Epilepsy Resource Center

Neuropsychological testing may help differentiate epileptic seizures from psychogenic nonepileptic seizures (PNES) according to a study that evaluated data from 72 patients with epilepsy and 33 patients with PNES.

• In the past, psychometric testing has been shown to have limited utility in differentiating PNES from epileptic seizures.
• The new research suggests that multivariate assessment using several psychological tests is more effective in making the differential diagnosis.
• Using logistic regression, investigators found that a combination of 7 neuropsychological tests accurately classified about 85% of patients.
• The researchers acknowledged that video-EEG monitoring remains the gold standard for separating PNES from epileptic seizures but suggest that a standardized battery of neuropsychological tests may improve the clinical decision-making process.

Tyson BT, Baker S, Greenacre M, et al. Differentiating epilepsy from psychogenic nonepileptic seizures using neuropsychological test data. Epilepsy Behav. 2018;87:39-45.

Neuropsychological testing may help differentiate epileptic seizures from psychogenic nonepileptic seizures (PNES) according to a study that evaluated data from 72 patients with epilepsy and 33 patients with PNES.

• In the past, psychometric testing has been shown to have limited utility in differentiating PNES from epileptic seizures.
• The new research suggests that multivariate assessment using several psychological tests is more effective in making the differential diagnosis.
• Using logistic regression, investigators found that a combination of 7 neuropsychological tests accurately classified about 85% of patients.
• The researchers acknowledged that video-EEG monitoring remains the gold standard for separating PNES from epileptic seizures but suggest that a standardized battery of neuropsychological tests may improve the clinical decision-making process.

Tyson BT, Baker S, Greenacre M, et al. Differentiating epilepsy from psychogenic nonepileptic seizures using neuropsychological test data. Epilepsy Behav. 2018;87:39-45.

Neuropsychological testing may help differentiate epileptic seizures from psychogenic nonepileptic seizures (PNES) according to a study that evaluated data from 72 patients with epilepsy and 33 patients with PNES.

• In the past, psychometric testing has been shown to have limited utility in differentiating PNES from epileptic seizures.
• The new research suggests that multivariate assessment using several psychological tests is more effective in making the differential diagnosis.
• Using logistic regression, investigators found that a combination of 7 neuropsychological tests accurately classified about 85% of patients.
• The researchers acknowledged that video-EEG monitoring remains the gold standard for separating PNES from epileptic seizures but suggest that a standardized battery of neuropsychological tests may improve the clinical decision-making process.

Tyson BT, Baker S, Greenacre M, et al. Differentiating epilepsy from psychogenic nonepileptic seizures using neuropsychological test data. Epilepsy Behav. 2018;87:39-45.

Health-related quality of life for children with epilepsy appears to be dependent in part on their parents’ ability to cope with the disorder, according to a recent study published in Epilepsy and Behavior.

• The analysis of 108 children and teens with epilepsy also revealed an association between parental helplessness and poorer quality of life.
• As expected, the severity of the child’s epilepsy was linked to poorer quality of life as well.
• These conclusions were based on parents’ responses to the Illness Cognition Questionnaire-Parent (ICQ-P), and the Quality of Life in Childhood Epilepsy questionnaire (QOLCE).
•  ICQ-P evaluates a parent’s ability to cope with disease with the help of constructs of illness cognition.
• QOLCE helps clinicians evaluates the overall functioning of a child as perceived by parents.

McLaughlin RM, Schraegle WA, Nussbaum NL, et al. Parental coping and its role in predicting health-related quality of life in pediatric epilepsy. [Published online ahead of print August 23, 2018] Epilepsy Behav. doi: 10.1016/j.yebeh.2018.08.009

Health-related quality of life for children with epilepsy appears to be dependent in part on their parents’ ability to cope with the disorder, according to a recent study published in Epilepsy and Behavior.

• The analysis of 108 children and teens with epilepsy also revealed an association between parental helplessness and poorer quality of life.
• As expected, the severity of the child’s epilepsy was linked to poorer quality of life as well.
• These conclusions were based on parents’ responses to the Illness Cognition Questionnaire-Parent (ICQ-P), and the Quality of Life in Childhood Epilepsy questionnaire (QOLCE).
•  ICQ-P evaluates a parent’s ability to cope with disease with the help of constructs of illness cognition.
• QOLCE helps clinicians evaluates the overall functioning of a child as perceived by parents.

McLaughlin RM, Schraegle WA, Nussbaum NL, et al. Parental coping and its role in predicting health-related quality of life in pediatric epilepsy. [Published online ahead of print August 23, 2018] Epilepsy Behav. doi: 10.1016/j.yebeh.2018.08.009

Health-related quality of life for children with epilepsy appears to be dependent in part on their parents’ ability to cope with the disorder, according to a recent study published in Epilepsy and Behavior.

• The analysis of 108 children and teens with epilepsy also revealed an association between parental helplessness and poorer quality of life.
• As expected, the severity of the child’s epilepsy was linked to poorer quality of life as well.
• These conclusions were based on parents’ responses to the Illness Cognition Questionnaire-Parent (ICQ-P), and the Quality of Life in Childhood Epilepsy questionnaire (QOLCE).
•  ICQ-P evaluates a parent’s ability to cope with disease with the help of constructs of illness cognition.
• QOLCE helps clinicians evaluates the overall functioning of a child as perceived by parents.

McLaughlin RM, Schraegle WA, Nussbaum NL, et al. Parental coping and its role in predicting health-related quality of life in pediatric epilepsy. [Published online ahead of print August 23, 2018] Epilepsy Behav. doi: 10.1016/j.yebeh.2018.08.009

Multiday epileptic seizure cycles may occur in many individuals with epilepsy, according to a retrospective cohort study published online ahead of print September 12 in Lancet Neurology.

About 80% of patients in the study showed circadian modulation of their seizure rates, and more than 20% had strong circaseptan (ie, seven-day) rhythms, said Mark J. Cook, MD, a neurologist at St. Vincent’s Hospital in Melbourne, and colleagues.

—Andrew D. Bowser

Suggested Reading

Karoly PJ, Goldenholz DM, Freestone DR, et al. Circadian and circaseptan rhythms in human epilepsy: a retrospective cohort study. Lancet Neurol. 2018 Sep 12 [Epub ahead of print].

Multiday epileptic seizure cycles may occur in many individuals with epilepsy, according to a retrospective cohort study published online ahead of print September 12 in Lancet Neurology.

About 80% of patients in the study showed circadian modulation of their seizure rates, and more than 20% had strong circaseptan (ie, seven-day) rhythms, said Mark J. Cook, MD, a neurologist at St. Vincent’s Hospital in Melbourne, and colleagues.

—Andrew D. Bowser

Suggested Reading

Karoly PJ, Goldenholz DM, Freestone DR, et al. Circadian and circaseptan rhythms in human epilepsy: a retrospective cohort study. Lancet Neurol. 2018 Sep 12 [Epub ahead of print].

Multiday epileptic seizure cycles may occur in many individuals with epilepsy, according to a retrospective cohort study published online ahead of print September 12 in Lancet Neurology.

About 80% of patients in the study showed circadian modulation of their seizure rates, and more than 20% had strong circaseptan (ie, seven-day) rhythms, said Mark J. Cook, MD, a neurologist at St. Vincent’s Hospital in Melbourne, and colleagues.

—Andrew D. Bowser

Suggested Reading

Karoly PJ, Goldenholz DM, Freestone DR, et al. Circadian and circaseptan rhythms in human epilepsy: a retrospective cohort study. Lancet Neurol. 2018 Sep 12 [Epub ahead of print].

Pooled data from an expanded-access program provide further evidence that adjunctive cannabidiol (CBD) provides meaningful reductions in seizure frequency in patients with treatment-resistant epilepsies. The data were published in the August issue of Epilepsia.

Studies have recently indicated that adjunctive CBD effectively reduces seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. An expanded-access program was created in January 2014 to offer CBD to patients with treatment-resistant epilepsies. Data on safety, tolerability, and efficacy during the first year of the study have been reported. Jerzy P. Szaflarski, MD, PhD, Professor of Neurology at the University of Alabama at Birmingham, and colleagues examined results for safety outcomes at 144 weeks and efficacy outcomes at 96 weeks.

An Expanded-Access Program

All participants in the program had treatment-resistant epilepsy and were receiving stable doses of antiepileptic drugs (AEDs) for at least four weeks before enrollment. During a four-week baseline period, parents and caregivers kept diaries of all countable seizure types. Participants subsequently received a plant-based oral pharmaceutical formulation of CBD (100 mg/mL). Treatment was initiated at a dose of 2–10 mg/kg/day and was titrated to a maximum dose of 25–50 mg/kg/day.

Patients were examined every two to four weeks until the 16th week, and every two to 12 weeks after that point. The efficacy outcomes included the percentage change from baseline in median monthly convulsive seizure frequency and total seizure frequency, and the percentages of patients with at least 50%, at least 75%, and 100% reductions in seizures, compared with baseline. Investigators documented adverse events at each visit.

CBD Was Well Tolerated

The safety analysis included 607 patients, and the efficacy analysis included 580 patients. Among patients included in the safety analysis, 24% withdrew from the study. The most common reasons for withdrawal were lack of efficacy (15%) and adverse events (5%). Participants’ mean age was 13, and 52% of patients were male. The median number of concomitant AEDs was three, the median dose of CBD was 25 mg/kg/day, and the median treatment duration was 48 weeks.

At 12 weeks, adjunctive CBD was associated with a 51% reduction in median monthly convulsive seizures and a 48% reduction in total seizures. Reductions in these seizure types were similar through 96 weeks. At 12 weeks, 52% of patients had a reduction in convulsive seizures of at least 50%, 31% had a reduction of at least 75%, and 11% had a 100% reduction. These response rates were similar through 96 weeks of treatment.

CBD was generally well tolerated. The most common adverse events were diarrhea (29%) and somnolence (22%). About 10% of patients had abnormal liver adverse events, and 75% of them were taking valproate. Among patients taking concomitant clobazam, 38% had somnolence, compared with 14% of patients not taking concomitant clobazam.

The expanded-access program is not placebo-controlled, and neither patients nor investigators are blinded. Furthermore, reporting methods varied between study sites. Despite these limitations, the data indicate that adjunctive CBD significantly reduces seizure frequency, according to the authors.

The data support the results of double-blind, placebo-controlled trials that found that add-on CBD reduces seizure frequency, compared with placebo. The FDA in June approved Epidiolex, the formulation of CBD used in the expanded-access program, for the treatment of seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.

—Erik Greb

Suggested Reading

Szaflarski JP, Bebin EM, Comi AM, et al. Long-term safety and treatment effects of cannabidiol in children and adults with treatment-resistant epilepsies: Expanded access program results. Epilepsia. 2018;59(8):1540-1548.

Pooled data from an expanded-access program provide further evidence that adjunctive cannabidiol (CBD) provides meaningful reductions in seizure frequency in patients with treatment-resistant epilepsies. The data were published in the August issue of Epilepsia.

Studies have recently indicated that adjunctive CBD effectively reduces seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. An expanded-access program was created in January 2014 to offer CBD to patients with treatment-resistant epilepsies. Data on safety, tolerability, and efficacy during the first year of the study have been reported. Jerzy P. Szaflarski, MD, PhD, Professor of Neurology at the University of Alabama at Birmingham, and colleagues examined results for safety outcomes at 144 weeks and efficacy outcomes at 96 weeks.

An Expanded-Access Program

All participants in the program had treatment-resistant epilepsy and were receiving stable doses of antiepileptic drugs (AEDs) for at least four weeks before enrollment. During a four-week baseline period, parents and caregivers kept diaries of all countable seizure types. Participants subsequently received a plant-based oral pharmaceutical formulation of CBD (100 mg/mL). Treatment was initiated at a dose of 2–10 mg/kg/day and was titrated to a maximum dose of 25–50 mg/kg/day.

Patients were examined every two to four weeks until the 16th week, and every two to 12 weeks after that point. The efficacy outcomes included the percentage change from baseline in median monthly convulsive seizure frequency and total seizure frequency, and the percentages of patients with at least 50%, at least 75%, and 100% reductions in seizures, compared with baseline. Investigators documented adverse events at each visit.

CBD Was Well Tolerated

The safety analysis included 607 patients, and the efficacy analysis included 580 patients. Among patients included in the safety analysis, 24% withdrew from the study. The most common reasons for withdrawal were lack of efficacy (15%) and adverse events (5%). Participants’ mean age was 13, and 52% of patients were male. The median number of concomitant AEDs was three, the median dose of CBD was 25 mg/kg/day, and the median treatment duration was 48 weeks.

At 12 weeks, adjunctive CBD was associated with a 51% reduction in median monthly convulsive seizures and a 48% reduction in total seizures. Reductions in these seizure types were similar through 96 weeks. At 12 weeks, 52% of patients had a reduction in convulsive seizures of at least 50%, 31% had a reduction of at least 75%, and 11% had a 100% reduction. These response rates were similar through 96 weeks of treatment.

CBD was generally well tolerated. The most common adverse events were diarrhea (29%) and somnolence (22%). About 10% of patients had abnormal liver adverse events, and 75% of them were taking valproate. Among patients taking concomitant clobazam, 38% had somnolence, compared with 14% of patients not taking concomitant clobazam.

The expanded-access program is not placebo-controlled, and neither patients nor investigators are blinded. Furthermore, reporting methods varied between study sites. Despite these limitations, the data indicate that adjunctive CBD significantly reduces seizure frequency, according to the authors.

The data support the results of double-blind, placebo-controlled trials that found that add-on CBD reduces seizure frequency, compared with placebo. The FDA in June approved Epidiolex, the formulation of CBD used in the expanded-access program, for the treatment of seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.

—Erik Greb

Suggested Reading

Szaflarski JP, Bebin EM, Comi AM, et al. Long-term safety and treatment effects of cannabidiol in children and adults with treatment-resistant epilepsies: Expanded access program results. Epilepsia. 2018;59(8):1540-1548.

Pooled data from an expanded-access program provide further evidence that adjunctive cannabidiol (CBD) provides meaningful reductions in seizure frequency in patients with treatment-resistant epilepsies. The data were published in the August issue of Epilepsia.

Studies have recently indicated that adjunctive CBD effectively reduces seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. An expanded-access program was created in January 2014 to offer CBD to patients with treatment-resistant epilepsies. Data on safety, tolerability, and efficacy during the first year of the study have been reported. Jerzy P. Szaflarski, MD, PhD, Professor of Neurology at the University of Alabama at Birmingham, and colleagues examined results for safety outcomes at 144 weeks and efficacy outcomes at 96 weeks.

An Expanded-Access Program

All participants in the program had treatment-resistant epilepsy and were receiving stable doses of antiepileptic drugs (AEDs) for at least four weeks before enrollment. During a four-week baseline period, parents and caregivers kept diaries of all countable seizure types. Participants subsequently received a plant-based oral pharmaceutical formulation of CBD (100 mg/mL). Treatment was initiated at a dose of 2–10 mg/kg/day and was titrated to a maximum dose of 25–50 mg/kg/day.

Patients were examined every two to four weeks until the 16th week, and every two to 12 weeks after that point. The efficacy outcomes included the percentage change from baseline in median monthly convulsive seizure frequency and total seizure frequency, and the percentages of patients with at least 50%, at least 75%, and 100% reductions in seizures, compared with baseline. Investigators documented adverse events at each visit.

CBD Was Well Tolerated

The safety analysis included 607 patients, and the efficacy analysis included 580 patients. Among patients included in the safety analysis, 24% withdrew from the study. The most common reasons for withdrawal were lack of efficacy (15%) and adverse events (5%). Participants’ mean age was 13, and 52% of patients were male. The median number of concomitant AEDs was three, the median dose of CBD was 25 mg/kg/day, and the median treatment duration was 48 weeks.

At 12 weeks, adjunctive CBD was associated with a 51% reduction in median monthly convulsive seizures and a 48% reduction in total seizures. Reductions in these seizure types were similar through 96 weeks. At 12 weeks, 52% of patients had a reduction in convulsive seizures of at least 50%, 31% had a reduction of at least 75%, and 11% had a 100% reduction. These response rates were similar through 96 weeks of treatment.

CBD was generally well tolerated. The most common adverse events were diarrhea (29%) and somnolence (22%). About 10% of patients had abnormal liver adverse events, and 75% of them were taking valproate. Among patients taking concomitant clobazam, 38% had somnolence, compared with 14% of patients not taking concomitant clobazam.

The expanded-access program is not placebo-controlled, and neither patients nor investigators are blinded. Furthermore, reporting methods varied between study sites. Despite these limitations, the data indicate that adjunctive CBD significantly reduces seizure frequency, according to the authors.

The data support the results of double-blind, placebo-controlled trials that found that add-on CBD reduces seizure frequency, compared with placebo. The FDA in June approved Epidiolex, the formulation of CBD used in the expanded-access program, for the treatment of seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.

—Erik Greb

Suggested Reading

Szaflarski JP, Bebin EM, Comi AM, et al. Long-term safety and treatment effects of cannabidiol in children and adults with treatment-resistant epilepsies: Expanded access program results. Epilepsia. 2018;59(8):1540-1548.

Self-management of epilepsy using a group-format, remote intervention improves mood, quality of life, and health functioning in high-risk individuals, according to a randomized, controlled trial published in the September issue of Epilepsia.

In the six-month trial, 120 individuals with epilepsy who had experienced at least one epilepsy-related negative health event in the previous six months were randomized to a wait-list control group or a novel self‐management intervention.

The eight-session intervention, known as SMART, focused on modifiable factors that can be addressed with self-management, such as stress, substance abuse, routine, nutrition, and social support. It was delivered remotely during eight to 10 weeks, either by telephone or online, after an initial in-person session.

“SMART combines the portability and low cost of a Web‐based intervention with the personally salient components of behavior modeling obtained by interacting with individuals who have walked the walk in living with epilepsy,” said Martha Sajatovic, MD, Professor of Psychiatry at Case Western Reserve University in Cleveland, and her colleagues.

—Bianca Nogrady

Suggested Reading

Sajatovic M, Colon-Zimmermann K, Kahriman M, et al. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. Epilepsia. 2018;59(9):1684-1695.

Self-management of epilepsy using a group-format, remote intervention improves mood, quality of life, and health functioning in high-risk individuals, according to a randomized, controlled trial published in the September issue of Epilepsia.

In the six-month trial, 120 individuals with epilepsy who had experienced at least one epilepsy-related negative health event in the previous six months were randomized to a wait-list control group or a novel self‐management intervention.

The eight-session intervention, known as SMART, focused on modifiable factors that can be addressed with self-management, such as stress, substance abuse, routine, nutrition, and social support. It was delivered remotely during eight to 10 weeks, either by telephone or online, after an initial in-person session.

“SMART combines the portability and low cost of a Web‐based intervention with the personally salient components of behavior modeling obtained by interacting with individuals who have walked the walk in living with epilepsy,” said Martha Sajatovic, MD, Professor of Psychiatry at Case Western Reserve University in Cleveland, and her colleagues.

—Bianca Nogrady

Suggested Reading

Sajatovic M, Colon-Zimmermann K, Kahriman M, et al. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. Epilepsia. 2018;59(9):1684-1695.

Self-management of epilepsy using a group-format, remote intervention improves mood, quality of life, and health functioning in high-risk individuals, according to a randomized, controlled trial published in the September issue of Epilepsia.

In the six-month trial, 120 individuals with epilepsy who had experienced at least one epilepsy-related negative health event in the previous six months were randomized to a wait-list control group or a novel self‐management intervention.

The eight-session intervention, known as SMART, focused on modifiable factors that can be addressed with self-management, such as stress, substance abuse, routine, nutrition, and social support. It was delivered remotely during eight to 10 weeks, either by telephone or online, after an initial in-person session.

“SMART combines the portability and low cost of a Web‐based intervention with the personally salient components of behavior modeling obtained by interacting with individuals who have walked the walk in living with epilepsy,” said Martha Sajatovic, MD, Professor of Psychiatry at Case Western Reserve University in Cleveland, and her colleagues.

—Bianca Nogrady

Suggested Reading

Sajatovic M, Colon-Zimmermann K, Kahriman M, et al. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. Epilepsia. 2018;59(9):1684-1695.

Among patients who have experienced a traumatic brain injury (TBI), the likelihood of developing post-traumatic epilepsy (PTE) increases with age, the early onset of seizures, and the severity of the brain injury, according to an analysis of insurance claims from 2004 to 2014.

• There were approximately 2.8 million emergency room visits, hospitalizations and deaths from traumatic brain injuries in the US in 2013.
• Early seizures occurred in 0.5% of patients with TBI.
• Over a 9 year period, the incidence of post-traumatic epilepsy (PTE) increased from 1 to 4% in this population.
• Early onset of seizures, older age, and TBI severity increased the likelihood of PTE.
• Prophylactic acetazolamide seemed to reduce the risk of PTE, when compared to patients who had received no anti-epilepsy drugs.

DeGrauw X, Thurman D, Xu L, et al. Epidemiology of traumatic brain injury-associated epilepsy and early use of anti-epilepsy drugs: An analysis of insurance claims data, 2004-2014. [Published online ahead of print July 23, 2018] Epilepsy Res. doi: 10.1016/j.eplepsyres.2018.07.012

Among patients who have experienced a traumatic brain injury (TBI), the likelihood of developing post-traumatic epilepsy (PTE) increases with age, the early onset of seizures, and the severity of the brain injury, according to an analysis of insurance claims from 2004 to 2014.

• There were approximately 2.8 million emergency room visits, hospitalizations and deaths from traumatic brain injuries in the US in 2013.
• Early seizures occurred in 0.5% of patients with TBI.
• Over a 9 year period, the incidence of post-traumatic epilepsy (PTE) increased from 1 to 4% in this population.
• Early onset of seizures, older age, and TBI severity increased the likelihood of PTE.
• Prophylactic acetazolamide seemed to reduce the risk of PTE, when compared to patients who had received no anti-epilepsy drugs.

DeGrauw X, Thurman D, Xu L, et al. Epidemiology of traumatic brain injury-associated epilepsy and early use of anti-epilepsy drugs: An analysis of insurance claims data, 2004-2014. [Published online ahead of print July 23, 2018] Epilepsy Res. doi: 10.1016/j.eplepsyres.2018.07.012

Among patients who have experienced a traumatic brain injury (TBI), the likelihood of developing post-traumatic epilepsy (PTE) increases with age, the early onset of seizures, and the severity of the brain injury, according to an analysis of insurance claims from 2004 to 2014.

• There were approximately 2.8 million emergency room visits, hospitalizations and deaths from traumatic brain injuries in the US in 2013.
• Early seizures occurred in 0.5% of patients with TBI.
• Over a 9 year period, the incidence of post-traumatic epilepsy (PTE) increased from 1 to 4% in this population.
• Early onset of seizures, older age, and TBI severity increased the likelihood of PTE.
• Prophylactic acetazolamide seemed to reduce the risk of PTE, when compared to patients who had received no anti-epilepsy drugs.

DeGrauw X, Thurman D, Xu L, et al. Epidemiology of traumatic brain injury-associated epilepsy and early use of anti-epilepsy drugs: An analysis of insurance claims data, 2004-2014. [Published online ahead of print July 23, 2018] Epilepsy Res. doi: 10.1016/j.eplepsyres.2018.07.012

Conventional medical wisdom insists that it is not possible to predict the onset of seizures with any certainty, but recent research suggests otherwise, according to a review published in Nature Reviews Neurology.

• An influential 2007 review of the medical literature concluded that there was insufficient evidence to foresee the onset of seizures.
• However, an international team of experts summarized several recent advances that suggest seizure prediction may be possible.
• The new review discusses a small experiment in which intracranial EEGs were used prospectively to predict seizures.
• Additional advances include EEG databases, seizure prediction competitions, and a better understanding of the mechanism of action behind seizures.

Kuhlmann L, Lehnertz K, Richardson MP, et al. Seizure prediction - ready for a new era. [Published online ahead of print August 21, 2018] Nat Rev Neurol. doi: 10.1038/s41582-018-0055-2

Conventional medical wisdom insists that it is not possible to predict the onset of seizures with any certainty, but recent research suggests otherwise, according to a review published in Nature Reviews Neurology.

• An influential 2007 review of the medical literature concluded that there was insufficient evidence to foresee the onset of seizures.
• However, an international team of experts summarized several recent advances that suggest seizure prediction may be possible.
• The new review discusses a small experiment in which intracranial EEGs were used prospectively to predict seizures.
• Additional advances include EEG databases, seizure prediction competitions, and a better understanding of the mechanism of action behind seizures.

Kuhlmann L, Lehnertz K, Richardson MP, et al. Seizure prediction - ready for a new era. [Published online ahead of print August 21, 2018] Nat Rev Neurol. doi: 10.1038/s41582-018-0055-2

Conventional medical wisdom insists that it is not possible to predict the onset of seizures with any certainty, but recent research suggests otherwise, according to a review published in Nature Reviews Neurology.

• An influential 2007 review of the medical literature concluded that there was insufficient evidence to foresee the onset of seizures.
• However, an international team of experts summarized several recent advances that suggest seizure prediction may be possible.
• The new review discusses a small experiment in which intracranial EEGs were used prospectively to predict seizures.
• Additional advances include EEG databases, seizure prediction competitions, and a better understanding of the mechanism of action behind seizures.

Kuhlmann L, Lehnertz K, Richardson MP, et al. Seizure prediction - ready for a new era. [Published online ahead of print August 21, 2018] Nat Rev Neurol. doi: 10.1038/s41582-018-0055-2

Understanding the relationship between epilepsy and sleep disorders can help clinicians improve the management of both disorders according to a recent review in Epilepsy Research.

• Sleep apnea, insomnia, restless legs syndrome and parasomnias often occur in patients with epilepsy.
• Researchers from Brigham and Women’s Hospital in Boston and Mayo Clinic reviewed the symptoms and diagnosis of these sleep disorders to help clinicians screen patients with epilepsy at risk for these problems.
• The review also explores treatment options and several case reports that illustrate the consequences of said sleep disorders in those with epilepsy.
• Latreille et al believe that employing the latest diagnostic and treatment approaches to co-morbid sleep disorders may improve patients’ functional status, alertness, quality of life and seizure burden.

Latreille V, St. Louis EK, Pavlova M. Co-morbid sleep disorders and epilepsy: A narrative review and case examples. Epilepsy Res. 2018; 145:185-197. https://doi.org/10.1016/j.eplepsyres.2018.07.005

Understanding the relationship between epilepsy and sleep disorders can help clinicians improve the management of both disorders according to a recent review in Epilepsy Research.

• Sleep apnea, insomnia, restless legs syndrome and parasomnias often occur in patients with epilepsy.
• Researchers from Brigham and Women’s Hospital in Boston and Mayo Clinic reviewed the symptoms and diagnosis of these sleep disorders to help clinicians screen patients with epilepsy at risk for these problems.
• The review also explores treatment options and several case reports that illustrate the consequences of said sleep disorders in those with epilepsy.
• Latreille et al believe that employing the latest diagnostic and treatment approaches to co-morbid sleep disorders may improve patients’ functional status, alertness, quality of life and seizure burden.

Latreille V, St. Louis EK, Pavlova M. Co-morbid sleep disorders and epilepsy: A narrative review and case examples. Epilepsy Res. 2018; 145:185-197. https://doi.org/10.1016/j.eplepsyres.2018.07.005

Understanding the relationship between epilepsy and sleep disorders can help clinicians improve the management of both disorders according to a recent review in Epilepsy Research.

• Sleep apnea, insomnia, restless legs syndrome and parasomnias often occur in patients with epilepsy.
• Researchers from Brigham and Women’s Hospital in Boston and Mayo Clinic reviewed the symptoms and diagnosis of these sleep disorders to help clinicians screen patients with epilepsy at risk for these problems.
• The review also explores treatment options and several case reports that illustrate the consequences of said sleep disorders in those with epilepsy.
• Latreille et al believe that employing the latest diagnostic and treatment approaches to co-morbid sleep disorders may improve patients’ functional status, alertness, quality of life and seizure burden.

Latreille V, St. Louis EK, Pavlova M. Co-morbid sleep disorders and epilepsy: A narrative review and case examples. Epilepsy Res. 2018; 145:185-197. https://doi.org/10.1016/j.eplepsyres.2018.07.005

A self-management program called SMART can help patients with epilepsy reduce the risk of negative health events according to researchers at Case Western Reserve University School of Medicine.

• A 6-month randomized controlled trial of the community-based program included 60 adult patients and was compared to 60 control patients on a waitlist.
• The experiment monitored a variety of events, including seizures, accidents, attempts at self-harm, emergency department visits, and hospitalizations.
• The average patient in this trial was about 41 years old, about 70% were African American, 74% were unemployed.
• Patients who were randomized to the SMART program had fewer negative health events by 6 months compared to controls.
• SMART was also linked to improved scores on the Patient Health Questionnaire (P=.002), the 10 item Quality of Life in Epilepsy Inventory, and the Short Form Health Survey.

Sajatovic  M, Colon-Zimmermann K,  Kahriman M, et al. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. [Published online ahead of print August 10, 2018]. Epilepsia. https://doi.org/10.1111/epi.14527.

A self-management program called SMART can help patients with epilepsy reduce the risk of negative health events according to researchers at Case Western Reserve University School of Medicine.

• A 6-month randomized controlled trial of the community-based program included 60 adult patients and was compared to 60 control patients on a waitlist.
• The experiment monitored a variety of events, including seizures, accidents, attempts at self-harm, emergency department visits, and hospitalizations.
• The average patient in this trial was about 41 years old, about 70% were African American, 74% were unemployed.
• Patients who were randomized to the SMART program had fewer negative health events by 6 months compared to controls.
• SMART was also linked to improved scores on the Patient Health Questionnaire (P=.002), the 10 item Quality of Life in Epilepsy Inventory, and the Short Form Health Survey.

Sajatovic  M, Colon-Zimmermann K,  Kahriman M, et al. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. [Published online ahead of print August 10, 2018]. Epilepsia. https://doi.org/10.1111/epi.14527.

A self-management program called SMART can help patients with epilepsy reduce the risk of negative health events according to researchers at Case Western Reserve University School of Medicine.

• A 6-month randomized controlled trial of the community-based program included 60 adult patients and was compared to 60 control patients on a waitlist.
• The experiment monitored a variety of events, including seizures, accidents, attempts at self-harm, emergency department visits, and hospitalizations.
• The average patient in this trial was about 41 years old, about 70% were African American, 74% were unemployed.
• Patients who were randomized to the SMART program had fewer negative health events by 6 months compared to controls.
• SMART was also linked to improved scores on the Patient Health Questionnaire (P=.002), the 10 item Quality of Life in Epilepsy Inventory, and the Short Form Health Survey.

Sajatovic  M, Colon-Zimmermann K,  Kahriman M, et al. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. [Published online ahead of print August 10, 2018]. Epilepsia. https://doi.org/10.1111/epi.14527.

Patients with psychogenic nonepileptic seizures (PNES) are more likely to suffer from sleep complaints than are patients with epilepsy according to an analysis conducted by clinicians at the Brigham and Women’s Hospital.

• 149 patients with PNES and 82 patients with epilepsy completed the Beck Depression Inventory and the Quality of Life in Epilepsy Inventory-10.
• By analyzing item 16 on the Beck Depression Inventory, which looks at changes in sleep patterns, the investigators found that PNES patients were more likely to report moderate to severe changes in sleep patterns, including waking up too early, sleeping less than usual, and having trouble falling back to sleep.
• The sleep complaints were associated with poorer quality of life, suggesting that they need to be addressed more closely in PNES patients.

Latreille V, Baslet G, Sarkis R, et al. Sleep in psychogenic nonepileptic seizures: time to raise a red flag. Epilepsy Behav. 2018;86:6-8.

Patients with psychogenic nonepileptic seizures (PNES) are more likely to suffer from sleep complaints than are patients with epilepsy according to an analysis conducted by clinicians at the Brigham and Women’s Hospital.

• 149 patients with PNES and 82 patients with epilepsy completed the Beck Depression Inventory and the Quality of Life in Epilepsy Inventory-10.
• By analyzing item 16 on the Beck Depression Inventory, which looks at changes in sleep patterns, the investigators found that PNES patients were more likely to report moderate to severe changes in sleep patterns, including waking up too early, sleeping less than usual, and having trouble falling back to sleep.
• The sleep complaints were associated with poorer quality of life, suggesting that they need to be addressed more closely in PNES patients.

Latreille V, Baslet G, Sarkis R, et al. Sleep in psychogenic nonepileptic seizures: time to raise a red flag. Epilepsy Behav. 2018;86:6-8.

Patients with psychogenic nonepileptic seizures (PNES) are more likely to suffer from sleep complaints than are patients with epilepsy according to an analysis conducted by clinicians at the Brigham and Women’s Hospital.

• 149 patients with PNES and 82 patients with epilepsy completed the Beck Depression Inventory and the Quality of Life in Epilepsy Inventory-10.
• By analyzing item 16 on the Beck Depression Inventory, which looks at changes in sleep patterns, the investigators found that PNES patients were more likely to report moderate to severe changes in sleep patterns, including waking up too early, sleeping less than usual, and having trouble falling back to sleep.
• The sleep complaints were associated with poorer quality of life, suggesting that they need to be addressed more closely in PNES patients.

Latreille V, Baslet G, Sarkis R, et al. Sleep in psychogenic nonepileptic seizures: time to raise a red flag. Epilepsy Behav. 2018;86:6-8.