is their first time having a seizure.

While it is a dramatic and life-changing event, do not pity us. Do not look differently at us. In the book Electricity, Ray Robinson says it best when his main character Lily says “I’m important. I matter. I can do anything. I’m a sexy, strong woman that happens to have epilepsy. Do you get it? I have epilepsy but it’s not who I am.”

Google’s Doodle celebrates the Canadian neurosurgeon who treated epilepsy with the help of a toasty hallucination

Today’s Google Doodle celebrates the 127th birthday of Wilder Penfield, a Canadian neurosurgeon famous for developing a ground-breaking treatment for epilepsy called the Montreal Procedure.

Google honored Wilder Penfield on his 127th birthday. Credit: Google.

Google honored Wilder Penfield on his 127th birthday. Credit: Google.

In the 1930s, while working at the Montreal Neurological Institute at McGill University, Penfield was seeing a patient who reported smelling burned toast just before her seizures. Most people suffering from epilepsy have so-called ‘auras’ — sensorial hallucinations in the form of smell, taste, or thought — that systematically occur before an epileptic episode.

It was at that moment that Penfield had a stroke of genius. He realized that he could use such a hallucination to pinpoint the part of the brain that was causing seizures.

Penfield opened the patient’s skull, who was under local anesthetic — but nonetheless completely awake as cooperation was essential — then asked her what she heard, smelled, or saw each time some area of the brain was stimulated. Penfield used electrodes to send mild electric shocks to one area of the brain after another until the patient exclaimed: “I smell burned toast!”. Bingo!

It was then only a matter of removing the small piece of brain tissue which produced the ‘aura’ when stimulated. After the small brain tissue was removed, the patient never had a seizure again. It was truly a groundbreaking moment in medicine!

There are, of course, various types of seizures and this procedure doesn’t work for everyone. Nevertheless, Penfield went on to perform numerous such surgeries, helping countless patients treat their epilepsy. 

WilderPenfield-AtBlackboard-ByMNI

Credit: McGill University.

What’s more, Penfield’s surgeries not only treated the debilitating effects of epilepsy, they also revealed numerous insights about how the human brain works. While probing nerve cells in the hippocampus, the region of the brain responsible for memory formation and storage, some patients would report vivid and complex recollections of past events.  For one patient, Penfield triggered a familiar song that sounded so clear, the patient thought it was being played in the operating room. Thus, simply reactivating nerve cells in the hippocampus can induce memory recall, something MIT scientists confirmed without a doubt in 2012. 

https://twitter.com/Passport2017/status/816758198917021697

Penfield also charted a map of the brain’s functions. He found that electrical stimulation could trigger the urge to move or the expectation of a movement, without actually triggering any movement itself. For instance, a patient might report various sensations, from vague feelings like the “need to do something with right hand” to very specific movement intentions such as the “urge to move right thumb and index finger.” With this information, Penfield drew a detailed map of where sensory and motor functions happen in the brain.

This image displays a brain that has been sliced lengthwise, dividing the front and back halves, viewed from the back. The cartoon-like drawings in the illustration show how much of the brain’s motor cortex is devoted to controlling specific body parts. The reason that some body parts are depicted larger than others (for example, the hand is larger than the shoulder) is that there are more muscles controlling those areas. Credit: PBS.

Penfield died in 1976 but his legacy lives on. His contributions to modern neuroscience raised Canada’s status in healthcare, science, and discovery. Not lastly, his work offered gave epileptic people a chance at a better life.

Empatica's wristband, called Embrace (pictured here), is “a consumer-looking, but medical-quality device” for monitoring stress and seizures. Credit: Empatica.

Life-saving wristbands monitor epilepsy by detecting and characterizing seizures

Italian and American researchers have devised wristbands that detect and characterize seizures in patients with epilepsy. These wearable devices offer a far more practical way to monitor seizures and might even save lives.

Empatica's wristband, called Embrace (pictured here), is “a consumer-looking, but medical-quality device” for monitoring stress and seizures. Credit: Empatica.

Empatica’s wristband, called Embrace (pictured here), is “a consumer-looking, but medical-quality device” for monitoring stress and seizures. Credit: Empatica.

If someone with epilepsy dies suddenly and unexpectedly, and no obvious cause of death can be found, it is called sudden unexpected death in epilepsy (SUDEP). It’s the most common type of epilepsy-related death, most frequently occurring at night. All in all, 50,000 people die each year in the United States from seizure-related causes, with SUDEP accounting for 8-17% of deaths in people with epilepsy.

Doctors typically monitor a patient’s seizures using video-electroencephalography. During video-EEG monitoring, the patient wears an EEG transmitter connected to a wall outlet by coaxial cable while going about her normal routine (like napping, talking, and watching television). Wall-mounted video cameras provide continuous behavioral observation. Both EEG and video signals are transmitted to a control room, where the EEG is reformatted and conducted to a video monitor. The EEG signal and video are displayed simultaneously for online observation, and both are recorded on videotape. The EEG may be recorded on paper or stored on an optical disc.

The problem with video-EEG is that the whole setup is extremely cumbersome and doctors have to rely on patients and caregivers to report seizure counts. Most often, the counts are inaccurate.

Giulia Regalia and Francesco Onorati, both scientists at Empatica, Inc. in Milan, Italy and Cambridge, Massachusetts, wanted to design a wearable system capable of detecting and characterizing convulsive epileptic seizures.

In a new paper published in the journal Epilepsia, the scientists report their findings after employing three different wristband designs that recorded 5,928 hours of data from 69 patients, including 55 convulsive epileptic seizures from 22 patients. The wristbands recorded two types of signals: electrodermal activity and accelerometer data. The strength of these signals can inform doctors whether or not a convulsive seizure is nigh.

Embrace, one of the wristbands designed by Empatica to detect epileptic seizures and monitor stress, is equipped with sensors that track pulse, body motion, temperature, and EDA. The latter involves subtle electrical changes across the skin. Boosts in EDA, without accompanying changes in motion, can signal stress. In people with epilepsy, a sharp rise in both signals could indicate a severe, potentially life-threatening seizure.

The wristbands detected 95% of all seizures with only one false alarm ocurring every four days, which was deemed acceptable. Besides detecting seizures, these devices could also reveal important characteristics of the seizures. This sort of data can alert doctors that their patients are about to enter a potentially dangerous and life-threatening seizure.

“The present work provides significant improvements for convulsive seizure detection both in clinical and ambulatory real-life settings,” said Dr. Regalia said in a press release. “Accurate seizure counts with real-time alerts to caregivers allows an early application of aid, which can be protective against SUDEP risk.”

CBD oil seems to reduce the frequency of seizures in children suffering from a rare form of epilepsy. Credit: Phyto.

CBD oil made from cannabis cuts rare epileptic seizures in half

CBD oil seems to reduce the frequency of seizures in children suffering from a rare form of epilepsy. Credit: Phyto.

CBD oil seems to reduce the frequency of seizures in children suffering from a rare form of epilepsy. Credit: Phyto.

Scientists gave children with a severe form of epilepsy a non-psychoactive form of medical cannabis and found the number of seizures dropped. What’s more, some of the children don’t have any seizures at all now. This is the first time scientists document a form of medical cannabis treating severe epilepsy despite the numerous anecdotal evidence presented on the TV or the internet.

43% of epileptic children had a 50% reduction in seizure frequency with cannabidiol (CBD)

For their study, the team of researchers enlisted 120 children and young adults across the US and Europe who are suffering from Dravet syndrome. This is a genetic dysfunction of the brain that begins in the first year of life with frequent and/or prolonged seizures. Current treatment options are limited, and the constant care required for someone suffering from Dravet syndrome can severely impact the patient’s and the family’s quality of life. The mortality rate is also very high, up to 20%. It’s an incredibly devasting disease with no cure in sight.

During the course of the randomised, double-blind and placebo-controlled trial, the researchers measured seizure frequency over a 14-week treatment period with cannabidiol or CBD, as it’s also known. Cannabidiol is one of at least 113 active cannabinoids identified in cannabis. CBD is the second most abundant compound in hemp, typically representing up to 40% of its extracts. Because CBD is an extract, it doesn’t contain THC which is the intoxicating and (in most parts of the world) illegal substance that is responsible for causing marijuana users to get “high”. But both CBD and THC interact with cells within our bodies by activating the cannabinoid receptors which transmit signals within our bodies, causing different physiological effects.

At the end of the trial, the frequency of convulsive seizures per month decreased considerably from 12.4 to 5.9 for the children who were given CBD compared to an insignificant 14.8 to 14.1 among the placebo control group. Overall 43 percent of children with the syndrome had a 50 percent reduction in seizure frequency with cannabidiol. Even more remarkably, 5 percent of the participants report seizures had stopped altogether.

“This is a major scientific breakthrough”, said  Professor Ingrid Scheffer from the University of Melbourne in a statement.

“If you can render any child or adult seizure free, that’s huge. It could contribute to stopping any further deterioration, or help development in a positive sense.”

For 1 in 20 children, the seizures stopped altogether

The participants also reported feeling better overall. When the children’s caregivers were asked to fill in the Global Impression of Change questionnaire — a scale which rates change in a patient — the patient’s overall condition improved by at least one category in 62 percent of the cannabidiol group, compared with only 34 percent of the placebo group.

If you use social media and you’re a Millennial, chances have it you’ve already seen various videos and memes of unidentified people who had their epilepsy seizures reduced by smoking cannabis or ingesting CBD oil. Some of these videos may be true nevertheless this is the first time science has proven this may be true.

“It’s the first scientific evidence that cannabidiol works. There have been anecdotal reports in the past, and people with firm beliefs that it works in epilepsy, but this is the first time it’s been proven,” Scheffer said.

While the results are very promising, the researchers caution that CBD isn’t a cure for this dreadful disease. Even so, for the estimated 1 percent of the population that has epilepsy or 65 million people globally, CBD could drastically change their lives for the better. Dravet syndrome is a rare condition though affecting around 1 in 16,000 people, so the next challenge will be investing whether or not the finding translate to other forms of epilepsy.

“But it does give cause to be optimistic about further research for its use. It also raises a lot of questions, not just in terms of the treatment of epilepsy, but where else it could be applied medicinally,” Professor Scheffer said.

“Cannabidiol is likely to be an important addition to our group of anti-epileptic tools,” he concluded.

The findings appeared in the New England Journal of Medicine.

Epilepsy patients turning more and more to medical cannabis

A new study revealed that 14% of people with epilepsy have turned to cannabis to alleviate their condition — almost all of them report significant improvements.

Image credits: Garretttaggs55 / Wikipedia.

Epileptic seizures are episodes that can vary from brief and nearly undetectable to long periods of vigorous shaking. For many people suffering from this group of neurological disorders, there’s no effective treatment. Although medication can control seizures effectively in about 70% of cases, that still leaves a great number of people suffering from seizures. Marijuana has often been reported as effective in dealing with seizures, but so far, scientific evidence is insubstantial. Yet, even so, people are turning to it more and more.

A nationwide Australian survey found that 14% of people with epilepsy had used cannabis products to manage the condition, with 90% of adults and 71% of children reporting some success in managing the seizures. The study was led by Anastatsia Suraeve from the Lambert Initiative, who said that the study didn’t aim to see whether or not cannabis actually helps epilepsy sufferers, but why people choose this line of alternative treatment.

The study does have major limitations, as it relies on the patients’ own reports and was carried out online, not in a controlled lab setup. But even so, the fact that so many people are turning to cannabis, and so many of them (almost all) report some progress is intriguing.

“Despite the limitations of a retrospective online survey, we cannot ignore that a significant proportion of adults and children with epilepsy are using cannabis-based products in Australia, and many are self-reporting considerable benefits to their condition,” Suraeve said. “More systematic clinical studies are urgently needed to help us better understand the role of cannabinoids in epilepsy,” she said.

Indeed, figuring out whether marijuana makes a difference in epilepsy — and ideally, figuring out how it does this — is essential. Stories of cannabis being able to alleviate seizures have been around for over 150 years, but interest in the medical capabilities of cannabis has increased sharply in the past decade. However, despite anecdotal evidence, the science has been inconclusive at best. Still, there have been some studies highlighting that marijuana can fight against epilepsy seizures. Orrin Devinsky, a neurologist at New York University Langone Medical Center recently published the largest study to date of a cannabis-based drug for treatment-resistant epilepsy in The Lancet Neurology. He reports that it can act as an anticonvulsant and may even have antipsychotic effects, but this is just one study — much more is needed, and funding is scarce.

This study was funded by one of the more spectacular donations in recent history. In 2015, the grandparents of a three-year-old girl suffering from a rare form of epilepsy offered a $33.7m donation to the Lambert Initiative to fund medicinal cannabis research. The Lambert initiative explores the potential of compounds derived from the cannabis plant (cannabinoids) in treating a range of diseases.

Scientists claim they have identified a 'crystal ball' mathematical equation which can be used to predict if a system is about to move over to a disorderly state. In theory, it could be used to predict complex real life systems like financial stock market crashes.

Mathematical equation helps predict calamities, financial crashes or epilepsy seizures

Scientists claim they have identified a 'crystal ball' mathematical equation which can be used to predict if a system is about to move over to a disorderly state. In theory, it could be used to predict complex real life systems like financial stock market crashes.

Scientists claim they have identified a ‘crystal ball’ mathematical equation which can be used to predict if a system is about to move over to a disorderly state. In theory, it could be used to predict complex real life systems like financial stock market crashes.

In science we have what are called “laws”, be them Newton’s Laws of Motion or Archimedes’ Principle, because these mathematical expressions describe systems in a rigid set of boundaries, essentially helping predict how these systems will behave in the future. What about overly complex, highly dynamic systems; could we use a single mathematical equation to predict outcomes for such systems? An  University of Sussex-led study found a mathematical equation that may help predict calamities such as financial crashes in economic systems and epileptic seizures in the brain.

The team of neuroscientists led by Dr Lionel Barnett sought to mathematically describe how various parts of a systems simultaneously behave differently, while still being integrated (the parts depend on each other). Collaborating with scientists at the University’s Sackler Centre for Consciousness Science and the Centre for Research in Complex Systems at Charles Sturt University in Australia, the team used mathematics and detailed computer simulations to show that a measure of ‘information flow’ reaches a peak just before a system moves from a healthy state to an unhealthy state.

This is known as a ‘phase transition’ and in real world systems these can have huge implications, like epileptic seizures or financial market crashes. Predicting such events in the past had been extremely difficult to undertake. Barnett and colleagues, however, showed for the first time that their method can reliably predict phase transitions in a physics standard system – so-called Ising models.

” This conjecture is verified for a ferromagnetic 2D lattice Ising model with Glauber dynamics and a transfer entropy-based measure of systemwide information flow. Implications of the conjecture are considered, in particular, that for a complex dynamical system in the process of transitioning from disordered to ordered dynamics (a mechanism implicated, for example, in financial market crashes and the onset of some types of epileptic seizures); information dynamics may be able to predict an imminent transition,” reads the paper’s abstract.

“The key insight in the paper is that the dynamics of complex systems – like the brain and the economy – depend on how their elements causally influence each other; in other words, how information flows between them. And that this information flow needs to be measured for the system as a whole, and not just locally between its various parts,” Dr. Barnett said.

It will be interesting to see how University of Susses researchers’ method fairs with complex real world system, and to which degree their equation can reliably predict when a phase transition will occur.

Professor Anil Seth, Co-Director of the Sackler Centre, says: “The implications of the work are far-reaching. If the results generalise to other real-world systems, we might have ways of predicting calamitous events before they happen, which would open the possibility for intervention to prevent the transition from occurring.”
“For example, the ability to predict the imminent onset of an epileptic seizure could allow a rapid medical intervention (perhaps via brain stimulation) which would change the course of the dynamics and prevent the seizure. And if similar principles apply to financial markets, climate systems, and even immune systems, similar interventions might be possible. Further research is needed to explore these exciting possibilities.”

The findings were published in the journal Physical Review Letters.

Stanford scientists build a ‘brain stethoscope’ to turn seizures into music

“My initial interest was an artistic one at heart, but, surprisingly, we could instantly differentiate seizure activity from non-seizure states with just our ears,” Chafe said. “It was like turning a radio dial from a static-filled station to a clear one.”

seizure

When Chris Chafe and Josef Parvizi from Stanford University began transforming recordings of brain activity into music, they had artistic pursuits in mind – but they quickly understood they could use the data in scientific purposes – developing a powerful tool for identifying seizures – even for people without experience.

Josef Parvizi was enjoying a performance by the Kronos Quartet, a concert in which the melodies were based on radio signals from outer space when the idea hit him – he began wondering what the brain’s electrical activity might sound like set to music. He turned to Chris Chafe for help – one of the world’s leading minds in terms of “musification” – the science of transforming natural signals into music.

So after they got a patients’ consent, they started working; first of all, they located the source of a seizure, by placing electrodes in patients’ brains to create electroencephalogram (EEG) recordings of both normal brain activity and a seizure state. Parvizi shared the EEG with Chafe, who began setting the electrical spikes of the rapidly firing neurons to music; he chose a tone close to a human voice, in an attempt to give the listener an empathetic connection to the patient as well as an intuitive understanding of what is happening inside the patient’s brain during a seizure. However, as they listened to the recording, they understood they had done more than create an interesting piece of music.

Here’s the audio, with a description:

Around 0:20, the patient’s seizure starts in the right hemisphere, and the patient is talking and acting normally. Around 1:50, the left hemisphere starts seizing while the right is in a post-ictal state.

Because a seizure can happen even without any immediate symptom, their work has the potential to help thousands (if nto more people). If they could achieve the same thing with real time brain data, then they could develop a tool to allow caregivers for people with epilepsy to quickly hear when an undetected seizure is occuring. They dubbed the device a “brain stethoscope”.

Taking care of somebody with seizures can be very difficult, because not all seizures are accompanied by behavioral changes.

“Someone – perhaps a mother caring for a child – who hasn’t received training in interpreting visual EEGs can hear the seizure rhythms and easily appreciate that there is a pathological brain phenomenon taking place,” Parvizi said.

Still, this innovative and potentially very helpful idea is still very far from becoming a clinical reality.

“We’ve really just stuck our finger in there,” Chafe said. “We know that the music is fascinating and that we can hear important dynamics, but there are still wonderful revelations to be made.”

Still, the potential is there, and even without it becoming a reality, this is a statement of what two fields which are apparently incompatible can accomplish together:

“This is what I like about Stanford,” Parvizi said. “It nurtures collaboration between fields that are seemingly light-years apart – we’re neurology and music professors! – and our work together will hopefully make a positive impact on the world we live in.”

Awheelchair-bound Peter Sellers (Dr. Strangelove) continually loses control of his right arm. He repeately attepmts to give the Nazi Party salute before being beaten by his left hand. This film illustrates the comical struggle of Alien-Hand-Syndrome.

Startling alien hand syndrome: when the hand has a mind of its own

In one of Stanley Kubrick’s weirdest movies (even by Kubrick standards), “Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb (1964)“, one of the characters played by Peter Sellers is tormented by the irresistible and convulsive urge of lifting his right arm in a Nazi salute. He can’t control it, it’s like it has a mind of its own. In most respects, the movie is hilarious if you have taste for cynical and exaggerated humour. What’s far from being hilarious is the real life condition that plagues some people. Yes, there are some people out there who can’t control one of their hands – the phrase “a mind of its own” is no figure of speech for these individuals. In popular literature this conditions is referred to as the alien hand syndrome.

Awheelchair-bound Peter Sellers (Dr. Strangelove) continually loses control of his right arm. He repeately attepmts to give the Nazi Party salute before being beaten by his left hand. This film illustrates the comical struggle of Alien-Hand-Syndrome.

A wheelchair-bound Peter Sellers (Dr. Strangelove) continually loses control of his right arm. He repeatedly attempts to give the Nazi Party salute before being beaten by his left hand. This film illustrates the comical struggle of Alien-Hand-Syndrome.

Imagine sitting in line at your local convenience store and all of a sudden some guy starts pinching you for no reason, only for the guy to immediately start punching his arm with his other, while frantically apologizing “sorry, sorry. I can’t control it! Sorry!”. Cases have been reported – although its difficult to attribute to alien hand syndrome or some conscious action taking advantage of the condition – in which the alien hand would grab a nearby breast or start masturbating, with little to any control from the ‘hand owner’. These are deepening embarrassing situations, but it’s even frightening to hear accounts of people being attacked by their own alien hand, which is actually no longer their own to call.

Scientists describe it as a “complex, goal-directed activity in one hand that is not voluntarily initiated,” and unfortunately due to the rarity of the phenomenon, it is yet poorly understood. What we know for certain is that it’s due to some malfunction in communication between the two hemispheres of the brain. For instance, the alien hand is always in the non-dominant half. If a person is right handed (left hemisphere dominant), then almost always the left hand (controlled by the right hemisphere of the brain. In this case non-dominant) will be the one at risk of becoming alienated.

Though it may occur due to a naturally occuring brain dysfunction, most of the cases surface following brain surgery, namely after some patients had their corpus callosum sectioned – the band of nervous fibres which keeps the two halves of the brain in constant contact. This radical procedure is used as a last resort to treat epilepsy patients. Sometimes, however side effects may include losing one’s non-dominant hand, leaving it to the control of an impulsive and unconscious part of one’s brain.

‘I can’t make it listen to me!’

55-year-old Karen Byrne from New Jersey had such a procedure performed on her brain, after battling epilepsy for as long as she could remember. She was cured, but now she faces another torment.

“Dr O’Connor said ‘Karen what are you doing? Your hand’s undressing you’. Until he said that I had no idea that my left hand was opening up the buttons of my shirt.

“So I start rebuttoning with the right hand and, as soon as I stopped, the left hand started unbuttoning them. So he put an emergency call through to one of the other doctors and said, ‘Mike you’ve got to get here right away, we’ve got a problem’.”

And more.

“I’d light a cigarette, balance it on an ashtray, and then my left hand would reach forward and stub it out. It would take things out of my handbag and I wouldn’t realise so I would walk away. I lost a lot of things before I realised what was going on.”

Extreme cases have occurred where the hand has attacked, and even tried to strangle with a cord, the person to which it’s attached.

What happens here: the nervous band that connects the two hemisphere being sectioned, communication between the halves of the brain becomes deleterious. In a normal, healthy brain the two halves coexist peacefully and share functions which are asymmetrically located, although physically the brain is symmetrical. What these cases potentially reveal however is that each half of our brains contain separate consciousnesses.

Two hands, two brains, two wills

In one experiment, neurobiologist Roger Sperry asked a participant who had his hemisphere split through the same surgery to perform a puzzle, which implied rearranging blocks so they matched the pattern on a picture. The person in question was left handed, meaning his right hemisphere was dominant. When attempting to complete the puzzle using his left hand only, the man was making good progress. When asked to perform the same task using his right hand, surprise; he had no clue what so ever where to begin and what to do next. The participant then tried using his left hand, the hand that could actually start fitting at least two pieces of the puzzle, only to have his right hand block it – the hands were actually fighting each other. Experiments like this led Sperry to conclude that “each hemisphere is a conscious system in its own right, perceiving, thinking, remembering, reasoning, willing, and emoting”. Powerful!

Sadly, there is no cure for the alien hand syndrome, yet some people manage to control their hands to a degree, but even then with great difficulty and imprecision in actions. For instance, while trying to touch the tip of the nose, they touch the shoulder instead. Most people suffering from the syndrome have learned that keeping their alien hand occupied (holding a cane) will offer them some peace for a time. What this startling condition reveals, in truth, is that there might be two personalities nested inside each of us.

Seizure detector treats epilepsy in rats

Just think about it: a minimally invasive brain stimulator that significantly reduces seizure duration for epilepsy patients. Such a device exists, but sadly, only works in rats so far.

The device was tested on nine rats with a ‘petit mal’ form of epilepsy, and it reduced the length of seizures by approximately 60 percent. Most electrical stimulation devices, most notably those that deliver deep-brain stimulation (DBS) to treat Parkinson and depression patients, work continuously, constantly delivering impulses, regardless of brain activity; this can cause a significant number of problems, most notably – headaches.

However, devices with only work on a seizure basis are finding their way on the market. Such a device was also described by György Buzsáki, a neuroscientist at the New York University School of Medicine; he and his colleagues however managed to create a much less invasive device, one that involves transcranial electrical stimulation (TES) of neurons using electrodes implanted in the skull. What the device does is modify the brain’s cortical (outermost) neurons, which during epileptical seizures become abnormally excited. To detect when a seizure sets in, electrodes were placed at the surface of the brain.

“The difference between a continuous stimulator and an on-demand device is comparable to the difference between an implantable cardiac pacemaker and an implantable defibrillator.”, says Martha Morrell, chief medical officer of NeuroPace and a neurologist at the Stanford School of Medicine in California.

Like DBS devices which are now in use, pacemakers comprise a battery attached to a pulse generator. However, something like an implantable defibrillator requires much more complicated elements, including integrated circuits, capable of sensing, interpreting, and transmitting signals whenever needed – which makes the technology much more complicated.

Still, despite all these impediments, Buzsáki and his team managed to make it work in animal trials, mostly by applying an accelerometer which helps the device filter out signals by correlating electric impulses with muscular signals. Hopefully, they can make the big step for humans in the nearby future.

Journal reference: Berényi, A., Belluscio, M., Mao, D. & Buzsáki, G. Science 337, 735–737 (2012).

Gene therapy in epilepsy could stop seizures

Researchers successfully tested gene therapy in rats to stimulate the production of a chemical which naturally occurs in the brain and stops seizures from taking place.

About 3.000.000 people are suffering from epilepsy in the US alone, and a major characteristic of this lifelong disease is uncontrollable seizures which prevent sufferers from normally carrying on with their lives. Epilepsy is at the moment treatable, but not curable, so finding novel ways to prevent these seizures would be one of the best ways to help people deal with their illness, and live as normal as possible under the circumstances. Dr. Paul Carney, chief of the division of neurology in the UF College of Medicine explains:

“For years people have focused only on treating the disease, not preventing the disease,” Carney said. “The mantra is no seizures, no side effects.”

Another one of the big problems for epilepsy patients is the lower levels of the hormone somatostatin, as do people with Alzheimer’s disease, a hormone that regulates the endocrine system. To test if they could stop seizures by bolstering this hormone, researchers administered a dose that triggers a surge in its production.

“There is some somatostatin in the brain anyway, because it’s a neuropeptide, but there was a dramatic increase after the injection,” Zafar explained.

The immediate results were that after the injection, subjects had weaker and shorter seizures, and perhaps even better, did not suffer any negative side effects. As a matter of fact, there was only one notable side effect, and that was quite positive: subjects learned faster and easier.

“Being able to restore somatostatin up to normal levels allows the brain to heal itself and that is the idea here,” Carney said. “We’re putting something back in that is normally there and allowing the brain to pick it up as part of its normal machinery. We’re not putting in a drug.”

But still, researchers warn that this is just a first step, and many more must be taken before we can get to business. Scientists are most cautious about inflammation.

“What effect a compound is going to have partly depends on where in the seizure circuit that new compound or gene is being placed. You could put the same chemical in two places and get two different results,” said Dr. Edward Bertram III, a professor of neurology at the University of Virginia, who was not involved in the study. “That is going to be the issue as they try to develop this: Where should we be putting this to have the best effect? On the promising side, they put (the gene) in a restricted area and had an effect. That is a great first step.”

Via MedicalXpress