Development of a Conceptual Framework for a Virtual Reality-Based Seizure Management Education Program for Parents (VR-ESMEPP)

Abstract found on  PubMed

Objective: Parents of children with epilepsy need support when managing epileptic seizures outside medical-care-center-settings. Previously developed training programs only provide information-based support. Therefore, within the scope of the Virtual Reality-based Seizure Management Education Program for Parents (VR-ESMEPP), a conceptual framework was developed in this study with the aim of developing parents’ skills and motivation as well as providing them information regarding seizure management.

Methods: The conceptual framework of the VR-ESMEPP was developed in four steps. In step 1, a scenario was developed wherein a pediatric patient with epilepsy is having a seizure. The selected seizure type was “Focal to bilateral tonic-clonic” seizure, which is the most common and most skill-intensive type of tonic-clonic-seizure. In step 2, data collection tools related to epileptic seizure management were developed for parents. These tools included Child and Parent Introductory Form, Parental Information Assessment Form for Epileptic Seizure Management, and Parental Skills Assessment Form for Epileptic Seizure Management. In step 3, the conceptual framework and data collection tools developed were confirmed by a group of 10 specialists consisting of physicians and pediatric nurses working in the field of pediatric neurology. In step 4, the epileptic-pediatric-patient-scenario and data collection tools confirmed by experts were programmed into an application by a software company and integrated into virtual reality headsets.

Results: The Virtual Reality-based Seizure Management Education Program for Parents with the conceptual framework described in the present study is a valid virtual reality-based program, which can be carried out under nurses’ supervision and used to provide epilepsy-related education to parents.

Significance: The Virtual Reality-based Seizure Management Education Program for Parents helped parents increase their knowledge and skills of epileptic seizure.

Women With Epilepsy Have Poorer Sleep Quality During Pregnancy

Article published by Neurology Advisor

Pregnant women with epilepsy are more likely to have poorer sleep quality during pregnancy and postpartum compared with women with epilepsy who are not pregnant, according to study findings published in Neurology.

Limited research has been conducted how sleep interacts with seizures in pregnant women.

About one-third of people with epilepsy experience seizures during sleep. Sleep deprivation can increase seizures, yet women with epilepsy don’t tend to experience increased seizures during pregnancy. Sleep disturbances are frequent among pregnant women, and epilepsy is the most common neurologic condition pregnant women experience. Poor sleep during pregnancy can increase the risk for poor fetal growth and fetal death.

For the study, researchers took a closer look at how sleep, epilepsy, and pregnancy influence each other.

Healthy pregnant women alone had different sleep quality in pregnancy and postpartum stages (change in mean score, 0.8; 95% CI, 0.2-1.3; P =.01).

Pregnant women with epilepsy only had significantly worse sleep scores during pregnancy compared with healthy pregnant women before researchers adjusted for covariates.

AI Model May Help Epilepsy Patients Become Seizure-Free

Article published by Medical Xpress

A study led by Monash University and believed to be a world first has demonstrated that an Artificial Intelligence (AI) model can potentially predict the best personalized, anti-seizure medication for patients with newly diagnosed epilepsy.

The predictive model, once fully developed, would spare these patients the uncertainty of not knowing when their lives would be returned to normal by taking anti-seizure medications, and possibly the harmful side-effects associated with some drugs.

Professor Patrick Kwan, a neurologist and researcher from the Monash Central Clinical School’s Department of Neuroscience is leading an international collaboration that is “training” the deep-learning prediction model (deep learning is a type of machine learning).

Their study is published in the influential JAMA Neurology.

“If the patient doesn’t respond to the first treatment, quite a few will respond to the second or third one, meaning that they might have become seizure-free sooner if the ‘right’ drug was chosen at the outset,” he said. “But if they get the wrong medication they still have seizures and may also get side-effects from it—they’re not getting the benefit and are getting harm from the drug.”

Pregnant Women with Epilepsy Have More Depression, Anxiety Symptoms

Article published by EurekAlert!

Pregnant women with epilepsy have more symptoms of depression and anxiety during pregnancy and postpartum than pregnant women who do not have epilepsy or women with epilepsy who are not pregnant, according to a study published in the August 17, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“The good news is we did not find that pregnant women with epilepsy were any more likely to have episodes of major depression than the other two groups,” said study author Kimford J. Meador, MD, of the Stanford University School of Medicine in Stanford, California, and a Fellow of the American Academy of Neurology. “However, these results underscore the importance of regularly screening pregnant women with epilepsy for any signs of depression or anxiety and providing effective treatment.”

The study involved 331 pregnant women with epilepsy, 102 pregnant women who did not have epilepsy and 102 women with epilepsy who were not pregnant. The pregnant women had study visits during each trimester, around the time of delivery and every three months through nine months postpartum. The women who were not pregnant had visits at comparable time points. At every visit, the women were screened for depression, anxiety and other psychiatric disorders.

There was no difference among the groups in episodes of major depression. However, pregnant women with epilepsy were more likely to have symptoms of depression during pregnancy than the women with epilepsy who were not pregnant had during the same time period. Postpartum, they were more likely to have symptoms of depression than both of the other groups.

Brain Abnormalities in Epilepsy Detected by New AI Algorithm

Article published by GEN

An artificial intelligence (AI) algorithm to detect subtle brain abnormalities that cause epileptic seizures has been developed. The abnormalities, known as focal cortical dysplasias (FCDs), can often be treated with surgery but are difficult to visualize on an MRI. The new algorithm is expected to give physicians greater confidence in identifying FCDs in patients with epilepsy.

The work, which was part of the Multicentre Epilepsy Lesion Detection (MELD) project, appeared in Brain “Interpretable surface-based detection of focal cortical dysplasias: a Multi-centre Epilepsy Lesion Detection study.” Konrad Wagstyl, PhD, and Sophie Adler, PhD, both from University College London, led an international team of researchers on the work.

To develop the algorithm, the team quantified features of the brain cortex—such as thickness and folding—in more than 1,000 patient MRI scans from 22 epilepsy centers around the world. They then trained the algorithm on examples labeled by expert radiologists as either being healthy or having FCD.

FCD is a malformation of cortical development in the brain, and have a propensity to cause epilepsy that does not respond to medication. Although FCDs are typically treated with surgery, MRI scans often look normal, making diagnosis challenging.

Tackling Increased Risks in Older Adults with Intellectual Disability and Epilepsy: Data from a National Multicentre Cohort Study

Abstract found on Seizure Journal

Purpose: People with intellectual disabilities (ID) suffer multimorbidity, polypharmacy and excess mortality at a younger age than general population. Those with ID and epilepsy are at higher risk of worse clinical outcomes than their peers without epilepsy. In the ID population the health profile of those aged ?40 years can be compared to those aged over 65 in the general population. To date there is limited data available to identify clinical characteristics and risk factors in older adults (?40 years) with ID and epilepsy.

Methods: The Epilepsy in ID National Audit (Epi-IDNA) identified 904 patients with ID and epilepsy from 10 sites in England and Wales. This subsequent analysis of the Epi-IDNA cohort compared the 405 adults over 40 years with 499 adults ?18 years aged under 40 years. Comparison was made between clinical characteristics and established risk factors using the Sudden Unexpected Death in Epilepsy (SUDEP) and Seizure Safety Checklist.

Results: The older adults’ cohort had significantly higher levels of co-morbid physical health conditions, mental health conditions, anti-seizure medications (median 5), and antipsychotics compared to the younger cohort. The older group were significantly less likely to be diagnosed with a co-morbid neurodevelopmental disorder, and to have an epilepsy care plan.

Conclusion: This is the largest study to date focused on adults with ID and epilepsy over 40 years. The ?40 years cohort compared to the younger group has higher levels of clinical risk factors associated with multi-morbidity, potential iatrogenic harm and premature mortality with worse clinical oversight mechanisms.

Dual Burdens of Felt Stigma and Depressive Symptoms in Patients with Epilepsy: Their Association with Social Anxiety, Marriage, and Employment

Abstract found on PubMed

Purpose: The present study evaluated whether patients with epilepsy with dual conditions of felt stigma and depressive symptoms are more strongly associated with social anxiety, being unmarried, and being unemployed than those with depressive symptoms or felt stigma alone.

Methods: This multicenter, cross-sectional study evaluated subjects using the Stigma Scale-Revised, the Patient Health Questionnaire-9, and the six-item versions of the Social Interaction Anxiety Scale, and the companion Social Phobia Scale. Subjects were grouped by depressive symptoms and felt stigma into four groups. Multivariate logistic regression analyses were performed.

Results: The 298 subjects included 173 men and 125 women. Of these subjects, 35 (11.7%) had depressive symptoms alone, 33 (11.1%) had stigma alone, and 27 (9.1%) had both depressive symptoms and felt stigma. Multivariate logistic regression analyses showed that, compared with the control group having neither depressive symptoms nor felt stigma, the odds ratios (ORs) for social interaction anxiety and social phobia were highest in the group of dual conditions (OR 18.7 and 13.5, respectively), followed by the depression-alone (OR 7.7 and 4.6, respectively) and stigma-alone (OR 5.0 and 2.8, respectively) groups. Similarly, the ORs for being unmarried (OR 29.2) and unemployed (OR 3.1) were significant only in the group of dual conditions. In addition, male sex and younger age were independently associated with being unmarried whereas seizures recurring ?1 per month were independently associated with being unemployed.

Conclusions: Dual conditions of felt stigma and depressive symptoms may be more strongly associated with social anxiety, being unmarried, and being unemployed than depressive symptoms or felt stigma alone in patients with epilepsy.

Third-Wave Psychotherapies to Promote Mental Health in Epilepsy: An Updated Systematic Review

Abstract found on PubMed

Purpose/objective: Research on third-wave cognitive behavioral therapies has burgeoned over the last ten years. However, questions remain about the effectiveness of these therapies for people with epilepsy. This article provides an up-to-date review of the current evidence-base.

Methods: Following protocol registration (PROSPERO CRD42021269882), two reviewers searched six databases (from inception until 1 March 2022) for mindfulness and acceptance interventions targeted at mental health in adults with epilepsy. The reporting quality of included studies was rated (QualSyst tool) and standardized mean group differences (Hedges’ g) with 95% confidence intervals and p values calculated. Results were narratively synthesized based on therapy characteristics and mental health outcome.

Results: Eleven randomized controlled trials, involving 941 adults with chronic epilepsy, were included. All studies were of sound methodological quality. Third-wave therapies were typically delivered in a group format although varied in their face-to-face, telephone, and online learning options. Programs evaluating Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy, or elements of both, outperformed wait-listed controls or usual care, although individual variability in treatment response was evident (grange = -0.11-2.28).

Conclusions: Acceptance techniques and mindfulness practice may bring mental health benefits for some people living with epilepsy, but do not have consistent results for everyone. Patient diversity and preferences need to be factored into effective third-wave approaches for this cohort.

Epilepsy Research News: August 2022

This issue of Epilepsy Research News includes summaries of articles on:

 

Impact of the COVID-19 Pandemic on People with Epilepsy: Findings From the US Arm of the COV-E Study

A recent survey of people with epilepsy and their caregivers showed that the COVID-19 pandemic has had negative effects on self-management and mental health for those with epilepsy. Some of the topics covered in the study include timeliness of taking medications, mental health, stress, and discussions with a healthcare provider about sleep, antiseizure medications, and potential side effects. The findings highlight the need for healthcare providers to be more aware of the increased emotional distress in people with epilepsy.
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Ketamine: An Effective Treatment for Neonatal, Pediatric Epilepsy

Treatment with a prescription medication called ketamine significantly reduced seizure occurrence related to refractory status epilepticus in neonates and children, according to results of a new study. In the study, researchers sought to determine the safety and efficacy of ketamine in young patients for this difficult to treat form of epilepsy. Results showed that after ketamine infusion, 32 patients experienced seizure cessation, 19 patients experienced seizure reduction, while there was no change in 18 patients. Three patients had adverse events requiring intervention during or within 12 hours of ketamine administration, including hypertension in two patients and delirium in one patient. “Many children with status epilepticus have persistent seizures despite administration of at least two appropriately dosed antiseizure medications,” stated the study authors. “Ketamine… may be a beneficial alternative.”
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Seizures in Young Stroke Survivors Doubles Dementia Risk

For young stroke survivors, the subsequent development of seizures more than doubles their risk of developing dementia, according to a recently published study. Researchers used the IBM Watson Health MarketScan Commercial Claims and Encounters database to identify 23,680 patients (aged 18 to 60 years) with ischemic strokes or hemorrhagic strokes from 2006 through 2009. The researchers found that young patients with stroke who developed seizures had a greater risk for dementia than those without seizures. The authors noted that “since strokes are occurring in younger people and survival rates are increasing, it is important to understand the long-term effects and determine who is at greatest risk for severe complications like dementia.”
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Age at Epilepsy Diagnosis and EEG can Help Predict Returning Seizures After Stopping Antiseizure Medication

Recent research has identified characteristics that can help predict the likelihood of seizures returning in children who have stopped taking antiseizure medication (ASM) after becoming seizure free. Among the characteristics studied, three were associated with a higher chance of having returning seizures after stopping ASM and included adolescent age at diagnosis, unusual EEG findings after the medication was stopped, and having a high number of seizures while taking medication. This information may be useful to doctors as they consider discontinuing antiseizure medication in their patients.
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A New Technique to Understand Temporal Lobe Epilepsy

A team of researchers used a new technique to find a link between a specific protein in the brain and increased vulnerability to neurodegeneration for individuals with temporal lobe epilepsy. The technique used by the researchers made it possible to study small amounts of tissue from hard-to-reach regions within the brain. Using this new technique, the researchers identified changes in a protein called GluN3 that is associated with cellular damage. The technique allowed the researchers to narrow the focus to specific areas of the brain where neurons are dying. The study author has applied to patent the technique, known as ‘area-specific tissue analysis’. This advanced technique may lead to a new understanding of the causes of epilepsy and therapies to help patients, stated the study author.
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Delayed Diagnosis of Functional Seizures Associated With Abnormal Processing of Face Emotions

Article published by NeurologyLive

Increased posterior cingulate cortex activation to sad faces in the long-delay diagnostic group were associated with worse symptoms of depression, as expressed by Beck Depression Inventory scores.

By assessing emotion processing circuits, recently published findings in Epilepsy & Behavior showed that diagnostic delays for functional seizures (FS) are associated with functional MRI (fMRI) changes in the insula and cingulate regions of the brain. Both are implicated in mood control, self-referencing, and other emotion-relevant processes.

In addition to completing several assessments related to symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and quality of life, patients also underwent fMRI at 3T with emotional faces task (EFT). Here, they indicated “male” or “female” via button press while implicitly processing happy, sad, fearful, and neutral faces. Findings showed that those with long-delay diagnosis (l-DD) had significantly greater fMRI activation than short-delay diagnosis (s-DD) to sad faces in the bilateral posterior cingulate cortex (PCC; 403 mm3= 4.66; peak MNI coordinates at x = –2, y = –43, z = 18) and to neutral faces in the right anterior insula (AI; 384 mm3= 5.04; peak MNI coordinates at x = 32, y = 20, z = –12).