As a result, these children are two to three times more likely to sustain fractures than their healthy peers.

The researchers reviewed available literature on the subject, as well as on the role of vitamin D supplementation in children using antiepileptic medications.

They found that while studies have generally found little difference in bone mineral density markers between children with epilepsy and healthy youngsters, most had small sample sizes.

Furthermore, many failed to take into account other factors that may have influenced children’s bone mineral density, including co-morbidities, mobility, nutrition and obesity.

The researchers also observed that studies assessing the role of vitamin D supplementation in children with epilepsy have shown little evidence of benefits. But these again failed to take confounding factors into consideration.

In light of the lack of reliable evidence, the Leicester-based experts say larger studies are needed to look at outcomes such as fractures.

Writing in the Journal of Paediatric Neurosciences, they argue that in the absence of good evidence to the contrary, concerns remain that children with epilepsy are at risk of poor bone health “and that vitamin D therapy may be beneficial”.

“As low-dose vitamin D supplementation (400 IU per day) is now recommended for healthy children and it is biologically feasible that children with epilepsy may be at higher risk of clinically significant deficiency, it is important that neurologists ensure that low-dose vitamin D supplementation should be prescribed and compliance followed up in children with epilepsy,” they conclude.

Published by Steve Long

Tiagabine works by increasing levels of a chemical called gamma-aminobutyric acid (GABA) in the brain, thereby helping to stabilise electrical activity and reducing the likelihood of seizures.

Researchers at the University of Washington in Seattle, US, set out to assess the effects of tiagabine on seizure control and behaviour when used as part of regular clinical practice.

They studied 292 patients – 39 of whom were children – including 231 who were given tiagabine at a median dose of 28 mg per day.

Eighty-six per cent of patients had focal-onset seizures, while 12 per cent had generalised-onset episodes and two per cent had multiple seizures associated with Lennox-Gastaut syndrome.

The researchers recorded any instances of adverse effects and seizures among the study participants.

Analysis revealed that the following adverse events were common among patients taking tiagabine: fatigue, dizziness, psychomotor slowing, ataxia (loss of coordination), stomach upsets, weight change, insomnia and behavioural changes.

Twelve patients experienced serious behavioural effects; three developed status epilepticus; a further three had other serious adverse events and there was one case of sudden unexplained death.

However, there were no instances of suicidal thoughts or behaviour, rash, kidney stones or organ failure.

In terms of seizure outcomes, five per cent of patients experienced freedom from their seizures, while 12 per cent had at least a 75 per cent reduction in episodes and 23 per cent at least a 50 per cent reduction.

Seventeen per cent of patients experienced an increase in the number of seizures while one developed a new seizure type.

Publishing their findings in the journal Epilepsy & Behaviour, the study authors noted that clinical trials conducted prior to a drug’s approval tend to provide data in limited groups of patients.

They revealed: “Behavioural adverse events occurred in a larger proportion of patients compared to those reported in tiagabine pre-approval randomised controlled trials.

“A moderate percentage of patients had a meaningful reduction in seizure frequency.”

Overall, they concluded that “in clinical practice, tiagabine remains a useful antiepileptic drug”.

Posted by Steve Long

Temporal lobe epilepsy involves seizures that originate in the brain’s two temporal lobes, which are responsible for processing emotions and play an important role in short-term memory.

Depression is known to be common in children with this type of epilepsy, but little is known about its severity and links with clinical variables.

Researchers at the University of Sao Paulo in Brazil studied 31 children with temporal lobe epilepsy, with an average age of 11 years, and found that 25 had depression, with 84 per cent of these experiencing moderate or severe symptoms.

There were no links between the severity of depression and age, gender, seizure control, duration of epilepsy or hippocampal sclerosis.

Adolescents tended to have greater functional impairment than children.

Publishing their findings in the journal Seizure, the study authors confirmed: “Children with temporal lobe epilepsy had moderate to severe depressive symptoms early in the course of their disease with a relevant impact on their global functional activities, especially considering adolescents.”

The researchers noted that the severity of epilepsy did not seem to be linked to the severity of depressive symptoms.

They concluded that more research is needed “to better understand the association of depressive disorders in children and adolescents with temporal lobe epilepsy”.

Posted by Steve Long

Researchers at the Prince of Songkla University in Thailand focused on a version of the gene known as the Bsml polymorphism.

They studied 75 adults with epilepsy, all of whom were using valproate and were free from seizures.

Analysis revealed that 22.7 per cent of the patients had the Bsml polymorphism.

Patients with this genetic variant were found to have significantly higher levels of triglycerides, total cholesterol, high-density lipoprotein (HDL or ‘good cholesterol’) and low-density lipoprotein (LDL or ‘bad cholesterol’).

They also tended to have higher systolic blood pressure and were more likely to have metabolic syndrome – a cluster of risk factors for cardiovascular disease – than patients with a normal copy of the gene (64.7 per cent versus 41.4 per cent).

Fasting blood glucose and fasting insulin levels were similar for patients with both versions of the gene.

Publishing their findings in the journal Seizure, the study authors concluded: “Young patients with epilepsy taking valproate who carry the Bsml polymorphism are at an increased risk of having vascular risk factors.”

Posted by Steve Long

Researchers at the University of Gothenburg’s Sahlgrenska Academy have reported long-term observations on the first 47 children to undergo epilepsy surgery at the University Hospital in Lund between 1991 and 2007.

Participants ranged in age from 0.5 years to 18.7 years, with a median age at the time of surgery of eight years.

All of the children underwent cognitive function tests before having surgery, and again at a follow-up appointment between five and 21 years later.

The researchers also looked at the children’s medical records to obtain information on demographics and seizure-related characteristics.

Analysis revealed that almost half of the children (23 out of 47) were seizure-free at the time of their follow-up appointment, while a further six benefited from a greater than 75 per cent improvement in the frequency of their seizures.

Twenty-one of the children required a second surgical procedure in order to achieve a satisfactory outcome, but none of the youngsters experienced any increase in their seizure frequency.

In terms of cognitive function, epilepsy surgery did not seem to have any adverse effects.

Just over three-quarters (76 per cent) of patients saw their cognitive functional level progress as expected and there was a significant improvement in cognitive processing speed among those who became seizure-free.

Publishing their findings in the journal Acta Neurologica Scandinavica, the study authors concluded that epilepsy surgery during childhood “offers suitable candidates a good chance of significantly improved outcome and low rates of complications”.

However, they noted: “Several children … required a reoperation to achieve satisfactory seizure outcomes.”

The study authors also observed that improvements in children’s cognitive processing speed “appear to occur in parallel with seizure control and were even more pronounced in subjects with no anti-epilepsy drugs … even after long-term follow-up”.

Posted by Steve Long

Cerebral hemispherectomy is sometimes used to treat drug-resistant seizures and involves the removal or disabling of one half of the brain in patients whose seizures only originate from a single hemisphere.

Scientists at the University of Cartagena in Colombia performed a review and meta-analysis of data from eight previous studies that had looked at seizure control rates following cerebral hemispherectomies in adults.

Participants were followed-up for a median of 70 months, after which almost four-fifths (79.4 per cent) remained seizure-free.

The researchers were unable to identify any factors that could be used to predict the likelihood of freedom from seizures prior to patients undergoing surgery.

Publishing their findings in the journal Neurocirugia, the study authors concluded: “Cerebral hemispherectomy has a high seizure control rate in adult patients with drug-resistant epilepsy.

“None of the variables analysed in the present study were associated with surgical success.”

Posted by Steve Long

Experts at the Ann & Robert H Lurie Children’s Hospital of Chicago analysed data on 2,239 children from four separate cohorts of youngsters with newly diagnosed epilepsy.

The information from these groups was combined, providing follow-up data on more than 30,000 person-years.

A total of 79 patients died during the follow-up period, ten of whom had lethal neurometabolic conditions and were excluded from the final analysis.

The researchers calculated that the overall death rate was 228 per 100,000 person-years.

Among children whose epilepsy was complicated by neurodisability or an underlying brain condition, the death rate was higher at 743 per 100,000 person-years, while the rate dropped to just 36 per 100,000 children with uncomplicated epilepsy.

A total of 13 deaths were seizure-related, including ten that were classified as sudden unexpected death (SUDEP).

Seizure-related death rates were 43 per 100,000 overall, including 122 per 100,000 children with complicated epilepsy and 14 per 100,000 for uncomplicated epilepsy.

Forty-eight deaths were due to other natural causes, including 37 from pneumonia or other respiratory conditions.

Overall, just 19 per cent of all deaths were seizure-related, leading the study authors to conclude that “most excess death in young people with epilepsy is not seizure-related”.

They confirmed that death rates are significantly higher among children with complicated epilepsy than among the general paediatric population.

However, the same is not true for children with uncomplicated epilepsy.

The researchers revealed: “In uncomplicated epilepsy, sudden and seizure-related death rates were similar to or higher than rates for other common causes of death in young people (e.g. accidents, suicides, homicides).”

They added that relating the risk of death in children with epilepsy to familiar risks such as these “may facilitate discussions of seizure-related mortality with patients and families”.

Posted by Steve Long

Refractory status epilepticus is a life-threatening condition involving seizures that do not respond to first or second-line anticonvulsant medications.

Some research suggests the ketogenic diet – a high-fat, adequate-protein, low-carbohydrate regime – may help to control seizures in this type of epilepsy.

Doctors at Hillerod Hospital in Denmark have reported the outcomes of three cases of children with refractory status epilepticus who were treated at the hospital using the ketogenic diet.

The first child, a three-year-old girl with hemiconvulsion-hemiplegia epilepsy syndrome, was started on the ketogenic diet on day six of her treatment.

Her seizures stopped with ketosis – a state where levels of ketone bodies in the blood are elevated and replace glucose as an energy source in the brain – on day seven.

The second case involved a ten-year-old boy with rapidly developing status epilepticus and a mitochondrial disorder.

Doctors attempted to treat him with the ketogenic diet on two separate occasions but this did not result in effective seizure control and the boy experienced severe side-effects.

The third child with status epilepticus was an otherwise healthy 11-year-old boy with fever-induced refractory epileptic encephalopathy in school-age children (FIRES), a syndrome that develops in previously unaffected youngsters.

After the ketogenic diet was initiated, seizures stopped for 24 hours, one day after reaching the state of ketosis. The boy’s condition subsequently improved over the next three to four weeks.

Publishing their findings in the European Journal of Paediatric Neurology, the study authors confirmed that the ketogenic diet “was efficient in two of three cases of refractory status epilepticus”.

They observed that the non-responder’s pre-existing mitochondrial disorder may have made the ketogenic diet an unsuitable approach and explained his severe side-effects.

“More studies are needed to prove efficacy of the ketogenic diet in refractory status epilepticus, to define optimal timing of the ketogenic diet and possible contraindications,” they concluded.

Posted by Steve Long

A survey involving more than 2,100 carers found that three-quarters did not feel prepared for all aspects of their caring role.

More than four-fifths (81 per cent) also said they were not made aware of the support on offer, while a third felt they had been given the wrong advice about where to turn for help.

The findings contained in the ‘Prepared to Care?’ report – which was published to coincide with Carers Week (June 10th to 16th) – are concerning given the fact that approximately 6,000 people take on a new caring role every day in the UK.

Helen Clarke, manager of Carers Week, said: “Becoming a carer can happen overnight and without information and guidance, carers can be left feeling isolated and alone.”

Ms Clarke claimed that many new carers are not offered support or receive the wrong advice or incomplete information.

“It’s vital that GPs, health and social care professionals and the government all play a role to ensure that carers are offered the support they deserve from day one,” she added.

Posted by Steve Long

Researchers at Mayo Clinic recently reported preliminary results at the American Academy of Neurology and say the technology could change the way epilepsy surgery is performed in the future.

At present, an invasive procedure called temporal lobectomy is often used to treat medication-resistant epileptic seizures, involving a small circle of skull being removed to allow the part of the brain responsible for the seizures to be cut out.

While it has a good success rate, patients typically require several days in hospital and do not return to normal day-to-day activities for up to three months.

Now, patients at two of Mayo Clinic’s facilities – in Rochester and Jacksonville – are being offered a far less invasive procedure that employs a laser-based tool.

During the procedure, the patient is placed under general anaesthesia and a small hole is made in the back of the skull.

A laser-tipped catheter is inserted into the affected region of the brain and a tiny lesion burnt into the site of the seizures, with an MRI scan performed during the operation to verify the location for the laser treatment.

Some 14 patients with highly localised seizures in part of the brain called the hippocampus have undergone the new treatment to date and the researchers have presented promising results from the first five of these cases.

The patients typically only required one overnight stay in hospital and returned to ordinary daily activities within a week of treatment.

Three of the patients had a type of epilepsy called mesial temporal sclerosis; two were seizure-free several months after surgery, despite previously having an average of 64 seizures a month, and one had experienced nothing more than brief ‘warning signs’ since the procedure.

The other two patients reported on by the team had a localised epilepsy syndrome called hypothalamic hamartoma and were averaging 41 seizures a month before treatment.

One of them experienced just three partial seizures in the months following the operation, while the other benefited from a 50 per cent reduction in seizures.

Study co-author Dr Richard Marsh revealed: “We continue to investigate this new minimally invasive technique that could change how epilepsy surgery is done.

“As we continue to refine the technique and are able to ablate a larger area, I believe we may be able to make the approach as effective as open surgery.”

Posted by Steve Long