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NEWS

• Early diagnosis lets patients look Alzheimer's square in the face...
• "Our data strongly suggest that genetic factors make a substantial contribution to autism, but that does not mean that the entire cause of autism is genetic. Together with many other studies, our study argues that genetic factors play a very important role in autism, while leaving open a role for other, environmental factors..."
• "Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure."
• Meningitis is far more common in children than is encephalitis.
• Alzheimer’s is the most common cause of dementia in the elderly, representing 60 percent of all dementias in those over 65.
• The Epilepsy Therapy Project will provide almost US$300,000 over the next two years to a group of researchers from leading Australian institutions including the University of Newcastle.
• Headache is the seventh leading reason for outpatient physician visits in the United States.
• Severe septicaemia including meningococcal septicaemia - the blood poisoning form of meningitis - is a major cause of death and disability in children.
• Initial hopes for improved narcolepsy medicines that replace hypocretin have faded, because studies showed that the molecule did not readily cross the blood-brain barrier.
• Michael J. Fox Foundation Awards $2.4 Million For Validation Of Nine Promising Therapeutic Targets For Parkinson's Disease.
• A long-term study provides important clues that may help doctors predict the clinical course of some individuals’ multiple sclerosis.
• "We found that we could pick up seizure activity in most of the patients using aEEG monitors that included the raw signals."
• Chemotherapy, while effective at treating tumors, often harms healthy cells as well, leading to severe side effects especially in young children.

Epilepsy & Seizures

Epilepsy is a disorder characterized by the occurrence of at least 2 unprovoked seizures. Seizures are the manifestation of abnormal hypersynchronous discharges of cortical neurons. The clinical signs or symptoms of seizures depend upon the location and extent of the propagation of the discharging cortical neurons. That seizures are a common nonspecific manifestation of neurological injury and disease should not be surprising, because the main function of the brain is the transmission of electrical impulses. The lifetime likelihood of experiencing at least one epileptic seizure is about 9%, and the lifetime likelihood of being diagnosed as having epilepsy is almost 3%. However, the prevalence of active epilepsy is only 0.8%.

Classification of Epileptic Syndromes

Epileptic seizures are symptoms of neurological dysfunction and are but one manifestation of many neurological diseases. Like any other syndrome in medicine, an epileptic syndrome is a group of signs and symptoms that share a common pathogenesis, prognosis, and response to treatment.

Epileptic seizures have been recognized for several millennia. One of the earliest descriptions of a secondarily generalized tonic-clonic seizure was recorded over 3000 years ago in Mesopotamia. The seizure was attributed to the god of the moon. Epileptic seizures were described in several ancient cultures, including China, Egypt, and India. An ancient Egyptian papyrus described a seizure in a man who had experienced prior head trauma. Hippocrates wrote the first book about epilepsy almost 2500 years ago. He rejected ideas regarding the divine etiology of epilepsy and concluded that it was caused by an excess of phlegm that caused abnormal brain consistency. Hippocratic teachings were forgotten, and divine etiologies again dominated beliefs about epileptic seizures during medieval times. Even at the turn of the last century, excessive masturbation was considered a cause of epilepsy. This hypothesis is credited as leading to the use of the first effective anticonvulsants, bromides.

Partial-onset seizures

1. Simple partial seizures: The key-defining element of simple partial seizures is the occurrence of a seizure with preservation of consciousness. Many patients with complex partial seizures have an aura warning them of their seizure. An aura is a simple partial seizure. Many kinds of simple partial seizures exist, including sensory, motor, autonomic, and psychic experiences. Essentially, any discrete human experience that involves the cerebral cortex could be a simple partial seizure.

2. Complex partial seizures: Consciousness is impaired during a complex partial seizure. In practice, assessing historically whether consciousness was impaired is difficult. The most common way to assess preservation of consciousness is by asking patients whether they were able to recollect the event. In many occasions, patients are able to remember their aura but are unaware that they were briefly unable to respond to the environment. Typically, a complex partial seizure begins with behavioral arrest and is followed by staring, automatisms, and postictal confusion. Frequently, the automatisms consist of chewing, lip smacking, mumbling, and fumbling with the hands. Dystonic posturing of the contra lateral upper extremity often is seen when a complex partial seizure originates from the mesial temporal lobe. A typical complex partial seizure lasts about 60-90 seconds and is followed by brief postictal confusion. However, generalized weakness, asthenia, and fatigue may last for a few days.

3. Secondarily generalized seizures: These seizures often begin with an aura that evolves into a complex partial seizure and then into a generalized tonic-clonic seizure. However, a complex partial seizure may evolve into a generalized tonic-clonic seizure, or an aura may evolve into a generalized tonic-clonic seizure without an obvious complex partial seizure. Clinically, classifying a generalized tonic-clonic seizure by history alone as being secondarily generalized (partial onset) or primarily generalized is difficult. In most cases, the more severe a secondarily generalized seizure, the more it is associated with prominent amnesia for the aura.

Generalized-onset seizures

1. Absence seizures: These are brief episodes of impairment of consciousness with no aura or postictal confusion. They typically last less than 20 seconds and are accompanied by few or no automatisms. Facial automatisms are most frequent, and repetitive blinking is the most common facial automatism. Absence seizures often are precipitated by hyperventilation or photic stimulation. They typically begin during childhood or adolescence but may persist into adulthood. A diagnosis of new-onset absence seizures in adulthood is incorrect in the vast majority of cases. Often, those adult patients have complex partial seizures with relatively minor automatisms. In children, absence seizures often are unrecognized until a child develops a generalized tonic-clonic seizure and is brought to medical attention. A sudden decreased performance in school grades or overall attention is a subtle manifestation of frequent absence seizures.

2. Myoclonic seizures: This seizure type consists of brief, arrhythmic, jerking, motor movements that last less than a second. Myoclonic seizures often cluster within a few minutes. If they evolve into rhythmic jerking movements, they are classified as evolving into a clonic seizure. Myoclonus is not always epileptic in origin. For example, the myoclonic jerks during phase I of sleep are normal “release” phenomena.

3. Clonic seizures: This seizure type consists of rhythmic, motor, jerking movements with impairment of consciousness. Clonic seizures also could have a focal origin with or without impairment of consciousness. The focal seizures are classified as simple or complex partial seizures. Typically, generalized clonic seizures simultaneously involve the upper and lower extremities.

4. Tonic seizures: This seizure type consists of sudden-onset tonic extension or flexion of the head, trunk, and/or extremities for several seconds. Typically, these seizures occur in relation to drowsiness, shortly after falling asleep, or just after awakening. They often are associated with other neurological abnormalities.

5. Tonic-clonic seizures:This seizure type commonly is referred to as "grand mal" seizures. They consist of several motor behaviors including generalized tonic extension of the extremities lasting for few seconds followed by clonic rhythmic movements and prolonged postictal confusion. Clinically, the only behavioral difference between these seizures and secondarily generalized tonic-clonic seizures is that these seizures lack an aura. However, the aura preceding the secondarily generalized seizure often is forgotten because of postictal amnesia.

6. Atonic seizures: This seizure type occurs in people with significant neurological abnormalities. These seizures consist of brief loss of postural tone, often resulting in falls and injuries.