2008 European Federation of Neurological Societies Conférence
Hello from Madrid, September 23-26, site of the 2008 European Federation of Neurological Societies conférence. My rôle hère is that of a ‘roving reporter’ meaning I will attend courses intended for neurologists, visit poster sessions and sit in on lectures and debates where neurologists may devulge new research, discuss research already done, and cover subjects that as patients with epilepsy we are all keen to discover.
Before diving head first (no pun intended) into the world of neurology let me just mention that neurologists have a language of their own often shortened to several letters. After hearing LTD in a lecture I was convinced it was some sort of far out complicated scientific name for an enzyme produced by the brain….I asked all kinds of people what it could possibly mean and finally…one evening in a restaurant in Madrid I ran into my friend Reinhardt (whom I will now fondly call a walking médical dictionary). I asked him if he had any idea what LTD could mean and without batting an eye he said Long Term Depression. Hah ! why search for the complicated when things can be so simple….Ill try to do the same in the next few pages…keep it simple !
For your information-AED=anti epilepsy drug/AE=adverse effects
Let me first start off with the EFNS. The European Federation of Neurological Societies is based in Austria. Thier rôle is to advance the development of neurology as an idependent speciality caring for all patients with a nervous system disorder ; to ensure that all Europeans have access to neurological services, to support research and dissemination of resesarch results throughout europe, to organise and support pre and postgraduate level courses on neurology throughout europe, and to handle the current political issues in European neurology on behalf of it’s members. The EFNS is made up of 42 European national neurological societies.
Over the next few pages Ill go over the lectures and courses I attended as well as the poster sessions and fill you in on what is happening in epilepsy treatment and diagnosis today. Enjoy Reading and should you have any questions dont hesitate to ask !
Each course and or debate lasted 2 hours and was divided into 4 sections presented by 4 different médical professors. The first session I attended was :
Course 1-Practical clinical management of epilepsy : basic clinical knowledge
- Diagnostic pitfalls in epilepsy : presented by Maria Mar Carreno , doctor and professor from Barcelona spain.
Going back in time and looking at the 43 or so famous people considered to have epilepsy it was found that some of them suffered from sévère anxiety attacks, agitation, alchohol withdrawal seizures, or something other than epilepsy. This brings us back to the fact that epilepsy IS NOT A DISEASE. Epilepsy is a symptom making it different for different reasons for each individual. What all of this means is that it is often difficult without eyewitnesses and a complete history to know if someone has had an actual seizure attributed to epilepsy or another condition such as
-fainting spell, anxiety attack, hyperventiliation, dizziness, and the list goes on.
A large amount of patients dont see a specialist after their first seizure or more because they dont attribute thèse episodes to epilepsy or anything serious….leading to misdiagnosis. In order for a specialist to make a correct clinical diagnosis they really need a description of the seizure, the évents leading up to it, was there an aura ? trembling ? With enough information a specialist can usually distinguish epilepsy from another type of seizure although mistakes are sometimes made. Is it epilepsy or a cardiac syndrome ?? pyschogenic seizure (meaning that the cause would be psychological rather than physical)?? How do you know ? A psychogenic seizure is more likely if the patient has suffered an emotional trauma of some sort. A cardiac seizure ?? What could that be ?? A few examples were given I will share this one as it could happen to anyone. After 15 years of uncontrolled seizures a woman entered a clinic as a potential surgery candidate to stop her seizures. She had been on a variety of anti epileptic médications and nothing seemed to change…. Upon performing a vidéo EEG along with an EKG to measure the heart’s activities the doctors noticed that each time this woman had a seizure her heart would slow down reducing the oxygen to her brain. The result was what looked exactly like a partial complex sezure. She was properly diagnosed, a pace maker was put in and she went on her merry way with no more seizures….
Another diagnostic ‘pitfall’ is diagnosing one type of epilepsy for another which can result in using the wrong type of Anti Epileptic Medication (AED). Misdiagnosis happens quite often because some seizures look similar, the EEG Readings may be similar, a patient may be eager to start treatment to ‘get it over with’ but above all because there can be a lack of communication amongst the specialists who have seen this patient. If given the wrong treatment some cases may be aggravated causing more seizures as well as different types of seizures.
Conclusion? Are we treating for epilepsy or something else ?
Keep an open mind as to when certain seizures may start and or what type of seizure they are. A large part of idiopathic generalized seizures (28%) start after the age of 20 meaning that there is not always a rule of thumb for the times and types of seizures to occur. Communication is essential between patient and neurologist. For the neurologist to really get the full détails a full background search on the patient and the patient’s family history is necessary….
- Treating epilepsy across its different stages : This was presented by Professor and Doctor Ettore Beghi from Milano, Italy.
The International League Against Epilepsy has modified the définition of epilepsy.
« Atleast one seizure is required to establish the présence of epilepsy ; a predisposition as determined by a family history , or by the présence of epileptiform EEG changes ». According to Dr Beghi, « This is not sufficient to determine epilepsy. The définition does not inlcude a requirement that the seizure is unprovoked. »
In this présentation Dr Beghi begins by distinguishing by provoked seizures (those resulting from tumours, infections, haemorrhage, head traumas) and unprovoked seizures which occur in the absence of a known cause. He goes on to discuss the logistics of if and when treatment should begin and continue. A few statistics : After a first unprovoked seizure the possibility of a relapse is from 25-69% with the average hovering around 51%. It is easy to come out with numbers though many things must be considered : the type of seizure, the EEG, are the seizures during sleep, family history, and the cause of the seizure.
Studies have shown that :
After two years the risk of recurence of a first unprovoked seizure=25% in patients with an unprovoked seizure from an unknown cause and a normal EEG.
48% in patients with a documented cause OR an abnormal EEG.
65% with both a documented cause and an abnormal EEG.
Does this mean someone should automatically be treated after a first seizure ?
What to consider :
There is a 35% chance that the patient wont have another seizure within two years
Some clinical trials have shown that patients treated after a first seizure have a lower risk of relapse with in the first 12 months compared to untreated patients. (table 1)
39% of cases have adverse effects to the drug or the drugs fail to have a long term effect on the rémission of seizures.
Most specialists chose to start treatment when at least two unprovoked seizures have occured as the risk of a third seizure has been estimated at 73%.
Dr Beghi mentioned the following interesting facts :
The safety profile of a drug is probably the most important élément when chosing between monotherapy or add on (adding another médication to the existing one if it doesnt work). It can often come down to the patients réactions, side effects, making it that much more important to tailor each treatment to each patient’s needs.
Treatment discontinuation-If a patient has been in rémission for more than two years discontinuation of drug treatment can be a valuable option. The importance in the décision is to weigh the risks of relapse, conditions, social and emotional profile and of course include the patient in the décision procèss.
The conclusion hère is that treatment for epilepsy can not be standardized as the word really is épilepsies making each case an individual one requiring individual tailored care.
- Surgical treatments of epilepsy, how to select a patient and what needs to be done to identify the best candidates including vidéo.
Presented by Dr/Prof Paul Boon of Ghent, Belgium
30% of patients with epilepsy do not respond to AED’s. Most of thèse patients who have refractory (uncontrolled) epilepsy have partial epilepsy…seemingly the most difficult to treat. An intractable epilepsy refers to seizures that cant be controlled via the resources available to the patient’s doctor.
Does this mean the patient should have surgery ?
The first step is to explore all possibilities-ranging from médication adjustement to counseling depending on the conditions, and keeping in mind that the quality of a patient’s life is important !
Once it has been concluded that a patient is a candidate for surgery the next step is to pinpoint the irritated zone, find the source of the seizure.
High quality neuroimaging is indispensable-similar to a High quality photo of the Inside of your brain. MRI’s are also used to offer more precise information along with a selected répertoire of various High tech, High image scans, photos, and if necessary even placing an électrode in the brain to record activity with more precision (PET scans, vidéo EEG’s)
It is also necessary to find out what downfalls the epilepsy is causing in someone’s brain and if the patient has surgery could more downfalls be caused ?
Before moving on to more invasive procédures some psychological tests are performed to make sure the patient will be able to handle all of the probing that needs to be done before surgery as well as the surgery itself and possible complications that may arrise afterwards.
Surgery has proved to be successful. The success rate varies depending upon the origin of the seizures in the brain . As far as numbers (percentage of seizure free patients) again, this varies depending on which part of the brain was affected. There are some numbers that give hope including AED discontinuation, achieveing monotherapy. Intelligence appears to be unchanged by surgery though some long term Memory may be affected.
Vagus Nerve Stimulation
The candidates for VNS appear to be those who arent candidates for surgery and have exhausted all AED possibilities. It appears to have a 1 in 3 success rate on improved seizure control with improvements after 18 months of treatment. It does appear to be in need of further research.
Deep Brain Stimulation
Effective for certain types of Parkinsons Disease DBS is perhaps the future for certain types of épilepsies. It consists of placing électrodes over the cortical convexity for cortical stimulation or into targets which are deeper in the brain for DBS. Trials are very récent so no exact numbers are yet ready…
Just to keep you assured however….if youre thinking of surgery as your last option you can not just walk into any clinic and say hey, take this part of my brain out, it’s causing havoc ! There is a list of criteria that both surgeons and clinics have to meet to be able to explore around in your brain so if they do go in theyve done it before. A few détails :
Neurophysiologis, neurologist, and expérienced neurosurgeon must be part of the crew.
25 epilepsy opérations must be done in a center per year for the center to be considered expert and expérienced enough in this domain.
Regular meetings are held between the above specialists as well as neuroradiologists, neuroanaestesiologists, and more.
The facilities must be able to handle complete EEG vidéo recordings as well as their analysis.
The surgery team must be able to recognize when invasive recordings are indicated…meaning 24/24 hours serveillance in the vidéo EEG monitoring unit, a neuro ICU (intensive care unit) and a complete specific team on hand.
Regular follow up for atleast five years is a necessity and centers need to exchange with other centers for international follow up studies.
- AED DRUG INTERACTIONS YOU SHOULDNT MISS
Svein I. Johannessen PhD Oslo, Norway
It appears that 70% of patients taking one drug are well controlled and only 30% of patients taking several drugs are well conrolled. The big risk in mixing drugs is the risk of drug interactions. This can lead to many problems that range from
Weight gain, weight loss, drowziness, hair loss, effect on organs (liver).
It is recomended to keep track of the levels of the médications taken in the blood to try and improve the quality of treatment and avoid overdosing. Finding the balance is the most important-too much can lead to side effects and not enough can lead to inefficient control.
Some other effects caused by AED’s can exist on the enzyme level meaning that the AED may block the absorption of another drug or that the AED and that drug will compete for the same site on an enzyme. The result can be that your birthcontrol pills (for women) are neutralized making them ineffective as well as certain antibiotics. In récent years there have been developments in understanding the journey of certain drugs through our systems. This has allowed the scientific community to really understand how drugs transform in our systems allowing them to create more specific molécules that will be more reactive or efficient in our systems. This progress can lead us to hope that individualized tailor made AED’s are on their way.
Conclusion : interactions between AED’s are numerous. New AED’S have less drug interactions, there is a potential for interactions between herbal remedies and AEDs so always read the notice !!
The second series of courses I attended are Under the title : Advanced clinical Aspects of Epilepsy for the Clinician
This course was divided into sub courses with the first one covering dépression in epilepsy.
- Depression in Epilepsy. Mechanisms and Therapeutic approach
Presented by Dr Bettina Shcmitz from Berlin, Germany.
The question Dr Schmitz started off with was do epilepsy and dépression have a biodirectional Relationship ? Depression is often présent before epilepsy but once epilepsy is in place dépression often seems to worsen. She looked at the rate of epilepsy that appears in patients who have suffered from dépression first and there appears to be a relationship in some cases that could be due to a possible defficiency of an amino acid that can provoke seizures in both cases (Monamine deficiencey-Kanner and Balabanov 2002).
Dr Shcmitz looked at various criteria for a dépressive syndrome-it was found that candidates for epilepsy surgery had a high rate of dépression (44%) with 10% having some sort of post surgery manias. None of thèse cases were recognized or treated for dépression.
In some studies children have shown very high rates of dépression or some sort of psychiatric disorder yet few were treated for them. In yet other studies patients who abused alchohol had a higher rate of dépression than those with out, and epilepsy onset came soon after dépression. It appears that some AED’s are more influential then others on dépression yet the dépression often goes un noticed. Why ? There are several reasons. Neuroligsts aren’t trained in psychiatry and dont often have extra time when they consult with their patients. If the patient doesnt complain the doctor wont ask. Via questionnaires given to patients it was understood that patients with epilepsy have several fears : fear of having a seizure, fear of the unknown, and some who have lived for epilepsy for a long time and have gone into rémission also suffer from a fear of normalcy. Via a questionnaire for doctors it was found that 82% of doctors don’t screen for dépression and that 85% would if a study showed that antidepressants would help petients mood and decrease seizure risk.
In march 2008 the FDA published a warning that there was an increase in suicide rates (1 in 1000) for people taking AED’s. This warning has possibly caused more damage because when some patients read the warning they stopped taking their médications bringing on a whole new cycle of seizures and possible dépression.
Dr Schmitz suggested that doctors screen for dépression and that if it is decided that a patient should take something for dépression the doctor must be honest with the patient. The first two weeks of a treatment for dépression symptoms often get worse before getting better. The patient may expérience weight gain or loss, tiredness, sexual problems, and more. IN order for people with epilepsy to achieve a better quality of life it is important to recognize that dépression can exist in epilepsy. New anti depressants seem to be better for people with epilepsy and the importance is to start them at low dosage and very slowly. It is also important for doctors to consider the pyscotropic effects of AED’s and to check the dosage level of the AED as often as needed. Support groups exist and are a good tool for patients.
- Effects of seizures and anti epileptic drugs during pregnancy
Dr Torbjorn Tomson, Stockholm, Sweden
The management of pregnancy and epilepsy lies on balancing risks for the mother and the fœtus associated with uncontrolled seizures vs the potential harm on the fœtus coming from AED’s. This lecture really deals with the rationale used for treating women with epilepsy with AED’s during their pregnancy.
RISKS
Maternal and fœtal risks with seizures
From 1985-1999 maternal deaths in the UK were studied. It was found that out of 11 million births there were 1200 deaths, 46 due to epilepsy. This is about 4% and the cause of death was often caused by seizure occurrence after an abrupt withdrawal of AED’s by the mother. Quite often during the early stages of pregnancy the mother had read the potential side effects the AED she was taking could have on her child so she stopped taking the AED immediately making her more suseptible to having seizures. The effect of the mother having a seizure on the fœtus really dépends on the type of seizure. The biggest risk is that of generalised tonic clonic seizures-they can induce lactic acidosis which is transferred to the fœtus and can cause feotal bradycardia. (lactic acid into the bloodstream causing the heart to slow down) Uncontrolled tonic clonic seizures are considered a higher risk to the fœtus than taking AED’s.
There is no proof of increased malformations or miscarriages as a result of seizures.
Taking AED’s while prégnant
Although I can not go into the specific drugs mentioned the conclusion is that the most effective treatment during pregnancy is low dose monotherapy. The best way to approach pregnancy for women with epilepsy is prepregancy counseling. It is important for the prégnant woman to develop the proper strategy to best handle her epilepsy while prégnant as the outcome for most women with epilepsy are normal births.
- Treating Epilepsy in children
Dr Lieven Lagaie, Luven, Belgium
The challenge when treating epilepsy in children is ensuring that the seizure is indeed the symptom related to epilepsy and if it is how can it best be treated without effecting the child’s cognition. A thorough investigation is required after the first seizure to find the underlying cause-including vidéo EEG’s, genetic work up, and more.
It does appear that when epilepsy is caught early enough and treated early enough preventing further seizures the child has a normal cognitive development. When dealing with children there are several obstacles-there is no short list defining the optimal drug per epileptic syndrome, the seizure type can change, so the ‘perfect drug’ doesnt exist yet. There does appear to be to be a few drugs that are considered broad Spectrum and can be used as first treatments making things a little easier.
The best way to choose the right AED with children is to look at possible side effects and effects on cognition and behavior and work from there, tailoring the treatment and dosage to the child’s needs.
Newer AED’s do appear to be better tolerated.
This next session was one I was really looking forward to and was in the end the most disapointed with !
- What is the évidence to impose restrictions to life style ?
Prf/Md Antonio Gil-Nagel from Madrid, Spain
The first issue Dr Gil addressed were the common restrictions applied to people with epilepsy. From there he adressed each restriction.
- Sleep deprivation
- Alcohol
- Caffeine
- Stress
- Accident risks
- Flashing lights
- Sports
Sleep deprivation :
The majority of people with epilepsy can have occasional partial sleep deprivation without influence on their seizures.
Stress :
Chronic stress may have an impact and should be screened for with an eventual treatment
Alchohol :
Alittle bit is ok-they actually did test for this in an epilepsy clinic (Hoppener y col, Epilepsia 1983) by giving 30 patients who had never had alchohol before 1-3 drinks twice a week for 16 weeks. They were in 2 groups-one group drinking orange juice and the other orange juice and vodka. The result was no change in seizure frequency or and that alchohol abuse is dangerous for everyone !
Caffeine-there is no évidence that one or two doses of caffeine can cause seizures in humans. Energy drinks with caffeine and taurine are reported to ahve caused seizures though
Sports :
Benefit of effect vs risk of sport
I stood up and asked if this doctor hadnt thought of studying the effects of endorphins and adrénaline released during sports as oppose to studying the effects of alchohol….
The conclusion of the brave doctor’s report was that imposign restrictions impairs social intégration for people with epilepsy
Bravo.
Sunday August 24
Today’s subject is Neurostimulation for Epilepsy
- Neurostimulation, how, where, and when ?
Wytse J. Wadman from Amsterdam, The Netherlands
Why use neurostimulation for epilepsy ? It has proved effective in Parkinson’s disease and it appears to work more locally than certain drugs.
Why use thèse methods for epilepsy ?
1% of today’s population has epilepsy and with the best médication only 7% find seizure freedom. Can neurostimulation be the road to drug freedom ?
Where ? will refer to the sights on the brain which will essentailly be local though this field is still Under exploration. It appears that the stimulation one neuron wont have the same effect as stimulating a group of neurons (called multi sites).
How ? meaning the duration, intensity, and frequency of stimulation and the patterning refers to how the électrodes are placed.
When ? should neurostim be used continuously, intermittently, or on demand ?
Who ? Who are the candidates for this type of treatment ? Patients résistant to drugs and not suitable for surgery.
Now we get to the essential question which is what is neurostimulation ?
There are two types in this discussion : DBS-deep brain stimulation and VNS-vagal nerve stimulation
VNS-In theory the patient should be able to recognize an aura, trigger the VNS and prevent a seizure. The side effects can be hoarseness and voice change.
DBS –deep brain stimulation is presently Under research but all modes of action are not yet fully developed or understood. What is known is that it is a local and targeted stimulation-meaning that if the cells provoking the seizures are found they can be targetted precisely which also means the action is réversible unlike surgery. It sounds simple right ? It’s all about finding the right stimulus, placing it on the right area of the brain to get the right réaction needed….
- Clinical Experience with VNS and DBS in epileptic patients
Presented by Paul boon, Ghent, Belgium
Why VNS ? VNS if effective on patients with epilepsy will decreases médical costs per patient because there will be less costs per patient per year on drugs and doctors.
There would be an increase in efficiency with with longer follow up and the magnetic feature’ is that the patient should be able to prevent his/her own seizures via recognition of an aura. In various studies 1/3 of patients treated with VNS had no benefit and 2/3 could prevent seizures. The other positive effect is that because no drugs are used there would be no side effects or behavioral changes to deal with.
DBS-As deep brain stimulation has worked for parkinson’s the idea that it could work for epilepsy is attractive. The problem is that it is very invasive and large scale clinical studies are very difficult to put into place. The positive side of DBS is that no tissue is removed but installing an électrode does leave a lésion. The mechanism of action in epilepsy is not fully understood just yet but out of 115 patients studied 56 patients improved.
Again, because the exact targets and modes of actions are not yet understood it will take some time before this method is considered.
- The Future of Neurostimulation for Epilepsy
Presented by Prof/Md Stephane Chabardes, Grenoble, France
The notion that DBS Works for Parkinsons disease and dystonia and has been promising for OCD-Obsessive compuslive disorder and dépression also raises hope that it could be effective for epilepsy.
This future is based on the idea that a stimulation can be placed directly on the seizing neuron. For now the main aspect that is understood is that on one or very Small population of neurons seizures can be reduced but when large populations of neurons the effect is pro convulsive meaning it can cause seizures. For now in DBS the scientific community can only discuss théories as they dont yet have the large mammals to study on. Strategies are being disucussed including new nano technology meaning that with microstimulation électrodes, which are less invasive, seizures could be detected at an earlier cellular level.
However, this still remains a long road before being used as targets have to be defined, multiple studies must be accomplished.
EFNS-EUREPA Epilepsy Symposium
Are new drugs better than old ones ?
Treatment of a single seizure
Pros presented by Dr. Kristina Malmgren-Goteberg, Sweden
Cons presented by Dr. Bettina Schmitz. Berlin, Germany
This debate was very interesting and really comes down to is that first seizure epilepsy ? Alot of this information is in the above lectures as well.
Dr Kristina Malmgren :
The main message as always is for doctors to consider the risks and conséquences. If you start treatment after one or two seizures what psychosocial effects and or side effects of médications might you be subjecting a patient to ?
In a very well documented study 40-50% of untreated patients can expect a rémission within 2 years. Treatment can lower the risk of another seizure by as much as half.
If the patient asks is this epilepsy and if so, how do you know ?
As a doctor it is important to know the full history-what could have provoked the seizure, how is the patient’s sleep cycle, family history, co morbidity.
Typical indications of a first tonic clonic seizure would be latéral tonue biting, hayper salivation ( drooling), disorientation, any prior épisodes.
25-30% of first seizures are caused by toxic –metabolic disturbances which could be hypogycemial (sugar imbalance), a head injury, or fever. If the patient asks will it happen again ?
Seizures from metablic-toxic disturbances are 3% less likely to happen again
Unprovoked seizures are likely to happen by up to 42% over the next two years and up to 60% with in the following 6 months.
Predicting risk of récurrence
LOW- one seizure-EEG is normal, no neuro déficit, not necessary to start treatment
MED- one seizure, EEG abnormal or neurological defecit.
HI-one seizure and both EEG abnormal and neurological deffecit-
Status –no risk of récurrence after the first épisode though if there is récurrence it will be status.
Should we start AED’s after the first seizure ?
Bettina Schmitz Berlin, Germany
Dr Schmitz has a more conservative view. Why ?
The risks are unnecessary as 50% of people who have had a first seizure will never expérience a second one. 30% of first seizures are misdiagnosed-they can be fainting (syncope) or other similar spells easy to confuse with epilepsy. The other problems in starting someone immediately on AED’s are that this wont change the EEG, only supress seizures.
Risk of malformations during pregnancy is a 2/3 risk for women.
Starting AED’s will cause uneccesary treatment risks as well as unnecessary costs.
Dr Schmitz recomends looking into all seziure provoking behaviors (irratic sleep, drugs, alchohol) and regulating those first and foremost. Starting an AED after the first seizure wont change the outcome of treating after the second seizure.
The next débate is on the Pros and Cons of monotherapy as the new gold standard
Pro
Guenther Kraemer, Zurich, Switzerland
After a long drought in the development of new AED’s between the 70’s and 90’s over the past twenty years atleast ten new AED’s ahve been developed. These new molécules are not proven to be more effective in reducing seizure freedom but for the most part they appear to be better tolerated by patients with some being less sédative and for women who want to have children some of the newer molécules appear to be less harmful for the fœtus. Dr Kraemer states that more double blind tests need to be conducted but considering what we already know about the new génération of AED’s he considers them the new gold standard in treating epilepsy
Con
Dr Philippe Ryvlin, Lyon, France
Dr Ryvlin takes a much different approach in his présentation narrowing it down to AED’s shouldnt be new vs old but What AED suits which patient ?
Each country varies in their use of AED’s. Trials are not open and there doesnt appear to be diversity in terms of groups tested or meds used.
Tuesday August 26
Syncope vs epilepsy
Dr Philip Ryvlin, Lyon , France
Syncope and epilepsy dont really resemble eachother but in certain cases the diagnosis can be confusing.
Syncope is defined as self limited loss of conciousness leading to falling. Recovery is complete and prompt.
Syncope can be caused by orthostatic hypotension-when you stand up and feel really dizzy, some people faint., Cardiac arythmia-irregular heart beat causing a lack of oxygen to the brain
Epilepsy is classified as partial, generalized and unclassified.
Again to ensure proper diagnosis it is important to have the patient’s history, if the person had a seizure is there an eyewitness, did they bite their tongue laterally, amnésia, muscle pain
The most difficult task has been to diagnose assistole properly. Several cases were filmed and the patient did look like they were having a generalized tonic clonic siezure. The electrocardiogram showed that the patient was actually suffering from a heart disorder that prevented oxygen from going to the brain and causing a seizure. The patient was treated with a pacemaker and had no more seizures.
The finality of this discussion is to distinguish the symptoms between one another to ensure that the patient is treated accordingly if necessary.
Well, there you have pretty much everything I saw and learned at the EFNS conférence in Madrid this year. people with epilepsy can remain hopeful that with the new technology being proposed one day soon we will all have a solution that may allow us to live free of seizures !
