Blog #177: Heart Attacks, Strokes and Cardiovascular Dangers from Some Epilepsy Drugs

 

 

If your seizure control is not satisfactory, and if you and your doctor are trying different antiepileptic drugs (AED), be aware that some side-effects can be more common with certain AEDs and less with others. Your choice could be beneficial for you. This topic was reviewed by Mary Beth Nierengarten in the November 21, 2024, issue of Neurology Today page 9. Older adults with epilepsy are much more likely to experience new cardiovascular events, including strokes, transient ischemic events (TIA) and heart attacks if they take the enzyme-inducing antiepileptic drugs.¹

Enzyme-inducing antiepileptic drugs (EIAEDs) are a class of medications used to manage seizures. They have the effect of increasing the activity of certain liver enzymes, primarily the cytochrome P450 (CYP450) family. How Enzyme Induction Works:

•    EIAEDs, the enzyme-inducing drugs, stimulate the production of CYP450 enzymes in the liver.

•    These enzymes are responsible for metabolizing (breaking down) many drugs and other substances in the body. Carbamazepine (Tegretol), Phenytoin (Dilantin), Phenobarbital (Luminal)and Primidone (Mysoline) are the classical enzyme-inducing antiseizure drugs (ASDs). Non-enzyme-inducing ASDs include Levetiracetam (Keppra), Lamotrigine (Lamictal), Lacosamide (Vimpat). The EIAEDs were used in a third of those with the increased risk and this Canadian study (reference 1) highlights the risk of long-term use of these medications for epilepsy. Co-morbidities with other medical diseases, especially cardiovascular risks, should be considered when choosing among 25 commonly used AEDs.

Those patients studied ranged in age from 62 to 85. Most were white. males and females of comparable numbers. None in the study had had a previous reported stroke, transient ischemic attack (TIA) or heart attack but the study showed 24.6% of the enzyme-inducing ASMs were then associated with new-onset cardiovascular events. Consider these findings, if possible, with your doctor when choosing your first-line therapy, avoiding Tegretol, Dilantin, Phenobarbital, and Primidone. If you have cardiovascular symptoms and risks, consider an EIAED as Levetiracetam (Keppra), Lamotrigine (Lamictal) or Lacosamide (Vimpat). Other common AED adverse effects, e.g. balance and cognition problems, should also be discussed with your physician.

We need to take a comprehensive approach for long-term outcomes for patients with epilepsy as most patients with epilepsy will be on these medications for decades or life-long.

 

1.    Li J, Shlobin NA, Thijs RD, et al. Antiseizure medications and cardiovascular events in older people with epilepsy. JAMA Neurol 2024; Epub 2024 Sept 30.

 

Lance Fogan, M.D., is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

  and is now available in eBook, audiobook, soft and hard cover editions.

Blog # 174: Transcranial Magnetic Stimulation for Drug-Resistant Epilepsy

 

Susan Fitzgerald summarized this study in the January 2, 2025, issue of Neurology Today. Transcranial Magnetic Stimulation (TMS) is a non-invasive neurotherapeutic procedure using magnetic fields from coils placed over the head to stimulate specific areas of the brain. Safe and painless, it has been used for chronic pain, migraine and various mental health conditions as depression, obsessive=compulsive disorder, etc. TMS is being investigated for other conditions including movement disorders, neuropathic pain and stroke.

 

A Chinese study of patients aged 18-65 diagnosed with drug-resistant epilepsy (DRE) found that sessions of continuous transcranial magnetic stimulation (TMS) targeting the cerebellum (in the back of the brain, hitherto not usually believed to play a major role in epileptic seizures but has been considered for several decades) may reduce seizure frequency in patients whose anticonvulsant medications fail to control their seizures. Thirty-eight patients were randomized to receive active stimulation followed by sham stimulation. The frequency positive responder-rate increased by 24% compared with sham stimulation. Some patients became seizure-free during the entire two months of the study. The exact mechanism how these results were achieved, and which type of epilepsy are more likely to benefit, are unknown.¹

 

Of the 38 studied patients, 31 had focal epilepsy, one had generalized epilepsy and six had uncertain onset. Each patient had a total of 10 TMS sessions. The sham patients then switched to the active TMS arm of the study. Both sides of the cerebellum (the dentate nucleus) were targeted but are there other nearby structures affected? Participants studied had a 34% reduction in seizures following active treatment and 23% reduction in seizures following sham treatments. Adverse reactions included headache, tinnitus (ringing in the ears) and dizziness. All these problems resolve within days.

 

One consideration in interpretating the result is that “blinding” the study population is problematical as actual stimulation feels nothing like the sham stimulation.

 

Large-sample, multicenter, randomized controlled trials are needed to further validate the efficacy but if further research confirms the efficacy and safety of TMS, it’s an easy and inexpensive treatment. A new treatment option for poorly controlled epilepsy that doesn’t involve surgery or more medications should appeal to patients.

 

I describe another research to control epilepsy that can give hope to our patients that they are not alone.

1.     Wang YY, Ma L, Shi X-J, et al. Cerebellar transcranial magnetic stimulation to treat drug-resistant epilepsy: A randomized, controlled, crossover clinical trial. Epilepsia 2024; Vol 66, Issue 1: p240-252. https://doi.org/10.1111/epi.1816

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

 

Blog # 173: THE SUNFLOWER SEIZURE SYNDROME

 

 

   The Sunflower Syndrome was described in a recent BrainAndLife by Susan Fitzgerald ¹ It is a rare photosensitive type of seizure disorder. The common Petit Mal form of epilepsy is characterized by loss of awareness for seconds, some eyelid fluttering without falling or significant limb jerking nor incontinence. Its EEG is characteristically identifiable with the classic “3/second spike-wave complexes”. But unlike petit mal epileptic seizures which can be induced by flashing lights or by driving under trees whose branches intermittently block the sun causing “flashing”, the EEG abnormality in sunflower epilepsy occurs simultaneously by bright sun or other light. It does not seem to be triggered by the light as the hand waving and EEG abnormality are simultaneous.²

 

   A sunflower seizure is a rare stereotypical form of epileptic seizure consisting of eye fluttering with a hand waving before the eyes as the person irresistibly turns toward the sun or some other bright light accompanied with altered awareness. This turning toward the sun, like a sunflowers’ heliotropism, is due to the strong desire to face the sun or light while wiping the hands before the eyes. It lasts seconds and can occur up to a hundred times a day. Additionally, generalized convulsions often occur. Other neurological disorders usually don’t occur.

 

   Victims are made fun of by others in schools because of this strange, uncontrollable misunderstood behavior. Diagnosis is commonly delayed because of ignorance that this is a specific form of epilepsy. “He would be outside, facing the sun and waving his hand.” The patient cannot explain what and why he is doing this. People often exhibit these behaviors a long time before they seek medical evaluation.

 

   The EEG shows cerebral hemispheric involvement on both sides similar to the spike and wave pattern with 3 complexes/second of petit mal epilepsy. It does not appear to be a focal type of epilepsy. The EEG test should include bright light exposure, a routine part of EEGs. Sunflower epilepsy generally begins in childhood and mostly in girls. No blood tests are diagnostic. The diagnosis can be difficult and is based on the clinical seizure features of hand-before eyes and simultaneously attending to the sun.

 

   Physicians should be aware of this syndrome. The first report of SS is likely by H. Gastaut in 1951 who described two children that seemed to seek out the light and induce seizures by rapidly passing their hands in front of their eyes (HW).

 

   Treatment: There haven’t been enough trials to evaluate treatment yet. Valproate is helpful. Wearing dark glasses or blue-tinted lenses or contact lenses, favor shaded rooms

 

1) Brain and Life. Pages 35-37; December 2024/January 2025

2) Sourbron J, Neishay A, Yancheng L, Thiele EA. Ictal EEG in sunflower syndrome: Provoked or unprovoked seizures? Epilepsy & Behavior Volume 113, December 2020, 107470

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

Blog # 172: EPILEPSY AWARENESS IS RAISED AT A LOS ANGELES THEATER

 

 

Everyone in the epilepsy world, i.e. patients and the millions who are touched by their epilepsy and those who support these people, should salute a new epilepsy-themed musical produced in a small Los Angeles theater.

 

Any attempt to raise epilepsy awareness in the public is so welcome. The Hudson Backstage Theatre on Santa Monica Blvd., Hollywood, CA is staging the world premiere of It’s All Your Fault, Tyler Price. Ashley Lee reviewed this musical in the November 20, 2024, Los Angeles Times. With actors, the musical tells of a family’s experience supporting their daughter and her epilepsy. Lee describes the work as entertaining, empathetic and educational. This ubiquitous condition affects one out of every hundred people in America. Leaders in all fields are counted among them, notably Chief Justice of the Supreme Court John Roberts.

 

The musical was created by the girl’s father, Ben Decter, an Emmy-winning composer of several TV shows. Ben shares that he couldn’t discuss his daughter’s seizures due to anger, sadness and isolation—a familiar story in the epilepsy community upon learning the diagnosis in one’s child. Decter found personal relief when he began to compose songs on his piano. He and his wife appreciated that he could put things into songs that he couldn’t say out loud. Unburdening oneself from painful feelings and thoughts, such as the topic in this play, can be accomplished by sharing them with loved ones and close friends. All people touched in some way by epilepsy appreciate how hard it is to accept the diagnosis of epilepsy. Divorce and separation are quite common.

 

A friend overheard his songs and put him in touch with the director, Kristin Hanggi, who took to this material. They developed it together. A school bully mocks the protagonist’s epilepsy. In part such an incident pushed the creators to educate the public about epilepsy via this musical play. The actors teach the audience how to reassure and to keep patients safe during a seizure by the actors leading audience members to call-and-respond gospel-like to safety tips.

 

Reporter Lee empathizes that Addie, the real-life daughter with epilepsy who inspired the show, celebrates how people with epilepsy are seen and to know that they’re not alone. The musical play exposes how the diagnosis affects all family members; open communication is stressed.

 

UCB, a global pharmaceutical company involved in developing epilepsy medicines, learned of this play. UCB is a major financial sponsor in producing It’s All Your Fault, Tyler Price.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

 

 

Blog #170: CAN YOU PREVENT YOUR SEIZURES?

 

     You can if you are among the 50% of epilepsy patients who are on the “right anti-convulsant at the right dosage.” You and your neurologist will know this is the right anti-convulsant for you because your seizures stop while taking your prescription. It’s trial and error. ¹

 

     Unfortunately, the other patients in the epilepsy population will continue to experience seizures, some very infrequently and others almost daily. These groups find their seizures do not disappear.

 

     Epilepsy surgery, no matter how drastic this sounds to you, in selected patients is very safe and can be curative. A pertinent blog on this topic is on this link: https://lancefogan.blogspot.com/2017/12/blog-89-surgical-removal-of-seizure.html In addition, the GAMMA KNIFE offers hope: http://lancefogan.blogspot.com/2024/01/blog-162-gammaknife-is-focused.html?m=1

 

     How to lower your risk of more seizures? You have heard this guidance from your neurologist/physician repeatedly: “Are you taking your medication as directed?” You all know what is important but too often our patients don’t follow our recommendations. Especially our youthful patients. Life interferes: “I got sick with a high fever or I forgot my pills or I traveled and left the pills at home or I drank too much alcohol or I didn’t sleep and etc.”

 

     Keep a seizure journal to keep track of seizures. Is there a discernable pattern: not enough sleep, another illness, menstruation, stress, recreational drugs, beginning a new medication from another physician that could have an effect on your epilepsy?

 

     Side effects can discourage taking your medication regularly. Reporting these side effects to your neurologist can help the doctor work with you to adjust dosages or change the medication to another effective one if the side effects are intolerable.

 

     Consider a pill-dispensing container that will separate the day’s dosages to discourage forgetting or taking more than prescribed any one day. Carry your physician’s contact information with you if you run out of meds.

 

     Always wear a bicycle helmet when bicycling, avoid bright flickering lights if they precipitate your seizures as they often do in some people. Do not drive a car until your neurologist clears you and consults with the Department of Vehicles.

 

1)     Richardson G. How Can People with Epilepsy Prevent Seizures? BrainandLife,org. June/July 2024. p37.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

 

Blog # 169: Balancing Reality with Hope in Epilepsy Treatment

 

 

 

Experience in our neurology clinics is that half of the epilepsy population in the United States, i.e. more than three million Americans (similar percent of the global population afflicted with epilepsy) can control their epilepsy. When the epilepsy is controlled with just the initial trial of anticonvulsant drugs (ACD) the long term prognosis for that person’s epilepsy is very good. We physicians start treatment with a commonly used ACD that from experience has shown effectiveness at the commonly used dosage. Side-effects such as drowsiness and laboratory tests of liver function, blood counts, etc. hopefully won’t be significant and the patient will adapt to the treatment quickly.

 

Edward Faught, MD, wrote on the reality and the hope in treatment.¹ As our patients are no doubt familiar, the course of epilepsy is variable. Experience shows that not achieving good control averages one-third of the epilepsy population, despite multiple different ACD treatments at various dosages. Identifying the presence or absence of brain lesions can still lead us astray as some patients do well despite significant abnormalities on scans. Younger age at onset, abnormal EEGs and very frequent seizures can adversely affect the prognosis.

 

According to the International League Against Epilepsy, drug resistant epilepsy is suggested when 2 ACDs appropriate for their type of epilepsy, as judged by your experienced neurologist, at tolerated dosages fail, then a third drug probably will also fail to control all seizures, too (10%).² However, other studies suggest hope. Schiller and Najjar noted that even after 2 to 5 ACDs had failed another drug could possibly produce seizure control. That was found in 16% of those patients deemed therapeutic failures.³

 

Keep in mind that a highly successful treatment that can cure epilepsy is brain surgery. In highly selected patients studied to rule out adverse side effects that would result from surgery, these procedures are safe. Post surgery life can be normal. Refer to my previous surgery-related blogs #155 (Successful surgery with robot assistant:  https://lancefogan.blogspot.com/2017/12/blog-89-surgical-removal-of-seizure.html), # 145 (Epilepsy patient passes driving test after brain surgery for poorly controlled epilepsy https://lancefogan.blogspot.com/2022/08/blog-145-epilepsy-patient-passes.html), #121 (…Epilepsy surgery is safe.  https://lancefogan.blogspot.com/2020/08/blog-121-if-your-seizures-arent.html).

 

In conclusion we should keep in mind that there is always hope in epilepsy therapy.          

 

1.     Faught E. Balancing reality with hope in epilepsy therapy. Neurology 2018;91: p989-990.

2.     Kwan P, Arzimanoglou A, Berg AT, et.al. Definition of Drug-Resistant Epilepsy Epilepsia 2010; 51: 1069-1077.

3.     Schiller Y, Najjar Y. Quantifying the response to antiepileptic drugs: effect of past treatment history. Neurology 2008; 70: 54-65.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Blog # 167: WHAT ABOUT NON-EPILEPTIC SEIZURES, THE PSYCHOGENIC, CONVERSION AND SOMATIC SYMPTOM DISORDERS?

 

Neurologists have long been aware of fake seizures. People would fall and shake and even lose control of urine. Called pseudoseizures or psychogenic nonepileptic seizures, they can be involuntary due to psychological disturbances. Frightening to witness as family and observers can attest. Yet the patient can still bite and lacerate lips and tongue and be incontinent of urine and bowel despite the EEG brain waves remaining normal.  Pseudoseizure can also be voluntary-malingered faked seizures of which the patient is very aware. These can serve some practical purpose in the person’s life e.g. avoiding stressful situations. These pseudoseizures occur in up to a third of patients evaluated in epilepsy clinics. One-third of patients who suffer from true epilepsy have additional pseudoseizures typically occurring during Their psychogenic nonepileptic seizures tend to occur when other people are present and during times of heightened emotional stress when secondary gain is available. Patients exhibiting feigned, or pseudoseizures, tend to have significant emotional problems. Schizophrenia, hysteria and hypochondriasis are common diagnoses.

 

Veterans with psychogenic nonepileptic seizures tend to have higher rates of anxiety, post-traumatic stress disorder and chronic pain, as compared with veterans with true epileptic seizures. Civilians with psychogenic nonepileptic seizures usually attribute their seizures to a past head injury, usually mild ones.

 

Selim Benbadis, MD reviewed this topic in Neurology 2019;92: 311-312.¹ Psychogenic nonepileptic seizures (PNES) are so very common in epilepsy centers in the U.S. that they account for 30-40 percent of referrals.²

 

Treatment results of pseudoseizures are not encouraging. Adherence to psychotherapy and cognitive behavioral therapy was poor. Minorities and victims of abuse tend not to adhere to these therapies, but a better outcome is seen if they do adhere over time.

 

Anticonvulsant medications are usually disappointing. Convincing psychiatrists/psychologists that their patients are suffering pseudoseizures and not true epilepsy by neurologists can be difficult. Combined psychological and organic neurological on-going cooperative care can lead to success.

 

 

1)    Benbadis SR. Psychogenic noonepileptic seizures, conversion, and somaic symptom disorders. Neurology 2019;92: 311-312.

2)    Benbadis SR. The Problem of psychogenic symptoms in the psychiatric community in denial? Epilepsy Behav 2005;6:9-14.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Blog #164: MEMORY: SUBJECTIVE COMPLAINTS VS ACTUAL OBJECTIVE DEFICITS IN EPILEPSY

 

 

Who amongst us doesn’t find fault with our own memory? But are memory concerns and complaints due to actual brain pathology or are they within the normal age-spectrum? Over half of patients with epilepsy complain of impaired memory. Are they actual memory deficits, though? We know that anticonvulsant medications commonly have deleterious effects on memory as can depression, other medications and illnesses.

Exploring memory researchers recruited patients with Temporal Lobe Epilepsy (TLE).¹ TLE diagnosis was based on abnormal EEG and clinically typical seizures. Our temporal lobes are where memory is generated and preserved. Damage there does affect memory whereas damage to other parts of the brain does not have as serious effects on memory. Generalized epilepsy, which does not focus on temporal lobes, seems to have less deleterious effects on memory as compared with TLE.

Researchers recruited 47 patients with TLE. Age and sex-matched 35 healthy controls were similarly studied. Self-evaluation memory questionnaires were used to assess the magnitude of memory complaints. All were then studied with neuropsychological examinations. A surprise recall testing 3 weeks later occurred. No significant differences on standard testing were found between the performance of patients and controls.

The two groups were then brought back three weeks later. The surprise recall tests 3 weeks later revealed significant differences between the two groups. They were assessed if they recalled simple events that occurred during that original testing 3 weeks before. For example, was there a memory of a water glass being offered? Did the examiner leave the room and change what they wore? Did the subject recall the phone ringing twice during the visit, or recall being asked to retrieve a questionnaire from a shelf, etc.? In the absence of spontaneous recall without cues, cues were then provided by the researchers followed by recognition questions such as “did the phone ring once or twice? Were you offered water etc.? Scores were generated.

The standard neuropsychological battery we have relied on to test cognition and memory has some blind spots; an adequate assessment of autobiographical memory and our “long term” memory assessments occur 10 to 30 minutes after the information is encoded. Traditionally these tests haven’t been performed. It is these blind spots that have been addressed in this study. People with subjective memory complaints that were corroborated by family members had normal performance on standard neuropsychological testing. But scores 3 weeks later were significantly lower in the epilepsy group.

This information is another reminder that we need to listen closely to our patients’ complaints, and that our gold standards need to be updated as our understanding of memory evolves.

1)     Lemesle B, Barbeau EJ, Milongo Rigal E, et al. Hidden objective memory deficits behind subjective memory complaints in patients with temporal lobe epilepsy. Neurology. 2022;98(8): E818-E828

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

Blog #163 February: ALZHEIMER'S DISEASE AND EPILEPSY

Articles are ubiquitous in the media on Alzheimer's Disease (AD). It is estimated that Alzheimer's currently affects 5 million Americans. In 2050 ten percent of us will be affected according to Harvard.edu.

Increasing knowledge based on multiple studies (meta-analysis) shows a link between AD and epilepsy. People with epilepsy had a 1.8-fold increased risk of AD. Patients with AD had a 3.1- fold higher risk of epilepsy, both generalized and focal seizures with impaired awareness (complex partial epileptic seizures). Temporal lobe epilepsy and AD share some pathologic features such as both show hippocampal sclerosis in the temporal lobe tip. The study populations to confirm this information is interesting but it is inconclusive due to the relatively small populations in the studies.1 

Increased chemical amyloid compounds are found in the brains of patients with AD. Elderly people who may be intellectually normal all have some amyloid in their brains, too, but this chemical compound is more prolific in AD dementia. It appears that amyloid pathology increases the propensity to generalized seizures. There is an association between AD and focal seizures, too, with hippocampal sclerosis (scarring) in the temporal lobes.

1. Fang Y, Xiaoli S, Jial W, et. al. Alzheimer Disease and Epilepsy. Neurology;2023 101:e 399-e409. Doi:10.1212 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions

Blog # 161: WEEKLY EPILEPTIC SEIZURES REDUCED BY MEDICAL CANNABIS

 

A study was summarized by Robert Herpen, MA and Shenaz Bagha on the American Epilepsy WebSite. The researchers, Xintian Lyn, BS, a student in the department of experimental and clinical pharmacology at the College of Pharmacy at the University of Minnesota and her team reported on their recent poster at the American Epilepsy Society meetings earlier in December 2023 that adults with epilepsy given medical cannabis had a significant decrease in weekly seizure frequency.¹

There is a paucity of data on the effects of THC (Tetrahydrocannabinol, the principal psychoactive constituent of cannabis) on seizure frequency. This researcher group in Minnesota was interested in cannabis’ effects on seizure frequency.

From 2016 to 2019 one-hundred-twelve adults with epilepsy, 70% of whom were aged 18-64 (54.5 % were male) were studied. The participants had at least four visits for treatment for at least 6 months. They may or may not have had antiseizure medications prescribed, too. The outcome of the study was that 57 participants reported fewer weekly seizures, 47 enrollees reported no change—including 34 with zero frequency seizures during the study period—while 10 patients reported an increase in their seizure frequency. In all three of these groups, participants were dispensed both CBD (cannabis) and THC. The study found a significant difference reported in CBD total daily dose among those who recorded either a decrease or no change in seizure frequency. CBD is a chemical found in marijuana. CBD doesn't contain tetrahydrocannabinol (THC), the psychoactive ingredient found in marijuana that produces a high.

Thirty patients relied on only CBD cannabis to manage their epileptic seizures. Most of this study population were also taking one to five antiseizure medications.

If your epilepsy is poorly controlled discuss adding CBD (cannabis) to your treatment with your physicians. Additionally, explore the potential of brain surgery as your epilepsy treatment if no other treatments benefit you. Several of my previous 160 monthly blogs on my website: LanceFogan.com dealt with brain surgery as a chance to improve your epilepsy when medications fail (See Blog # 89 December 26, 2017: Surgical Removal of Seizure Foci in Your Brain to Cure Poorly Controlled Epilepsy is Safe!; Blog # 103 February 26, 2019: Epilepsy—fit to drive?; Blog # 114 January 26, 2020: Epilepsy surgery in childhood and long-term employment is encouraging.; Blog # 121 August 25, 2020: If your seizures aren’t controlled epilepsy surgery is safe and really can help).

 

1.      Lyu X. et al. Medical cannabis and seizure control in Minnesota medical cannabis program. Presented at AmericanEpilepsy Society annual meeting Dec. 1-5, 2023: Orlando, FL.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

Blog #160: Life Expectancy Varies by Epilepsy Type

 

Overall, life expectancy is comparable to the general population.¹ But in certain types of epilepsy, the risk of premature death is higher than that of the general population. Most of the increased risk is directly related to what causes your epilepsy.

Only a small number of deaths in the epilepsy patient population are epilepsy related. These are deaths caused by a seizure or accidents during or immediately after the seizure, as well as sudden unexpected death for which no cause of the death can be identified. SUDEP (see below) is one example of this. Sudden unexpected deaths are more common in patients with poorly controlled, intractable epilepsy. Improved seizure control, medical advice and avoiding the hazards that occur during a seizure are key. Regular medical follow-up care and supervision may help reduce the risks of epilepsy-related death occurring.

What causes epilepsy?

Epilepsy can be categorized into three broad groups:

Idiopathic epilepsy

Common among children, idiopathic epilepsy is an inherited type of epilepsy with a strong genetic component and no structural brain abnormalities. Provoked seizures (for example, from flashing lights) are often seen in idiopathic epilepsy.

Cryptogenic epilepsy

Cryptogenic epilepsy is the type with no known cause and often involves unprovoked seizures. This accounts for approximately 20% of seizure cases.

Symptomatic epilepsy

Symptomatic epilepsy is caused by an injured brain. Common causes: head injuries, central nervous system infections, loss of oxygen to the brain, strokes, brain tumors and brain surgery.

How can your epilepsy result in premature death?

Premature deaths in people living with epilepsy: failure to take antiseizure medications as prescribed; the seizures themselves; collateral damage related to a seizure; reduced quality of life that comes with living with epilepsy; fatal unintentional injuries (for example, falls and burns), or through aspiration pneumonia during a seizure.

Additionally:

Serious transportation accidents: Seizures — which can result in impaired awareness and uncontrolled motor activity — put people living with epilepsy at increased risk of serious transportation accidents. This increased risk doesn’t apply to just car accidents but to the increased risk of pedestrian accidents and increased risk of bicycle accidents.

Drowning: because seizures can lead to a loss of consciousness or uncontrolled motor activity, people living with epilepsy are at increased risk of drowning. The risk of drowning is much higher in people with epilepsy. Despite my warnings, one of my young surfer patients ignored this warning and continued surfing. I don’t know his current condition While cases of drowning often occur in the bathtub (Mark Twain’s adult daughter had epilepsy; she drowned in her bath, for example), less frequently patients die in the shower; the body, face-down, blocks the drain resulting in drowning in just inches of water.

Status epilepticus: status epilepticus is a condition in which a person experiences abnormally prolonged seizures (longer than five minutes in the case of generalized tonic-clonic seizures; they usually last under 2 minutes) that can lead to long-term consequences, including brain damage and death.

Psychiatric illness: people with epilepsy commonly have depression, which increases the risk of suicide. The high incidence and prevalence of psychiatric illness (including impulsivity, psychosis, and substance abuse) correlates with the duration and severity of epilepsy. Depression is also associated with not taking medications as recommended, which can increase mortality.

What is a sudden unexpected death in epilepsy (SUDEP)? Premature mortality in people with epilepsy can also be attributed to a sudden unexpected death in epilepsy (SUDEP): Blog #108: SUDEP—Sudden Death in Epilepsy—Occurs in All Types of Epilepsies; Blog #74: New Studies Reveal High SUDEP Risk of Death in Poorly Controlled Epilepsy. In the US, there are at least 2,750 cases of SUDEP per year. SUDEP refers to deaths among people with epilepsy that cannot be attributed to other known causes. Studies suggest that for every 100,000 people with epilepsy, there will be approximately 116 cases of SUDEP. While the causes of SUDEP are not yet fully understood, most cases occur during or immediately after a seizure and generally during sleep. Possible seizure-related factors contributing to SUDEP include breathing and/or heart rhythm disruptions.

Does epilepsy shorten your life expectancy? People with epilepsy are two to three times more likely to die early than those without the condition. This suggests that epilepsy can shorten life expectancy by ten years for those living with symptomatic epilepsy and by two years for those with idiopathic/cryptogenic epilepsy where no serious brain pathology can be identified. While life expectancy is reduced in cases of symptomatic epilepsy (by approximately seven years), people with cryptogenic epilepsy had an almost normal life expectancy.

SUMMARY: While epilepsy can increase your risk of premature death, it is possible, in most cases, to manage these risks with anti-epileptic drugs, appropriate mental healthcare, and lifestyle changes. Mortality in patients with newly diagnosed epilepsy is higher than in patients with chronic epilepsy due mainly to the underlying epilepsy cause.

MY ADVICE: making family, friends, and colleagues aware of the risks and how they might be able to help you reduce these risks can go a long way to keeping you safe. Be certain that you have follow-up care and observation by your physician for your best chance of thriving with epilepsy.

1.     Granbichler CA, Zimmerman G, Oberaigner W, et. al. Potential years lost and life expectancy in adults with newly diagnosed epilepsy. Epilepsia. 2017;58(11): 1939-1945.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.