Sharp Waves: ILAE's epilepsy podcast

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Katja Kobow is the most recent winner of the Michael Prize, an international award in epilepsy research. Her work focuses on epigenetics and epilepsy, a field that has grown exponentially in only the past 10 to 15 years. Dr. Kobow talked about her research and its potential for epilepsy diagnosis and treatment.

Epigenetics is the bookmarking system or the data management system of our genome. It decides which part of the genome is read, and when to read it. The epigenome is what makes the genome versatile in terms of regulating gene expression.

Epigenetics is crucial for all aspects of brain development and function. It’s also reversible, which has exciting implications for anti-epileptogenic therapies.  

Dr. Kobow is assistant professor at the Institute of Neuropathology at the University Hospital Erlangen, Germany. 

Selected recent publications:
 

DNA methylation-based classification of malformations of cortical development in the human brain (Acta Neuropathologica, 2022)

Molecular diagnostics in drug-resistant focal epilepsy define new disease entities (Brain Pathology, 2021)

Epigenetics explained: a topic “primer” for the epilepsy community by the ILAE Genetics/Epigenetics Task Force (Epileptic Disorders, 2020)

The Michael Prize is awarded in odd-numbered years; entries for the 2023 prize are now open and accepted until December 31, 2022.

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This episode was reported, edited, and produced by Nancy Volkers.

Contact us with feedback or episode ideas at [email protected]g

Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

ILAE website | Facebook | Instagram

Twitter feeds: English | French | Japanese | Portuguese | Spanish | ILAE-YES

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

Can women with epilepsy get pregnant, give birth to healthy babies, and breastfeed? What are the myths and misconceptions around epilepsy during pregnancy, and what do physicians and women need to know? Dr. Anca Arbune interviews Dr. Page Pennell about the latest research and knowledge.

Women with epilepsy were once counseled to avoid pregnancy, but epilepsy is no longer a barrier to giving birth. The vast majority of women will have good outcomes.

Fertility issues are not a given in women with epilepsy, though they may arise in men or women taking enzyme-inducing anti-seizure medications.

A long history of taking anti-seizure medication does not affect a woman’s fertility or other outcomes. Only the type of medication taken during pregnancy can exert an influence. Significant reductions in the use of valproate in women of childbearing age mean that most women are taking anti-seizure medications that have lower risks to their babies.

A planned pregnancy with consistent seizure control can lead to safe and healthy outcomes. Certain anti-seizure medications require monitoring during pregnancy, due to changes in physiology and hormone levels.

Breastfeeding is safe and studies show beneficial effects to the infant, similar to those in infants in the general population. 

Research discussed during the episode:

MONEAD (Maternal Outcomes and Neurodevelopmental Effects of Anti-epileptic Drugs) Study

Two-Year-Old Cognitive Outcomes in Children of Pregnant Women With Epilepsy in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study (2021) JAMA Neurology (KJ Meador, MJ Cohen, DW Loring, et al.)

Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study (2013) The Lancet Neurology (KJ Meador, GA Baker, N Browning, et al.)

Antiseizure Medication Concentrations During Pregnancy: Results From the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) Study (2022) JAMA Neurology (PB Pennell, A Karanam, KJ Meador, et al.)

Effects of breastfeeding in children of women taking antiepileptic drugs (2010) Neurology (KJ Meador, GA Baker, N Browning, et al.)

Antiepileptic Drug Exposure in Infants of Breastfeeding Mothers With Epilepsy (2019) JAMA Neurology (AK Birnbaum, KJ Meador, A Karanam, et al.)
 
This episode was reported by Dr. Anca Arbune, and edited and produced by Nancy Volkers.

Contact us with feedback or episode ideas at [email protected]

 ILAE is a global organization of health care professionals and scientists,  working toward a world where no person's life is limited by epilepsy.
 
ILAE website | Facebook | Instagram

Twitter feeds: English | French | Japanese | Portuguese | Spanish | ILAE-YES

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

Could annual dramatic shifts in day/night patterns in the Arctic have an effect on seizures? One researcher went looking for answers – and found more than he bargained for. His research revealed a public health crisis in one of the wealthiest countries in the world, highlighting the needs of geographically isolated communities and Indigenous peoples. (He also found intriguing results to his original question.)
 
 Dr. Marcus Ng reviewed 11 years of data on emergency evacuations from the Kivalliq region of northern Canada. There, anyone who has seizures that last more than 5 minutes - an emergency condition known as status epilepticus - is helicoptered to a single hospital in Winnipeg, Manitoba.
 
Dr. Ng wondered if the frequency of evacuations changed as the seasons changed. Were people more likely to have seizures in the 24-hour darkness of winter, the 24-hour daylight of summer, or somewhere in between?
 
He found that the people of the Kivalliq region had the highest reported incidence of status epilepticus in the world, far higher than Canada's overall estimates. His research also revealed the barriers to timely care faced by this population.
 
 This episode was reported and produced by Nancy Volkers. Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.
 
Studies mentioned or used as sources of information:
  Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight. Epilepsia Open 2021

Circannual incidence of seizure evacuations from the Canadian Arctic. Epilepsy & Behavior 2022 

Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study. Epilepsy & Behavior 2019 

Addressing provider turnover to improve health outcomes in Nunavut. Canadian Medical Association Journal 2019

Contact ILAE with feedback or episode ideas at [email protected]

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

Anti-seizure medications are not a cure, and about 30% of people with epilepsy don't respond to them. How are new medications discovered, and what's on the horizon?  Dr. Patricia Grandizoli Saletti interviews Dr. Karen Wilcox about her work with the Anticonvulsive Drug Development Program.

Only about two-thirds of people with epilepsy have their seizures controlled by medication. The Anticonvulsive Drug Development (ADD) Program at the University of Utah is the contract site for the Epilepsy Therapy Screening Program (ETSP), a program run by the US National Institutes of Health that is dedicated to preclinical testing of potential new medications to stop seizures - and perhaps one day, to stop epilepsy from developing.

Dr. Karen Wilcox directs the ADD Program, which over the years has evaluated the majority of the anti-seizure medications on the market today.

The program uses a battery of assays and experiments to blind-test compounds, which are provided by pharmaceutical companies, academic labs, or medicinal chemists. The data is returned to the source lab, which can use it to pursue clinical testing if warranted.

Identifying promising new anti-seizure medications relies on model systems that approximate epilepsy in human beings. Dr. Wilcox and colleagues' work on better pre-clinical models can help to identify more effective anti-seizure medications.  For example, finding compounds effective against drug-resistant epilepsy depends on models that simulate drug-resistant epilepsy. Dr. Wilcox's program uses such a model and is working on developing others. And in a 2020 Epilepsia paper, her group described results from a study of subchronic administration of anti-seizure compounds in a rodent model of spontaneous seizures.

This episode was reported by Dr. Patricia Grandizoli Saletti, and edited and produced by Nancy Volkers.

Contact ILAE with feedback or episode ideas at [email protected]

Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

Can electrical current stop seizures, or make seizures less severe? How does it work, and who can benefit?  Dr. Laurent Sheybani interviews Dr. Robert Fisher about deep-brain stimulation for epilepsy.


Disclosure: Dr. Fisher is a consultant for Medtronic but receives no compensation for using its deep-brain stimulation devices.

Deep-brain stimulation (DBS) is the newest of three types of neuromodulation for epilepsy, and targets a part of the thalamus called the anterior nucleus. 

In DBS treatment, targeted electrical pulses inhibit  a network in the brain  involved in starting and spreading seizures. This interference is linked with a reduction in the number and/or severity of seizures in some people who haven’t found relief with anti-seizure medications.

In a randomized, double-blind study of DBS, the SANTE trial , 43% of people had significant reductions in their seizure frequency after one year, and 74% had reductions after 7 years. The treatment also had high patient satisfaction (84% after 7 years).

The mechanisms of DBS are still largely unknown, though pre-clinical studies have found synaptogenesis, receptor changes, and changes in gene expression, suggesting the growth or regeneration of neurons. DBS is usually well tolerated, acceptably safe, and associated with improvement in quality of life.

Research discussed during the episode:

Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy (2010) Epilepsia (Fisher R, Salanova V, Witt T, for the SANTE study group)

Experience and consensus on stimulation of the anterior nucleus of thalamus for epilepsy (2021) Epilepsia (Fasano A, Eliashiv D, Herman ST, et al.)

Closed-loop stimulation of the medial septum terminates epileptic seizures (2021) Brain (Takeuchi Y, Harangozo M, Pedraza L, et al.)

Medial septal GABAergic neurons reduce seizure duration upon optogenetic closed-loop stimulation (2021) Brain (Hristova K, Martinez-Gonzalez C, Watson TC, et al.)

 Other resources:

ILAE/YES webinar on neurostimulation with Dr. Robert Fisher (January 2022)

This episode was reported by Dr. Laurent Sheybani, and edited and produced by Nancy Volkers.

Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

Someone who has persistent seizures that last more than 24 hours, despite treatment, is in super refractory status epilepticus, or SRSE. The condition is rare, but often results in death or disability.

Bringing someone out of SRSE usually involves treatment with anti-seizure medications and anesthetics, but other therapies are beginning to gain attention. One of those therapies is the ketogenic diet. This high-fat diet has been used to treat some cases of epilepsy for more than 100 years.

A recent paper in Neurology Clinical Practice offers practical considerations for the use of the ketogenic diet in patients with super-refractory status epilepticus. ILAE spoke with two of the paper’s authors – dietitian Neha Kaul and epileptologist Joshua Laing.

For guidance on providing the ketogenic diet, contact Neha Kaul.

Read the paper: Practical Considerations for Ketogenic Diet in Adults With Super-Refractory Status Epilepticus | Neurology Clinical Practice 

More about the ketogenic diet as epilepsy treatment (ILAE Epigraph article).

Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

How can you describe your first seizures to a doctor if you don't remember them happening? What if your university professors don't believe you have epilepsy? How do you handle misinformation from family and friends about what epilepsy is?

Bright M. Bwalya has had to answer each of these questions, and more. Diagnosed with epilepsy in 2016, Bright coupled his experiences with curiosity and compassion to become one of Zambia's foremost epilepsy advocates. In 2021, he won an IBE Golden Light Award for his efforts.

Sharp Waves talked with Bright, as well as Drs Naluca Mwendaweli and Deanna Saylor, to learn about issues facing people with epilepsy in Zambia and how doctors and patients are working to increase awareness and understanding of the condition. Bright's story is unique, and yet it could be almost anyone's story, anywhere in the world.

Bright is developing an app (Seizure Assistant) to help people with epilepsy. He is active on Facebook and Twitter.

Sharp Waves content is meant for informational purposes only. The International League Against Epilepsy is the world's pre-eminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Edited and produced by Nancy Volkers.  We welcome feedback and ideas for future episodes at [email protected].

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Send comments and feedback

Before 2018, epilepsy in Zambia was treated as a mental illness by the health care system,  though many people viewed it as a manifestation of demonic possession or witchcraft. Epilepsy education for the public was non-existent, and specialty care unheard of.  Now Zambia's first neurology training program, launched in 2018, is shifting an entire country's perception of what epilepsy is, and how to treat it.
 
 This episode includes interviews with Deanna Saylor, program director of the post-graduate training program in neurology at the University of Zambia, and Melody Asukile, an adult neurologist with an interest in epilepsy, and one of the program's first graduates.
 
 Edited and produced by Nancy Volkers. Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

We welcome episode feedback and ideas for future episodes at [email protected].

Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.

Let us know how we're doing:  [email protected]

The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.