Epilepsy Currents

Epilepsy Currents - Episode 12- "Drugs, Diets, and DEEs — Add-on Ketogenic Diet versus Antiseizure Medications Alone in Children with Developmental and Epileptic Encephalopathies"

Join Dr.Marawar in a conversation with Dr. Chalongchai Phitsanuwong and Dr. Priyamvada Tatachar as they discuss the article, "Add-on ketogenic diet versus antiseizure medications alone in children with developmental and epileptic encephalopathies: a prospective comparative cohort study" and its accompanying Epilepsy Currents commentary "Drugs, Diets, and DEEs: A Comparative Review of Medical and Dietary Treatments in Developmental and Epileptic Encephalopathies". Click here to read the article. This podcast was sponsored by UCB. We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage. This episode covers a 2025 Frontiers in Neurology study by Hu et al. and its accompanying Epilepsy Currents commentary on ketogenic diet therapy for developmental and epileptic encephalopathies (DEEs). Host Dr. Rohit Marawar speaks with Dr. Chalongchai Phitsanuwong and Dr. Priyamvada Tatachar about the study's findings that add-on ketogenic diet nearly doubled seizure-freedom rates versus medication adjustment alone, and produced meaningfully better developmental/cognitive outcomes. They discuss the rationale for earlier diet initiation, practical implementation (patient evaluation, dietician-led clinics, monitoring), manageable side effects, the search for response biomarkers, referral pathways for general neurologists, and the future of DEE treatment moving toward genetically targeted therapies alongside continued diet use. Key takeaways: 1. Ketogenic diet outperformed medication adjustment alone: ~50% seizure response rate vs. ~29%, and ~20% seizure-free vs. ~10% (RR 1.73 for response, RR 1.9 for seizure freedom), consistent with prior literature (40-60% response, 10-30% freedom in DEEs). 2. Developmental gains, not just seizure control, may be the more striking finding: 36% vs. 5% showed developmental improvement on formal assessment, occurring even without medication changes, suggesting the diet has an intrinsic neuroprotective effect independent of seizure reduction. 3. Both experts argue for earlier initiation of ketogenic diet, especially in syndromes like epilepsy with myoclonic-atonic seizures (Doose syndrome, 79% response rate) and infantile epileptic spasms, rather than reserving it as a last resort after drug resistance and developmental regression are already established. 4. Side effects (mostly GI, constipation, "keto flu") are generally mild and manageable with proper monitoring (renal, bone health, lipids, micronutrients), and only ~3% discontinued therapy in the study; dedicated multidisciplinary keto clinics significantly improve feasibility and adherence. 5. No validated biomarker yet predicts individual response to the diet (early signals around acetylcarnitine levels), but resources exist for clinicians to start a program, including the Charlie Foundation, Matthew's Friends Foundation, the International Neurological Ketogenic Diet Society, and ILAE regional clinic listings. Dr. Rohit Marawar (Host): Imagine a child whose first year of life is measured not in milestones, but in seizures, dozens a day, while medication after medication is tried and falls short, and development quietly regresses. For children with developmental and epileptic encephalopathies, this is an all too common story. But what if one of our oldest therapies, a carefully formulated diet, could change not just the seizures, but the trajectory of a child's development? Welcome to the Epilepsy Currents podcast, the podcast for Epilepsy Currents Journal, exploring the latest research and expert commentaries from the world of epilepsy. UCB is the proud sponsor of this episode, Episode Number 12 of Epilepsy Currents podcast. I'm your host and associate editor for the podcast, Rohit Marawar. Today, we are discussing a prospective comparative cohort study by Hu and colleagues, published in Frontiers in Neurology in 2025, and the accompanying Epilepsy Currents commentary, Drugs, Diets, and DEEs to help us unpack what this means for clinical practice. We are joined by two expert voices in pediatric epilepsy. First is Dr. Chalongchai Phitsanuwong, author of the commentary. Dr. Phitsanuwong is a pediatric epileptologist with a focus on ketogenic diet therapy, practicing at Bumrungrad International Hospital in Bangkok, Thailand. Welcome, Dr. Phitsanuwong. Chalongchai Phitsanuwong, MD: Hello and good evening. Thank you very much for having me today. Host: And then, we are also joined by Dr. Priyamvada Tatachar, a pediatric epileptologist based in Chicago with a special interest in tuberous sclerosis and who also contributed to the commentary. Welcome, Dr. Tatachar. Priyamvada Tatachar, MBBS, MD: Good morning from Chicago, and thank you for having me on this podcast. Host: Great to have you both with us. Let's dive in. Dr. Phitsanuwong, I'm going to start with you. To set the stage for our audience, what exactly are developmental and epileptic encephalopathies, sometimes abbreviated as DEEs, and how often are they likely to be drug resistant? Chalongchai Phitsanuwong, MD: Thank you very much, Dr. Marawar. So, developmental and epileptic encephalopathies, or DEEs, represent some of the most severe forms of epilepsy. It's characterized by frequent seizures and abundant epileptiform activity on the EEG. It is commonly associated with developmental slowing and/or regression, like you said. The current consensus is that both the underlying etiology and the seizures or epileptiform discharges contribute directly to this developmental stagnation or regression. DEEs carry an exceptionally high prevalence of becoming drug-resistant epilepsy, reaching up to 70% in some cohorts, by comparison to the typical 1/3 we see in general epilepsy population. So, more than double the numbers. Host: Dr. Tatachar, from a frontline clinical standpoint, what does the day-to-day burden of a drug-resistant DEE looks like for a child and their family, and where do current medication strategies most often fall short? Priyamvada Tatachar, MBBS, MD: I think the word overwhelming comes to mind when families face the diagnosis of developmental and epileptic encephalopathies. For most patients and parents, the initial diagnosis is basically an uncharted territory that comes with a lot of fear, uncertainty, financial and social burdens, and the day-to-day challenges of caring for a child with significant medical, social, and developmental needs. It's a very daunting situation for them. Now, the current medical management focuses on the perspective of seizure control with several drugs added either alone or in combination for this reason. And as Dr. Phitsanuwong said, DEEs are particularly drug resistant. And based on the child's underlying diagnosis, addition...

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Epilepsy Currents - Episode 11 -"TRADEOFFS: What Are Patient-Reported Outcome Measures Missing?"

Apr 900:30:08Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Danielle Becker, Dr. Jacqueline French and Dr. Ammar Kheder as they discuss the article, "TRADEOFFS: What Are Patient-Reported Outcome Measures Missing?" Click here to read the article. This podcast was sponsored by UCB. We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage. The episode focuses on epilepsy outcomes that matter beyond seizure counts alone, using two 2025 papers and a related commentary to rethink how success should be measured in epilepsy care. Validation of the Seizure-Related Impact Assessment Scale by Dr. French and authors introduces a brief patient-reported tool that captures how many days are lost to seizures and how many are lost to treatment side effects. More Than Seizure Control: Multi-Dimensional Outcome Reporting in Epilepsy (MORE) as a patient-centered framework, redefining success in treatment by Dr. Kheder proposes a broader framework that combines seizure control, quality of life, and the patient's own experience of treatment. The commentary by Dr. Becker, TRADE-OFFS: What Are Patient-Reported Outcome Measures Missing?, ties these ideas together by emphasizing that better seizure control is not always a true success if it comes with worse cognition, mood, fatigue, or day-to-day functioning. The overall message is that epilepsy treatment should be judged not only by fewer seizures, but by whether life is actually better. Key Takeaways Seizure counts alone do not capture treatment success Across the discussion, a major point was that patients often care just as much, or more, about cognition, mood, side effects, independence, work, driving, and daily function as they do about seizure frequency. SERIAS measures the real-life impact of seizures and side effects Validation of the Seizure-Related Impact Assessment Scale highlights a simple tool that asks how many days, or parts of days, were disrupted by seizures and separately by treatment-related adverse effects. This helps clinicians see the net impact of treatment rather than focusing only on seizure reduction. MORE broadens outcome measurement beyond seizure control More Than Seizure Control: Multi-Dimensional Outcome Reporting in Epilepsy (MORE) as a patient-centered framework, redefining success in treatment proposes a structured way to combine seizure control, quality of life, and patient experience, so that meaningful improvement is recognized even when seizure reduction is modest. The commentary frames these issues as trade-offs TRADE-OFFS: What Are Patient-Reported Outcome Measures Missing? emphasizes that every treatment decision should consider what is gained and what is lost. A patient may have fewer seizures but worse fatigue, worse memory, heavier medication burden, or new social and functional problems. These approaches could improve both clinic care and research trials The discussion suggests that tools like SERIAS and frameworks like MORE could help with medication decisions, surgical counseling, neuromodulation follow-up, and clinical trials by capturing outcomes that matter most to patients in everyday life. Adriana Bermeo-Ovalle, MD (Host): What if the most difficult part of living with epilepsy is not the seizures? Most people living with epilepsy report being more burdened by stigma, social limitations, and psychiatric comorbidities than by seizures themselves. So, the real question becomes: how do we measure the impact of epilepsy and the success of our treatments beyond side effects and seizure counts? UCB is the proud sponsor of Episode 11 of Epilepsy Currents Podcast. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Today, we will be discussing the epilepsy outcomes beyond seizures with a phenomenal panel of speakers. Let me first introduce our own Epilepsy Currents contributing editor, Dr. Danielle Becker, who's a recurrent guest in our Epilepsy Currents podcast. Dr. Becker wrote a commentary titled TRADE-OFFS: What Are Patient‑Reported Outcome Measures Missing? This commentary was published in October 2025. Dr. Becker, welcome back. Danielle Becker, MD, MS: Thank you so much for having me. Host: It is also my pleasure to welcome Dr. Jackie French, senior author of one of the studies which inspired that commentary published in Neurology in August 2025, titled Validation of the Seizure-Related Impact Assessment Scale. Dr. French is Professor of Neurology in the Comprehensive Epilepsy Center at NYU Grossman School of Medicine and Founder and Director of the Epilepsy Study Consortium and leader of multiple initiatives in our epilepsy community. Dr. French, welcome. It is a pleasure to have you. Jacqueline French, MD: It's great to be here. Thanks a lot for inviting me. Host: And last but not least, I am very happy to introduce Dr. Ammar Kheder, who wrote a second paper referenced also in Dr. Becker's commentary titled More Than Seizure Control: Multi-Dimensional Outcome Reporting in Epilepsy (MORE) as a patient-centered framework, redefining success in treatment. This article was published in epilepsy in March 2025. Dr. Kheder is Associate Professor at Emory University and Assistant Medical Director for Epilepsy and Neurodiagnostics at WellStar Health Systems in Georgia. Welcome, Dr. Kheder. Ammar Kheder, MD: Thank you so much for having me. It's a pleasure to be here with you today. Host: Okay. So, let's get started. Dr. Becker, how would you describe the current state of patient-reported outcomes in epilepsy? What are we still missing? What are we not capturing? Danielle Becker, MD, MS: Thank you for this important question. I feel the current state focuses on seizure frequency and seizure freedom, but we need to acknowledge that seizure freedom may not be the number one goal of our patients or the only thing that matters. And the other question is at what costs. So, there are other important factors: cognition, memory, mood, side effects, quality of life. And when you talk to patients, they often will focus on functional outcomes such as driving and employment and their independence. But they will also talk about the treatment-related adverse events and the unpredictability of seizures and how that individually affects their everyday lives. So as was mentioned in the two reporting outcome papers that we'll talk about today, they call for the incorporation of individual priorities for patients' subjective experiences really to promote that patient-centered care and improvement in outcomes not only looking at seizure frequency or seizure freedom, but also at that balance or tradeoff of treatment-related adverse events. So ultimately, with where we are today, I think we need to refocus our epilepsy care on considering outcomes that are most important to each individual patient and their families, and really move to that patient-centered care of the goals that are most important to them, as well as their seizure frequency and seizure freedom possibility. Host: Thank you for that, Dr. Becker. Very important to keep in mind what matters to each patient, what maybe to ask our patients, what really matters to you on an individualized basis. Dr. Kheder, can you please give us a quick overview of what MORE is and what it was designed to measure? And how do you envision people to use it? Ammar Kheder, MD: Well, thank you for this question. MORE is a way for capturing what doing well in epilepsy actually means in real life. I see it as a complementary to what Dr. French has done in making impact visible over time, and to the questions Dr. Becker raises about what current outcomes don't fully capture when taken individually. So instead of focusing only on seizures, MORE brings together three domains: seizure control, quality of life, and the patient's own experience. The idea in my mind is simple, a treatment isn't necessarily successful unless it improves how someone lives, not just how often they have seizures. For example, if you have two patients who might have the same seizure reduction, but one has gone back to work and reduced medication while the other is cognitively worse and more depressed, MORE is designed to see that difference. It's meant to be practical using structured questions that can fit into a routine clinic visit. It's less about replacing existing systems and more about bringing together dimensions that have often been measured separately. Host: Very ...

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Epilepsy Currents - Episode 10 -"The Impact of Perceived Epilepsy Stigma"

Jul 2900:27:28Tap to summarize

Join Dr. Marawar in a conversation with Dr. Danielle Becker and Dr. Martha Sajatovic, as they discuss the article, "The Impact of Perceived Epilepsy Stigma" Click here to read the article. This podcast was sponsored by the American Epilepsy Society through a grant from the Centers for Disease Control (CDC). This activity is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,500,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage. Summary In a baseline analysis from the CDC-funded SMART self-management trial, Dr. Martha Sajatovic's team evaluated 120 adults with uncontrolled epilepsy using the 10-item Epilepsy Stigma Scale. Higher perceived stigma was not tied to seizure frequency or most demographics; instead it clustered around a short list of modifiable factors: being single, receiving little social support, scoring low on the Epilepsy Self-Efficacy Scale, and reporting poorer day-to-day functioning. Dr. Danielle Becker's accompanying commentary argues that these "big three" drivers—self-efficacy, social isolation, and depression—form a hidden clinical burden as real as any EEG abnormality and should be addressed as routine vitals in epilepsy care. Both authors highlight peer-led programs such as SMART, which blend nurse facilitation with a trained person-with-epilepsy co-leader, as a scalable way to lift self-confidence, expand support networks, and ultimately blunt stigma's impact. Key Takeaways Core Correlates of Stigma: In the SMART cohort, the strongest independent predictors of high stigma scores were low social support, low self-efficacy, and poorer functional status; seizure count and most demographic variables showed no significant link. Self-Efficacy Is Central—and Modifiable: Lower confidence in managing seizures (self-efficacy) tracked closely with higher stigma. Boosting patients' belief that they can control triggers, medications, and disclosure decisions is a direct route to stigma reduction. Depression Magnifies Stigma's Weight: Undiagnosed or undertreated depression deepens perceived stigma and worsens quality-of-life scores, underscoring the need for systematic mood screening and at least initial SSRI therapy while specialty referrals are arranged. Peer-Led Self-Management Programs Work: Evidence-based curricula such as SMART (eight weekly Zoom sessions co-led by a nurse and a trained person with epilepsy) consistently raise self-efficacy scores, increase rescue-plan use, and shrink stigma—benefits that persist when agencies or clinics adopt the program. Clinic & Policy Action Points: Ask about stigma, self-efficacy, and mood at every visit; offer a printed or electronic referral to a vetted self-management course or local support group; and advocate for payer coverage of these programs so that addressing stigma becomes as routine—and reimbursed—as ordering an MRI. Dr Rohit Marawar (Host): [00:00:00] Picture this scenario. Two patients leave clinic on the same day. One with excellent seizure control, yet feeling ashamed to mention their diagnosis. The other with daily seizures, but surrounded by supportive friends who see them not their epilepsy. Those contrasting stories sit at the heart of today's conversation about stigma and invisible force as real as any spike and view on an EEG. Welcome to Epilepsy Currents podcast, the podcast for Epilepsy Currents Journal, exploring the latest research and expert commentaries from the world of epilepsy. I'm your host and associate editor for the podcast, Rohit Marwar. To unpack why stigma still sticks, and more importantly, what we can do about it. We are joined by two leading voices. First is Dr. Martha Stoic, first author of the article, clinical Correlates of Perceived Stigma Among People Living With Epilepsy, enrolled in a Self-Management Clinical Trial. Published in Epilepsy and Behavior Journal in [00:01:00] 2024. She's a professor and director of the Neurological and Behavioral Outcome Center, university Hospitals, Cleveland Medical Center in Cleveland, Ohio. Welcome Dr. Wick. Dr Martha Sajatovic: Thank you. Dr Rohit Marawar (Host): Then we have Dr. Daniel Baker, whose commentary, the stigmatizing impact of perceived epilepsy stigma. Puts those findings in a broader public health frame. Dr. Becker is the division director of epilepsy and associate professor of neurology at the Ohio State University Wexner Medical Center. Welcome, Dr. Becker. Dr Danielle Becker: Thank you for having me. Dr Rohit Marawar (Host): Great to have both of you on our podcast today. Let's dive in. To kick things off, Could you give us a quick elevator pitch of your study, who you enrolled, what you measure, and the takeaway finding our listeners should remember? Dr Martha Sajatovic: Yes. Thank you. I'm happy to talk about that. So, this analysis comes from a larger parent study. That was funded by the Centers for Disease Control and Prevention, or CDC. we are part of a, network called the Managing [00:02:00] Epilepsy Well or MU Network, which has been supported by the CDC for many years. The goal of the MU network is to develop, and test, evidence-based epileptic self-management. Curricular programs. This, analysis came from one of our randomized clinical trials that we are doing, testing a program called the Smart Epilepsy Self-Management, program. In this analysis, we focused just on baseline data. So we weren't looking at outcomes, but we were interested in looking at the correlations or the associations between, perceived stigma. So stigma that people, perceive people with epilepsy perceive in relation to demographic and other, clinical variables. So, basically we found that, stigma was related to, not very many demographic variables, really just, not being married or, cohabiting, but we did find that, higher levels of stigma were associated with. Less social support. So I was thinking of that in the little scenario that you gave, lower, scores [00:03:00] on a standardized rating of self-efficacy and lower functioning as well. So, there's appears to be that inverse, relationship. Dr Rohit Marawar (Host): Dr. Becker, you call stigma a hidden burden in your commentary from your vantage point, what does the burden look like in the everyday lives of people living with epilepsy in 2025? Dr Danielle Becker: Thank you. So I do wanna say that I think this hidden burden is not only on our patients, but also on the caregivers. Both the patients and the caregivers live with fear that a event or a seizure can happen at any time, and we know that that's associated with significant emotional burden. This emotional burden leads to both mental and physical health. It leads to anxiety and depression. We also know that it affects opportunities for patients with employment, with education, with developing social relationships. So in all we know that it, really is impacting mental health and we really, through this commentary and through Martha's. Paper and [00:04:00] work with the smart program. We know that when you have depression, especially undiagnosed depression, it worsens stigma and really that is a heavy burden on our patients and caregivers. Dr Rohit Marawar (Host): Well said, Dr. Vic. We hear the terms stigma and perceived stigma to. Around, and I think you also mentioned that just now, but how do you separate the two and why did you land on the 10 item epilepsy stigma scale? To capture it, Dr Martha Sajatovic: so that's a really excellent question. There are actually different types of stigma. if you look at the stigma literature, so there's, felt stigma, you know, if I am going to discriminate against you, sometimes called proceed stigma. there's, what we. As individuals get from our society or from those who are close to us, how do we get treated or discriminated against? there's also a, internalized stigma. Where were people? you know, if you tell something to somebody often enough that's negative [00:05:00] about themselves, often, eventually they will start to believe that. So what we are really looking at is a standardized scale. So there aren't actually that many specific, epilepsy stigma scales around. Rather, this was one that had already been tested and used, and we, thought would be generalizable to, the other literature. So what do people with epilepsy experience and what do they perceive? Dr Rohit Marawar (Host): Okay, great. and I'll stay with you Dr. So. We have moved away from the term epileptic people to the more app appropriate term persons with epilepsy or people with epilepsy. I noticed that you use the term people living with epilepsy in this study, which was a first for me. Why did you use that term, and why is that wording choice important in the fight against stigma? I. Dr Martha Sajatovic: Thank you for noticing that and appreciate that. so the goal here is that we really want...

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Epilepsy Currents - Episode 9 - "Genetic Testing in Epilepsy: Improving Outcomes and Informing Gaps in Research"

Dec 17, 202400:29:53Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Elizabeth Gerard, and Dr. Christa Habela, as they discuss the article, " Genetic Testing in Epilepsy: Improving Outcomes and Informing Gaps in Research ". Click here to read the article. This podcast was sponsored by Marinus Pharmaceuticals. We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage. In episode nine of the Epilepsy Currents podcast, Dr. Adriana Bermeo discusses the evolving role of genetic testing in epilepsy with Dr. Krista Habela and Dr. Elizabeth Gerard. They explore how genetic insights are enhancing diagnosis and treatment, highlighting the rapid advancements and future potential of this field. Key Takeaways Technological Advances: Since the first epilepsy gene discovery in 1997, technological advancements such as next-generation sequencing have dramatically accelerated gene identification, enhancing genetic testing's accessibility and effectiveness. Basic Genetic Concepts Clarified: Dr. Gerard explains critical genetic components—genes, chromosomes, and exomes—and their relationship to different genetic tests, providing a foundational understanding crucial for grasping how genetic variations impact epilepsy. Diagnostic Yield and Personalized Treatment: Genetic testing varies in diagnostic yield based on patient-specific factors like age of onset and associated conditions. Higher yields in targeted groups underscore its role in developing precise, personalized treatment plans. Impact on Patient Understanding and Future Testing: Genetic testing not only aids in diagnosis but also provides patients and caregivers with valuable explanations for the conditions, reducing uncertainty and informing better treatment choices. The future of genetic testing in epilepsy includes potential advancements in gene therapy and precision medicine, aiming to develop targeted treatments based on specific genetic profiles. Overcoming Barriers to Integration: Challenges like insurance coverage, the availability of genetic counseling, and the need for provider education must be overcome as genetic testing becomes integral to standard epilepsy care. This integration promises to streamline diagnostics and potentially reduce the need for other invasive tests. Adrianna Bermeo-Ovalle, MD (Host): Why do I have epilepsy? What causes epilepsy? Are my children or other family members at increased risk of developing epilepsy as well? These are some of the most frequent questions I hear in the clinic these days. In a healthcare environment which turns more and more towards personalized medicine, genetics presents a unique opportunity to answer some of our patients most pressing questions. Today, we will explore the current indications and use of genetic testing in epilepsy and we'll take a peek into the future of epilepsy diagnosis and care. Marinus Pharmaceuticals is the proud sponsor of episode number nine of Epilepsy Currents podcast. I am your host, Adriana Bermejo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Let me first welcome Dr. Christa Habela. Dr. Habela is a Child Neurologist, Epileptologist, and the Director of the Long Term EEG Monitoring Program and the Epilepsy Genetics Clinic at the John Hopkins Hospital in Baltimore, Maryland. Dr. Habela is the author of the review, Genetic Testing in Epilepsy, Improving Outcomes and Informing Gaps in Research. This article was published online first on March of 2024 in Epilepsy Currents. Dr. Habela, thank you for joining us today. Christa Whelan Habela, MD, PhD: Thank you so much for having me. Host: It is also my pleasure to welcome Dr. Elizabeth Zoe Gerard. Dr. Gerard is an Associate Professor of Neurology at the Northwestern Feinberg School of Medicine and the Founding Director of the Women in Epilepsy Program, as well as the Adult Epilepsy Genetics Clinic at Northwestern. Dr. Gerard, thank you for being with us. Elizabeth E. Gerard, MD: Thank you so much for having me. It's my pleasure to be here. Host: Dr. Habela, your review starts with a very nice historical perspective, a historical overview of the development of genetic testing in epilepsy. Can you please help us understand how did we get where we are today? Christa Whelan Habela, MD, PhD: It has always been generally thought that epilepsy was a genetic disorder, even prior to any discovery of epilepsy genes. And the first gene associated with epilepsy was only discovered in 1997, and this was for the nicotinic acetylcholine receptor, and then from 1997 to 2007, only 10 more genes were discovered, and this was because we were using, very robust, but very slow and expensive Sanger Sequencing. Early in the 2000s, the first untargeted genomic testing, came into clinical use, and this was the chromosomal microarray. This can be thought of as a very high resolution karyotype, and allowed us to look for deletions and duplications. But it really wasn't until the development of next generation sequencing which is a much faster and a much cheaper way of sequencing our DNA; that we really began to have an explosion in gene discovery. And so, beginning with next generation sequencing, this allowed us to develop whole exome sequencing, sequencing the exomes of our genes, as well as whole genome sequencing. And these two studies allowed us to identify hundreds of genes, up to a thousand genes from the years 2007 to present day. Host: Wow. So it looks like our baby steps took a long time, but we are going on leaps and bounds these days. And I imagine that we will be advancing much faster, now and into the future. Dr. Gerard, let's start with the basics to orient our audience. Could you please explain the difference between a gene, a chromosome, an exome in a way that helps our listeners follow the conversation on genetics? And if you could please link that to which tests correspond to which concept? Elizabeth E. Gerard, MD: So a gene can be thought of as a recipe for making a specific protein that's important to our body. And human genetic code contains about 20,000 recipes or 20,000 genes that make proteins. And so, as Dr. Habela was explaining, we had much faster understanding and ability to give back feedback on misspellings or typos in genes as we develop next generation sequencing. The Sanger sequencing she referred to, could really process one gene at a time. But now with next generation sequencing, we can process and understand the genetic code of multiple genes at a time. So while single gene testing is still rarely used for very specific phenotypes, like tuberous sclerosis or neurofibromatosis, more often, patients with epilepsy, with or without neurodevelopmental disorders may need a bunch of genes sequenced at the same time to increase the diagnostic yield. And one of the ways to do that are epilepsy gene panels or neurodevelopmental gene panels, which use next generation sequencing to look at usually on the order between 200 and 500 genes all at the same time and look for errors in the genetic code that may affect how that recipe works or how it may affect how you make proteins. So that's one commonly done tests now which are gene panels. The genes or the recipes we have are organized into chromosomes. So humans have 23 pairs of chromosomes, and you can think about these as like sort of cookbooks, that contain the recipes. So another genetic variation that can happen that can contribute to disease and contribute to epilepsy, are sort of rearrangements within that chromosome book. So you can think about this as a missing page or half of a page missing. These are really deletions or duplications at the chromosomal level known as copy number variations. And these can include several genes or it can include just as small as part of one gene. And this stuff can be sometimes missed by gene panels or some next generation sequencing that's only focusing on certain parts of gene known as the exome, which we'll get to in a second. So the chromosomal microarray was one of the early tests used to make diagnosis in epilepsy and neurodevelopmental disorders. I think Dr. Habela will talk about the yield of this test, but this looks specifically for deletions or duplications at the chromosomal level. As I mentioned, there are 20,000 genes or recipes in our genetic code. And so we are moving very quickly away from these first two tests I mentioned to exomes. So whole exome sequencing, really sequences all those recipes, all the exonic parts of our recipes. We'll talk about the genetic code in our recipes, and can look at many, many, many genes at once. Even though they're looking at all of those genes in our genetic code; most exome analys...

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Epilepsy Currents - Episode 8 - "The Tell on Telehealth"

Nov 14, 202400:16:27Tap to summarize

Join Dr. Marawar in a conversation with Dr. Anup Patel, and Dr. John Stern, as they discuss the article, "The Tell on Telehealth". Click here to read the article. This podcast was sponsored by Marinus Pharmaceuticals. We'd also like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, and the team at Sage. In episode eight of the Epilepsy Currents Podcast, hosted by Dr. Rohit Marawar, the focus is on telehealth's role in epilepsy care. The episode features insights from Dr. Anup Patel and Dr. John Stern, who co-authored a review article on telehealth. They discuss the evolution of telehealth services, their importance for epilepsy patients, particularly in providing access to specialized care, and the challenges and future of telehealth in clinical practice. Brief Summary The podcast delves into how telehealth has become integral to epilepsy care, especially during the COVID-19 pandemic which accelerated its adoption and acceptance. The experts discuss the practicalities of telehealth, including the technological advancements that have made remote healthcare more accessible and effective. They also touch on the regulatory and reimbursement changes that have facilitated its broader use. The episode emphasizes telehealth's role in overcoming geographical barriers to specialized care, making it a critical service for those with mobility restrictions or who live far from epilepsy centers. Key Takeaways Historical Context and Evolution: Dr. Patel highlights that telehealth has been around for over two decades, but significant advances in technology and the necessity brought on by the COVID-19 pandemic have greatly expanded its use. The easing of restrictions around reimbursement during the pandemic also played a crucial role in its widespread adoption. Importance for Epilepsy Patients: Dr. Stern points out that beyond the convenience, telehealth is crucial for epilepsy patients due to the driving restrictions often associated with the condition. It allows patients to access specialized care regardless of geographical limitations, enhancing the quality of care they can receive. Challenges in Telehealth: Despite its benefits, telehealth presents challenges such as difficulties in performing complete neurological exams, managing neurostimulator devices and managing technological issues from both patient and provider sides. These challenges necessitate a hybrid model of care where telehealth complements, but does not replace, in-person visits. Patient Suitability: According to Dr. Patel, while telehealth is ideal for follow-up visits where a physical exam might not be critical, new patients or those needing detailed physical assessments might be better served by in-person visits. This distinction helps in optimizing care delivery based on patient needs. Future of Telehealth: Both experts agree that telehealth will continue to be a part of the healthcare landscape. Dr. Stern speculates that future enhancements may include more integrated remote patient monitoring and possibly satellite offices that provide some in-person support functions to complement telehealth visits, which could improve the quality of remote care. This episode effectively outlines the transformative impact of telehealth on epilepsy care, highlighting both its potential and limitations, and underscores the ongoing need to adapt and refine this mode of healthcare delivery to better serve patients' needs. Rohit Marawar, MD (Host): What if a doctor's visit no longer meant hours of travel or long waits in a clinic? For people with epilepsy, telehealth is redefining what access to care looks like. But is this shift here to stay? Today, we're unpacking the reality of telehealth and its growing role in epilepsy. Welcome to the Epilepsy Currents Podcast, an audio accompaniment to the Epilepsy Currents Journal, where we discuss the latest in epilepsy research and care. I'm your host, Rohit Marawar. Joining us today are Dr. Anup Patel, pediatric neurologist, and Dr. John Stern, adult neurologist, both leaders in epilepsy and co authors of the recently published Epilepsy Currents Review article, The Tell on Telehealth, which explores the evolution of telehealth, the challenges, and its impact on epilepsy patients. before we get started, a quick thanks to Mariners Pharmaceuticals, who is proud to sponsor this episode of Epilepsy Currents Podcast. welcome both. Thank you for joining us. Let's get started, Dr. Patel. So I was intrigued to learn from your review article that telehealth isn't [00:01:00] actually a new concept and has been around for more than two decades. Could you give us a brief rundown of how telehealth has evolved over the years? And what led you to write this review article? Anup D. Patel, MD: that's a really great question. I think one of the things when we, started to look into this area as an opportunity that obviously became more available during the COVID 19 pandemic, we realized that others have been using telehealth and like you said for about 20 years, but I think the evolution really exists in the technology advances that we've had to make easier for us to actually do telehealth with a video in a safe but secure environment. I think the other big advantage obviously was the tipping point that occurred, and, during the COVID 19 pandemic. And what we recognize as an author group was that, there was not as much guidance as we needed or would want as it relates to telehealth visits, specifically The other thing is there's more than just a video [00:02:00] visit, which became obviously commonplace during the pandemic. The other advances, obviously, because of the pandemic was like the restrictions around reimbursement were reduced. And we'll talk more later in this episode about some of the licensure changes, but it was pretty open at that time, which allowed us to be able to access this technology to help improve or continue to maintain patient care. Rohit Marawar, MD (Host): Dr. Stern, why do you think telehealth has become such a crucial service for people with epilepsy? John M. Stern, MD: think an obvious part of the answer is the driving restrictions that people have who don't have seizure freedom and have epilepsy. think that's really only a small part of the importance because thankfully most people with epilepsy are seizure free. And the issue really becomes a matter of access because care for epilepsy has become much more sophisticated. It's required more specialized understanding. And Physicians who can provide that are not commonly distributed across the United States, so it's a matter of distance and access more than [00:03:00] drivability, in my mind, why it's so important, because you wouldn't want people, because of geography, to not have access to physicians with the expertise who can provide better care for them, whether or not they're seizure free. And this, in fact, maybe is no different for other conditions. beyond epilepsy. Whereas healthcare in general is shifting with this catalyst of COVID 19 to allowing people who are not geographically well situated for expertise to not be denied those opinions. Rohit Marawar, MD (Host): And again, Dr. Stern, when we compare outcomes for epilepsy patients who use telehealth versus those who have in person visits, what does the data show? Are there any major differences? John M. Stern, MD: have questions about the data because it comes down to the question of the outcomes and it comes down to, as well, how do you ascertain the outcome? people like telehealth because of the convenience, and that goes for both doctors and patients, but telehealth is not, perfect, and there are definitely problems that arise with telehealth care, which [00:04:00] we'll talk about, and so if the outcome is appreciation If we can't do this without availability and ability to communicate effectively, then telehealth can do very well. But, we need to be cognizant of telehealth being part of care delivery, and in my opinion, it's never going to replace in person visits because of the specific needs Benefits of being present with a person is two people. Rohit Marawar, MD (Host): Dr. Patel, kind...

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Epilepsy Currents - Episode 7 - "It's Current: NAEC Provides Us With the Recipe to Build a Better Epilepsy Center"

Aug 20, 202400:22:19Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Susan Arnold, and Dr. Fred Lado, as they discuss the article, "It's Current: NAEC Provides Us With the Recipe to Build a Better Epilepsy Center". Click here to read the article. This podcast was sponsored by the National Association of Epilepsy Centers (NAEC). 2023 Guidelines for Specialized Epilepsy Centers We'd also like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, and contributing editor Dr. Rohit Marawar, and the team at Sage. In episode 7 of the Epilepsy Currents podcast, the discussion focuses on the 2023 Guidelines for Specialized Epilepsy Centers, published by the National Association of Epilepsy Centers (NAEC). Hosted by Dr. Adriana Bermeo, the episode features insights from Dr. Susan Arnold, the senior author of the executive summary of the report, and Dr. Fred Lado, president of the NAEC and the first author of the guidelines. The guidelines aim to set comprehensive standards for epilepsy care, particularly addressing the needs of patients with drug-resistant epilepsy. Brief Summary The 2023 NAEC guidelines for epilepsy care are designed to elevate the standards of care provided at specialized epilepsy centers. These guidelines distinguish between best practices for patient care and accreditation standards, the latter being what centers must meet to receive NAEC accreditation. Developed through an "evidence-informed consensus" process, these guidelines include contributions from a diverse panel, including neurologists, nurses, EEG technologists, social workers, neuropsychologists, patients, and caregivers. This inclusive approach ensures that the guidelines address comprehensive needs across the spectrum of epilepsy care. Key Takeaways Guideline and Accreditation Distinction: Dr. Lado clarified the difference between the NAEC's guidelines and its accreditation process. The guidelines represent consensus on best practices in epilepsy care, while accreditation standards are specific criteria that centers must meet to demonstrate adherence to these practices. This distinction helps centers focus on gradual implementation of the guidelines without immediate pressure for compliance. Inclusive Development Process: Dr. Arnold emphasized that the guidelines were developed through an evidence-informed consensus, incorporating opinions from a broad array of stakeholders, including those directly affected by epilepsy. This method helps ensure that the guidelines are comprehensive and address practical aspects of patient care. Focus on Comprehensive Care: The guidelines have expanded to cover not only inpatient and surgical care but also comprehensive outpatient services, reflecting the realities of where most epilepsy care occurs. This shift acknowledges the importance of accessibility, communication, and specialized services for various patient groups. Resource Considerations: Recognizing the resource-intensive nature of comprehensive epilepsy care, the guidelines provide a framework for centers to gradually adapt to higher standards without abrupt changes. This gradual implementation is intended to ease the burden on centers, allowing them time to secure necessary resources. Future Directions and Improvements: The guidelines are seen as a living document, with the NAEC planning more frequent updates to keep pace with advancements in epilepsy treatment and care. This adaptive approach aims to ensure that the guidelines remain relevant and practical for implementing the latest best practices in epilepsy care. Transcript Adrianna Bermeo-Ovalle, MD (Host): The main purpose that brings our community together is our desire and resolve to offer people living with epilepsy the best alternatives of diagnosis and treatment; the ones that will empower them to live their best possible life. But what does that mean in practical terms? How do we put that intention into clinical practice? The National Association of Epilepsy Centers, NAEC, has taken a careful look at this question. We are delighted to have the opportunity to discuss together the 2023 Guidelines for Specialized Epilepsy Centers that will inform epilepsy care in the present and the future. Welcome to Episode 7 of Epilepsy Currents Podcast. I am your host, Adriana Bermeo. I am the Senior Podcast Editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Let me first welcome Dr. Susan Arnold. Dr. Arnold is Adjunct Professor of Pediatric Neurology at Yale University School of Medicine. She's the Senior Author of the Executive Summary of the Report of the National Association of Epilepsy Centers, entitled Guidelines for Specialized Epilepsy Centers, which was published by the Green Journal Neurology in February of 2024. Dr. Arnold, thank you very much for joining us today. Susan T Arnold, MD: I'm very happy to be here. Host: It is also my pleasure to welcome Dr. Fred Lado. Dr. Lado is the president of the NAEC and professor of neurology at the Zucker School of Medicine in Hofstra University in Long Island, New York. Dr. Lado is the first author of the guidelines, which you can find linked to the Epilepsy Current site and at the NAEC home site. Dr. Lado, thank you for being with us today. Fred A. Lado, MD, PhD: Thank you, Adriana, for the opportunity to speak with you. Host: Great. For our listeners and our readers of Epilepsy Currents, you can also find an It's Currents commentary authored by Dr. Katherine Nichols and published in the May 2024 issue of Epilepsy Currents. So let's get this conversation started. Dr. Lado, I will start with you. Could you please explain to our listeners the role of the National Association of Epilepsy Centers in setting national standards for epilepsy care, especially for those dealing with drug resistant epilepsy? Fred A. Lado, MD, PhD: So the NAEC was founded in 1987, and since almost the beginning, has published quality standards around the functioning and the care given in epilepsy centers. These standards have been updated approximately every 10 years. And these standards are different from the accreditation program that the NAEC runs. That accreditation program began in 2016. The guidelines have been the basis for developing accreditation standards, but for accreditation standards, centers have to provide evidence that they're meeting the guidelines. Guidelines are really focused on what is best practices. What is the best level of care that patients should be receiving? Accreditation standards are focused on, are centers implementing these guidelines? Are they actually providing these services? Many of the recommendations that you'll find in these new guidelines are already present in prior versions of the NAEC guidelines and in the accreditation program, but many of the guidelines in the current version are new and sort of stretch the boundaries of areas that the NAEC is addressing as part of comprehensive epilepsy care. We recognize that in sort of moving the goalpost somewhat, that in expanding the scope of guidelines, that epilepsy centers need to have adequate resources to implement. And so the process of incorporating these guidelines into accreditation is one that will unfold over the coming years, not all at once. Host: Thank you very much for that answer. Can you just once more clarify what is the difference, how are the guidelines different from the accreditation process for the people in the epilepsy centers who may get a little bit nervous about all the new recommendations that come in the guidelines? What is the urgency for them to implement all of these recommendations into the care they provide for their patients? Fred A. Lado, MD, PhD: Yes, this is a topic of great sensitivity in epilepsy centers. The guidelines, as we'll discuss are really the product of a consensus across sub specialists, patients, administrators, EEG techs, certainly epileptologists, about what makes a good epilepsy care, what makes a successful epilepsy center in taking care of patients. But the gui...

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Epilepsy Currents - Episode 6 - " Hiding in Plain Sight—Neighborhood Versus Individual Determinants of Psychological Outcomes in Patients With Epilepsy"

Jun 5, 202400:29:47Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Jarrod E. Dalton, Dr. Bruce Hermann, and Dr. Samuel Terman, as they discuss the article, "Hiding in Plain Sight—Neighborhood Versus Individual Determinants of Psychological Outcomes in Patients With Epilepsy ". Click here to read the article. This podcast was sponsored by the American Epilepsy Society through a grant from the Centers for Disease Control (CDC). These activities are supported by the Centers for Disease Control (CDC) and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,500,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor are they an endorsement, by CDC/HHS, or the U.S. Government. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage. Summary The podcast features a discussion on how environmental conditions, specifically neighborhood deprivation, affect cognitive outcomes and mood in individuals with pharmacoresistant temporal lobe epilepsy. Dr. Hermann & Dr. Dalton's study found that patients living in more deprived areas exhibited significantly lower cognitive performance and increased levels of anxiety and depression compared to those in less deprived areas. Dr. Terman's commentary critically assesses these findings, stressing the importance of considering environmental factors alongside biological ones in understanding and treating epilepsy. Key Takeaways Impact of Neighborhood Deprivation: The study highlighted a strong correlation between increased neighborhood deprivation and poorer cognitive outcomes as well as higher levels of anxiety and depression among epilepsy patients. This suggests that external environmental factors play a crucial role in the health outcomes of individuals with temporal lobe epilepsy. Role of Area Deprivation Index (ADI): The ADI is utilized to quantify neighborhood deprivation, encompassing factors like income, education, and housing conditions. It provided a robust framework for analyzing the socioeconomic conditions impacting patient outcomes, underlining the relevance of broader social determinants in health disparities. Implications for Clinical Practice: These findings underscore the need for clinicians to consider the socioeconomic environment of patients when diagnosing and treating epilepsy. Addressing environmental factors could enhance therapeutic outcomes and improve quality of life for patients. Study Limitations and Future Research: Dr. Terman noted limitations such as the cross-sectional nature of the study, which complicates the ability to infer causation. He advocates for longitudinal studies to better understand how and when neighborhood factors impact patient health, potentially leading to more targeted interventions. Potential for Broader Implications: The discussion extends beyond epilepsy, suggesting that similar environmental influences could be significant across other neurological and psychiatric conditions. Future research might explore how modifications in social policy and urban planning could mitigate these health disparities. [00:00:00] Adriana Bermeo (Host): It is well known that individuals living with epilepsy are at risk of experiencing cognitive decline and psychiatric comorbidities. But did you know that the individual's home address plays a significant role in the cognitive and psychiatric outcomes of people living with temporal lobe epilepsy? [00:00:18] Welcome to episode number six of Epilepsy Currents podcast. Today, we will be talking about the role of environmental factors on cognition and mood of patients with temporal lobe epilepsy. I am your host, Adriana Bermeo. I am the Senior Podcast Editor for Epilepsy Currents, the official journal of the American Epilepsy Society. [00:00:40] I want to first welcome contributing editor, Dr. Samuel Terman, who wrote the commentary, Hiding in Plain Sight--Neighborhood vs. Individual Determinants of Psychological Outcomes in Patients with Epilepsy. This commentary was published on the March 2024 issue of Epilepsy Currents. [00:01:00] Dr. Terman is an Assistant Professor at the University of Michigan. Dr. Terman, welcome to Epilepsy Currents Podcast. [00:01:07] Samuel W. Terman, MD, MS: Thanks so much. Happy to be here. [00:01:09] Host: It is also my pleasure to welcome Dr. Bruce Hermann, who is the Senior Author of the work that inspired this commentary, titled Association of Neighborhood Deprivation with Cognitive and Mood Outcomes in Adults with Pharmacoresistant Temporal Lobe Epilepsy. Their paper was published in Neurology in June 2023. Dr. Hermann is Emeritus professor of Neuropsychology at the University of Wisconsin School of Medicine and Public Health. Welcome, Dr. Hermann. Thank you for being with us. [00:01:39] Bruce Hermann: Thank you, and good afternoon. [00:01:41] Host: We are also joined by Dr. Jarrod Dalton, who is co-author on the original paper. Dr. Dalton is an Associate Professor and the Director of the Center for Population Health Research at the Cleveland Clinic's Lerner Research Institute. Dr. Dalton, thank you for being with us today. [00:01:58] Jerrod Dalton, PhD: And thank you. [00:01:59] Host: While [00:02:00] neurologists and epileptologists are familiar with the effects of the biological characteristics of the lesions causing epilepsy, the neurophysiological findings of the treatments we use in the clinic, we are much less likely to consider their patient's immediate living environment, their access to healthy foods, exposure to violence, or their access to transportation as potential modifiable variables directly affecting someone's epilepsy outcomes. [00:02:28] Dr. Hermann. Would you mind sharing with us a snapshot of the findings from your study in a way our listeners can grasp? [00:02:35] Bruce Hermann: Dr. Busch and I have been collaborators for quite some time, and she was able to compile an amazing cohort of 800 patients with pharmacoresistant temporal lobe epilepsy who underwent neuropsychological assessment as part of their inpatient evaluations at the Cleveland Clinic. And then, she and Dr. Dalton extracted home addresses from the EMR and binned the patients into ADI quintiles. [00:03:00] And from the neuropsychological battery that was quite extensive, as is commonly the case in preoperative evaluations, the data was reduced to seven mean cognitive domains, things such as intelligence, language, visual perception, verbal and visual memory, executive function, processing speed. And then, secondarily classified all the patients into four cognitive phenotypes that range from intact, essentially unaffected, to generalized cognitive impairment. [00:03:32] So, the core finding and most important finding was that examination of the relationship of the Area Deprivation index was closely aligned with the cognitive scores. So as deprivation increased, cognitive scores went down. This was seen across seven of the six cognitive domain scores, and greater deprivation was associated with the more abnormal cognitive phenotype. And increasing neighborhood deprivation was also associated with [00:04:00] greater anxiety and depression. So, it really was quite a signal that we were able to observe. And as Dr. Terman pointed out in his commentary, you can just take a look at IQ. Quintile 1, the least deprived group, had a mean IQ score of 100, which is dead average. And the most deprived quintile, Quintile 5, their mean IQ was 86, which is a full standard deviation below average. So, very reliable and fairly strong signal throughout these results. [00:04:28] Host: Yeah. Really striking findings, which seem to point out that the deprivation that patients are exposed is almost as important as the biology of the condition. And I'm sure we will discuss that in length later. Dr. Dalton, the concept of the Area Deprivation Index, or ADI, plays a central role in the study. Can you please help us understand what does this measure? How do these quintiles work? And how is this measurement different from other measurements of socioeconomic status? [00:04:59] Jerrod Dalton, PhD: [00:05:00] Sure. Yeah, the Area Deprivation Index is a tool that we use in our research in a lot of settings. We work with clinical specialties across Cleveland Clinic and use this as one tool for understanding place-based health disparities. Essentially, the Area Deprivation Index, it's a latent variable model or a factor model that produces an index that captures correlation among 17 neighborhood-level characteristics. The ADI was established at the National Cancer Institute in 2003 by a demographer and sociologist named Gopal Singh. It was designed as scale of neighborhood socioeconomic position as opposed to socioeconomic status, which I can...

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Epilepsy Currents - Episode 5 - "More Than Meets the Eye: Human Versus Computer in the Neuroimaging of Temporal Lobe Epilepsy"

Mar 29, 202400:25:05Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Ezequiel Gleichgerrcht, Dr. Erik Kaestner, and Dr. Peter Widdess Walsh, as they discuss the article, "More Than Meets the Eye: Human Versus Computer in the Neuroimaging of Temporal Lobe Epilepsy". Click here to read the article. This podcast was sponsored by the American Epilepsy Society. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage Publishing. Summary This fantastic Epilepsy Currents podcast episode delves into a groundbreaking study on the application of artificial intelligence (AI) in differentiating temporal lobe epilepsy from Alzheimer's disease and healthy controls using MRI-based deep learning. The study, co-authored by Dr. Ezequiel Gleichgerrcht and Dr. Erik Kaestner, demonstrated AI's potential to significantly improve the accuracy of neuroimaging analysis in epilepsy. The commentary by Dr. Peter Widdess-Walsh provided a critical examination of these findings, highlighting the practical implications for clinical practice and the limitations of current methodologies. The discussion framed AI not only as a tool for enhancing diagnostic accuracy but also as a means to uncover subtle neurobiological differences between diseases, potentially leading to more personalized treatment approaches. Key Takeaways High Diagnostic Accuracy with AI: The study highlighted showed that AI, specifically convolutional neural networks (CNNs), could differentiate between temporal lobe epilepsy, Alzheimer's disease, and healthy controls with high accuracy. This demonstrates AI's capability to identify nuanced patterns in neuroimaging that may not be visible to the human eye. AI Identifies Subtle Neurological Differences: The inclusion of Alzheimer's disease as a comparative group in the study was strategic to determine if the AI was recognizing temporal lobe epilepsy based on hippocampal atrophy alone or other disease-specific patterns. The findings suggest that AI can discern epilepsy-related patterns beyond the typical markers, indicating a profound potential for AI in understanding complex neurological conditions. Impact on Clinical Practice: Dr. Widdess-Walsh's commentary underscores the importance of these findings for clinical practice. AI's superior detection rate compared to human analysis (90% versus 47%) suggests that AI could significantly augment clinicians' ability to diagnose temporal lobe epilepsy, potentially leading to earlier and more accurate interventions. Limitations and Ethical Considerations: Despite AI's impressive capabilities, the podcast discussion acknowledges limitations, including the current inability of AI systems to interpret scans holistically, consider clinical context, or replace human decision-making. These factors highlight the need for AI to be used as an adjunct tool in clinical practice, enhancing rather than replacing the expertise of healthcare professionals. Future Directions and Challenges: The episode concludes with reflections on the broader implications of AI in neurology, from predicting surgery outcomes to possibly revolutionizing epilepsy care. However, challenges such as external validation, regulatory approval, and integration into clinical workflows must be addressed to fully realize AI's potential in epilepsy diagnosis and treatment. Transcript Adriana Bermeo, MD (Host): Hello and welcome to episode five of Epilepsy Currents podcast. Today, we will be talking about the use of artificial intelligence and machine learning in the study of temporal lobe epilepsy. I am your host, Adriana Bermeo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Today, I am joined by a team of experts in this very exciting neurodiagnostic arena. I want to first welcome contributing editor, Dr. Peter Widdess-Walsh, who wrote the commentary "More Than Meets the Eye: Human vs. Computer Neuroimaging of Temporal Lobe Epilepsy." This commentary was published on December 2023 issue of Epilepsy Currents. Dr. Widdess-Walsh is a consultant neurologist and Clinical Associate Professor at Beaumont Hospital in Dublin, Ireland. Peter, welcome to Epilepsy Currents podcast. podcast. Peter Widdess-Walsh, MD: Thank you very much, Adriana. I'm delighted to be here. Host: Thank you for being here. It is also my pleasure to welcome Dr. Ezequiel Zeke Gleichgerrcht, who authored the work that inspired this commentary titled, "MRI Based Deep Learning Can Discriminate Between Temporal Lobe Epilepsy, Alzheimer's Disease, and Healthy Controls. Their paper was published in Nature Communications Medicine in 2023. Dr. Gleichgerrcht is an Assistant Professor of Neurology at Emory University. Zeke, welcome. Ezequiel Gleichgerrcht, MD: Thank you. Thanks for having me. Host: We are also joined by Dr. Erik Kaestner, co-author on the original paper and lead author on other related publications addressing the use of artificial intelligence in epilepsy. Dr. Kaestner is a postdoctoral scholar at University of California, San Diego. Erik, thanks for being with us today. Erik Kaestner, PhD: Thank you. Excited for the conversation. Host: Very good. I can tell you that artificial intelligence is one of the most requested topics when we ask our listeners and the epilepsy community. The challenges and opportunities presented by the use of AI in almost every aspect of our daily life, but particularly in healthcare, are intriguing, exciting, and potentially concerning to some. But before we start discussing AI, Peter, can you share with our listeners what is the added value of expanded neuroradiology in the care of patients with epilepsy? Peter Widdess-Walsh, MD: Thanks, Adriana. And thank you for highlighting this very interesting and topical article for the podcast. And many thanks to Dr. Gleichgerrcht and Dr. Kaestner for being here with us. We know that MRI is a key tool in finding the underlying cause of focal epilepsy. However, up to 30% of MRIs are non-lesional. That is, there is no visible lesion responsible for the patient's epilepsy. We can sometimes lower this non-lesional percentage by using additional MRI techniques such as volumetry or various additional sequences or higher strength magnets. But these are not universally available or have limitations, so there's a gap there. We know that there is a focal epileptogenic network, but we cannot see it. And it is partly due to limitations of MRI technology, which are improving all the time, but it's partly due to limitations of what we can see visually with the human eye. There are also human error rates in analyzing MRI, even with skilled radiologists known as perceptual errors. A shrunken, bright hippocampus is easier to see than subtle alterations in grey matter volumes. Particularly in surgically remediable epilepsies, finding a lesion or visualizing the epileptic network can make a huge difference in a better patient outcome after surgery. And even in non-surgical patients, it's very reassuring to have an imaging correlate of the epilepsy that you know is clinically present. I'm not an AI expert and I wrote the commentary from the perspective of an epileptologist in clinical practice like many of our listeners. So, it was fascinating to learn more about AI and how it might fit into our daily practice in this area. The authors used the term computer vision in this article, and I'm excited to learn more about how computer vision can help us in the diagnosis of epilepsy. Host: Thank you very much. We are certainly excited to see how we can advance our field further than what we are practicing at the moment. Zeke, could you paint the picture as for how is AI revolutionizing the field of radiology and particularly when it comes to neuroimaging analysis? Ezequiel Gleichgerrcht, MD: Yeah, absolutely. And I think we start acknowledging that AI is becoming this true transformative force in medicine. Like you said, neuroimaging is by no means the exception. So for instance, if we think about AI and how it gives us frameworks to analyze huge amounts of imaging data, the pace and precision with which it can achieve it is unattainable by humans alone, right? Humans not using this computer vision that Peter was mentioning. So, let's talk about neuroimaging specifically. AI algorithms can sift through MRI, CT scans, and, almost do a first pass at detecting abnormalities from brain tumors, there's applications for aneurysms, areas affected by stroke, you name it. Of course, our interest is in epilepsy, but we know how crucial early and accurate detection of some of these findings can be. So, you know, when trying to answer this question, how is it revolutionizing the field of radiology? I think it's really about how the accurate detection of these findings can be instrumental in patient care. So, AI ap...

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Epilepsy Currents - Episode 4 - "Dobbs vs Jackson - Epilepsy Reproductive Health and Abortion"

Oct 23, 202300:25:01Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Page Pennell and Dr. Alison Pack as they discuss the article, "Dobbs Versus Jackson: Epilepsy, Reproductive Health, and Abortion". Click here to read the article. This podcast was sponsored by the American Epilepsy Society. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage Publishing. Summary: In this episode of the Epilepsy Currents podcast, Dr. Adriana Bermeo discusses the Supreme Court's decision on Dobbs v Jackson and its implications for people living with epilepsy. She is joined by Dr. Allison Pack, a professor of neurology at Columbia University, and Dr. Page Pennell, the chair of the Department of Neurology at the University of Pittsburgh School of Medicine. They discuss the key points and historical significance of the Roe v. Wade and Dobbs v Jackson rulings, the current state-by-state variation of abortion access in the United States, and the impact on women and people of childbearing age living with epilepsy. They also address the importance of contraception, the risks of anti-seizure medications during pregnancy, and the need for evidence-based care and advocacy for patients. Resources such as the Guttmacher Institute and the National Abortion Federation Hotline are mentioned for further information and support. 5 Key Takeaways: 1. The Supreme Court's decision on Dobbs v Jackson has significant consequences for persons living with epilepsy and their access to abortion. 2. The current state-by-state variation of abortion access in the United States is complex and can range from very restrictive to most protective. 3. Planned pregnancies are crucial for individuals with epilepsy to optimize outcomes for both the individual and the developing fetus. 4. Effective contraception is important for individuals with epilepsy, and options such as long-acting reversible contraception (IUDs) and birth control pills should be considered. 5. Neurologists and epilepsy specialists should advocate for their patients' rights and women's rights, ensuring that medical decisions are made by qualified practitioners based on evidence and with respect for the individual patient. Resources such as the Guttmacher Institute and the National Abortion Federation Hotline can provide information and support. Transcript Dr. Adriana Bermeo (00:05): Hello and welcome to episode four of Epilepsy Currents podcast. I am your host, Adriana Bermeo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. It is my pleasure to welcome today's guest to talk about the Supreme Court's decision on Dobbs v Jackson and its consequences for persons living with epilepsy. We have two very special guests to help us understand the implications of this ruling on reproductive health and access to abortion for people living with epilepsy of childbearing potential. First, I want to welcome Dr. Pack, senior author of a commentary titled Dobbs versus Jackson Epilepsy Reproductive Health and Abortion, published online first in the May, 2023 issue of Epilepsy Currents. Dr. Pack is a professor of neurology at Columbia University. She's the Chief division of Epilepsy and sleep at New York Presbyterian, Columbia University Medical Center. I also want to especially welcome Dr. Page Pennell, who's the Henry B. Hickman Professor of Neurology and chair of the Department of Neurology at the University of Pittsburgh School of Medicine. Dr. Pennell is a global expert on the management of pregnancy-related issues in epilepsy, and she's also a past president of the American Epilepsy Society. Dr. Pack, let me start with you. Most of our listeners are familiar with Roe versus Wade and Dobbs versus Jackson Supreme Court rulings, but could you give us a quick refresher on the key points and historical significance of these two landmark cases? Dr. Allison Pack (01:43): Thank you very much, Adriana, and it's a pleasure to be here today and I want to thank the American Epilepsy Society for supporting this discussion as we go through our discussion today. Today we will be referring to persons with epilepsy of childbearing potential. Please recognize that we are aware that not all individuals who seek pregnancy or become pregnant identify as a woman. So I'm going to go through right now the court rulings ruling Roe v. Wade was enacted in 1973. In this ruling, the court ruled that the Constitution of the United States generally protected a right to abortion. This ruling was reaffirmed in 1992 in the ruling Planned Parenthood of Southeastern Pennsylvania versus Casey. Dobbs v Jackson was enacted on June 24th, 2022. With this ruling, the Constitution does not confer a right to abortion. Essentially, Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania versus Casey were overturned. The authority to regulate abortion went back to the state and the constitutional right to abortion was eliminated. Dr. Adriana Bermeo (03:08): Thanks, Dr. Pack, you were mentioning how things went back to the state, and as we know, the legal landscape of these rulings then are evolving. Acknowledging this is a moving target, could you please help us understand the current state-by-state variation of abortion access in the United States, and what does this mean for the physicians practicing in the different states? Dr. Allison Pack (03:37): Well, I have to say understanding the state-by-state variations is quite complex. I would draw all of your attention to the Guttmacher Institute, and there's a very good website whereby you can see the map of the United States and the outline of the various regulations or the various degrees of restriction. And these vary from most restrictive occurring in over 15 states whereby abortion is banned at 12 weeks and later. There are very restrictive, which bans abortion at 12 weeks and later. Some restrictions starting at the third trimester. Protective, it's banned at fetal viability between 24 and 26 weeks, and very protective whereby it's banned at fetal viability. And then there's some other regulations that give more protections than those states that are protective and then most protective whereby there is no restriction based on gestational age. As I mentioned earlier, the most restrictive; this includes, for example, Kentucky, Texas, very restrictive, North Carolina, Georgia, some restrictions, Virginia protective, Illinois, very protective New York, and then most protective, there's only one, and that is the state of Oregon. So it is important to understand that there are varying degrees of restrictions across the United States in these different categories. And as I mentioned earlier, I would draw your attention to the website from the Guttmacher Institute, which really is very helpful for you to understand what the restrictions are or not in the state that you live. Dr. Adriana Bermeo (05:29): Thank you very much, Dr. Pennell. Can I turn it to you? Can you please help us understand how these rulings affect particularly women and person of childbearing age or childbearing potential living with epilepsy? Dr. Page Pennel (05:42): Yes. Thank you also for inviting me for this very important podcast and to sit alongside Dr. Pack who is such an expert in this area. So unplanned pregnancies in the general population are known to have a higher complication rate, but especially in persons with epilepsy, it's incredibly important to have a Planned Pregnancy and for the woman to have the best seizure control possible for her with the medication regimen and vitamin regimen that will provide the opportunity for the safety of the developing fetus. Pregnancy also carries a risk to women directly and with persons with epilepsy there are reports of elevated maternal mortality. Studies in the UK have actually shown that the elevated rates of death in persons with epilepsy are due to SUDEP or sudden unexpected death in epilepsy. So if a woman with epilepsy goes into a pregnancy unplanned and also with a high seizure burden, the chances that pregnancy will be unsafe for her and her developing fetus are much higher. And if she doesn't have the opportunity to make a decision with her clinician about what to do after that time, it can be particularly devastating. Dr. Adriana Bermeo (07:05): Dr. Pack, your commentary in Epilepsy Currents really makes the point that neurologists ,epileptologists and the organizations who represent their interests should care and take action in protecting patients' rights and women's rights. Can you please expand on this idea? Why should neurologists and epilepsy specialists care? <p clas...

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Epilepsy Currents – Episode 3 "Keto Is Not Just for Kids: A Randomized Trial of a Modified Atkins Diet for Adolescents and Adults With Anti-Seizure Medication Resistant Epilepsy"

Jun 20, 202300:27:05Tap to summarize

Join Dr. Bermeo in a conversation with Dr. Mackenzie Cervenka and Dr. Manjari Tripathi as they discuss the article, " Keto is Not Just for Kids: A Randomized Trial of a Modified Atkins Diet for Adolescents and Adults With Anti-Seizure Medication Resistant Epilepsy ". Click here to read the article. This podcast was sponsored by the American Epilepsy Society. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage Publishing. Five Key Takeaways: Effectiveness of Modified Atkins Diet (MAD): The research conducted by Dr. Manjari Tripathi found that 26% of the people who supplemented their drug therapy with the MAD experienced a more than 50% reduction in seizure frequency compared to only 2.5% of people who used only drug therapy. Importantly, some patients even became seizure-free. Improved Quality of Life: Along with a significant decrease in seizures, patients following the MAD also reported improved quality of life and behavior. Difference in Adherence Between Adolescents and Adults: The study found that adults were more likely to adhere to the diet than adolescents, possibly due to a combination of food preferences and possible differences in gut microbiota. Potential Long-Term Effects of Ketogenic Diets: While ketogenic diets can be effective in managing epilepsy, there are potential long-term side effects to consider, such as vitamin and mineral deficiencies, bone loss, risk of nephrolithiasis (kidney stones), and hyperlipidemia (high levels of lipids in the blood), which may lead to cardiovascular and cerebrovascular diseases. Approach to Weaning off the Diet: Dr. Mackenzie Cervenka suggests that weaning off the diet should be considered in a similar manner to removing anti-seizure medication. The decision should be made considering the side effects and the overall burden of the therapy on the patient. Abrupt discontinuation of the diet can result in an increase in seizures, hence the diet should be gradually reduced. Dr. Adriana Bermeo (00:06): Hello, and welcome to episode three of Epilepsy Currents podcast. I am your host, Adriana Bermeo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. It is my pleasure to welcome today's guest to talk about the use of ketogenic diets in the treatment of refractory epilepsy in adolescents and adults. First, I want to welcome our contributing editor for epilepsy current, Dr. Mackenzie Cervenka, who wrote a commentary titled "Keto Is Not Just For Kids: a randomized trial of a modified Atkins diets for adolescents and adults with anti-seizure medication resistant epilepsy". This was published online first in the March, 2023 issue of Epilepsy Currents. Dr. Cervenka is Professor of Neurology at John Hopkins School of Medicine. She's the medical director of the Adult Epilepsy Diet Center and the Adult Epilepsy Monitoring Unit. She developed the John Hopkins Adult Epilepsy Dietary Center in 2010 and has treated nearly 450 adults with epilepsy using ketogenic diet. Dr.Cervenka, welcome to Epilepsy Currents podcast. Dr. Mackenzie Cervenka (01:16): Thank you so much Dr. Bermeo for inviting me as a guest today at the Epilepsy Currents Podcast. Dr. Adriana Bermeo (01:22): It's a pleasure to have you. I also want to specially welcome Dr. Manjari Tripathi, who is the senior author of the publication that inspired this commentary titled "Safety, efficacy, and Tolerability of Modified Atkins Diet in Persons with Drug-Resistant Epilepsy." This was published in Neurology in March of 2023. Dr. Tripathi is a professor of neurology and epilepsy at the All India Institute of Medical Sciences, where she serves as director of the Epilepsy, Behavioral Neurology, and Sleep Medicine Programs. Dr. Tripathi, it's a pleasure to have you. Dr. Manjari Tripathi (01:57): Hi. Thank you. Great being here. Dr. Adriana Bermeo (02:00): Dr. Cervenka, I want to start with you. Our listeners may or may not be familiar with the concept of ketogenic diets for the treatment of epilepsy in adults particularly, but they may not know that there are different options for treatment. Can you please give us an overview of the principles of these dietary treatments and tell us what options can we can offer to our patients Dr. Mackenzie Cervenka (02:21): In our field? We refer to ketogenic diets for epilepsy actually as ketogenic diet therapies. And we do this to distinguish them from ketogenic diets that we typically hear about being used for weight loss or for other purposes, and that are not necessarily recommended or monitored by clinicians or treating teams. Technically, a ketogenic diet therapy is any dietary manipulation that can produce a state of nutritional ketosis, and that is a state where the body metabolizes fatty acids into ketone bodies. Those are beta hydroxybutyrate, acetoacetate, and acetone. There are a whole variety of ketogenic diet therapies, and these include what are called the classic or classical ketogenic diet. This was first described over one century ago. There are also modified versions of this classic ketogenic diet, specifically the Modified Atkins diet and a modified ketogenic diet. In addition to that, there is a low glycemic index diet or treatment, and that can also produce a state of ketosis, although it is not the primary goal of that particular diet, and any of these diets can be supplemented with medium chain triglyceride oil, and that is readily metabolized into ketone bodies. So that can be added to any of these other diets that I mentioned. Finally, these diets can also be combined with fasting, which also, encourages ketosis as well. Dr. Adriana Bermeo (03:51): Thank you so much, Dr. Tripathi. Do different options fit different demographics? Particularly I'm curious of why did your team choose to try specifically the modified Atkins diet in adults and adolescents with refractory epilepsy as opposed to other options as Dr. Cervenka was describing? Dr. Manjari Tripathi (04:10): So this is a very pertinent question. We need to give something which is acceptable, accessible, and affordable. Now, if you look at the traditional classic ketogenic diet, as Dr. Cervenka described it, it's a very restrictive diet, and it's rigid. It's rigid in terms that it restricts the calories and the fluids. It often requires weighing of food, at least in our center, the ketogenic diet requires the patient to be admitted for a washout and monitoring before the diet is started, whereas a modified Atkins diet does not restrict calories. However, it produces the same effect that is ketosis. So, it's more flexible, it's easier on the gut and the palate, and we know that adults and adolescence can be picky eaters and cho...

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All episodes

Epilepsy Currents - Episode 12- "Drugs, Diets, and DEEs — Add-on Ketogenic Diet versus Antiseizure Medications Alone in Children with Developmental and Epileptic Encephalopathies"

Epilepsy Currents - Episode 11 -"TRADEOFFS: What Are Patient-Reported Outcome Measures Missing?"

Epilepsy Currents - Episode 10 -"The Impact of Perceived Epilepsy Stigma"

Epilepsy Currents - Episode 9 - "Genetic Testing in Epilepsy: Improving Outcomes and Informing Gaps in Research"

Epilepsy Currents - Episode 8 - "The Tell on Telehealth"

Epilepsy Currents - Episode 7 - "It's Current: NAEC Provides Us With the Recipe to Build a Better Epilepsy Center"

Epilepsy Currents - Episode 6 - " Hiding in Plain Sight—Neighborhood Versus Individual Determinants of Psychological Outcomes in Patients With Epilepsy"

Epilepsy Currents - Episode 5 - "More Than Meets the Eye: Human Versus Computer in the Neuroimaging of Temporal Lobe Epilepsy"

Epilepsy Currents - Episode 4 - "Dobbs vs Jackson - Epilepsy Reproductive Health and Abortion"

Epilepsy Currents – Episode 3 "Keto Is Not Just for Kids: A Randomized Trial of a Modified Atkins Diet for Adolescents and Adults With Anti-Seizure Medication Resistant Epilepsy"