News Briefs:

Teens with Epilepsy Twice Hit

March 31, 2006
Teens with chronic illness are more likely to suffer from depression than teens in the general population. The association between teens with epilepsy and depression appears to be even stronger, according to researchers. Society’s negative attitude toward each of these conditions imposes a double burden on affected teens they report. As a result, many will tend to minimize their depressive symptoms until they can’t function any more.

In the study reported in the March issue of the journal Neurology, up to 60 percent of all teens with epilepsy will experience depression or other mental illness. But only 33 percent of them will get any treatment. The lack of treatment puts these teens at a high risk of suicide as well.

Depressive symptoms also tend to be minimized by parents who are reluctant to ask for referral to mental health professionals for help. The problem is made worse by family health insurance that limits or does not cover payments for mental health care.

The Epilepsy Foundation has a special concern for teens who have epilepsy and offers programs to improve feelings of confidence and self-worth and to increase understanding and acceptance among their peers.

Epilepsy Gene Discovered in Amish Children

March 30, 2006
In a major discovery, scientists today described a new severe childhood-onset disorder in Old Order Amish children. The disorder is marked by focal seizures, hyperactivity, impulsive behavior, language regression and other features identified with autism. The disease was traced to a mutation in a gene that codes for a protein called CASPR2. The mutation is a possible cause of both epilepsy and autism in the affected children, the scientists report in the March 30 issue of the New England Journal of Medicine.

The seizures typically begin around the age of 16 months followed by deterioration in learning ability and social development. The seizures are frequent—50 to 90 per week—in the form of simple partial and complex partial episodes.

According to Dr. Holmes Morton of the Clinic for Special Children, Strasburg, PA, one of the medical centers involved in the study, “The identification of the mutation in CASPR2 in our Amish patients has already allowed us to recognize affected newborns before they become symptomatic. Our hope is that early treatment and prevention of prolonged seizures in these infants will lessen the effects of the disorder upon the lives of children and their families.”

Scientists at the Translational Genomics Research Institute, Phoenix, PA, Lancaster General Hospital, Lancaster, PA, and Marshfield Clinic Research Foundation, Marshfield, WI, also participated in the research.

New Epilepsy Drugs on the Horizon

March 29, 2006
German drug manufacturer Schwarz Pharma has announced that the company is submitting new drug applications in Europe and the United States for lacosamide as add-on therapy for adults with focal seizures. The drug, which has a novel mode of action, has been dosed twice daily in clinical trials.

Lacosamide (formerly harkoseride) is expected to become available in 2008 or 2009, according to industry estimates. The company says clinical trials are continuing, along with simultaneous development of an intravenous or injectable form of the drug.

The Schwarz product is one of perhaps a dozen epilepsy medications currently in advanced stages of development, among them brivaracetam and seletracetam (UCB), remacemide (Astra), retigabine (Valeant), rufinamide (Eisai), safinamide (Newron), and others.

Marijuana Clouds Memory, Slows Thinking

March 28, 2006
There is some scientific evidence regarding the effectiveness of marijuana for the management of epilepsy in animal studies. Other animal and human studies suggest that depression, psychosis or even increased seizures can also occur with the use of this drug. A new study reported in the March issue of Neurology has found that smoking four or more joints per week harms memory, slows thinking and causes a decline in the ability to learn and remember new information over time.

The study, involving people ages 17 to 49, was conducted by scientists at the University Hospital of Patras in Patras, Greece. The researchers report that the effect in several areas of ability "were significant enough to be considered impaired, with more impairment in the longer-term users than the shorter-term users."

The Epilepsy Foundation considers studies of the effects of marijuana on seizures in an appropriate legal and scientific environment as the best way to determine whether this currently illegal drug has any appropriate use in the treatment of epilepsy.

Ginkgo Use and Seizures in Nursing Homes

March 27, 2006
Ginkgo biloba is among the most widely used of herbal supplements. It is sometimes prescribed for Alzheimer's disease, dementia, memory loss and poor peripheral blood flow, although there is little medical proof of its effectiveness as treatment for these conditions. Because ginkgo has both components that can cause seizures and components that can inhibit seizures, researchers at the University of Minnesota have studied how often this herb is prescribed for people with seizure conditions who live in nursing homes.

The researchers found the use of herbs of any kind in nursing homes to be very small. When herbs were used, however, ginkgo biloba was the one most often prescribed. It was just as likely to be prescribed for residents who have seizures as for residents who did not have seizures.

In the report published recently in the journal Epilepsia, the authors point out that the concentration of seizure-provoking components varies in different parts of the ginkgo plant. The highest concentration comes from the seed. The mix of components also varies from manufacturer to manufacturer and from batch to batch, complicating conditions for evaluating the safety of this herb in people who have epilepsy, according to the authors.

New Vaccine Could Eradicate Some Epilepsy

March 24, 2006

A brain infection caused by tapeworm larvae is a significant cause of epilepsy in many parts of the world. In the United States, the condition is mostly seen among immigrants from countries where the infection, called neurocysticercosis, is widespread. A potential breakthrough in eliminating this parasitic disease was reported recently by researchers at the University of Melbourne, Australia.

Tapeworm infection is spread from pigs to humans through water or food contamination. According to a televised Australian Broadcasting Corporation interview of the University's project leader on March 13, the researchers have developed a vaccine that attacks the parasite right at the source, the animals that are its natural host. From successful tests in the laboratory, the vaccine will now go into field testing among pig populations in Mexico, Peru, Cameroon and Honduras.

Scientists Investigate Zinc's Possible Role in Prolonged Seizures

March 23, 2006
By re-engineering a special protein molecule, researchers report that they can now measure very low concentrations of zinc in healthy cells. The technique gives scientists the ability to recognize miniscule levels of free zinc in the cells, even in the presence of million-fold levels of other metals like calcium and magnesium that the cells might contain. The discovery is expected to lead to a better understanding of the role that zinc might play in the destruction of neurons in status epilepticus (prolonged seizures) and other medical conditions.

The report, by research teams at the University of Maryland and the University of Michigan, is published in the current issue of Chemical Biology. According to Richard B. Thompson, Ph.D., of the University of Maryland School of Medicine, the researchers believe that "this new technique can help us understand how zinc is involved in plaque formation in Alzheimer's disease; how prolonged seizures or stroke kill brain cells; and how the cell normally allocates zinc to different proteins."

Cell Therapy Shows Promise in Treating Brain Disorders

March 22, 2006
One avenue for conquering brain disorders now being pursued by scientists is cell transplantation therapy. In a new study published in the March 22 issue of The Journal of Neuroscience, researchers in Italy demonstrated that myelin-producing cells transplanted in animals successfully moved to regions of the brain where the cells aided in producing myelin (the protective covering of nerve fibers). The animals had symptoms of metachromatic leukodystrophy (MLD), an inherited progressive disease that impairs the growth or development of the myelin sheath. The experimental therapy resulted in healthy myelin production and improved motor skills in the animals.

People with MLD, for which there is no cure, experience seizures, spasticity, and declining mental abilities, among other symptoms. According to the lead scientist, the results of these experiments “contribute to a growing field of intense research where the use of brain-derived cells, including myelin-producing cells and neural stem cells, may be envisioned as direct cell therapies to target specific neurological diseases.”

Annals of Neurology (July 11, 2005)

Posted: July 22, 2005
When epilepsy strikes people over 60 it is often the after-effect of stroke. Although stroke is largely associated with the elderly, it can happen also in infants. A study of 199,000 births in California has found an overall rate of strokes during labor, delivery and in the first month after birth to be about 1 in 5,000 births.

According to the authors of the study, "Predictors of Outcome in Perinatal Arterial Stroke: A Population-Based Study," well over a third of these young stroke victims (39 percent) developed epilepsy. The most frequent adverse outcome, however, was cerebral palsy (59 percent). The authors recommend that, "Infants with unexplained seizures or weakness on one side of the body should be evaluated by a neurologist, and should receive a head imaging study to evaluate for perinatal stroke."

Additional studies are needed to confirm these results. Keep in mind that seizures in newborns have a number of causes of which stroke may not be the most common. And, it must not be assumed that a child acquired epilepsy from a stroke, even when seizures began at birth or in the first few months thereafter.

Proceedings of the National Academy of Sciences (March 28, 2005)

Posted: April 21, 2005
In a new science that links genetic variations to how individuals respond to medicines, researchers have shown that variations of two genes are more likely to be found in people who need higher doses of anticonvulsant drugs to control their seizures. It is the first clear evidence that gene variations involved in the action of carbamazepine (Carbatrol) and phenytoin (Dilantin) can predict how different people might respond to these epilepsy drugs. If the results are confirmed in future studies, making genetic tests part of the prescribing process might improve treatment results for epilepsy patients. The studies were conducted in the United States by researchers at Duke University and at University College by researchers in England.

People with epilepsy often undergo a long process of trial and error to find the dose of epilepsy medicine that works for them. This research is advancing a new field of personalized medicine that could bring seizures under control quicker and more effectively. However, it will likely be some time, perhaps years, before this personalized approach is developed enough to benefit physicians and their epilepsy patients.

Editor's note: In a related development, the U.S. Food and Drug Administration issued guidelines on March 22, 2005, to encourage pharmaceutical companies to collect information on how genetic variations affect the way people respond to drugs. The companies were also urged to submit this information to the FDA as a way of helping the federal agency to learn more about this developing field of personalized medicine.

Neurology (March 2005)

The potential effect of certain antiepileptic drugs on the fetus during pregnancy is the topic of three reports and an associated editorial. The reports are evidence again that women on epilepsy medications who wish to have children should see their doctors before becoming pregnant.

Researchers from the North American AED Pregnancy Registry report a fourfold increase in the risk of major malformations among newborns of women taking divalproex sodium (Depakote) compared to women taking other epilepsy medications. In another article in this issue, researchers in Great Britain report that memory and verbal abilities of school children who had been exposed to this medication before birth were lower on average when compared to children exposed to other epilepsy drugs. The third report, from the International Lamotrigine (Lamictal) Pregnancy Registry, suggests that the risk of major birth defects in newborns exposed to this medication is similar to the risk of birth defects in the general population.

The accompanying editorial points out that these studies do not provide absolute answers since none considered the role of nutrition, including the potential effect of taking folic acid during pregnancy. Nor was the type of epilepsy taken into account. The editorial also points out that stopping epilepsy drug therapy poses a greater risk to the mother and to the unborn child than if she were to stay on the medication.

Editor's note: The successful study of all epilepsy drugs and their potential effects on pregnancy rests on the number of women who sign up with the AED pregnancy registries. Women in the United States and Canada who take antiepileptic medication and who are pregnant, or who are considering pregnancy, are strongly urged to contact the North American AED Pregnancy Registry for information at (888) 233-2334.