Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label epilepsy. Show all posts
Showing posts with label epilepsy. Show all posts

Monday, February 23, 2026

A machine learning model for predicting post-stroke epilepsy risk by integrating multimodal EEG-fMRI and clinical biomarkers

 No prevention protocol written!

Precisely why was this research done? Incompetence of the mentors and senior researchers not knowing previous research? That's being polite!

Look how long we've known of the problem.

Just maybe you want your doctor to try these solutions.


Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 The latest here:

A machine learning model for predicting post-stroke epilepsy risk by integrating multimodal EEG-fMRI and clinical biomarkers


  • Department of Neurology II, Qingdao Traditional Chinese Medicine Hospital, Qingdao Hiser Hospital Affiliated to Qingdao University, Qingdao, Shandong, China

Abstract

Objective: 

This study aimed to develop and validate a machine learning model integrating multimodal electroencephalography-functional magnetic resonance imaging (EEG-fMRI) features with clinical biomarkers for predicting post-stroke epilepsy (PSE) risk, thus providing a quantitative tool for early identification of high-risk patients.

Methods: 

A total of 365 acute stroke patients admitted to our hospital from January 2021 to June 2024 were retrospectively enrolled and randomly divided into training (n = 256) and validation (n = 109) sets in a 7:3 ratio. Demographic data, EEG parameters, multimodal MRI indices, and serum biomarkers were collected. In the training set, univariate analysis was first performed to screen relevant factors, followed by LASSO regression for variable selection. Multivariate logistic regression was ultimately used to identify independent risk factors. Based on key predictors, random forest (RF), support vector machine (SVM), and gradient boosting (GB) models were constructed using Python. Model performance was evaluated and optimized via the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). A nomogram was developed for risk visualization, and SHapley Additive exPlanations (SHAP) values were employed for interpretability analysis to quantify the direction and magnitude of feature contributions.

Results: 

No significant differences in baseline characteristics were observed between the training and validation sets (P > 0.05), confirming data comparability. Univariate and multivariate logistic regression showed that epileptiform discharge frequency (EDF), background EEG delta wave ratio (BEDWR), stroke lesion volume (SLV), National Institutes of Health Stroke Scale (NIHSS) score, and serum neuron-specific enolase (NSE) levels were independent risk factors for PSE (all P < 0.05). Among the models, RF demonstrated superior predictive performance, with AUCs of 0.892 (training set) and 0.731 (validation set). Interpretability analysis showed that the nomogram enabled individualized risk calculation. SHAP values confirmed EDF (highest mean SHAP value), NIHSS score, and lesion volume as the top three positively contributing features (higher values correlated with increased PSE risk), aligning with regression results and validating clinical rationality.

Conclusion: 

An RF model integrating multimodal data was successfully developed to effectively predict PSE risk. EDF, NIHSS score, SLV, BEDWR, and serum NSE were identified as core predictive indicators.

Introduction

Post-stroke epilepsy (PSE) was one of the most severe complications of stroke, significantly increasing mortality risk, exacerbating neurological deficits, and adversely affecting rehabilitation and quality of life (12). Currently, clinical practice lacks effective tools for early and accurate identification of high-risk patients, relying primarily on retrospective clinical feature analysis with limited predictive precision and strong subjectivity (3).

Recent advances in multimodal neuroimaging and electrophysiological techniques provide new insights into the pathological mechanisms of PSE. Studies suggest that epileptiform discharge frequency (EDF) and delta wave activity on electroencephalography (EEG), along with imaging-derived markers such as stroke lesion volume (SLV) and clinical scores (e.g., National Institutes of Health Stroke Scale, NIHSS), may be closely associated with seizure risk (4). Additionally, serum biomarkers like neuron-specific enolase (NSE) indicate the role of neuronal injury in epileptogenesis (56). Recent studies have explored computed tomography (CT)-based deep learning models for PSE prediction, such as an automatic deep-learning approach for predicting post-stroke epilepsy after initial intracerebral hemorrhage based on non-contrast computed tomography imaging (7), which highlights the potential of emergency imaging modalities. However, single-modality predictors exhibit limited performance. Effectively integrating multimodal data—including electrophysiological, imaging, and clinical biomarkers—for precise individualized risk stratification remains a major clinical challenge.

Machine learning, with its capacity to handle complex, high-dimensional data, demonstrates unique advantages in extracting deep features from heterogeneous sources. Therefore, this study aims to develop a machine learning-based predictive model integrating electroencephalography-functional magnetic resonance imaging (EEG-fMRI) features and key clinical biomarkers to stratify PSE risk, providing an objective and reliable tool for early high-risk identification and personalized intervention strategies.

More at link.

Monday, December 9, 2024

Could a Hypertension Drug Protect Against Post-Stroke Epilepsy?

 

With your chance of epilepsy and seizures post stroke make sure your competent? doctor has a prevention solution for these.


Just maybe you want your doctor to try these solutions.

Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 The latest here:

Could a Hypertension Drug Protect Against Post-Stroke Epilepsy?

      Observational study suggests one antihypertensive class might be preventive

LOS ANGELES -- Use of angiotensin receptor blockers (ARBs) was linked to a lower risk of epilepsy after an acute ischemic stroke, according to an observational study.

Among hypertensive patients, ARB use was the only factor significantly associated with onset of post-stroke epilepsy after multivariate adjustment, reported Giacomo Evangelista, MD, of G. D'Annunzio University of Chieti-Pescara in Chieti, Italy, at the American Epilepsy Society annual meeting.

ARB users accounted for about 5% of those who developed epilepsy (two of 38) and 25% of those who didn't develop epilepsy after their stroke (104 of 409).

The findings match up with observational findings among hypertensive persons without prior stroke, the researchers noted. One large study from Germany showed a hazard ratio of 0.77 (95% CI 0.65-0.90) for epilepsy incidence among ARB users compared with users of other antihypertensive drug classes. An even larger U.S. study showed similar adjusted hazard ratios of 0.70 to 0.75 for ARBs versus other antihypertensive classes, which appeared to be driven by a reduction with losartan.

"In our study, ARBs show a potential protective role in epilepsy development in patients with hypertension and stroke," Evangelista concluded. "These insights can help inform clinical guidelines and therapeutic strategies, emphasizing the need for larger, prospective studies to confirm these results and further elucidate the mechanisms involved."

Ischemic stroke is the most common cause of seizures in patients older than 60 years, Evangelista noted, as it accounts for about 6-8% of new epilepsy diagnoses in elderly patients.

"It has been postulated that the brain's renin-angiotensin-aldosterone system plays a special mediating role in epilepsy pathology and may be associated with the hyperactivation of angiotensin II type 1 receptor and ACE [angiotensin-converting enzyme] signaling in astrocytes, oligodendrocytes, and microglia," the researchers noted.

Potential mechanisms could include reducing neuronal loss and microglia-mediated inflammatory responses or other neuroinflammatory processes. Evangelista's group added that ARBs "downregulate the TGF-beta-mediated signaling cascade displaying numerous neuroprotective benefits, such as diminishing neuroinflammation or reducing epilepsy severity and seizure frequency."

Although the findings corroborate those of prior studies, Alain Lekoubou Looti, MD, of Penn State College of Medicine in Hershey, Pennsylvania, cautioned against overinterpreting the results from observational studies, which cannot account for all possible variables or make any conclusions about causality. He was not involved in the study.

"At this stage it's too premature to just use these results to make a recommendation on antihypertensive medication prescription to prevent late-onset seizures," he told MedPage Today. "I think at this point it's important to start thinking about a randomized clinical trial that would test the impact of ARBs, and more specifically losartan, on preventing seizures in patients with hypertension."

Evangelista's retrospective study used data from 528 patients (mean age 71, 57% men) who had hypertension and a diagnosis of ischemic stroke, which had to be confirmed by clinical and neuroimaging evaluations, and who were seen at the neurology ward of a single center in Italy from January 2016 through January 2022.

All participants were followed up at a median of 24 months with a telephone interview based on a validated seizure detection questionnaire. Those who screened positive for possible epilepsy had an in-person neurological consultation and an electroencephalogram to determine the epileptic etiology of their episodes and to rule out mimic seizures.

Post-stroke epilepsy diagnosis was made according to International League Against Epilepsy criteria in 38 (7.2%) patients.

Most of the patients had pre-existing hypertension before stroke (70.3%), and each antihypertensive class was taken by 20-30% of patients. The same spread was seen post-stroke, with 34% on an ACE inhibitor, 21% on an ARB, 31% on a beta-blocker, and 28% on a calcium channel blocker. Most patients took a single antihypertensive; 37% took two or more drugs.

Unadjusted findings suggested a lower epilepsy risk with a number of the classes. The proportion of patients on each class in the epilepsy versus no-epilepsy groups were significantly lower with:

  • ARBs (P=0.009)
  • Beta-blockers (P=0.008)
  • Calcium channel blockers (P=0.019)

However, the associations of epilepsy incidence with beta-blockers and calcium channel blockers disappeared upon multivariate adjustment.

The observational study could not draw any causal conclusions and was hampered by a limited sample size at a single institution, the researchers noted.

Disclosures

The researchers disclosed no relevant relationships with industry.

Lekoubou Looti reported no relevant relationships with industry.

Primary Source

American Epilepsy Society

Source Reference: Evangelista G "Angiotensin receptor blockers (ARBs) reduce the risk of developing epilepsy in patients with ischemic stroke and hypertension" AES 2024; Abstract 1.34.

Wednesday, November 13, 2024

Novel calculator predicts risk of epilepsy after rare stroke

 Where is the protocol to prevent this epilepsy? Without that, this prediction is totally fucking useless!

Novel calculator predicts risk of epilepsy after rare stroke

Date:
November 12, 2024
Source:
University of Gothenburg
Summary:
A practical calculator predicts the risk of epilepsy after venous stroke. The aim is to improve care for those affected, which are predominantly young adults.
Share:
FULL STORY

A practical calculator that predicts the risk of epilepsy after venous stroke is presented in a study from the University of Gothenburg and others. The aim is to improve care for those affected, which are predominantly young adults.

A blood clot in the cerebral venous system (cerebral venous thrombosis) is a rare but important cause of stroke.

In Sweden, around 150 individuals are affected each year, typically affecting women between the ages of 20 and 50. One in three patients experiences a seizure during the acute phase. 

Thursday, September 26, 2024

Stroke-related epilepsy in the rehabilitation setting: Insights from the inpatient post-stroke rehabilitation study – RIPS

 Precisely why was this research done? Incompetence of the mentors and senior researchers not knowing previous research? That's being polite!

Look how long we've known of the problem.

Just maybe you want your doctor to try these solutions.


Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 The latest here:

Stroke-related epilepsy in the rehabilitation setting: Insights from the inpatient post-stroke rehabilitation study – RIPS

, , , , , , ,
https://doi.org/10.1016/j.ebr.2024.100713
Get rights and content
Under a Creative Commons license
open access

Highlights

  • In stroke survivors, persistent seizure activity could be associated with poor functional outcomes.
  • Over-treatment could hamper post-stroke recovery.
  • We analyzed EEG and anti-seizure medication management on 163 post-stroke patients.
  • Multi-centre prospective study involving two intensive rehabilitation units (IRUs).

Abstract

Objective

In stroke survivors, persistent seizure activity could be associated with poor functional outcomes. At the same time, antiepileptic over-treatment could hamper post-stroke recovery. We systematically investigated the occurrence of seizures, the prevalence of epileptic discharges, and delta slow waves on electroencephalogram (EEG) and anti-seizure medication (ASM) management in relation to clinical manifestations and EEG abnormalities.

Materials and methods

This was a multi-centre prospective study involving two intensive rehabilitation units (IRUs). Clinical and EEG data were acquired at admission to the IRU, discharge (T1), and six-month follow-up (T2).

Results

A total of 163 patients underwent EEG recording upon admission to the IRU, while 149 were available for analysis at discharge from the IRU. Eighteen patients were treated with ASMs upon IRU admission despite only five of these patients having early seizures. Among the 145 patients not treated upon admission to the IRU, eight had late seizures, of which six were during the IRU stay, while two were after discharge from the IRU. During IRU stay, ASMs were generally discontinued in patients with no early seizures reported and were started in patients with late seizures. Among the 18 patients treated with ASMs at admission to the IRU, only six maintained the therapy also at T2.

Conclusion

Our results suggest that post-acute inpatient rehabilitation is a proper setting to observe patients treated with ASMs after stroke and provide personalized post-stroke epilepsy management.

Keywords

ASMs
EEG
Epilepsy
Rehabilitation
Seizures
Stroke

1. Introduction

Stroke-related epilepsy (STRE) [1] ranges from 2 % to 14 % depending on the study population [2], [3] and accounts for nearly 50 % of newly diagnosed epilepsy inpatients over 60 years old. With the increasing prevalence of post-stroke survivors, mainly related to the aging of the population and the improvement of hyperacute stroke care, the number of patients with STRE is expected to increase [4], [5]. Seizures may occur in close temporal association with stroke (acute symptomatic, provoked, or early seizures (ESs), or after a variable interval, from several days to years following the stroke (late seizures, LSs) [6]. While ESs result from local metabolic disturbances, LSs occur in relation to altered neuronal networks, i.e. when the brain acquires a predisposition for seizures. In stroke survivors, persistent seizure activity could hamper post-stroke recovery, cause temporary or even permanent neurological deterioration, and predict poor functional outcomes [7]. Furthermore, seizures affect not only the quality of life of the patient but also that of their families [8]. STRE may occur or recur during post-acute rehabilitation [9]. Therefore, the management of LSs should be considered as part of the individual rehabilitation project, aiming to improve functional outcomes in post-stroke patients with STRE. Specifically, STRE diagnosis and the management of anti-seizure medication (ASM), mainly based on careful evaluation of efficacy combined with the evaluation of side effects and drug-drug interaction, are a necessary intervention to be carried out during the rehabilitation stay [10].
To the best of our knowledge, the incidence of STRE and ASM management in post-acute stroke inpatient rehabilitation, although relevant to aiming to identify any clinical/instrumental indicators for the development of LSs and to improve the management of post-stroke patients in a sub-acute setting, has not been investigated by previous studies. Thus, in the context of a multicentre observational prospective study investigating predictors of functional outcomes at discharge from inpatient post-stroke rehabilitation (RIPS study) [11], we aimed to systematically observe the occurrence of early and late seizures, from admission to the Intensive Rehabilitation Unit (IRU) to discharge and to six-month after the stroke and the relationship between seizure and the prevalence of epileptic discharges, and delta slow waves on the electroencephalogram (EEG) In addition, we aimed to describe and discuss ASM management in relation to clinical manifestations and EEG abnormalities.

Wednesday, February 28, 2024

Outcomes and Predictors of Seizure Recurrence in Post-Stroke Epilepsy, A Retrospective Hospital-based Study

 Predicting post stroke epilepsy rather than preventing it is the HEIGHT OF STUPIDITY! And you're still employed in stroke? Look how long we've known of the problem.

Just maybe you want your doctor to try these solutions.


Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 The latest here:

Outcomes and Predictors of Seizure Recurrence in Post-Stroke Epilepsy, A Retrospective Hospital-based Study

, , , , , , , , , , , , ,
https://doi.org/10.1016/j.clineuro.2024.108208Get rights and content

Highlights

  • Recurrence in Post-Stroke seizure (PSS) is associated with significant functional decline in stroke patients.

  • Choice of anti-seizure medications (ASMs) may influence the morbidity and mortality.

  • Future research is needed to explore the effects of ASMs on PSS pathophysiology.

Abstract

Background

The occurrence of seizures following a stroke is a well-recognized complication associated with a significant increase in morbidity and mortality. Despite the numerous studies examining outcomes and risk factors related to post-stroke seizures (PSS), there remains a lack of clarity(And you incompetently didn't create a protocol on how to prevent this problem?)  regarding the clinical characteristics, treatment, and PSS recurrence (PSSR) rates in patients experiencing their initial episode of PSS.

Purpose

This study aimed to determine the risk factors for developing recurrent seizures after first PSS and their effects on functional outcomes and mortality.

Methods

All patients underwent an electroencephalography (EEG) and were monitored for a minimum of 24 months following the first PSS. The primary endpoint was the recurrence of seizures. Predictive factors for PSSR were determined by using the Cox-proportional hazards model, and the cumulative latency of recurrence at 90, 180, 360, and 720 days was estimated using Kaplan-Meier analysis.

Results

Seizure recurred in 36.8% (39/106). Significant association of PSSR was noted with female gender, use of older anti-seizure medications (ASMs) (p<0.001), EEG findings as focal slow wave activity (p<0.001), Ictal epileptiform abnormalities (p=0.015), status epilepticus (p=0.015), and with severe disability (p=0.008). However, multivariate cox-proportional hazards model showed significant association of female gender (HR=3.28; 95% CI: 1.42-7.58; p=0.006). Hazard ratio (HR) was increased with older ASMs use, focal aware seizure types, Ictal EAs, and periodic discharges on EEG; though, statistically significant.

Conclusion

Factors such as the type of ASMs, EEG findings, and seizure type were significantly linked to PSSR. Female gender was the only independent predictor established. Additionally, significant functional decline was reported with recurrence.

More at link.

Sunday, September 3, 2023

How Live Viola Music Calms Epilepsy Patients

This is treatment after it occurs. What is your doctor EXACTLY doing to prevent epilepsy?

With your chance of epileptic seizures post stroke, your doctor is responsible to know EXACTLY how to prevent them. 

Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Be careful out there. Some research points to a 10-40% epilepsy incidence rate for survivors. What is your doctor doing to ensure you don't get epilepsy?

How Live Viola Music Calms Epilepsy Patients

Summary: Patients undergoing testing for epilepsy often experience significant distress when their medication is reduced to provoke seizures. However, a recent study reveals that listening to live improvisatory viola music helps these patients achieve a meditative state, as shown by EEG measurements.

This calming effect allows testing to proceed and reduces self-reported stress and anxiety. The research offers promising implications for non-pharmacological interventions in healthcare.

Key Facts:

  1. Live improvisatory viola music reduced the patients’ brain wave frequencies to an alpha state, indicating a meditative, calm state.
  2. The viola was specifically chosen for its pitch range, which falls within the human “safe” vocal range known to activate the brain’s calming systems.
  3. While listening to recorded favorites did not show the same impact, the live, personalized 40-minute music session over FaceTime was clinically effective.

Source: Northwestern University

Patients with epilepsy endure difficult conditions in the hospital to undergo testing. They must temporarily stop or decrease their medications during their hospitalization to provoke seizures. Many feel distressed and anxious. Some are so uncomfortable, they cannot complete their testing.   

But when these patients listened to improvisatory music — a violist playing live music who responded to their state of agitation in real time — the patients’ brain waves (as monitored on an EEG) slowed to a calmer state, allowing the testing to continue. Patients also reported decreased feelings of stress and anxiety after their clinical music experience.   

Credit: Northwestern University

“Their brains went into a meditative state,” said lead investigator Dr. Borna Bonakdarpour, associate professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist.

“When they engaged with the real world, such as watching a TV show or browsing social media on their phone, their brain frequency was an average of 12 or 13 (beta waves) Hertz, but after the music it dropped to an 8 or 9, which is the alpha state.” 

The study was published Sept. 1 in Frontiers of Neurology.  

The viola was chosen for this research due to its pitch range reflecting the human “safe” vocal range, which is the two middle octaves. Research shows this range, used for lullabies, activates the calming systems of the brain.

“There has been a scarcity of non-pharmacological interventions for epilepsy patients in the hospital, and we show that the patients benefited significantly from music intervention,” Bonakdarpour said.

“Importantly, the patients’ self-reports correlated with objective EEG changes, which is something that had not been previously done in an epilepsy-monitoring unit.”

The study with five patients was small, but Bonakdarpour is planning a larger clinical trial with 30 to 50 patients. 

This shows a viola..
The improvisation is slow and meterless, played in the form of two-minute-long statements with an ending that tapers to silence. Credit: Neuroscience News

The impact of the findings may apply to patients in the hospital for other reasons, Bonakdarpour said.  

“Music as a clinical tool is underutilized in outpatient settings and in hospitals,” he said. 

During the pilot study, 21 patients with epilepsy were identified as suitable for the trial. Five of these individuals were reported by the nursing and social work staff to have significant distress and were included in this study to receive the intervention. Listening to recordings of their favorite songs alone did not seem to be effective for these patients.

Participants in the study received a personalized 40-minute live music session over FaceTime by a clinically trained violist in consultation with a music therapist. 

Clinically designed improvisatory music has simple meandering melodies played at a slow tempo. The improvisation is slow and meterless, played in the form of two-minute-long statements with an ending that tapers to silence.  

The music was offered as part of the Northwestern Medicine Telemusic Intervention program during COVID-19 lockdown to relieve patients’ distress in the Northwestern Memorial Hospital neurosciences unit. The results of the broader study included 87 sessions during a three-month period.  

Northwestern co-authors include: Guangyu Zhou, Daniel Huang, Catherine Vidano, Stephan Schuele, Christina Zelano and Clara Takarabe. 

Funding: The research is funded by National Institutes of Deafness and other Communication Disorders (NIDCD) grant R01-DC-018539 of the National Institutes of Health and Northwestern’s department of neurology philanthropy.

About this music therapy and epilepsy research news

Author: Marla Paul
Source: Northwestern University
Contact: Marla Paul – Northwestern University
Image: The image is credited to Neuroscience News

Original Research: Closed access.
Calming Effect of Clinically Designed Improvisatory Music for Patients Admitted to the Epilepsy Monitoring Unit during the COVID-19 Pandemic: A Pilot Study” by Borna Bonakdarpour et al. Frontiers in Neurology


Abstract

Calming Effect of Clinically Designed Improvisatory Music for Patients Admitted to the Epilepsy Monitoring Unit during the COVID-19 Pandemic: A Pilot Study

Background: Epilepsy monitoring requires simulating seizure-inducing conditions which frequently causes discomfort to epilepsy monitoring unit (EMU) patients. COVID-19 hospital restrictions added another layer of stress during hospital admissions. The purpose of this pilot study was to provide evidence that live virtual Clinically Designed Improvisatory Music (CDIM) brings relief to EMU patients for their psychological distress.

Methods: Five persons with epilepsy (PWEs) in the EMU during the COVID-19 lockdown participated in the study (average age ± SD = 30.2 ± 6 years). Continuous electroencephalogram (EEG) and electrocardiogram (EKG) were obtained before, during, and after live virtual CDIM. CDIM consisted of 40 minutes of calming music played by a certified clinical music practitioner (CMP) on viola. Post-intervention surveys assessed patients’ emotional state on a 1–10 Likert scale. Alpha/beta power spectral density ratio was calculated for each subject across the brain and was evaluated using one-way repeated analysis of variance, comparing 20 minutes before, during, and 20 minutes after CDIM. Post-hoc analysis was performed using paired t-test at the whole brain level and regions with peak changes.

Results: Patients reported enhanced emotional state (9 ± 1.26), decrease in tension (9.6 ± 0.49), decreased restlessness (8.6 ± 0.80), increased pleasure (9.2 ± 0.98), and likelihood to recommend (10 ± 0) on a 10-point Likert scale. Based on one-way repeated analysis of variance, alpha/beta ratio increased at whole-brain analysis (F3,12 = 5.01, P = 0.018) with a peak in midline (F3,12 = 6.63, P = 0.0068 for Cz) and anterior medial frontal region (F3,12 = 6.45, P = 0.0076 for Fz) during CDIM and showed a trend to remain increased post-intervention.

Conclusion: In this pilot study, we found positive effects of CDIM as reported by patients, and an increased alpha/beta ratio with meaningful electroencephalographic correlates due to the calming effects in response to CDIM. Our study provides proof of concept that live virtual CDIM offered demonstrable comfort with biologic correlations for patients admitted in the EMU during the COVID-19 pandemic.


Wednesday, December 28, 2022

Epilepsy Drugs May Up Risk of Parkinson's

Make sure your doctor isn't increasing your risk of Parkinsons more than it is already is by treating your seizures this way. 

Your risk of Parkinsons here:

Parkinson’s Disease May Have Link to Stroke March 2017

With your chance of epileptic seizures post stroke, your doctor is responsible to know EXACTLY how to prevent them. 

Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Be careful out there. Some research points to a 10-40% epilepsy incidence rate for survivors. What is your doctor doing to ensure you don't get epilepsy?

The latest here:

Epilepsy Drugs May Up Risk of Parkinson's

Strongest association seen for sodium valproate

A photo of a person holding a blisterpack of Epilium sodium valporate tablets.

Taking antiepileptic drugs (AEDs) was associated with a subsequent diagnosis of Parkinson's disease (PD), a U.K.-based case control study suggested.

There was a significant association between AED prescriptions and incident Parkinson's disease (OR 1.80, 95% CI 1.35-2.40, P=0.0007), and the magnitude of the association rose with an increasing number of prescriptions and for those who took more than one AED, Alastair Noyce, PhD, of Queen Mary University of London, and colleagues reported in JAMA Neurologyopens in a new tab or window.opens in a new tab or window

Of the four most commonly prescribed AEDs in the U.K., carbamazepine wasn't significantly associated with Parkinson's, but three AEDs did have a significant relationship:

  • Lamotrigine (OR 2.83, 95% CI 1.53-5.25, P=0.009)
  • Levetiracetam (OR 3.02, 95% CI 1.51-6.05, P=0.02)
  • Sodium valproate (OR 3.82, 95% CI 2.41-6.05, P=0.00000001)

Previous work -- including a study from Noyce's own groupopens in a new tab or window -- has shown a link between epilepsy and Parkinson's disease, and it's "plausible that [AEDs] may account for some or all of the apparent association between epilepsy and PD," the researchers wrote.

To further explore that potential relationship, Noyce and colleagues conducted a nested case-control study using data from the U.K. Biobank, which began collection in 2006. Cases were defined as individuals with a hospital-coded diagnosis of PD.

Ultimately, they assessed 1,433 Parkinson's cases and 8,598 matched controls. Among patients with Parkinson's, 60.9% were male, median age at diagnosis was 71 years, and about 98% were white.

Overall, 62 patients with Parkinson's had an AED prescription prior to their Parkinson's diagnosis, compared with 211 controls (4.3% vs 2.5%). Among Parkinson's patients, 4.4% had an epilepsy diagnosis compared with 1% of controls.

The researchers noted that the association between sodium valproate and incident Parkinson's was the most robust, and remained strong in further adjusted models.

They also conducted sensitivity analyses excluding prescriptions issued 1, 2, and 5 years before the date of the Parkinson's diagnosis to control for cases of transient drug-induced parkinsonism. Once again, the analyses didn't alter the strength of the associations between the three drugs and Parkinson's disease, they reported.

This analysis also reduces the possibility of reverse causation "in which some patients with PD may have been treated with selected AEDs for early mood or neuropsychiatric symptoms," they wrote.

Noyce and colleagues noted that studies have shown AEDs can interfere in dopamine pathways. Sodium valproate and carbamazepine are associated with downregulation of dopamine receptors and with dopamine insensitivity, they noted.

"While this may explain drug-induced Parkinsonism, it is likely that other factors may contribute to PD pathogenesis," they wrote. One case series found, for instance, that patients who initially experienced remission of drug-induced Parkinsonism after stopping their AEDs later developed Parkinson's. "This may suggest that these patients had subclinical PD or were at risk of PD," they wrote.

Their observation is also supported "by postmortem studiesopens in a new tab or window showing that individuals with drug-induced parkinsonism have reduced levels of homovanillic acid and dopamine in the striatum," they added. A higher risk of psychotropic adverse effectsopens in a new tab or window has been observed in individuals taking levetiracetam "if they had genetic variants associated with decreased dopamine activity."

Noyce and colleagues noted that a "major limitation" of the study is that epilepsy is a "common reason for admission to the hospital," so ascertainment of Parkinson's "may contribute to the observed associations simply because patients with epilepsy had been admitted to the hospital more than patients without epilepsy."

They also warned that their study was likely underpowered to detect effects in some of their sensitivity analyses and that results couldn't be extrapolated to other AEDs.

Still, the researchers concluded that the study "sets the scene and highlights the need for further work to corroborate our findings in other large data sets because these findings could have important implications for clinical decision-making."

  • author['full_name']

    Kate Kneisel is a freelance medical journalist based in Belleville, Ontario.

Disclosures

The authors reported financial relationships with Barts Charity, Parkinson's U.K., Cure Parkinson's, the Michael J. Fox Foundation, Innovate U.K., Solvemed, Alchemab, AstraZeneca, AbbVie, Zambon, BIAL, Umedeor, Alchemab, Britannia, and Charco Neurotech.

Primary Source

JAMA Neurology

Source Reference: opens in a new tab or windowBelete D, et al "Association between antiepileptic drugs and incident Parkinson Disease in the UK biobank" JAMA Neurol 2022; DOI: 10.1001/jamaneurol.2022.4699.

Wednesday, June 22, 2022

Protective Effects of Intranasally Administrated Oxytocin-Loaded Nanoparticles on Pentylenetetrazole-Kindling Epilepsy in Terms of Seizure Severity, Memory, Neurogenesis, and Neuronal Damage

 

With your chance of epileptic seizures post stroke, your doctor is responsible to know EXACTLY how to prevent them. Now we need followup human testing

Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Be careful out there. Some research points to a 10-40% epilepsy incidence rate for survivors. What is your doctor doing to ensure you don't get epilepsy? YOUR DOCTOR'S RESPONSIBILITY!

Protective Effects of Intranasally Administrated Oxytocin-Loaded Nanoparticles on Pentylenetetrazole-Kindling Epilepsy in Terms of Seizure Severity, Memory, Neurogenesis, and Neuronal Damage

  • Hakan Sahin*
  • Oguz Yucel
  • Serkan Emik
  • , and 
  • Gozde Erkanli Senturk

Pentylenetetrazole (PTZ)-induced kindling is an animal model for studying human temporal lobe epilepsy (TLE), which is characterized by alterations of hippocampal neurons and memory. Although the intranasal (IN) administration of oxytocin (OT) has limited efficiency, nanoparticles (NPs) are a promising candidate to deliver OT to the brain. However, there are very limited data on epilepsy research about oxytocin-loaded nanoparticles (NP-OTs). The aim of this study is to investigate the effects of IN administration of chronic NP-OTs on the hippocampus of PTZ-induced male epileptic rats in terms of seizure severity, memory, neurogenesis, and neuronal damage. Saline/OT/NP-OTs were administrated to both control (Ctrl) and PTZ groups intranasally. Consequently, saline and PTZ were injected, respectively, 25 times every 48 h. Then, seizure severity (score and latency) was calculated for the PTZ groups. A spatial working memory evaluation test (SWMET) was performed after the last injection. Hippocampus histopathology, neurogenesis, and apoptosis were demonstrated. Serum total antioxidant status (TAS) and total oxidant status (TOS) levels and the oxidative stress index (OSI) were measured. We showed that OTs and NP-OTs prevented the kindling development and had positive effects on seizure severity. SWMET-related behaviors were also recovered in the PTZ + NP-OT group. A significant increase of neurogenesis and decrease of apoptosis in the hippocampus of the PTZ + NP-OT group were observed, while OTs and NP-OTs had protective effects against PTZ-induced damage to hippocampal neurons. Our results indicate that the chronic administration of NP-OTs may have positive effects on hippocampal damage via increasing neurogenesis and decreasing apoptosis and seizure severity.

 

Monday, May 9, 2022

The gut microbiome and adult hippocampal neurogenesis: A new focal point for epilepsy?

With your chance of epileptic seizures post stroke, your doctor is responsible to know EXACTLY how to prevent them. 

Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Be careful out there. Some research points to a 10-40% epilepsy incidence rate for survivors. What is your doctor doing to ensure you don't get epilepsy? YOUR DOCTOR'S RESPONSIBILITY!

The gut microbiome and adult hippocampal neurogenesis: A new focal point for epilepsy?

2
https://doi.org/10.1016/j.nbd.2022.105746Get rights and content
Under a Creative Commons license
Open access

Abstract

Temporal lobe epilepsy (TLE) is a neurological disorder affecting millions of people worldwide and currently represents the most common form of focal epilepsy. Thus, the search for aetiological and pathophysiological parameters of TLE is ongoing.

Preclinical work and post-mortem human studies suggest adult hippocampal neurogenesis as a potentially relevant factor in TLE pathogenesis. Although progress has been made in elucidating the molecular links between TLE and hippocampal neurogenesis, recent evidence suggests that additional peripheral mediators may be involved.

The microbiota-gut-brain axis mediates bidirectional communication between the gut and the brain and could comprise a link between neurogenesis and TLE. In this review, we discuss emerging evidence highlighting a potential role for the gut microbiome in connecting TLE pathogenesis and hippocampal neurogenesis. We focus in particular on mechanisms associated with neuronal excitability, neuroinflammation and gut microbial metabolites. As the evidence does not yet support a direct link between gut microbiota-regulated hippocampal neurogenesis and TLE aetiology or pathophysiology, future studies are needed to establish whether current findings comprise circumstantial links or a potentially novel avenue for clinically relevant research.