tag:theconversation.com,2011:/us/topics/seizures-20212/articlesSeizures – The Conversation2024-02-14T13:21:02Ztag:theconversation.com,2011:article/2207482024-02-14T13:21:02Z2024-02-14T13:21:02ZRecognizing when someone is having a seizure – and how you can help during those first critical moments<figure><img src="https://images.theconversation.com/files/574237/original/file-20240207-24-u7tbcw.jpg?ixlib=rb-1.1.0&rect=0%2C45%2C7680%2C4265&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Seizures occur because of sudden and abnormal activity in the brain.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/neuron-system-disease-royalty-free-image/1434534146?phrase=epilepsy&adppopup=true">koto_feja/E! via Getty Images</a></span></figcaption></figure><p><em>Approximately 1 in 26 people develop <a href="https://www.who.int/news-room/fact-sheets/detail/epilepsy#">epilepsy</a>, a condition in which someone experiences recurring and unprovoked seizures. But <a href="https://theconversation.com/silent-subtle-and-unseen-how-seizures-happen-and-why-theyre-hard-to-diagnose-184740">experiencing a seizure</a> does not always mean a person has epilepsy. Seizures can be provoked by acute head injuries, alcohol withdrawal and <a href="https://my.clevelandclinic.org/health/diseases/9815-hyperglycemia-high-blood-sugar">high blood sugar</a>, among other things. Approximately 1 in 10 people will <a href="https://www.cdc.gov/epilepsy/about/first-aid.htm#">experience a seizure during their lifetime</a>.</em> </p>
<p><em>The Conversation asked <a href="https://som.cuanschutz.edu/Profiles/Faculty/iframeProfile/30305">Dr. Jacob Pellinen</a>, a neurologist <a href="https://scholar.google.com/citations?user=DMld-5MAAAAJ&hl=en">specializing in epilepsy</a>, to walk us through how to recognize a seizure in a bystander or loved one, and what to do in those crucial moments after a seizure begins.</em></p>
<h2>What does a seizure look like?</h2>
<p>It varies. For some people, their seizure is a purely internal sensation. To an untrained observer, it may appear as though nothing’s wrong. In fact, most people with epilepsy have only relatively subtle, nonconvulsive seizures at first, then <a href="https://doi.org/10.1111/epi.16707">develop convulsive seizures over time</a>. </p>
<p>But others having seizures experience full body convulsions with a loss of consciousness. This is the type of seizure most of us are familiar with, probably because it’s the kind most frequently depicted, though not always accurately, in movies and on television. It’s also <a href="https://www.mountsinai.org/health-library/diseases-conditions/generalized-tonic-clonic-seizure#">the most dangerous type of seizure</a>.</p>
<p>These kinds of seizures are sudden, unprovoked and last a couple of minutes. After recovering from the convulsions and loss of consciousness, the person is usually fatigued and confused <a href="https://doi.org/10.1016/j.yebeh.2021.108484">for several minutes to several hours</a>. </p>
<p><a href="https://www.epilepsy.com/what-is-epilepsy">If someone has epilepsy</a>, the seizures they experience will be <a href="https://doi.org/10.1111/epi.12550">very similar each time they occur</a>. The most common type of epileptic seizure are those that are focal – that is, they arise from a confined region of the brain. This accounts for two-thirds of cases overall and <a href="https://doi.org/10.1111/j.1528-1167.2009.02481.x">99% of cases that occur after the age of 25</a>. </p>
<p>Epileptic seizures may begin with nonconvulsive symptoms, including staring, unresponsiveness, repetitive movements and purely internal sensations, which either stop or progress to convulsions and loss of consciousness. </p>
<h2>What causes a seizure to occur?</h2>
<p>Seizures are the result of <a href="https://epilepsydiagnosis.org/seizure/seizure-classification-groupoverview.html">abnormal electrical activity in the brain</a>. The bursts of activity disrupt normal functioning and initiate hyperactivity in the affected brain area, which then can affect the corresponding body part. </p>
<p>For instance, if the seizure arises from the part of the brain involved in arm movement, that arm will experience involuntary hyperactivity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5120%2C3395&q=45&auto=format&w=1000&fit=clip"><img alt="An illustration of chaotic brain waves during a seizure event." src="https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5120%2C3395&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572338/original/file-20240131-21-c72v6r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lengthy or back-to-back seizures can be life-threatening.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/brain-and-brain-waves-in-epilepsy-royalty-free-illustration/973895676?phrase=seizure&adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span>
</figcaption>
</figure>
<h2>If you’re a bystander, how can you help?</h2>
<p>First, <a href="https://www.epilepsy.com/recognition">keep the person safe</a>. Many seizure-related injuries occur due to falling or coming in contact with sharp or hard objects. If they begin to fall, help them to the floor as gently as possible and put something soft under their head.</p>
<p>During the convulsive phase of a seizure, breathing may be intermittent. So turn the person on their side so they can breathe more easily and lower the risk of aspiration. </p>
<p>Do not put any objects into their mouth. This is unnecessary and dangerous. It is <a href="https://doi.org/10.1016/j.seizure.2020.09.023">not possible to swallow your tongue</a>.</p>
<p>Do not restrain or shout at them. Neither one of those things will stop the seizure. </p>
<p>Although not everyone with epilepsy has one, check for any visible medical identification such as a wristband.</p>
<p>If they stop convulsing, but remain unresponsive, continue to keep them on their side and monitor their breathing.</p>
<p>Following the seizure, and as the person gradually recovers and wakes up, help them sit up in a safe space. If they are confused, reorient them and don’t let them wander near roads, stairs or platforms. </p>
<p>Do not give them water or food until they are fully awake. Stay with them until they are fully alert. It’s also important to tell them what happened, and offer to help further. </p>
<p>Keeping track of time is critical. Call 911 if the seizures last more than five minutes or if they begin to cluster back to back, such as when another seizure begins before a person fully recovers from the first. Although rare, <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/status-epilepticus#">both of these situations are life-threatening emergencies</a>.</p>
<p>You should also call 911 if the person continues to have difficulty breathing; if the person has a seizure in water or is pregnant; if it’s the first time they’ve had a seizure; or if they have the seizure without a diagnosis of epilepsy. </p>
<p>However, if a person diagnosed with epilepsy experiences a habitual seizure, recovers fully and does not experience any injury, they may not need to go to the emergency room for further evaluation. They should, however, call their doctor.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/RodeQ86_bxY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Although seeing a person having a seizure is a scary experience, there are many things you can do to help.</span></figcaption>
</figure>
<h2>Are new treatments available?</h2>
<p>People with epilepsy, particularly those who experience frequent seizures, will often have emergency medications in their possession. </p>
<p>The most common emergency medications – <a href="https://www.epilepsy.com/recognition/rescue-medications">also called seizure rescue medications</a> – are a type of anticonvulsants called benzodiazepines. The most common ones used are diazepam, clonazepam, lorazepam and midazolam. </p>
<p>All are fast-acting medications. Some are pills to be swallowed, others are dissolvable tablets placed in the cheek or under the tongue, and some are nasal sprays or gels for rectal administration. Patients and their caretakers may have access to rescue medications and know how to use them. </p>
<p>One cautionary note: If the medication is in pill form, and if the person is in the midst of a convulsive seizure, don’t put the pill in their mouth. But remember: Not all seizures are convulsive or cause a loss of consciousness. So if a person is awake and alert, they may be able to swallow a pill. </p>
<h2>What if it’s not a seizure?</h2>
<p>If a bystander does not witness a seizure, but instead finds someone unresponsive or minimally responsive, call 911. They may be suffering from other medical issues, such as a drug overdose. </p>
<p>And if you are interested in training and certification for seizure first aid, or if you simply want to know more, the Epilepsy Foundation <a href="https://www.epilepsy.com">has more information</a>.</p><img src="https://counter.theconversation.com/content/220748/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacob Pellinen has received research support from the Department of Neurology at the University of Colorado School of Medicine, the Colorado Clinical and Translational Sciences Institute, NIH/NINDS, and the American Epilepsy Society. J. Pellinen serves as chair of the professional advisory board for the Epilepsy Foundation of Colorado and Wyoming (unpaid), serves as the Epilepsy Section Editor for Current Neurology and Neuroscience Reports, and has received compensation for serving on the scientific advisory board for SK Life Science.</span></em></p>What you don’t do: Don’t shout at them, don’t put things in their mouth and don’t let them get near things that are sharp or hard in case of a fall.Jacob Pellinen, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169622023-11-03T17:29:55Z2023-11-03T17:29:55ZBrooke Shields had a grand mal seizure – here’s what you need to know about the condition<figure><img src="https://images.theconversation.com/files/557459/original/file-20231103-21-94pua8.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C2991%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shields suffered the seizure in September 2023.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/los-angeles-jun-8-brooke-shields-104740769">Joe Seer/ Shutterstock</a></span></figcaption></figure><p>Actress and model Brooke Shields has revealed she suffered a <a href="https://www.glamour.com/story/brooke-shields-glamour-women-of-the-year-2023">grand mal seizure</a> in September. In an interview, Shields revealed that the seizure caused her to lose control of her movements, froth at the mouth and eventually lose consciousness. The actress doesn’t have a history of seizures – and many people reading her story may be wondering if they’re also at risk.</p>
<p>“Grand mal”, which means “great sickness” in French, is actually the old term for what’s now called a <a href="https://www.cdc.gov/epilepsy/about/types-of-seizures.htm">tonic-clonic seizure</a>. These seizures involve both stiffening (tonic) and twitching (clonic) muscle movements. It’s just one type of seizure a person can experience. </p>
<p>Seizures happen when the electrical activity in our brain becomes disrupted.</p>
<p>Normally, the electrical activity in our brains carries information inward from the sensory world around us, outward to our muscles, and also transmits our thoughts, feelings and intentions everywhere else in between. To carry all this information, the brain activity forms complex patterns – like how the pixels on your computer or phone’s screen form complex patterns of colour and shape to bring you the information you’re reading now.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448698/">during a seizure</a>, the electrical activity in some or all of the brain instead enters a rhythmic sequence, alternating between high and low-intensity activity. This disrupts the information being sent and received in those parts of the brain. Think of it like your computer or phone screen suddenly being covered only in alternating black and white stripes. This on/off pattern is an extreme type of neural oscillation.</p>
<p>The symptoms a person experiences during a seizure depends on the brain region being affected.</p>
<p>Tonic-clonic seizures, which involve muscle stiffening and twitching, usually involve large parts of the cerebral cortex – the outer, wrinkly layers of the brain. Because of this, they are referred to as generalised seizures and they affect the motor cortex, which controls the body’s voluntary muscle movements. This brain area would have been involved in Shields’ seizure.</p>
<p>Other types of seizures include absence seizures (formerly known as petit mal, or “little sickness”) and focal seizures. </p>
<p>Absence seizures also involve large parts of the cerebral cortex. These cause a person to suddenly stop all activity and stare ahead of them with a blank look. Their eyes may also turn upwards. Researchers aren’t quite sure why absence seizures and tonic-clonic seizures have such different symptoms, but it might be down to the <a href="https://pubmed.ncbi.nlm.nih.gov/36627270/">patterns of activity</a> that make up the seizures. </p>
<p>Focal seizures, on the other hand, happen only in part of the cerebral cortex. Symptoms will depend on the function of the brain area affected by the seizure. If it’s a motor region, some muscle twitches might be observed. </p>
<p>The affected brain regions usually go back to working as normal after the seizure ends – either straight away or after some minutes. In unusual cases, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK526004/#:%7E:text=Continuing%20Education%20Activity,%2C%20headache%2C%20nausea%2C%20etc.">post-seizure state</a> can last for hours. </p>
<p>If a person has a seizure more than once, they might be <a href="https://www.nhs.uk/conditions/epilepsy/">diagnosed with epilepsy</a> – a lifelong condition that causes frequent seizures. But some people – like Shields – can have a one-off seizure caused by temporary changes in their environment or body.</p>
<h2>Disrupted brain patterns</h2>
<p>Anything that sufficiently disrupts our <a href="https://pubmed.ncbi.nlm.nih.gov/21861061">brain’s normal patterns</a> of activity has the potential to cause seizures.</p>
<p>While such disruptions usually only happen as part of an epilepsy syndrome, they can also happen when the body (and therefore the brain) is put under <a href="https://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/symptoms-causes/syc-20363458">extreme stress</a>. Potential causes of this stress include a stroke, brain trauma, a fever and very low blood sugar.</p>
<p>Shields has said that her tonic-clonic seizure was caused by drinking too much water, resulting in low blood sodium levels. This condition, known as <a href="https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711">hyponatraemia</a>, has significant consequences for the brain – most notably a swelling of brain cells as their water content increases. </p>
<p>Because the brain is contained within the skull it doesn’t have room to freely expand. As such, it has mechanisms in place to counteract increases in water content. Some of these mechanisms can throw off the delicate balance of the charged particles (ions) that allow the brain to be electrically active. </p>
<p>This could in turn alter the electrical activity in the brain and lead to the seizures that are sometimes observed in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470176/">advanced cases of hyponatraemia</a>.</p>
<p>While hyponatraemia is a very rare cause of tonic-clonic seizures, it’s still worth being aware that it can sometimes cause them. This may particularly be a concern to older people and those staying in hospital long-term, as certain treatments and medications (such as diuretics) can disrupt sodium levels. </p>
<p>For most of us, this is not a significant risk. Our bodies normally tell us when we’ve had enough water, and we typically consume enough salt in our diet to maintain balance. </p>
<p>And, because our brains typically only become vulnerable to one-off seizures in extreme conditions – such as a very unusual diet, alcohol or drug overuse, extreme exhaustion, or trauma – they aren’t something the majority of us will need to worry about.</p><img src="https://counter.theconversation.com/content/216962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cian McCafferty has been a member of, and received funding from, the Epilepsy Foundation.</span></em></p>Shields said the seizure was caused by drinking too much water – which can be a cause in very rare circumstances.Cian McCafferty, Lecturer and Researcher, Department of Anatomy & Neuroscience, University College CorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2069142023-07-11T12:30:49Z2023-07-11T12:30:49ZImmune cells in the brain may reduce damage during seizures and promote recovery, according to study in mice<figure><img src="https://images.theconversation.com/files/536347/original/file-20230707-29-x9vfl9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1977%2C1514&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Microglia perform many functions in the brain, and their role in seizures is unclear.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/nerve-cell-conceptual-illustration-royalty-free-illustration/1359390614">KTSDesign/Science Photo Library via Getty Images</a></span></figcaption></figure><p>Seizures are like sudden electrical storms in the brain. Seizure disorders like epilepsy affect <a href="https://www.cureepilepsy.org/for-patients/understanding/basics/what-is-epilepsy/">over 65 million people worldwide</a> and can have profound effects on a person’s quality of life, cognitive function and overall well-being. Prolonged seizures called <a href="https://www.epilepsy.com/complications-risks/emergencies/status-epilepticus">status epilepticus</a> can cause lasting brain damage.</p>
<p>Specialized immune cells in the brain <a href="https://theconversation.com/harnessing-the-brains-immune-cells-to-stave-off-alzheimers-and-other-neurodegenerative-diseases-193606">called microglia</a> are activated during seizures to help clean up the damage. Researchers don’t fully understand exactly how these cells are involved in seizures. Some studies have found that microglia <a href="https://doi.org/10.1002%2Fbrb3.403">promote seizures</a>, while other studies <a href="https://doi.org/10.1016/j.bbi.2020.06.028">show the opposite</a>.</p>
<p>I am a scientist who studies the roles that microglia play in seizures. My colleagues and I at the <a href="https://www.microgleyolab.com">Eyo Lab</a> at the University of Virginia wanted to investigate the possible protective function microglia serve during seizures and how they affect recovery.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LcO9YU-Pdws?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The exact neurobiology of seizures remains unclear.</span></figcaption>
</figure>
<p>We induced seizures in mice using three different methods – chemical, hyperthermic and electrical – and temporarily removed their microglia. In all three cases, we found that <a href="https://doi.org/10.1002/glia.24364">seizures worsened</a> when these cells were absent. Mice without microglia also experienced significant weight loss and decrease in mobility compared with mice with microglia. </p>
<p>Our findings highlight the importance of microglia in safeguarding the brain during seizures and promoting recovery; but they also raise important questions about how these cells provide a protective rather than detrimental effect.</p>
<p>While removing all microglia allowed us to better understand their overall effects on seizures, it meant we were unable to fully assess their contributions in specific brain regions and how they interact with other cells. This is because removing microglia also affects the function of other brain cells. Future studies that more selectively modify microglia or alter their function in a controlled way could help researchers gain a more nuanced understanding of the role these cells play in seizures.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/JmQIaOp4vKs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">This video shows microglia moving in cell culture.</span></figcaption>
</figure>
<p>Researchers also don’t fully understand what specific molecules and signals microglia use to protect the brain during seizures. How well our findings apply to seizure disorders like epilepsy is also unclear. These knowledge gaps highlight the complexity of seizure disorders and the need for continued study.</p>
<p>Identifying strategies to harness the beneficial functions of microglia can help researchers develop better treatments that prevent long-term brain damage and enhance the quality of life of people with seizure disorders.</p><img src="https://counter.theconversation.com/content/206914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Synphane Gibbs-Shelton receives funding from the National Institutes of Health.</span></em></p>Seizures are like sudden electrical storms in the brain that can cause lasting damage. A set of immune cells in the brain called microglia may provide protection.Synphane Gibbs-Shelton, Ph.D. Candidate in Pharmacology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869012023-02-09T13:35:20Z2023-02-09T13:35:20ZCBD is not a cure-all – here’s what science says about its real health benefits<figure><img src="https://images.theconversation.com/files/488378/original/file-20221005-18-19r1y.jpg?ixlib=rb-1.1.0&rect=440%2C26%2C5514%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Since 2018, it has been legal in the U.S. to use a drug made from purified cannabis-derived cannabidiol – CBD – to treat certain childhood seizure disorders.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/scientist-checking-cannabis-plants-in-marijuana-royalty-free-image/1298557693?adppopup=true">Visoot Uthairam/Moment via Getty Images</a></span></figcaption></figure><p>Over the last five years, an often forgotten piece of U.S. federal legislation – the Agriculture Improvement Act of 2018, also known as the <a href="https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019">2018 Farm Bill</a> – has ushered in an <a href="https://peoria.medicine.uic.edu/cbd-blog/">explosion of interest</a> in the medical potential of cannabis-derived cannabidiol, or CBD. </p>
<p>After decades of debate, the bill made it legal for farmers to grow industrial hemp, <a href="https://www.nifa.usda.gov/industrial-hemp">a plant rich in CBD</a>. Hemp itself has tremendous value as a cash crop; it’s used to produce biofuel, textiles and animal feed. But the CBD extracted from the hemp plant also has numerous medicinal properties, with <a href="https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476#">the potential to benefit millions</a> through the treatment of seizure disorders, pain or anxiety. </p>
<p>Prior to the bill’s passage, the resistance to legalizing hemp was due to its association with marijuana, its biological cousin. Though hemp and marijuana belong to the same species of plant, <em>Cannabis sativa</em>, they each have a unique chemistry, <a href="https://doi.org/10.1177%2F2045125312457586">with very different characteristics and effects</a>. Marijuana possesses tetrahydrocannabinol, or THC, <a href="https://nida.nih.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects">the chemical that produces the characteristic high</a> that is associated with cannabis. Hemp, on the other hand, is a strain of the cannabis plant that contains virtually no THC, and <a href="https://www.cdc.gov/marijuana/featured-topics/CBD.html#">neither it nor the CBD derived from it</a> can produce a high sensation. </p>
<p><a href="https://pennstate.pure.elsevier.com/en/persons/kent-vrana">As a professor and chair</a> of the <a href="https://scholar.google.com/citations?user=B7QZGgoAAAAJ&hl=en">department of pharmacology</a> at Penn State, I have been following research developments with CBD closely and have seen some promising evidence for its role in treating a broad range of medical conditions.</p>
<p>While there is growing evidence that CBD can help with certain conditions, caution is needed. Rigorous scientific studies are limited, so it is important that the marketing of CBD products does not get out ahead of the research and of robust evidence.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5aMu4mvug-k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Before purchasing any CBD products, first discuss it with your doctor and pharmacist.</span></figcaption>
</figure>
<h2>Unpacking the hype behind CBD</h2>
<p>The primary concern about CBD marketing is that the scientific community is not sure of the best form of CBD to use. CBD can be produced as either a pure compound or a complex mixture of molecules from hemp that constitute <a href="https://www.healthline.com/nutrition/cbd-oil-benefits">CBD oil</a>. CBD can also be formulated as a <a href="https://www.healthline.com/health/best-cbd-cream-for-pain#A-quick-look-at-the-best-CBD-creams-for-pain">topical cream or lotion</a>, or as a <a href="https://www.drugs.com/lifestyle/cbd-gummies-health-benefits-3515165/">gummy</a>, <a href="https://www.medicalnewstoday.com/articles/best-cbd-capsules#how-to-shop">capsule</a> or <a href="https://www.medicalnewstoday.com/articles/cbd-oil-vs-tincture#risks">tincture</a>. </p>
<p>Guidance, backed by clinical research, is needed on the best dose and delivery form of CBD for each medical condition. That research is still in progress.</p>
<p>But in the meantime, the siren’s call of the marketplace has sounded and created an environment in which CBD is often <a href="https://www.nbcnews.com/health/health-news/even-without-proof-cbd-finding-niche-cure-all-n945516">hyped as a cure-all</a> – an elixir <a href="https://www.forbes.com/health/body/cbd-for-sleep/#">for insomnia</a>, <a href="https://www.healthline.com/health/cbd-for-anxiety">anxiety</a>, <a href="https://www.health.harvard.edu/blog/cbd-for-chronic-pain-the-science-doesnt-match-the-marketing-2020092321003">neuropathic pain</a>, <a href="https://www.mdanderson.org/cancerwise/cbd-oil-and-cancer--9-things-to-know.h00-159306201.html">cancer</a> and <a href="https://www.acc.org/About-ACC/Press-Releases/2022/09/06/14/48/As-CBD-Use-Rises-Clinical-Trials-Needed-to-Determine-Safety-Efficacy-in-Heart-Disease-Patients">heart disease</a>. </p>
<p>Sadly, there is precious little rigorous scientific evidence to support many of these claims, and much of the existing research has been performed in animal models. </p>
<p>CBD is simply <a href="https://doi.org/10.1038/d41586-019-02524-5">not a panacea for all that ails you</a>.</p>
<h2>Childhood seizure disorders</h2>
<p>Here’s one thing that is known: Based on rigorous trials with hundreds of patients, CBD has been shown to be a <a href="https://www.neurocenternj.com/blog/cbd-for-seizures-use-effectiveness-side-effects-and-more/#">proven safe and effective drug for seizure disorders, particularly in children</a>. </p>
<p>In 2018, the U.S. Food and Drug Administration granted regulatory approval for the use of a purified <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">CBD product sold under the brand name Epidiolex</a> for the treatment of <a href="https://medlineplus.gov/genetics/condition/lennox-gastaut-syndrome/">Lennox-Gastaut</a> and <a href="https://dravetfoundation.org/what-is-dravet-syndrome/">Dravet syndromes</a> in children. </p>
<p>These two rare syndromes, appearing early in life, produce large numbers of frequent seizures that are <a href="https://www.neurologylive.com/view/childhood-epilepsies-dravet-and-lennox-gastaut-syndromes">resistant to traditional epilepsy treatments</a>. CBD delivered as an oral solution as Epidiolex, however, <a href="https://doi.org/10.3389/fphar.2020.00063">can produce a significant reduction</a> – greater than 25% – in the frequency of seizures in these children, with 5% of the patients becoming seizure-free. </p>
<h2>More than 200 scientific trials</h2>
<p>CBD is what pharmacologists call a promiscuous drug. That means it could be effective for treating a number of medical conditions. In broad strokes, CBD affects more than one process in the body – a <a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922">term called polypharmacology</a> – and so could benefit more than one medical condition.</p>
<p>As of early 2023, there are <a href="https://clinicaltrials.gov/ct2/results?cond=&term=cannabidiol&cntry=US&state=&city=&dist=">202 ongoing or completed scientific trials</a> examining the effectiveness of CBD in humans on such diverse disorders as chronic pain, substance use disorders, anxiety and arthritis. </p>
<p>In particular, CBD appears to be <a href="https://www.ncbi.nlm.nih.gov/books/NBK547742/">an anti-inflammatory agent and analgesic</a>, similar to the functions of aspirin. This means it might be helpful for treating people suffering with inflammatory pain, like arthritis, or headaches and body aches. </p>
<p>CBD also holds potential for use in <a href="https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy.html">cancer therapy</a>, although it has not been approved by the FDA for this purpose. </p>
<p>The potential for CBD in the context of cancer is twofold: </p>
<p>First, there is evidence that it <a href="https://doi.org/10.3390/biom11040582">can directly kill cancer cells</a>, enhancing the ability of traditional therapies to treat the disease. This is not to say that CBD will replace those traditional therapies; the data is not that compelling. </p>
<p>Second, because of its ability to reduce pain and perhaps anxiety, the addition of CBD to a treatment plan may <a href="https://doi.org/10.3390/biom11040582">reduce side effects</a> and increase the quality of life for people with cancer.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_00K0gV016g?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Things to consider before purchasing a CBD product.</span></figcaption>
</figure>
<h2>The risks of unregulated CBD</h2>
<p>While prescription CBD is safe when used as directed, other forms of the molecule come with risks. This is especially true for CBD oils. The over-the-counter CBD oil industry <a href="https://www.forbes.com/health/body/cbd-legalization-by-state/">is unregulated and not necessarily safe</a>, in that there are no regulatory requirements for monitoring what is in a product. </p>
<p>What’s more, rigorous science does not support the unsubstantiated marketing claims made by many CBD products. </p>
<p>In a <a href="https://doi.org/10.1159/000489287">2018 commentary</a>, the author describes the results of his own study, which was published in Dutch (in 2017). His team obtained samples of CBD products from patients <a href="https://www.researchgate.net/publication/321679450_Grote_variatie_in_samenstelling_cannabisolie_noopt_tot_regels">and analyzed their content</a>. Virtually none of the 21 samples contained the advertised quantity of CBD; indeed, 13 had little to no CBD at all and many contained significant levels of THC, the compound in marijuana that leads to a high – and that was not supposed to have been present. </p>
<p>In fact, studies have shown that there is <a href="https://theconversation.com/the-dietary-supplement-youre-taking-could-be-tainted-with-prescription-medications-and-dangerous-hidden-ingredients-according-to-a-new-study-181418">little control of the contaminants that may be present</a> in over-the-counter products. The FDA has <a href="https://www.fda.gov/news-events/public-health-focus/warning-letters-and-test-results-cannabidiol-related-products">issued scores of warning letters</a> to companies that market unapproved drugs containing CBD. In spite of the marketing of CBD oils as all-natural, plant-derived products, consumers should be aware of the risks of unknown compounds in their products or unintended interactions with their prescription drugs. </p>
<p>Regulatory guidelines for CBD <a href="https://www.statnews.com/2023/02/03/fda-right-agency-regulate-cbd-products-but-it-needs-help/">are sorely lacking</a>. Most recently, in January 2023, the FDA concluded that the existing framework is “not appropriate for CBD” and said it would work with Congress to chart a way forward. In a statement, the agency said that “<a href="https://www.fda.gov/news-events/press-announcements/fda-concludes-existing-regulatory-frameworks-foods-and-supplements-are-not-appropriate-cannabidiol">a new regulatory pathway for CBD is needed</a> that balances individuals’ desire for access to CBD products with the regulatory oversight needed to manage risks.” </p>
<p>As a natural product, CBD is still acting as a drug – much like aspirin, acetaminophen or even a cancer chemotherapy. Health care providers simply need to better understand the risks or benefits.</p>
<p>CBD may <a href="https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743#">interact with the body in ways that are unintended</a>. CBD is eliminated from the body by the same liver enzymes that remove a variety of drugs such as blood thinners, antidepressants and organ transplant drugs. Adding CBD oil to your medication list without consulting a physician could be risky and could interfere with prescription medications. </p>
<p>In an effort to help prevent these unwanted interactions, my colleague Dr. Paul Kocis, a clinical pharmacist, and I have created a free online application called the <a href="https://cann-dir.psu.edu/">CANNabinoid Drug Interaction Resource</a>. It identifies how CBD could potentially interact with other prescription medications. And we urge all people to disclose both over-the-counter CBD or recreational or medical marijuana use to their health care providers to prevent undesirable drug interactions.</p>
<p>In the end, I believe that CBD will prove to have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">place in people’s medicine cabinets</a> – but not until the medical community has established the right form to take and the right dosage for a given medical condition.</p><img src="https://counter.theconversation.com/content/186901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kent E Vrana receives unrestricted research grant funding from PA Options for Wellness (a Pennsylvania-approved clinical registrant medical marijuana company).
Vrana is the director of the Pennsylvania-designated Medical Marijuana Academic Clinical Research Center at Penn State. </span></em></p>CBD isn’t a miracle cure for everything that ails a person – but science shows that it has the potential to help treat a number of health conditions.Kent E Vrana, Professor and Chair of Pharmacology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947672022-11-18T17:18:09Z2022-11-18T17:18:09ZThe risk of seizures and epilepsy is higher after COVID than after the flu – new research<figure><img src="https://images.theconversation.com/files/495707/original/file-20221116-26-kgd3xh.jpg?ixlib=rb-1.1.0&rect=0%2C26%2C4500%2C2964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-ct-scan-67-year-old-473967136">hutpaza/Shutterstock</a></span></figcaption></figure><p>Epilepsy is one of the most common neurological disorders, affecting roughly <a href="https://www.who.int/publications/i/item/epilepsy-a-public-health-imperative">50 million people</a> around the world. It’s a condition characterised by seizures which involve episodic, abnormal activity in nerve cells in the brain. </p>
<p>People can have convulsive seizures, where the body stiffens and shakes. There are also more subtle seizures during which people may, for example, lose awareness for short periods of time. While epilepsy always involves seizures, some people can have seizures without being diagnosed with epilepsy.</p>
<p>Epilepsy is more common <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33064-8/fulltext">as we get older</a>, and the main risk factor for the condition in later life is stroke. Given that COVID affects older adults most severely and <a href="https://pubmed.ncbi.nlm.nih.gov/33879319/">can result in stroke</a>, some might speculate that COVID could see more people develop epilepsy. Whether this is actually the case, though, has been difficult to prove. </p>
<p>In <a href="https://n.neurology.org/content/early/2022/11/16/WNL.0000000000201595">a new study</a>, we’ve found that the risk of seizures or epilepsy following a COVID infection is significantly higher than after an influenza infection.</p>
<p>We know that COVID is associated with psychiatric and neurological symptoms <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext">such as anxiety</a> and <a href="https://www.science.org/doi/10.1126/science.abm2052">difficulty with memory</a>. Many early studies exploring the impact of COVID on the brain, however, focused on the immediate period after infection or had low patient numbers.</p>
<p>To try to more definitively answer whether COVID is associated with epilepsy or seizures, we looked at the health records of people who had been infected with COVID. We then carefully matched them (so that they were similar in characteristics like age, sex and medical conditions) with a group of people who had been infected with influenza. </p>
<p>Each group consisted of 152,754 people, none of whom had previously been diagnosed with epilepsy or recurrent seizures. We compared the incidence of epilepsy and seizures between the two groups over a six month period following the initial infection. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19s-impacts-on-the-brain-and-mind-are-varied-and-common-new-research-161215">COVID-19's impacts on the brain and mind are varied and common – new research</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>The rate of new cases of epilepsy or seizures was 0.94% in the people who had COVID, compared with 0.6% in those who had influenza. While the overall risk of seizures is therefore small, these cases show that people who had COVID were 55% more likely to develop epilepsy or seizures over the next six months than people who had influenza.</p>
<p>We then looked to see if certain groups were particularly susceptible to seizures or epilepsy after COVID. We found that, compared to influenza, children aged under 16 and people who were not hospitalised were more likely to develop epilepsy or seizures.</p>
<p>There was also a delay to when children and non-hospitalised patients experienced seizures or epilepsy, perhaps explaining why this phenomenon has not been detected in studies of shorter duration.</p>
<p>Severe infections can make people more susceptible to seizures, so it’s possible that if someone is hospitalised for either COVID or the flu that seizures will manifest as part of the acute illness.</p>
<figure class="align-center ">
<img alt="Three children walking in a forrest." src="https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495714/original/file-20221116-12-11pzf8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The increased risk was more noticeable in children than adults.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/children-having-fun-balancing-on-tree-389052964">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>We see this in our data. For people with COVID who were hospitalised, the point at which a diagnosis of seizures or epilepsy was most common was at nine days after infection. For those who were not hospitalised, the peak was at 41 days. </p>
<p>In children with COVID, the peak point for seizures or epilepsy was at 50 days after infection and at that time children who had COVID were three times more likely to have epilepsy or seizures than children who had flu.</p>
<p>It’s possible that seizures occur due to changes in the immune system which may take some weeks to manifest, thereby contributing to this delay. But we don’t know why seizures might happen after COVID, nor why their onset appears to be delayed after an infection in children and patients with less severe disease.</p>
<p>Most people who have a stroke while infected with COVID will be hospitalised. So it doesn’t seem that stroke is the explanation for the relative increase in post-COVID seizures seen in adults, given we saw an increase among non-hospitalised patients too.</p>
<h2>What now?</h2>
<p>Although the overall rate of seizures and epilepsy after COVID is small, given the large number of people who have been infected with COVID, this could result in increases in the number of people with seizures and epilepsy.</p>
<p>Our study also demonstrates that even relatively milder COVID infections can be associated with neurological conditions, and shows the need for vaccination programmes that try to prevent COVID infection, perhaps especially in children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-studied-how-covid-affects-mental-health-and-brain-disorders-up-to-two-years-after-infection-heres-what-we-found-188918">We studied how COVID affects mental health and brain disorders up to two years after infection – here's what we found</a>
</strong>
</em>
</p>
<hr>
<p>There are some limitations to this study. For example, we didn’t know which variant of COVID people were infected with or whether they had been vaccinated.</p>
<p>We now need to do more research to try and understand why people may be developing epilepsy and having seizures following COVID. It will also be vital to continue to pool data on the neurological consequences of COVID and track longer-term trajectories of people who do develop seizures following a COVID infection.</p><img src="https://counter.theconversation.com/content/194767/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This study was supported by the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Centre (BRC), grant BRC-1215-20005</span></em></p>People who had COVID were 55% more likely to develop epilepsy or seizures over the next six months than people who had influenza – but the overall risk is still small.Arjune Sen, Head of the Oxford Epilepsy Research Group, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1938192022-11-07T12:34:36Z2022-11-07T12:34:36ZEpilepsy: gene therapy technique targeting overactive brain cells shows promise in treating drug-resistant form of the condition<figure><img src="https://images.theconversation.com/files/493789/original/file-20221107-13-i4n7qr.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C3500%2C1996&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Epileptic seizures are caused by brain cells becoming overactive.
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/neuronal-network-electrical-activity-neuron-cells-1691666992">MattLphotography/ Shutterstock</a></span></figcaption></figure><p>Something like <a href="https://www.who.int/news-room/fact-sheets/detail/epilepsy">50 million people worldwide</a> have epilepsy. While the majority of these people are able to use medications to manage and prevent their seizures, around one-third don’t respond well to these treatments. In such cases, the only option available to bring seizures under control is to <a href="https://epilepsysociety.org.uk/about-epilepsy/treatment/epilepsy-and-brain-surgery">remove the part of the brain</a> where seizures arise. But this procedure is extremely risky.</p>
<p>Since epileptic seizures are caused by excessive activity of brain cells (neurons) in specific parts of the brain, being able to target these neurons and turn them off could very well prevent seizures from happening.</p>
<p>Using an innovative new gene therapy approach we have developed, we were able to show in cell and animal models that it is possible to <a href="https://www.science.org/doi/epdf/10.1126/science.abq6656">specifically target the neurons</a> that cause epileptic seizures. This subsequently prevented them from becoming overactive and causing seizures in the future. </p>
<p>This discovery not only has major implications for treating drug-resistant epilepsy, but there’s a chance it may also be used to treat other neurological conditions caused by overactive neurons, including Parkinson’s disease and migraines.</p>
<h2>Gene therapy</h2>
<p>Gene therapy works by directly altering a person’s genes in order to treat a disease or condition. There are a few different ways of doing this.</p>
<p><a href="https://www.jneurosci.org/content/early/2019/02/12/JNEUROSCI.1143-18.2019?versioned=true">Previous studies</a> that have used gene therapy to treat epilepsy in animal models have done this by using a virus that has been altered in the lab so it’s no longer harmful. Researchers would inject the virus into the brain region where seizures occur. The virus would then implant stretches of DNA into the cells, effectively modulating the way they worked – <a href="https://www.nature.com/articles/s41591-018-0103-x">making them less active</a> and preventing seizures.</p>
<p>While this technique is far less invasive than brain surgery, the problem with the method is that it affects all the neurons in the brain region – not just those causing the seizures. It also permanently alters the properties of the cells that take up the virally delivered DNA, which can permanently modify brain function. </p>
<p>But our innovative new gene therapy tool has shown it’s possible to alter only the brain cells that cause seizures, leaving nearby healthy neurons unaffected. We were able to do this by taking advantage of how gene expression is normally regulated.</p>
<figure class="align-center ">
<img alt="An image of multiple DNA strands." src="https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493795/original/file-20221107-3705-r3aoea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our new gene therapy tool targeted the body’s promoters.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dna-molecule-macro-blue-string-on-775854724">SynthEx/ Shutterstock</a></span>
</figcaption>
</figure>
<h2>The role of promoters</h2>
<p>The 20,000 or so genes we have in our body each contain instructions to make different proteins and molecules. These genes are typically under the control of neighbouring stretches of DNA, called promoters. These determine whether and how much of a particular protein is made. Different cells express different proteins depending on which promoters are active or inactive.</p>
<p>There’s also a special type of promoter (called “activity-dependent” promoters) that will only switch on in response to biochemical signals made by neurons when they fire intensely – such as during a seizure. We took advantage of these activity-dependent promoters, creating a gene therapy that senses and turns down the excitability of neurons that cause seizures. We did this by coupling activity-dependent promoters to DNA sequences that contain proteins which calm down neurons.</p>
<p>We initially tested the gene therapy tool in neurons grown in a dish, and then in mice that had drug-resistant epilepsy. We also tested this technique in lab-grown human “mini brains”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/scientists-grow-brain-tissue-with-different-regions-in-lab-17560">Scientists grow brain tissue with different regions in lab</a>
</strong>
</em>
</p>
<hr>
<p>In each test, we were able to show this new gene therapy technique was effective in calming down the overactive neurons involved in seizures, while leaving healthy bystander cells unaffected.</p>
<p>Although it takes an hour or so to switch on – longer than the typical duration of a seizure – the new gene therapy is highly effective in preventing subsequent seizures. It does this by automatically selecting which neurons to treat and switching them off. It’s also able to return neurons to their original state when brain activity returns to normal. If seizures occur again, the promoter is ready to switch on. </p>
<p>The treatment therefore only has to be given once, but has a lasting effect – possibly lifelong. Importantly, the treatment did not affect the performance of the mice in tests of memory and other normal behaviour (such as their anxiety levels, learning and mobility).</p>
<p>We are excited by the breakthrough, because it could in principle bring the prospect of gene therapy to a wide range of people with drug-resistant epilepsy. But before the therapy is ready to use with these patients, we will need to put it through a number of tests to verify that it can be scaled up to larger brains.</p><img src="https://counter.theconversation.com/content/193819/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriele Lignani consults to/owns shares in a company that aims to bring epilepsy gene therapy to the clinic. He received funding from Epilepsy Research UK and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Dimitri Kullmann consults to/owns shares in a company that aims to bring epilepsy gene therapy to the clinic. He received funding from the Wellcome Trust and the Medical Research Council.</span></em></p>This technique could also be applied to other conditions, such as Parkinson’s disease.Gabriele Lignani, Associate Professor, Clinical & Experimental Epilepsy, UCLDimitri Kullmann, Professor of Neurology, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1889182022-08-18T14:12:07Z2022-08-18T14:12:07ZWe studied how COVID affects mental health and brain disorders up to two years after infection – here’s what we found<figure><img src="https://images.theconversation.com/files/479704/original/file-20220817-8116-s4twhd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID has been linked with a higher rate of psychiatric and neurological disorders.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-brain-puzzle-paper-cutout-1814268452">SewCream/Shutterstock</a></span></figcaption></figure><p>The occurrence of mental health conditions and neurological disorders among people recovering from COVID has been a concern since early in the pandemic. Several studies have shown that a <a href="https://www.sciencedirect.com/science/article/pii/S2215036621000845">significant proportion</a> of adults <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00042-1/fulltext">face problems</a> of this kind, and that the risks are greater than following other infections.</p>
<p>However, several questions remain. Do the risks of psychiatric and neurological problems dissipate, and if so, when? Are the risks similar in children as in adults? Are there differences between COVID variants? </p>
<p>Our new study, published in <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext">The Lancet Psychiatry</a>, explored these issues. In analyses led by my colleague Maxime Taquet, we used the electronic health records of about 1.25 million people diagnosed with COVID, mostly from the US. We tracked the occurrence of 14 major neurological and psychiatric diagnoses in these patients for up to two years. </p>
<p>We compared these risks with a closely matched control group of people who had been diagnosed with a respiratory infection other than COVID. </p>
<p>We examined children (aged under 18), adults (18-65) and older adults (over 65) separately.</p>
<p>We also compared people who contracted COVID just after the emergence of a new variant (notably omicron, but earlier variants too) with those who did so just beforehand.</p>
<p>Our findings are a mixture of good and bad news. Reassuringly, although we observed a greater risk of common psychiatric disorders (anxiety and depression) after COVID infection, this heightened risk rapidly subsided. The rates of these disorders among people who had COVID were no different from those who had other respiratory infections within a couple of months, and there was no overall excess of these disorders over the two years.</p>
<p>It was also good news that children were not at greater risk of these disorders at any stage after COVID infection. </p>
<p>We also found that people who had had COVID were not at higher risk of getting Parkinson’s disease, which had been a concern early in the pandemic.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-long-lasting-symptoms-rarer-in-children-than-in-adults-new-research-165701">COVID: long-lasting symptoms rarer in children than in adults – new research</a>
</strong>
</em>
</p>
<hr>
<p>Other findings were more worrying. The risks of being diagnosed with some disorders, such as psychosis, seizures or epilepsy, brain fog and dementia, though mostly still low, remained elevated throughout the two years after COVID infection. For example, the risk of dementia in older adults was 4.5% in the two years after COVID compared with 3.3% in those with another respiratory infection.</p>
<p>We also saw an ongoing risk of psychosis and seizures in children.</p>
<figure class="align-center ">
<img alt="A woman sits by a window, hiding her head." src="https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rates of depression and anxiety were higher after COVID, but only for a short time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-young-blonde-caucasian-female-feeling-2057071157">Stock Unit/Shutterstock</a></span>
</figcaption>
</figure>
<p>In terms of variants, although our data confirms that omicron is a much milder illness than the previous delta variant, survivors remained at similar risk of the neurological and psychiatric conditions we looked at. </p>
<p>However, given how recently omicron emerged, the data we have for people who were infected with this variant only goes up to about five months after infection. So the picture may change.</p>
<h2>Mixed results</h2>
<p>Overall, our study reveals a mixed picture, with some disorders showing a transient excess risk after COVID, while other disorders have a sustained risk. For the most part, the findings are reassuring in children, but with some concerning exceptions. </p>
<p>The results on omicron, the variant currently dominant around the world, indicate that the burden of these disorders is likely to continue, even though this variant is milder in other respects.</p>
<p>The study has important caveats. Our findings don’t capture people who may have had COVID but it wasn’t documented in their health records – perhaps because they didn’t have symptoms. </p>
<p>And we cannot fully account for the effect of vaccination, because we didn’t have complete information about vaccination status, and some people in our study caught COVID before vaccines became available. That said, in <a href="https://pubmed.ncbi.nlm.nih.gov/35447302/">a previous study</a> we showed the risks of these outcomes were pretty similar in people who caught COVID after being vaccinated, so this might not have significantly affected the results.</p>
<p>Also, the risks observed in our study are relative to people who had had other respiratory infections. We don’t know how they compare to people without any infection. We also don’t know how severe or long lasting the disorders were. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-covid-affect-the-brain-two-neuroscientists-explain-164857">How does COVID affect the brain? Two neuroscientists explain</a>
</strong>
</em>
</p>
<hr>
<p>Finally, our study is observational and so cannot explain how or why COVID is associated with these risks. Current theories include persistence of the virus in the nervous system, the immune reaction to the infection, or problems with blood vessels. These are being investigated in <a href="https://academic.oup.com/braincomms/advance-article/doi/10.1093/braincomms/fcac206/6668727?searchresult=1">separate research</a>.</p><img src="https://counter.theconversation.com/content/188918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Harrison receives funding from the National Institute for Health and Care Research, MQ, and The Wolfson Foundation. </span></em></p>People who get COVID continue to face increased risks of developing some neurological and psychiatric conditions, like psychosis and dementia, for up to two years afterwards.Paul Harrison, Professor of Psychiatry, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1886842022-08-12T22:28:00Z2022-08-12T22:28:00ZUnsealed court documents show the FBI was looking for evidence Trump violated the Espionage Act and other laws – here’s how the documents seized show possible wrongdoing<figure><img src="https://images.theconversation.com/files/478977/original/file-20220812-15-ho14f1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A police officer drives by Mar-a-Lago on August 9, 2022. </span> <span class="attribution"><a class="source" href="https://media.gettyimages.com/photos/local-law-enforcement-officers-are-seen-in-front-of-the-home-of-picture-id1242402806?s=2048x2048">Giorgio Viera/AFP via Getty Images </a></span></figcaption></figure><p><em>The <a href="https://int.nyt.com/data/documenttools/mar-a-lago-search-warrant-and-inventory/6478c5980764438f/full.pdf">FBI recovered</a> confidential and top-secret items from Mar-a-Lago during its Aug. 8, 2022, search of the estate – pointing to former President Donald Trump’s potential violation of several federal laws.</em> </p>
<p><em>A Florida federal judge – the same one who issued the warrant to search Trump’s estate – <a href="https://www.courthousenews.com/wp-content/uploads/2022/08/trump-search-warrant-unseal-order.pdf">ordered on Aug. 12, 2022</a>, that the document be made public – along with an inventory of items seized during the FBI’s raid.</em> </p>
<p><em>The unsealed documents <a href="https://www.nytimes.com/live/2022/08/12/us/trump-news">seem to indicate</a> that the U.S. Department of Justice believes <a href="https://www.wsj.com/articles/fbi-recovered-eleven-sets-of-classified-documents-in-trump-search-inventory-shows-11660324501?st=ql9humks0e7gckv&reflink=desktopwebshare_permalink">Trump may have violated</a> the Espionage Act, as well as other criminal laws relating to the handling of public records.</em></p>
<p><em><a href="http://www.clarkcunningham.org/">Clark Cunningham</a>, Georgia State University legal scholar and an <a href="https://www.yalelawjournal.org/forum/apple-and-the-american-revolution-remembering-why-we-have-the-fourth-amendment-1">expert on search warrants</a>, explains how this new information connects to possible criminal wrongdoing by the former president.</em></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older white man wearing a black suit is seen walking to a brown lectern, with the American flag standing to his left." src="https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478971/original/file-20220812-2527-qta4ii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">U.S. Attorney General Merrick Garland discussed the FBI’s search on Aug. 11, 2022.</span>
<span class="attribution"><a class="source" href="https://media.gettyimages.com/photos/attorney-general-merrick-garland-arrives-to-deliver-a-statement-at-picture-id1242440351?s=2048x2048">Drew Angerer/Getty Images</a></span>
</figcaption>
</figure>
<h2>These laws were potentially violated</h2>
<p>The <a href="https://int.nyt.com/data/documenttools/mar-a-lago-search-warrant-and-inventory/6478c5980764438f/full.pdf">released warrant</a> authorized the FBI to search for evidence that Trump has violated three key laws.</p>
<p>First, there is the <a href="https://www.law.cornell.edu/uscode/text/18/793">Espionage Act</a>, which applies to possession of information related to the national defense that could be used to harm the U.S. or aid a foreign adversary. This law applies to someone who, like Trump, initially had lawful possession of such information but who, after their time in office ended, refuses to return it to the government.</p>
<p>Then, there is <a href="https://www.law.cornell.edu/uscode/text/18/1519">obstruction of justice</a>, which includes concealing documents to obstruct a federal investigation. </p>
<p>Finally, there is the <a href="https://www.law.cornell.edu/uscode/text/18/2071">Public Records statute</a>, which prohibits someone entrusted with a public record from “concealing” that document. </p>
<h2>What’s in the inventory</h2>
<p>The inventory of items taken by the FBI from Mar-a-Lago apparently shows Trump may have violated these laws in a number of different ways. </p>
<p>The <a href="https://int.nyt.com/data/documenttools/mar-a-lago-search-warrant-and-inventory/6478c5980764438f/full.pdf">inventory shows</a> that FBI agents seized documents designated “SCI,” which refers to <a href="https://csrc.nist.gov/glossary/term/sensitive_compartmented_information">Sensitive Compartmented Information</a>. In simple terms, this is classified information that comes from intelligence sources – and must be handled only within secured government locations. </p>
<p>Because this kind of sensitive information can reveal both methods and procedures for collecting intelligence – including the identity of undercover agents in hostile countries – the presence of such materials at Mar-a-Lago may be a violation of the <a href="https://www.law.cornell.edu/uscode/text/18/793">Espionage Act</a>, if Trump was willfully retaining this information after the government demanded its return.</p>
<p>The inventory also refers to numerous “top-secret” documents. <a href="https://www.law.cornell.edu/cfr/text/18/3a.11">Federal law defines</a> <a href="https://theconversation.com/heres-how-government-documents-are-classified-to-keep-sensitive-information-safe-188687">this as</a> “information or material which requires the highest degree of protection” and could threaten national security. The FBI’s discovery of top-secret documents could corroborate <a href="https://www.washingtonpost.com/national-security/2022/08/11/garland-trump-mar-a-lago/">The Washington Post’s report</a> that the FBI search included classified documents related to nuclear weapons. The FBI also seized documents designated “secret” and “confidential.”</p>
<p>All told, the FBI removed 27 boxes and other individually listed items, including photographs. </p>
<p>Trump received a federal subpoena <a href="https://thehill.com/blogs/blog-briefing-room/news/3597357-doj-subpoenaed-trump-months-before-mar-a-lago-search-report/">in the spring of 2022</a> to return documents taken from the White House. </p>
<p>So if the inventory includes items that should have been returned in response to the subpoena, but were not, that can be evidence of obstruction of justice and concealment of public records. </p>
<h2>A defense that might not hold</h2>
<p><a href="https://www.nytimes.com/2022/08/10/nyregion/trump-fbi-planting-evidence.html">Trump has suggested</a> that the FBI may have planted evidence during its search. </p>
<p>However, <a href="https://www.law.cornell.edu/rules/frcrmp/rule_41">federal rules about search warrants</a> provide strong protection against such a possibility, by requiring that a government officer present when a search warrant is carried out “prepare and verify an inventory” of property seized in the presence of “another officer” and “the person from whom, or from whose premises, the property was taken.” </p>
<p>The officer must then “give a copy of the warrant and a receipt for the property taken to the person from whom, or from whose premises, the property was taken,” according to these rules. </p>
<p><a href="https://www.nytimes.com/live/2022/08/11/us/garland-trump-statement-doj#garland-fbi-trump-transcript">U.S. Attorney General Merrick Garland said</a> during his Aug. 11 statement about the search that these procedures were followed. “Copies of both the warrant and the FBI property receipt were provided on the day of the search to the former president’s counsel, who was on site during the search,” Garland said.</p>
<p>The federal rules say that if the owner of the premises is not present, another “credible person” can verify the inventory – in this case, the unsealed records confirm that Trump’s attorney, Christine Bobbs, acknowledged receipt of the inventory at 6:19 p.m. on Aug. 8, 2022.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older white man with white hair, wearing a navy suit and red tie, waves as he walks to a black SUV. Behind him a man wearing sunglasses and a dark suit stands." src="https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478975/original/file-20220812-4578-lxxzbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Donald Trump waves while walking to his car in New York City on Aug. 10, 2022.</span>
<span class="attribution"><a class="source" href="https://media.gettyimages.com/photos/former-us-president-donald-trump-waves-while-walking-to-a-vehicle-of-picture-id1242419266?s=2048x2048">Stringer/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Limited precedent for unsealing these types of documents</h2>
<p>It’s relatively rare for a judge to unseal court records of a search warrant, unless an actual criminal prosecution is underway. </p>
<p>One other notable exception occurred in December 2016 when a New York federal court issued <a href="https://lasvegassun.com/news/2016/dec/20/court-to-unseal-clinton-email-search-warrant/">an unsealing order </a> for <a href="https://www.politico.com/story/2016/12/clinton-email-investigation-search-warrant-released-232852">the Oct. 30, 2016, search warrant</a> requested by former FBI Director James Comey to investigate emails improperly stored by former Secretary of State Hillary Clinton. </p>
<p>Unlike the Aug. 12, 2022 order regarding Trump, the unsealing of the Clinton-related warrant included the underlying affidavit. An affidavit is a statement made under oath to the issuing judge to obtain the warrant. </p>
<p>Disclosure of these documents provided the basis for a <a href="https://www.politico.com/story/2016/12/clinton-email-investigation-search-warrant-released-232852">firestorm of criticism</a> by Clinton allies that there was insufficient evidence to support the FBI’s warrant application. </p>
<p>As explained in a judge’s October 2016 order to make the search warrant <a href="http://www.politico.com/f/?id=00000159-184d-d63b-af7f-f97f95f80001">for the Clinton investigation public</a>, warrant application proceedings “have historically been highly secretive in nature and closed to the press and public.” In that case, the judge said that in deciding whether to unseal, <a href="http://www.politico.com/f/?id=00000159-184d-d63b-af7f-f97f95f80001">courts must consider</a> both the government’s interest in not compromising an ongoing criminal investigation and the need to protect the privacy and reputation of the person subject to the search who may never be charged with a crime. </p>
<p>However, for the Mar-a-Lago warrant, both the government and Trump, the subject of the search, <a href="https://news.yahoo.com/trump-says-wont-oppose-release-051945792.html">consented to the unsealing</a>.</p>
<p>True to <a href="https://www.npr.org/2016/03/16/126614141/merrick-garland-has-a-reputation-of-collegiality-record-of-republican-support">his reputation</a> for careful judgment, Garland went by the book in response to an avalanche of attacks from Trump allies demanding transparency about the search. The warrant and inventory have now been released for all to see through a proper court procedure – which Trump <a href="https://www.pbs.org/newshour/politics/donald-trump-wont-object-to-release-of-mar-a-lago-search-warrant">publicly endorsed</a>.</p><img src="https://counter.theconversation.com/content/188684/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clark D. Cunningham does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A legal scholar analyzes the unsealed warrant for the FBI’s recent search of Donald Trump’s home and the list of materials seized there. The implications for Trump are potentially grave.Clark D. Cunningham, W. Lee Burge Chair in Law & Ethics; Director, National Institute for Teaching Ethics & Professionalism, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876072022-08-04T12:22:28Z2022-08-04T12:22:28ZIlluminating the brain one neuron and synapse at a time – 5 essential reads about how researchers are using new tools to map its structure and function<figure><img src="https://images.theconversation.com/files/475765/original/file-20220725-30588-3lzyhd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1960%2C1527&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The U.S. BRAIN Initiative seeks to elucidate the connection between brain structure and function.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/computer-artwork-of-human-brain-profile-royalty-free-illustration/85757401">Science Photo Library - PASIEKA/Brand X Pictures via Getty Images</a></span></figcaption></figure><p>Scientists know both a lot and very little about the brain. With <a href="https://doi.org/10.48550/arXiv.1906.01703">billions of neurons and trillions of connections</a> among them, and the experimental limitations of examining the seat of consciousness and bodily function, studying the human brain is a technical, theoretical and ethical challenge. And one of the biggest challenges is perhaps one of the most fundamental – seeing what it looks like in action.</p>
<p>The U.S. <a href="https://braininitiative.nih.gov">Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative</a> is a collaboration among the National Institutes of Health, Defense Advanced Research Projects Agency, National Science Foundation, Food and Drug Administration and Intelligence Advanced Research Projects Activity and others. Since its inception in 2013, <a href="https://braininitiative.nih.gov">its goal</a> has been to develop and use new technologies to examine how each neuron and neural circuit comes together to “record, process, utilize, store, and retrieve vast quantities of information, all at the speed of thought.”</p>
<p>Just as <a href="https://theconversation.com/genomic-sequencing-heres-how-researchers-identify-omicron-and-other-covid-19-variants-172935">genomic sequencing</a> enabled the creation of a <a href="https://theconversation.com/the-human-genome-project-pieced-together-only-92-of-the-dna-now-scientists-have-finally-filled-in-the-remaining-8-176138">comprehensive map of the human genome</a>, tools that elucidate the connection between brain structure and function could help researchers answer long-standing questions about how the brain works, both in sickness and in health.</p>
<p>These five stories from our archives cover research that has been funded by or advances the goals of the BRAIN Initiative, detailing a slice of what’s next in neuroscience.</p>
<h2>1. Mapping the brain</h2>
<p>Attempts to map the structure of the brain date back to <a href="https://web.stanford.edu/class/history13/earlysciencelab/body/brainpages/brain.html">antiquity</a>, when philosophers and scholars had only the unaided eye to map anatomy to function. New <a href="https://embryo.asu.edu/pages/golgi-staining-technique">visualization techniques</a> in the 20th century led to the discovery that, just like all the other organs of the body, the brain is composed of individual cells – <a href="https://doi.org/10.1016/j.cub.2006.02.053">neurons</a>.</p>
<p>Now, <a href="https://theconversation.com/mapping-how-the-100-billion-cells-in-the-brain-all-fit-together-is-the-brave-new-world-of-neuroscience-170182">further advances in microscopy</a> that make use of artificial intelligence and genomics have allowed scientists not just to see each individual neuron in the entire brain, but also to identify the connections among them and begin to ascertain their function. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Stitched high-resolution microscopy image of mouse brain." src="https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432261/original/file-20211116-25-1vtphzf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Zooming in on this high-resolution image of a mouse brain reveals rectangular lines where individual image tiles were stitched together, each colored dot representing a specific cell type.</span>
<span class="attribution"><a class="source" href="http://kimlab.io">Yongsoo Kim</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Neuroscientist <a href="https://scholar.google.com/citations?user=WOQx1ksAAAAJ&hl=en">Yongsoo Kim</a> of Penn State likened this method to a photo mosaic, piecing together areas of the brain that haven’t been charted before. “It’s like building a Google map of the brain,” wrote Kim. “By combining millions of individual street photos, you can zoom in to see each street corner and zoom out to see an entire city.” Creating these high-resolution maps, he wrote, could help scientists develop new theories on how the brain works and lead to better treatments for brain disorders like dementia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mapping-how-the-100-billion-cells-in-the-brain-all-fit-together-is-the-brave-new-world-of-neuroscience-170182">Mapping how the 100 billion cells in the brain all fit together is the brave new world of neuroscience</a>
</strong>
</em>
</p>
<hr>
<h2>2. Brain folds and wrinkles</h2>
<p>Another fundamental question researchers have been puzzling over is how the brain develops the bumps and grooves that riddle its surface. Until roughly the <a href="https://doi.org/10.1093%2Fcercor%2Fbhr053">second trimester</a> of fetal development, the human brain is completely smooth.</p>
<p>Scientists have proposed a number of theories on the mechanics of brain folding. One of them, <a href="https://www.jstor.org/stable/1740783">differential tangential growth</a>, posits that folds form because of a mismatch in growth rates between the outer and inner layers of the brain. To ease the forces compressing the outer layer and restore structural stability, the layers buckle and fold.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WBWJBFRnqwY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Harvard researchers modeled how folding reduces instability caused by differential growth rates in the brain.</span></figcaption>
</figure>
<p>Biomechanical engineer <a href="https://scholar.google.com/citations?user=ukOZ0BAAAAAJ&hl=en">Mir Jalil Razavi</a> and computer scientist <a href="https://scholar.google.com/citations?user=r6DIjzUAAAAJ&hl=en">Weiying Dai</a> of Binghamton University <a href="https://theconversation.com/brain-wrinkles-and-folds-matter-researchers-are-studying-the-mechanics-of-how-they-form-170194">created models</a> to clarify this theory. They identified other factors that may also be at play, like the number of axons – the part of the neuron that transmits electrical signals – in a particular area. “Our brain models provide a potential explanation for why brains may form abnormally during development, highlighting the important role that the brain’s structure plays in its proper functioning,” they wrote.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/brain-wrinkles-and-folds-matter-researchers-are-studying-the-mechanics-of-how-they-form-170194">Brain wrinkles and folds matter – researchers are studying the mechanics of how they form</a>
</strong>
</em>
</p>
<hr>
<h2>3. Where memories are stored</h2>
<p>Just like the RAM in a computer, memories take up physical space in the brain. Researchers have hypothesized that memories may be stored by <a href="https://doi.org/10.1016/0166-2236(94)90101-5">rearranging the connections, or synapses</a>, among neurons. While this theory has largely been confirmed by observing <a href="https://doi.org/10.1038/37601">changes in the electrical signals</a> neurons produce after memory formation, what triggers these changes has been unclear.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Image of magenta-colored neurons in a live fish brain, with the synapses colored in green" src="https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=766&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=766&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=766&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=963&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=963&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440053/original/file-20220110-27-14nulz7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=963&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Neurons in a live fish brain, with synapses colored green.</span>
<span class="attribution"><span class="source">Zhuowei Du and Don B. Arnold</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Biomedical engineer <a href="https://scholar.google.com/citations?user=z040dHgAAAAJ&hl=en">Don Arnold</a> of the University of Southern California and his colleagues took a mapping approach. They <a href="https://theconversation.com/where-are-memories-stored-in-the-brain-new-research-suggests-they-may-be-in-the-connections-between-your-brain-cells-174578">compared 3D maps of zebrafish synapses</a> before and after memory formation – namely, learning to associate a light with an unpleasant stimulus. They found that one brain region gained synapses while another’s were destroyed, indicating that associative memories may be a result of the formation and loss of connections among neurons.</p>
<p>These findings imply that it might one day be possible to treat conditions like PTSD by physically erasing the associative memory linking a harmless trigger with a traumatic experience. More research is needed, and there are obvious ethical considerations to address. “Nevertheless,” Arnold wrote, “it’s tempting to imagine a distant future in which synaptic surgery could remove bad memories.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/where-are-memories-stored-in-the-brain-new-research-suggests-they-may-be-in-the-connections-between-your-brain-cells-174578">Where are memories stored in the brain? New research suggests they may be in the connections between your brain cells</a>
</strong>
</em>
</p>
<hr>
<h2>4. Seizures hijack memory pathways</h2>
<p><a href="https://www.epilepsy.com/what-is-epilepsy/understanding-seizures">Seizures</a> are sudden surges of electrical activity in the brain. People who experience temporal lobe seizures are sometimes unable to remember what happened immediately prior. This may be due to disruptions to the circuitry in the hippocampus, the part of the temporal lobe key to memory consolidation.</p>
<p>Neurology researchers <a href="https://scholar.google.com/citations?user=bjrXv58AAAAJ&hl=en&oi=ao">Anastasia Brodovskaya</a> and <a href="https://scholar.google.com/citations?user=nMb-pTcAAAAJ&hl=en">Jaideep Kapur</a> of the University of Virginia hypothesized that seizures can cause memory loss by <a href="https://theconversation.com/seizures-can-cause-memory-loss-and-brain-mapping-research-suggests-one-reason-why-172280">using the same pathways</a> the brain uses to process memories. They mapped the neurons of mice learning to navigate a maze and during induced seizures, finding that both cases activated the same brain circuits.</p>
<p>“Because they use the same brain pathways, seizures can disrupt the memory consolidation process by taking over the circuit,” they wrote. “This meant that seizures can hijack the memory pathways and cause amnesia.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/seizures-can-cause-memory-loss-and-brain-mapping-research-suggests-one-reason-why-172280">Seizures can cause memory loss, and brain-mapping research suggests one reason why</a>
</strong>
</em>
</p>
<hr>
<h2>5. What the nose knows</h2>
<p>What the eye can’t see, the nose can for many organisms. From dogs to mosquitoes, many animals behave in ways that allow them to detect and pursue an odor long before its source comes into view.</p>
<p>Scientists <a href="https://scholar.google.com/citations?user=wn_f7y0AAAAJ&hl=en">John Crimaldi</a>, <a href="https://scholar.google.com/citations?user=JEi-fdoAAAAJ&hl=en">Brian Smith</a>, <a href="https://www.bbe.caltech.edu/people/elizabeth-j-hong">Elizabeth Hong</a> and <a href="https://scholar.google.com/citations?user=GpkJjVUAAAAJ&hl=en">Nathan Urban</a> of the <a href="https://www.odor2action.org/">Odor2Action</a> research network use technology to study olfaction, or sense of smell. They <a href="https://theconversation.com/from-odor-to-action-how-smells-are-processed-in-the-brain-and-influence-behavior-173811">trace how the shape of an odor plume</a> informs how it will be detected, how those odor molecules are translated into electrical signals in the brain, and how these electrical signals are reformatted into useful information that influence behavior.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MyHR6a-zJM0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">This video from the Wachowiak Lab at the University of Utah shows the activity of the olfactory bulb in a mouse brain. Each odor the mouse is exposed to makes different combinations of neurons light up.</span></figcaption>
</figure>
<p>A better understanding of the olfactory system, they wrote, can lead to the development of <a href="https://doi.org/10.1177%2F0278364908095118">electronic noses</a> that make searching for chemical weapons and disaster victims safer for people and animals. They also believe that examining the olfactory system can help advance study of the brain. “Its relative simplicity is what allows scientists like us to study it from end to end and learn how the brain works as a whole,” they wrote.</p>
<p>While a grand unified theory of the brain still remains elusive, new tools and techniques are helping researchers excavate its hidden depths. As Crimaldi and his team put it, “An exciting future in scientific and medical development, we believe, is right under our noses.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-odor-to-action-how-smells-are-processed-in-the-brain-and-influence-behavior-173811">From odor to action – how smells are processed in the brain and influence behavior</a>
</strong>
</em>
</p>
<hr>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/187607/count.gif" alt="The Conversation" width="1" height="1" />
From figuring out where memories are stored to how sensory information translates to behavior, new technologies are helping neuroscientists better understand how the brain works.Vivian Lam, Associate Health and Biomedicine EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1847242022-08-02T16:11:03Z2022-08-02T16:11:03ZWhat epilepsy teaches us about diversity and resilience<figure><img src="https://images.theconversation.com/files/476338/original/file-20220727-1405-kljymn.jpg?ixlib=rb-1.1.0&rect=26%2C33%2C4466%2C2957&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Epilepsy is characterized by spontaneous and recurrent seizures, often triggered by stress or visual stimuli.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>There is a growing recognition of the importance of equity, diversity and inclusion in society and its institutions. The most progressive, leading-edge organizations consider the diversity of people to be <a href="https://www.canada.ca/en/treasury-board-secretariat/corporate/reports/building-diverse-inclusive-public-service-final-report-joint-union-management-task-force-diversity-inclusion.html">essential to the success, growth, innovation and development of a society</a>.</p>
<p>The benefits of diversity, however, are far from exclusive to human organizations; heterogeneity and variability are design principles central to all complex natural systems, whether they are <a href="https://doi.org/10.1155/2018/3421529">ecological, cellular or genetic networks</a>.</p>
<p>Whether we are talking about an ecosystem, society or the brain, how does this diversity relate to the functioning and stability of a complex system?</p>
<p>As neuroscientists, our interdisciplinary research and clinical work has drawn us to the incredible complexity and richness of the human brain and natural systems. We seek not only to better understand how the brain’s circuitry works, but also to develop new treatments for neurological diseases such as epilepsy.</p>
<h2>Diversity means resilience</h2>
<p><a href="https://tile.loc.gov/storage-services/service/rbc/rbctos/2017gen17473/2017gen17473.pdf">First developed by Darwin</a>, the idea that diversity leads to stability and survival has been <a href="https://www.hindawi.com/journals/complexity/2018/3421529/">debated by scientists from many disciplines for over a century</a>. The ability of natural systems to resist change is a characteristic known as resilience. This fundamental characteristic emerges from interactions between members of the same system — such as species in an ecosystem, individuals in a group or cells in an organism — and enables it to maintain its functions over time.</p>
<p>Resilience is tested by change. Some ecosystems can adapt to the extinction of specific species or to drought. Some virtual communities or social networks can withstand cyberattacks. Some organizations can continue to operate in the wake of conflict, war, political revolution or … pandemic. </p>
<p>In light of these common examples — and many others related to the social or natural sciences — it is now more important than ever to understand the role played by diversity in maintaining the resilience of complex systems.</p>
<p>What if clues to the answer lie in the circuits of the brain, specifically in a brain with epilepsy?</p>
<h2>Tipping over in an electrical storm</h2>
<p>For several years, our interdisciplinary team has been studying epilepsy, <a href="https://doi.org/10.1046/j.1528-1157.43.s.6.1.x">the most common severe neurological disorder</a>. Epilepsy is characterized primarily by the apparently spontaneous and recurrent occurrence of seizures, often triggered by stress or visual stimuli (<a href="https://doi.org/10.1016/j.cub.2017.03.067">such as flashing lights or specific images</a>). Recent research has also shown that <a href="https://doi.org/10.1038/s41467-017-02577-y">the frequency of these seizures can vary with the time of day or month</a>, depending on the individual’s sleep-wake cycle, for example.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman holding herself against a wall with one hand and her head with the other while she appears to be having a seizure" src="https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466391/original/file-20220531-22-o8z5oe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Epilepsy is the most common serious neurological disorder.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In this light, a brain with epilepsy can be seen as fragile and not resilient, regularly tipping into an electrical storm. Thus, rather than adapting normally to changes, neurons become disproportionately active and synchronous, and the resulting intense electrical activity spreads, disrupting brain function.</p>
<p>Because of the significant impact of these seizures on patients and their families, our team has been relentlessly studying the circuits responsible for triggering them and exploring ways to prevent them.</p>
<p>What does diversity have to do with epilepsy? Our team recently measured the activity of neurons in people with epilepsy. We found that neurons in the brain regions responsible for triggering seizures <a href="https://doi.org/10.1016/j.celrep.2022.110863">were much less diverse than those in regions not responsible for seizures</a>. These neurons were strangely similar to each other, showing highly similar characteristics and responses.</p>
<p>Could this lack of diversity explain why seizure-prone brains are less resilient?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1529117822298775553"}"></div></p>
<h2>Mathematical models to the rescue</h2>
<p>To answer this complex question, we turned to mathematics. What if, through mathematical models of brain circuitry, we could understand how neural diversity (or the lack thereof) predicts seizure resilience? Could we determine whether neuronal diversity promotes resilience in the brain?</p>
<p>Using our equations, we found that when diversity was too low, seizure-like activity would spontaneously emerge: <a href="https://doi.org/10.1016/j.celrep.2022.110863">the activity of the neurons would become vulnerable to sudden change in synchrony</a>, reminiscent of what we observe during seizures. These results are unequivocal: low diversity made these neuronal circuits fragile, poorly resilient and unable to maintain the type of activity required to preserve brain function.</p>
<p>What do these result mean? They provide key insights about the role played by different types of neurons in maintaining brain function. </p>
<p>These results are helping us look at neurological diseases such as epilepsy differently than we did before, potentially opening up new avenues on how to treat them. Our approach of using interdisciplinary methods and mathematics allows us to go further and understand better how diversity increases resilience, providing invaluable cues and answering hard questions such as: Is there an optimal level of diversity? What are the different types of diversities and do they all promote stability equally? Could we enhance resilience by promoting neuronal diversity through targeted therapeutic interventions?</p>
<p>Most importantly, our results also provide a powerful reminder of the primordial role diversity plays in the robustness of systems in the face of change: which holds true not only for neurons and circuits, but for humans and collectives as well. Variety truly is the spice of life.</p><img src="https://counter.theconversation.com/content/184724/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jérémie Lefebvre has received funding from the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Institutes of Health Research (CIHR).</span></em></p><p class="fine-print"><em><span>Taufik A. Valiante has received funding from the Krembil Brain Institute, and the Natural Sciences and Engineering Research Council of Canada (NSERC).</span></em></p>Our team studied the activity of neurons in people with epilepsy. Neurons in the brain regions responsible for triggering seizures were much less diverse.Jérémie Lefebvre, Professeur agrégé de neurosciences computationnelles et neurophysiologie, L’Université d’Ottawa/University of OttawaTaufik A. Valiante, Neurosurgeon/neuroscientist, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1847402022-07-21T12:25:29Z2022-07-21T12:25:29ZSilent, subtle and unseen: How seizures happen and why they’re hard to diagnose<figure><img src="https://images.theconversation.com/files/470665/original/file-20220623-64215-3tfegq.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C5104%2C3380&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Approximately 10% of people will experience at least one seizure during their lifetime.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/brain-and-brain-waves-in-epilepsy-royalty-free-illustration/973895626?adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p>The dramatic and incapacitating nature of seizures is reflected in the word itself, which derives from the Greek “to take hold” – like an invisible force suddenly grasping someone and controlling their body. This sense of an unknown force has driven many superstitions and misrepresentations of seizures throughout history.</p>
<p>Over the past century, the public’s understanding of seizures has been gleaned mostly from depictions in movies and television, which are often as disturbing as they are inaccurate. While these dramatic representations intensify visual storytelling, they frequently perpetuate stigma and <a href="https://doi.org/10.1111/j.1528-1157.1999.tb00836.x">understate the complexity of seizures</a>. </p>
<p>The truth is, seizures are far more varied than what you see in popular culture. Instead, they are often subtle, silent and unseen.</p>
<p><a href="https://som.ucdenver.edu/Profiles/Faculty/iframeProfile/30305">As a neurologist</a> who focuses on the comprehensive care of people who experience seizures, I subspecialize in the treatment of those with epilepsy. That includes identifying and improving gaps in epilepsy care. Research shows there are many.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PG12JfJJW9U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Epilepsy is a complex condition, but it is also treatable.</span></figcaption>
</figure>
<h2>Why seizures occur</h2>
<p>A seizure is caused by sudden uncontrolled <a href="https://www.cureepilepsy.org/for-patients/understanding/basics/what-is-seizure/?">electrical activity from a group of neurons</a>. This hyperactivity overwhelms the brain’s normal tendency to suppress such abnormal activity on both a cellular and network level. </p>
<p>Not all seizures are indicative of epilepsy. An otherwise normal brain may experience seizures during alcohol withdrawal. Seizure-like events may also occur with an acute decrease in blood flow, which can cause fainting. </p>
<p>Seizures associated with epilepsy, on the other hand, are <a href="https://www.epilepsydiagnosis.org/">unprovoked and often very difficult to predict</a>. A broad spectrum of underlying abnormalities can all lead to the development of epileptic seizures, including brain tumors, infections, strokes, traumatic brain injury, autoimmune conditions, developmental abnormalities and genetic predispositions.</p>
<h2>Seizures are not uncommon</h2>
<p>Approximately 1 in 10 people <a href="https://doi.org/10.1212/WNL.40.8.1163">will experience a seizure</a> during their lifetime. But only those with a risk of recurrent unprovoked seizures are <a href="https://doi.org/10.1111/epi.13670">considered to have epilepsy</a>, which represents about <a href="https://doi.org/10.1111/J.1528-1157.1993.TB02586.X">1 in 26 people</a></p>
<p>Because of the wide variety of symptoms, substantial <a href="https://doi.org/10.1007/s11910-021-01161-8">delays to diagnosis and treatment</a> can happen. When unrecognized and untreated, seizures worsen over time and lead to <a href="https://doi.org/10.1016/j.yebeh.2015.10.020">decreased quality of life</a>, <a href="https://doi.org/10.1111/epi.16707">cognitive impairments</a>, <a href="https://doi.org/10.1111/j.1528-1157.1995.tb01660.x">injuries, including motor vehicle accidents</a>, and <a href="https://doi.org/10.1093/brain/awt117">sometimes death</a>. </p>
<p>The irony is, much of the suffering is unnecessary. Most people with epilepsy <a href="https://doi.org/10.1111/j.1528-1167.2009.02481.x">can be seizure-free</a> through the use of an inexpensive medication.</p>
<h2>Focal seizures</h2>
<p>Regardless of the cause, <a href="https://doi.org/10.1111/j.1528-1167.2009.02481.x">focal seizures</a> are the most common type found in adults. This seizure type arises from hyperactivation of a confined brain region. For instance, a seizure arising from the left motor cortex of the brain may result in shaking of the right arm. A seizure arising from the visual cortex may cause a person to see flashes of light or other strange visual phenomena. </p>
<p>The most common brain region for focal seizures to arise is one of the temporal lobes, of which there are two – one on either side of the brain. These lobes serve many functions and are involved in vocal, auditory and visual processing, as well as emotions and memory. This is why seizures arising from these areas can lead to a variety of unusual symptoms.</p>
<p>Frequently, focal temporal lobe seizures are relatively subtle, particularly to witnesses. Sometimes they are comprised of purely unusual internal sensations such as sudden intense fear, a sudden sense of déjà vu or possibly a strong odor. Until a seizure spreads to involve more areas of the brain, it may not cause loss of consciousness or convulsions.</p>
<p>Because untreated seizures become more frequent and severe over time, it is not uncommon for epilepsy to begin with these relatively subtle focal seizures, then worsen as the seizures begin to involve more brain tissue, and eventually progress to convulsions.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/W_uXaXwVQ4c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">People affected by epilepsy discuss the myths surrounding the condition.</span></figcaption>
</figure>
<h2>Delays in diagnosis</h2>
<p>A patient of mine described having strange symptoms for over a decade – symptoms he had not discussed before with me or anyone else. He described recurrent, sudden-onset euphoric sensations, which progressed to an inability to speak for one to two minutes. A bystander would think he was just staring into space. Over the years, these sensations increased in frequency. They eventually became more severe and led to loss of consciousness. </p>
<p>After the patient began an anti-seizure medication regimen, the sensations went away, and he reported improvements in both memory and cognition. Fortunately, he did not experience physical injury, or worse, before his evaluation. But many people are not so lucky.</p>
<p>Recent studies have confirmed that <a href="https://doi.org/10.1002/epi4.12443">delays in diagnosis are common</a> among people who have epilepsy. Undoubtedly, this is because the early subtle and unusual symptoms are not well recognized by patients, families or medical professionals. </p>
<h2>A revealing study</h2>
<p><a href="http://www.humanepilepsyproject.org/">The Human Epilepsy Project</a> is a large, multinational prospective study that followed nearly 500 people with newly treated focal epilepsy for five years. I was among the researchers who analyzed the study’s data, and we found a striking diagnostic delay among many participants. Many of them experienced seizures for <a href="https://doi.org/10.1111/epi.16707">several months or even several years before diagnosis</a>. </p>
<p>From those first seizures to the diagnosis, half the participants experienced injuries; 5% had car accidents attributable to seizures. Extrapolating this data to the general population suggests that every year in the U.S., over 1,800 motor vehicle accidents are due to <a href="https://doi.org/10.1111/epi.16707">undiagnosed subtle focal seizures</a>. With a timely diagnosis, these accidents are potentially preventable.</p>
<p>However, even those evaluated for seizures don’t always receive the correct diagnosis or treatment. Nearly two-thirds of those participating in the Human Epilepsy Project sought an initial seizure evaluation in an emergency department. About 90% were there only after their first convulsive seizure – that is, after the seizure spread and now involved the full brain. </p>
<p>But leading up to that first convulsive seizure, nearly half of participants had been experiencing nonmotor focal seizures, which went largely unrecognized. For that reason, many people who <a href="https://doi.org/10.1111/acem.14114">could have been diagnosed with epilepsy</a> and started on treatment were not. </p>
<p>As it stands now, about 200,000 U.S. adults <a href="https://doi.org/10.1111/j.1528-1167.2008.01443.x">seek evaluation at a hospital’s emergency department</a> for a first lifetime seizure every year. Often, they are diagnosed with epilepsy at that time or shortly thereafter. Poor recognition of subtle seizures bears significant consequences for individuals, communities and the health care system. Improving our understanding of the diverse ways seizures arise and affect lives will help us close the gap and lessen the consequences.</p><img src="https://counter.theconversation.com/content/184740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacob Pellinen receives funding in the form of grants from the University of Colorado Department of Neurology, NIH/NCATS Colorado CTSA Grant Number UL1 TR002535, and from the American Epilepsy Society.</span></em></p>Because some seizures are relatively subtle, they can go unrecognized, leading to a delay in diagnosis.Jacob Pellinen, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722802022-02-01T13:14:03Z2022-02-01T13:14:03ZSeizures can cause memory loss, and brain-mapping research suggests one reason why<figure><img src="https://images.theconversation.com/files/443023/original/file-20220127-4399-lt0flk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1732%2C1732&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In addition to memory loss, seizures can result in a complete loss of consciousness.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/digital-artwork-of-human-mental-energy-royalty-free-illustration/1283557418">pressureUA/iStock via Getty Images Plus</a></span></figcaption></figure><p><a href="https://doi.org/10.1016/j.eplepsyres.2017.11.015">Epilepsy</a> is a disease marked by recurrent seizures, or sudden periods of abnormal, excessive or synchronous neuronal activity in the brain. <a href="https://www.epilepsy.com/make-difference/public-awareness/1-26#">One in 26 people</a> in the U.S. will develop epilepsy at some point in their life. While people with mild seizures might experience a brief loss of awareness and muscle twitches, more severe seizures could last for several minutes and lead to injury from falling down and losing control of their limbs. </p>
<p>Many people with epilepsy also experience memory problems. Patients often experience retrograde amnesia, where they cannot remember what happened immediately before their seizure. Electroconvulsive therapy, a form of treatment for major depression that intentionally triggers small seizures, can also <a href="https://doi.org/10.1016/j.jad.2011.02.026">cause retrograde amnesia</a>. </p>
<p>So why do seizures often cause memory loss?</p>
<p>We are <a href="https://scholar.google.com/citations?user=bjrXv58AAAAJ&hl=en&oi=ao">neurology</a> <a href="https://scholar.google.com/citations?user=nMb-pTcAAAAJ&hl=en">researchers</a> who study the mechanisms behind how seizures affect the brain. Our <a href="https://doi.org/10.1016/j.pneurobio.2020.101984">brain-mapping study</a> found that seizures affect the same circuits of the brain responsible for memory formation.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LcO9YU-Pdws?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">One of the earliest descriptions of seizures was written on a Babylonian tablet over 3,000 years ago.</span></figcaption>
</figure>
<h2>Why do seizures cause memory loss?</h2>
<p>Seizures can be caused by a number of factors, ranging from <a href="https://www.epilepsy.com/learn/epilepsy-due-specific-causes/structural-causes-epilepsy">abnormalities in brain structure</a> and <a href="https://www.epilepsy.com/learn/epilepsy-due-specific-causes/genetic-causes-epilepsy">genetic mutations</a> to <a href="http://scitechconnect.elsevier.com/connections-between-infections-seizures">infections</a> and <a href="https://rarediseases.info.nih.gov/diseases/11979/autoimmune-encephalitis">autoimmune conditions</a>. Often, the root cause of a seizure <a href="https://dx.doi.org/10.4103%2Fjfmpc.jfmpc_322_16">isn’t known</a>.</p>
<p>The most common type of epilepsy involves seizures that originate in the brain region located behind the ears, the <a href="https://emedicine.medscape.com/article/1184509-overview">temporal lobe</a>. Some patients with temporal lobe epilepsy experience retrograde amnesia and are unable to recall events immediately before their seizure. </p>
<p>This may be because these seizures affect the <a href="https://doi.org/10.1016/0301-0082(91)90011-O">hippocampus</a>, a region in the temporal lobe important for memory storage and processing. During sleep, the hippocampus transmits new information learned during the day to another part of the brain called the cerebral cortex in order to consolidate it into new memories. This process occurs through many brain pathways connecting the hippocampus to the cortex. </p>
<p>With this in mind, our research group wondered if the electrical signals of seizures might also follow the same routes the brain uses for memory consolidation instead of creating their own separate path. We reasoned that disruption of this pathway might cause memory loss.</p>
<p>To figure this out, we trained mice to navigate a T-shaped maze to find a reward of sweetened condensed milk. The mice had to learn how to alternate between the left and the right arm of maze in a specific pattern to be given milk. When the mice were able to obtain the milk 80% of the time, we determined that the mice had successfully consolidated their memory of how to navigate the maze.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/cL7H5Sxw1KM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">T mazes are used to assess spatial learning and memory.</span></figcaption>
</figure>
<p>Fifteen minutes after the mice successfully learned how to navigate the maze, we injected them with a drug that causes seizures. The day following the seizure, we found that the mice performed poorly on the maze, as though they hadn’t learned how to navigate it in the first place. This confirmed that a single seizure was enough for the mice to forget what they learned just before the seizure. </p>
<p>Our next step was to figure out why seizures caused the mice to forget what they learned. To identify which parts of the brain were active during the learning process and during seizures, we used genetically engineered mice whose neurons produce a red protein when activated. We mapped the neurons of these mice as they were learning how to navigate the maze and during the induced seizures. In analyzing these maps, we found that learning and seizures activated the same brain circuits in the hippocampus and cortex. Because they use the same brain pathways, seizures can disrupt the memory consolidation process by taking over the circuit. This meant that seizures can hijack the memory pathways and cause amnesia.</p>
<p>Because memory is networked throughout the brain, memory impairments might not necessarily stem just from interference in the hippocampus alone. Future studies on other brain regions will further clarify how seizures cause memory loss.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/172280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaideep Kapur receives funding from the NIH and the University of Virginia. He is the chair of the International League against Epilepsy North America, a member of the Board of Directors of the American Epilepsy Society, and a member of the Scientific Advisory Committee of the CURE Epilepsy Foundation.</span></em></p><p class="fine-print"><em><span>Anastasia Brodovskaya does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people with epilepsy are unable to remember what happened immediately before they have a seizure. This may be because seizures and memory use the same pathways of the brain.Anastasia Brodovskaya, Postdoctoral Fellow in Neurology, University of VirginiaJaideep Kapur, Professor of Neuroscience and Neurology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1324262020-05-10T11:59:21Z2020-05-10T11:59:21ZPediatricians seeing a growing demand for medical cannabis for kids<figure><img src="https://images.theconversation.com/files/333398/original/file-20200507-49584-1rf7oga.jpg?ixlib=rb-1.1.0&rect=241%2C30%2C6176%2C4084&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are only a handful of conditions in which evidence supports the use of medical cannabis in children.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Most Canadian pediatricians are shying away from medical cannabis for patients, knowing that it can hurt the developing brain and that there isn’t much research to guide them.</p>
<p>But physicians say they are getting increasing requests for cannabis from parents, for a growing list of conditions.</p>
<p>Dr. Adam Rapoport, medical director of the pediatric palliative care team at the <a href="http://www.sickkids.ca/index.html">Hospital for Sick Children</a> in Toronto, says, “This is mostly driven by parents, and doctors have fallen behind.”</p>
<p>Lauren Kelly agrees. “It’s happening and we’re playing catch-up.” </p>
<p>Kelly is a pharmacologist and scientific director of the <a href="https://www.pharmalauren.com/uploads/1/2/2/7/122772561/c4t_workshop_report_vfinal_.pdf">Canadian Childhood Cannabinoid Clinical Trials</a>, a national research consortium. Her group is working quickly to develop answers to questions about cannabis for children. “The use of it has far outpaced the evidence, and that’s the biggest challenge.”</p>
<p>Fifty per cent of <a href="https://www.cpsp.cps.ca/publications">pediatricians surveyed</a> in 2017 had at least one patient who had used cannabis for medical reasons in the past year. But the cannabis use is not stemming from prescriptions (called physician authorizations). Only four per cent of pediatricians said they had authorized medical cannabis for one of their patients. </p>
<h2>Research still lacking for many conditions</h2>
<p>Since then, pediatricians like Dr. Daniel Flanders, director of <a href="https://kindercarepediatrics.ca">Kindercare Pediatrics in Toronto</a>, say that requests have grown only more frequent and the reasons for the requests more diverse.</p>
<p>Flanders is asked about medical cannabis at least two to three times a week for issues such as chronic pain, mental health issues, arthritis, ADHD and sleep problems.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&rect=1064%2C425%2C4390%2C3039&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333000/original/file-20200506-49584-kskyp4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In a survey, only four per cent of pediatricians said they had authorized medical cannabis for one of their patients.</span>
<span class="attribution"><span class="source">(AP Photo/Gerald Herbert)</span></span>
</figcaption>
</figure>
<p>But there are only a very few conditions for which the science is solid when it comes to using cannabis in children.</p>
<p>Pointing to a handful of well-executed randomized controlled trials and a recent systematic <a href="https://doi.org/10.1111/epi.14608">review</a> of the literature on medical cannabis for complex pediatric seizure disorders, Dr. Evan Lewis, a pediatric neurologist in Toronto, says there is very good evidence supporting its use in certain seizure conditions, such as <a href="https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs">Lennox-Gastaut syndrome</a>, <a href="https://www.epilepsy.com/learn/types-epilepsy-syndromes/dravet-syndrome">Dravet syndrome</a> and <a href="https://www.tscanada.ca/">tuberous sclerosis</a>.</p>
<p>“Outside of that, it is kind of extrapolating from the evidence and using less robust evidence in the literature,” he says.</p>
<p>That’s not stopping some parents and physicians from pushing the boundaries.</p>
<p>It’s a path worth taking in some cases, Lewis says.</p>
<p>Lewis is now using cannabis for other types of seizures, and also authorizes cannabis in select cases for a range of conditions such as migraines, concussions, sleep problems, autism, tics, movement disorders and behavioural problems in children with neurological conditions. It’s also being used in Canada for symptom relief in palliative care, chronic pain disorders, spasticity, incurable malignancies and ADHD.</p>
<p>But Lewis says that the research is not as high-quality as he would like, and for many conditions, does not exist at all.</p>
<h2>Dosing issues</h2>
<p>Another difficulty is that standard dosing has not been established and experimental cannabis protocols often use purified cannabidiol (CBD), a compound in marijuana with no psychoactive effects.</p>
<p>This type of CBD-only preparation is not available for patients in Canada, so physicians have to choose products that contain both CBD and the compound delta-9-tetrahydrocannabinol (THC), which is psychoactive and gives users a high.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319789/original/file-20200311-116240-1cvog1a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A parent holds a bottle of cannabis oil used to treat her son’s seizures caused by Dravet syndrome.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>Dr. Richard Huntsman, pediatric neurologist at the University of Saskatchewan, is part of a team trying to solve the problem of <a href="https://doi.org/10.3389/fneur.2019.00716">dosing regimens</a> for children with complex seizure disorders. In addition to establishing a target dose using oils, his study also measured CBD and THC levels in the blood and showed that these levels remained low. The study used an oil that contained 20 parts CBD to one part THC. </p>
<p>“People are very worried about their kids getting high,” he said, but based on these results, he adds, this is “not so much of a worry,” at least in this population.</p>
<p>And contrary to common belief, he found that the medication appeared to help with cognitive function, instead of impairing it. He is cautious though, and warns that the study was done in a small number of children.</p>
<h2>Guidelines in development</h2>
<p>With the cannabis landscape changing quickly in Canada, doctors are looking for advice. The Canadian Paediatric Society plans to publish guidance documents this summer, according to its cannabis working group co-chair, Dr. Christina Grant, an adolescent health specialist at McMaster Children’s Hospital.</p>
<p>In the meantime, she says that every day, she advises teens in her Hamilton office that cannabis is not a good treatment option for anxiety and depression.</p>
<p>“The effect is the opposite,” she says, noting that one-sixth of youth who experiment with cannabis, even for self-medication, <a href="https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Effects-of-Cannabis-Use-during-Adolescence-Report-2015-en.pdf">develop cannabis use disorder</a>.</p>
<p>While physicians await the recommendations, Kelly says that her research consortium has launched five new clinical trials of medical cannabis in kids, and other Canadian research groups are quickly trying to play catch-up as well.</p>
<p>“I certainly don’t think it can be the cure-all. It’s not magic. But there are some areas that are showing promise … we should be investing in research,” says Kelly.</p><img src="https://counter.theconversation.com/content/132426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Ward does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pediatricians say they are getting increasing requests from parents for medical cannabis for kids for a growing list of conditions.Michelle Ward, Academic Pediatrician & Journalist, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188042019-07-25T12:55:03Z2019-07-25T12:55:03ZCBD and genetic testing provide hope for ‘intractable’ epilepsy in children<figure><img src="https://images.theconversation.com/files/282921/original/file-20190705-51258-fawlut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A child with epilepsy during a seizure.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2MjM4ODExNywiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTAyMzEzNzEzNyIsImsiOiJwaG90by8xMDIzMTM3MTM3L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJPcUxIZUlQakJxMStEVGVkUFd6ZjhyZ2ZzVDAiXQ%2Fshutterstock_1023137137.jpg&pi=33421636&m=1023137137&src=pzfZOgU7zal9-hDGIZqOKg-1-59">www.shutterstock.com</a></span></figcaption></figure><p>It can start with a vacant stare, what appear to be muscle twitches or a full-blown seizure. But no matter how it begins, any time a child is diagnosed with epilepsy is often a frightening time for families.</p>
<p>About <a href="https://www.cdc.gov/epilepsy/data/index.html">470,000 children are living with epilepsy</a> in the U.S. While there are over a dozen anti-seizure medications that can be prescribed, approximately <a href="https://www.massgeneral.org/childhood-epilepsy/medical/treatment.aspx">30%</a> of children don’t respond. These children have what medical professionals call intractable, or uncontrollable, epilepsy.</p>
<p><a href="https://scholar.google.com/citations?user=RQGyTlAAAAAJ&hl=en">As a postdoctoral scholar</a> in the lab of <a href="http://www.dullalab.org/">Chris Dulla</a> at the Sackler School of Graduate Biomedical Sciences at Tufts University, I focus on researching a form of epilepsy called infantile spasms. These spasms in infants can develop into intractable epilepsy and other more severe forms if the seizures are not stopped.</p>
<p>Recently, promising advances have been made in the field of epilepsy treatment with the development of cannabidiol-derived <a href="https://theconversation.com/approval-of-drug-derived-from-cannabis-not-necessarily-a-win-for-weed-99018">drugs</a> and the rise of genetic testing. I believe these advances are paving the way to provide treatment options for children with intractable epilepsy.</p>
<h2>What is childhood epilepsy?</h2>
<p>Epilepsy is <a href="https://www.ilae.org/guidelines/definition-and-classification/definition-of-epilepsy-2014">usually diagnosed</a> when a person has two or more seizures, greater than 24 hours apart. Medically, a seizure is defined as when abnormal electrical activity occurs in the brain but to an average person it sometimes can be difficult to detect. It might look like a blank stare, or in the case of infantile spasms, muscle twitching. Other times it might be easy to spot because the individual may collapse and shake.</p>
<p>Epilepsy can be genetic; there are over <a href="https://www.nature.com/articles/nrdp201824">500 genes</a> that have been associated with the disorder. </p>
<p>The most common type of childhood epilepsy, <a href="https://www.epilepsy.com/learn/types-epilepsy-syndromes/juvenile-myoclonic-epilepsy">juvenile myoclonic epilepsy</a> (JME), tends to be inherited from family members but at least 50% of individuals with JME do not have mutations in genes associated with epilepsy. This makes JME hard to treat, because without a mutation to help guide treatment options, doctors may have to test multiple medications before finding one that stops the seizures. JME can also be intractable.</p>
<p>Epilepsy can also be caused by traumatic brain injury, infection, fevers and autoimmune disease, known as acquired epilepsy. In about <a href="https://www.epilepsy.com/learn/professionals/about-epilepsy-seizures/idiopathic-generalized-epilepsies">30%</a> of all people, a cause for epilepsy cannot be identified. </p>
<p>Intractable epilepsy is particularly vexing for researchers and families. It is diagnosed after a physician has usually tried multiple anti-seizure drugs (ASD) without success. Sometimes, ASDs can decrease seizure frequency, but not completely stop them from occurring. In these cases, children still might be prescribed medication as well as alternative treatment options. </p>
<h2>How Do We Treat Epilepsy?</h2>
<p>In childhood epilepsy, it is especially important to diagnose and stop seizures as soon as possible because their severity can worsen over time and cause <a href="https://www.massgeneral.org/childhood-epilepsy/medical/diagnosis.aspx">developmental delays</a>. </p>
<p>Many ASDs act by decreasing the excitability in the brain. But some individuals can become tolerant to their ASDs over time, making the drugs ineffective. The exact reasons for this remain unclear. Severe side effects can also include mood swings, irritability, vision impairment and sleepiness. </p>
<p>Many ASDs also have to be taken multiple times a day. In children, this can make it difficult to stick to a treatment because it becomes disruptive to daily life.</p>
<p>Yet there is hope for children whose drugs stop working, or who have intractable epilepsy.</p>
<p>One increasingly prescribed therapy is the <a href="https://journals.sagepub.com/doi/10.5698/1535-7597-13.2.103">ketogenic diet</a>. This is a medically prescribed, strict, high-fat diet that is an alternative treatment for children with intractable epilepsy. Researchers do not know exactly why the ketogenic diet stops seizures. It is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902940/">thought</a> that eating a 4:1 ratio of fat to carbohydrate forces the body to burn molecules called ketones for energy instead of carbohydrates. While this diet is effective, food preparation is very time-consuming and children may not stick to it because they cannot enjoy many popular snack foods.</p>
<h2>Advances in epilepsy treatment</h2>
<p>Advances in genetic testing technology have allowed for more genetic mutations to be identified in children with epilepsy. This can enable doctors to select ASDs that target specific mutations. Genetic screens could also identify previously undiscovered mutations associated with epilepsy and help lead to new drug development.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282919/original/file-20190705-51258-13olxus.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A parent holds up a bottle of cannabis-infused oil used to treat her 4-year-old daughter who suffers from severe epilepsy.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Medical-Marijuana-Kids/9db7d65d723f422c90030ddc57e7ac67/48/0">Brennan Linsley/AP</a></span>
</figcaption>
</figure>
<p>Recently, the use of CBD derivatives has gained popularity as a treatment for intractable epilepsy. These CBD products are derived from hemp plants and do not contain psychoactive compounds. They have been <a href="https://www.nejm.org/doi/10.1056/NEJMoa1611618">shown</a> to be effective in reducing seizures but it was not until last year that the Food and Drug Administration approved a CBD drug for childhood epilepsy, called Epidiolex. While the exact mechanism of action for CBD is unknown, it is thought to generally <a href="https://www.gwpharm.com/healthcare-professionals/research/mechanism-action#">increase inhibition</a> of brain cell activity to stop seizures. </p>
<p><a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">Epidiolex</a> has less severe side effects compared to current ASDs and is effective in reducing seizures in two types of intractable epilepsy. A 2019 <a href="https://www.nature.com/articles/s41598-019-44056-y">study</a> also showed that H2CBD, a similar drug, is able to reduce seizures with the same efficacy as CBD. This study, however, was only done on rats and much more research is needed before it is known if it will work on children with intractable epilepsy.</p>
<p>In 2019, the FDA <a href="https://www.ucb.com/stories-media/Press-Releases/article/UCB-announces-NAYZILAM-midazolam-nasal-spray-now-approved-by-FDA-to-treat-intermittent-stereotypic-episodes-of-frequent-seizure-activity-in-people-living-with-epilepsy-in-the-U-S">approved</a> a new form of a previously approved ASD. Midazolam was already approved for use in adults in pill form but is now available as a nasal spray for adolescents. It treats <a href="https://www.ncbi.nlm.nih.gov/pubmed/10488906">seizure clusters</a>, which is a seizure emergency that can occur in children with intractable epilepsy. This is the first new medication that has been approved for this disorder in the United States in over 20 years. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<p>It has been over 100 years since the first ASD was developed, and there is much more that needs to be done in treating and curing juvenile epilepsy. Some children can grow out of their medication, but others may need to take medications for their entire lives. </p>
<p>However, with the increased use of genetic screens and the approval of new drugs, like Epidiolex, there is hope that one day we can stop seizures and cure childhood epilepsy.</p><img src="https://counter.theconversation.com/content/118804/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Isabel Derera does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>About 470,000 children in the US have epilepsy. Promising advances are being made in the field of epilepsy treatment for children.Isabel Derera, Postdoctoral Scholar, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1022892018-08-29T18:02:01Z2018-08-29T18:02:01ZBrain implant could stop epilepsy seizures<figure><img src="https://images.theconversation.com/files/234039/original/file-20180829-195328-f75rh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/344282432?src=0qMPwIzLEtNMAGGfywpNHw-1-88&size=medium_jpg">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>For many people who suffer from neurological disorders, such as epilepsy, there are no viable treatment options. In our <a href="http://advances.sciencemag.org/content/4/8/eaau1291">latest research</a>, we developed an implantable device that may one day offer relief. We show that the implant can treat problems in the brain, such as epileptic seizures, by delivering brain chemicals – known as neurotransmitters – directly to the cells in the brain that cause the problem.</p>
<p>The implant works by using an electric field to push neurotransmitters out of the device from an internal reservoir. This process, known as <a href="https://www.thoughtco.com/electrophoresis-definition-4136322">electrophoresis</a>, allows for precise control over the dose and timing of drug delivery, which is important for addressing intermittent disorders such as epilepsy. </p>
<p>This way of delivering drugs also has the advantage of not increasing the local pressure where the drug exits the device because the drug molecules are not in a solvent – they exit the device “dry”. This is important because it means the drug molecules (neurotransmitters in this case) can interact directly with the tissue surrounding the implant without causing damage to those cells or the surrounding tissue.</p>
<p>Researchers have <a href="http://advances.sciencemag.org/content/1/4/e1500039">previously shown</a> that this method for delivering drugs can be used to manage pain, with an implant that was placed in the spinal cord of rats. The novelty of our work, published in Science Advances, was to engineer an implant small enough to be implanted in the brain of mice. We also incorporated tiny sensors into the implant to allow us to monitor the local brain activity where the device was implanted. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/234041/original/file-20180829-195298-10bkxsr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Neurotransmitters are the brain’s chemical messengers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/432573415?src=dOOXsUyelZUo17hUgHiTKQ-1-1&size=medium_jpg">Andrii Vodolazhskyi/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Using the on-board sensors, we could see the onset of seizure-like activity in mice. After a seizure was detected, we told the implant to send out inhibitory neurotransmitters to the brain tissue at the centre of the seizures. The neurotransmitters tell the cells in that tissue to stop propagating the seizure message to other cells. This stopped the seizures.</p>
<p>After finding that we could stop seizures, we wanted to see if we could prevent seizures altogether, rather than stop them after they have started. To test this, we started delivering the neurotransmitters before a dose of seizure-inducing chemicals was injected into the brain with a separate implant. These experiments showed that our implant could prevent any seizure-like activity from happening.</p>
<h2>Platform technology</h2>
<p>We are very excited because this is the first time anyone has seen that an electrophoretic drug delivery device can stop or prevent seizure-like activity. Also, we see this as a platform technology that could be adapted to help treat many different neurological disorders including epilepsy, Parkinson’s disease and brain tumours.</p>
<p>It is important to note that, so far, this device has only been tested in mice and rats. Judging from the time it has taken for other technologies to go from this stage to widespread clinical use, it is likely to be at least a decade before this technology would be widely available for humans. During this time much work will be done to prove the long-term viability of these implants for treating epilepsy as well as other neurological disorders.</p><img src="https://counter.theconversation.com/content/102289/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Proctor receives funding from the University of Cambridge where he is a research associate and Borysiewicz Biomedical Sciences fellow in the Department of Engineering.
</span></em></p>New approach to preventing seizures proves effective in mice.Christopher Proctor, Research Associate in the Fabrication and Validation of Implantable Ion Pumps, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/977712018-06-06T14:33:00Z2018-06-06T14:33:00ZMedical cannabis and the challenge for regulation of medicines<figure><img src="https://images.theconversation.com/files/222017/original/file-20180606-137318-lqfc31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/733038691?size=huge_jpg&src=lb-59856941&sort=newestFirst&offset=4">Shutterstock</a></span></figcaption></figure><p><a href="https://yougov.co.uk/news/2018/05/30/majority-now-support-liberalising-policy-towards-c">Three-quarters</a> of the British public think doctors should be able to prescribe cannabis for medical purposes. Wider interest has followed recent media reports about children such as six-year-old Alfie Dingley, whose seizures have been <a href="https://www.theguardian.com/commentisfree/2018/feb/19/war-on-drugs-medical-cannabis-children-alfie-dingley">dramatically reduced</a> after being given cannabis products – often by travelling abroad for treatment, or illegally sourcing or importing from countries such as the Netherlands. </p>
<p><a href="https://www.express.co.uk/news/uk/939834/Alfie-Dingley-PCDH19-epilepsy-Theresa-May-pledges-support-medical-cannabis">Senior politicians</a> have expressed a desire to help children with serious illnesses, but provision of individual cannabis licenses and legal exemptions on a case-by-case basis does not help the many thousands of other people across the UK who also say that cannabis helps them.</p>
<p>The All-Party Parliamentary Group (APPG) on <a href="https://www.drugpolicyreform.net/">Drug Policy Reform</a> <a href="http://volteface.me/uk-medicinal-cannabis-report/">recommended improving access</a> to medical cannabis through a dedicated regulatory body. However, a new system that would licence and regulate herbal medical cannabis products would require a rethink of how medicines are approved in the UK.</p>
<h2>How the system works</h2>
<p>There are currently only four cannabis-based medicines in Europe that have been approved by the <a href="http://www.ema.europa.eu/ema/index.jsp?curl=pages/about_us/document_listing/document_listing_000426.jsp&mid=">European Medicines Agency</a> (EMA). All are pharmaceutical products, such as oral sprays, containing defined active components such as <a href="https://www.leafscience.com/2017/11/09/what-is-thc-tetrahydrocannabinol/">tetrahydrocannabinol</a> (THC) and <a href="https://www.theguardian.com/society/2018/may/28/what-is-cbd-cannabidiol-cannabis-medical-uses">cannabidiol</a> (CBD) in specific amounts – they are not herbal cannabis preparations.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=701&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=701&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=701&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=880&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=880&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221975/original/file-20180606-137298-1i67lz4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=880&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alfie Dingley’s parents say cannabis oil treatment in the Netherlands has reduced the number, severity and duration of the seizures caused by a rare form of epilepsy.</span>
<span class="attribution"><a class="source" href="https://www.facebook.com/alfieshope/photos/a.188734344937170.1073741829.180342199109718/362645047546098/?type=3&theater">Hannah Deacon</a></span>
</figcaption>
</figure>
<p>To receive marketing authorisation, manufacturers are required to present evidence of efficacy and safety, and offer well-defined products for specific conditions that are produced, processed and packaged to high standards. This is an expensive and lengthy process that can cost millions of pounds.</p>
<p>Although the <a href="https://bedrocan.com/products-services/healthcare/prescribing-cannabis/">Bedrocan</a> company in the Netherlands has received certification for the quality of production of its herbal cannabis materials, none have received marketing authorisation as medical products because they have not been submitted for review in accordance with licensing criteria. </p>
<h2>The problems in testing medical cannabis</h2>
<p>Medical cannabis challenges scientific norms and the regulation of medicines. The evidence-based medicine approach, where medicines and practices are evaluated and recommended on the basis of high-quality experimental and economic evidence – rather than anecdote and industry marketing – has led to the identification and availability of many important medical treatments.</p>
<p>When medical cannabis is tested against traditional evidence-based principles, it does not fare as well as might be <a href="https://www.theguardian.com/society/2018/jan/15/medical-marijuana-does-it-work-miracle-drug-evidence">popularly believed</a>. Reviews of scientific evidence show promising findings for some, but not all, conditions for which cannabis is considered a treatment – and this evidence is difficult to untangle.</p>
<p>Cannabis products show general success in <a href="https://www.ncbi.nlm.nih.gov/pubmed/29511052">reducing seizures</a>, for example, but the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30136-3/fulltext">best evidence</a> is from studies of pharmaceutical-grade CBD in the treatment of rare forms of childhood epilepsy – and not the whole plant itself. Studies of whole plant products are difficult to interpret because of differences in product composition, dose and administration regimes, and the lack of long-term follow up.</p>
<p>Most medical cannabis patients in the UK are not using pharmaceutical grade products, but are instead smoking, vaping or consuming illicitly grown herbal cannabis products to self-treat a wide variety of conditions, many of which will not have been formally diagnosed. It is therefore difficult to know how to translate scientific findings into practice.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ZZIzb5p6BRg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>In contrast, there is a clear support from patients, the public and some <a href="https://www.rcn.org.uk/magazines/congress%20daily%20bulletin/2018/decriminalising-cannabis">professional healthcare bodies</a>for medical cannabis. Advocates point to benefits reported by patients, and the long history of folk medicine to argue for its safety and efficacy.</p>
<p>Campaigners argue that herbal cannabis is denied to patients because of the laws prohibiting recreational use and the inflexibility of medicines regulations that are set up to evaluate tightly defined pharmaceutical products.</p>
<p>The evidence-based medicine “brand” has also been <a href="https://www.bmj.com/content/348/bmj.g3725">criticised</a> as being too focused on large randomised controlled trials to generate evidence and discounting professional expertise, to the detriment of individualised responses to patient needs.</p>
<h2>An exceptional product?</h2>
<p>Suggesting that cannabis should not be subject to the same standards of evidence as other medicines and should bypass current regulatory processes is a radical move that positions cannabis as an exceptional product. An evidence-based approach is particularly valued in publicly funded healthcare systems such as the NHS where the majority of the financial burden is borne by taxpayers.</p>
<p>In England and Wales, the <a href="https://www.nice.org.uk/about">National Institute for Health and Care Excellence</a> (NICE) reviews clinical and economic evidence on new pharmaceuticals in order to decide which should be recommended for use in the NHS. Changing the law to allow healthcare providers to prescribe herbal cannabis products to patients would respond to patient demand – but without a new regulatory system those treatments would not subject to the same level of scrutiny as other medicines prescribed in their practice. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221988/original/file-20180606-137306-19k2r18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cannabis is now grown commercially in countries such as the US.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/marijuana-morning-light-asia-landscape-photo-511352467">Shutterstock</a></span>
</figcaption>
</figure>
<p>International regulators have tried to address this. Herbal cannabis products are available on prescription in several countries. But regulatory models are internationally <a href="http://www.emcdda.europa.eu/publications/topic-overviews/cannabis-policy/html_en">diverse</a> and many systems are not easily translated to the UK because of differences in healthcare funding and access to medicines.</p>
<p>In Germany, doctors are only allowed to prescribe government-approved cannabis products on a compassionate basis to severely ill patients with specific illnesses who have not benefited from other treatments. In contrast to more tightly regulated systems, in the USA the boundaries between medical and recreational cannabis have been blurred and cannabis has been presented as a panacea for many diverse conditions and “well-being” needs. </p>
<p>Medical cannabis is both an emotional issue and technical challenge. A plausible case can be made for changing the law and allowing patients access to medical products. However, this requires more than an act of Parliament and presents a fundamentally different way of thinking about what a medicine is, and how patients should get access.</p>
<p>For now, the UK government is <a href="https://www.theguardian.com/uk-news/2018/mar/01/alfie-dingley-home-office-considers-medical-cannabis-trial-to-help-boy-with-epilepsy">considering</a> the option of a cannabis oil trial for epilepsy sufferer Alfie Dingley, who currently has to travel 450 miles to the Netherlands for the treatment. </p>
<p>.</p><img src="https://counter.theconversation.com/content/97771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Sumnall receives and has received funding from grant awarding bodies for drug and alcohol research. He is an unpaid member of the Advisory Council on the Misuse of Drugs (ACMD), an unpaid trustee of the drug and alcohol prevention charity Mentor UK, an unpaid Board Member of the European Society for Prevention Research (EUSPR), and an unpaid scientific adviser to the MIND Foundation. He received travel and accommodation costs to speak at the Cannabis Europa conference in London in May 2018.This article represents his personal opinions only.
</span></em></p>Medical cannabis challenges scientific norms and the usual regulation of medicines.Harry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/788572017-06-07T15:29:41Z2017-06-07T15:29:41ZKenya has gaps in diagnosing and managing epilepsy<figure><img src="https://images.theconversation.com/files/172452/original/file-20170606-3662-14ha5g9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Epilepsy is a chronic disorder of the brain characterised by recurrent seizures.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Epilepsy affects the brain and causes repeated seizures. Prompt diagnosis and effective management are key to controlling the condition, the cause of which is not fully understood . There are huge gaps in the way that epilepsy is managed in African countries, including Kenya. The Conversation Africa’s Health Editor Joy Wanja Muraya spoke to Dr Symon Kariuki on what success might look like.</em></p>
<p><strong>Can you explain epilepsy, and its prevalence in Kenya?</strong></p>
<p>Epilepsy is a serious <a href="https://www.ncbi.nlm.nih.gov/pubmed/24730690">condition</a> affecting the nervous system. Unprovoked repetitive seizures, often leading to a loss of consciousness, are common in persons with epilepsy. Epilepsy can affect any person irrespective of age, sex, economic or geographic location.</p>
<p>The actual cause of epilepsy is not fully <a href="http://www.edmontonepilepsy.org/epilepsy/causes.html">understood</a>, and research about this is ongoing. What’s <a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023035/">known is that</a> seizures are caused by abnormal and excessive electrical discharges in the brain.</p>
<p>Research in <a href="http://onlinelibrary.wiley.com/doi/10.1111/epi.12236/full">Kenya</a> rates birth trauma, infections of the brain and head injuries as the top causes. Other <a href="https://www.ncbi.nlm.nih.gov/pubmed/24116877">risk factors</a> include a family history of seizures.</p>
<p>The severity of symptoms depends on which part of the brain is affected. The seizures can present as visible fits or convulsions, muscle contractions, odd stares, impaired awareness or confusion and behaviour like lip smacking, cycling movements, or moaning.</p>
<p>According to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114531/">study</a> we conducted in rural Kenya and other African countries, half of the 2,170 people with active convulsive epilepsy were children and 69% of the seizures began in childhood.</p>
<p>Other studies found that the prevalence of epilepsy is about 20 cases in every 1,000 people. About 77 new cases in every 100, 000 people are diagnosed every year. These estimates are <a href="http://www.who.int/mediacentre/factsheets/fs999/en/">two to three</a> times higher than in developed countries.</p>
<p><strong>What about diagnosis and treatment of the disease in Kenya?</strong></p>
<p>A detailed medical history from the patient, family members and eyewitnesses is an important diagnosis step in patients with repeated unprovoked seizures. The health worker takes a history of the seizures, the triggers and the date they began. Recorded videos of seizures should be also considered. </p>
<p>Laboratory blood tests are done to rule out severe seizures. One seizure doesn’t signify an epilepsy diagnosis because up to <a href="http://www.who.int/mediacentre/factsheets/fs999/en/">10% </a> of people globally can have a seizure during their lifetime. Epilepsy is defined as having two or more unprovoked seizures.</p>
<p>The measurement of electrical activity in different parts of the brain through a test known as an <a href="http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/electroencephalogram_eeg_92,P07655/">electroencephalography</a> can diagnose some forms of epilepsy particularly in people without physical signs of the condition.</p>
<p>Imaging tests like computed tomography (CT) scan and Magnetic resonance imaging (MRI) can be prohibitive because they are expensive and thus unavailable in many rural areas in Kenya. But people with a history of birth problems or head injuries should take them.</p>
<p>Epilepsy treatment drugs should be given immediately on diagnosis to control seizures and improve the quality of life. An epilepsy specialist may also prescribe a specific class of drugs for prolonged seizures.</p>
<p><strong>Where are the gaps in Kenya?</strong></p>
<p>Kenya’s lack of accessible and affordable health care is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22770914">major gap</a>. There’s also a lack of awareness about the disease. </p>
<p>About <a href="http://www.kawe-kenya.org/wp-content/uploads/2016/03/Epilepsy-Guidelines-2016.pdf">70%</a> of newly diagnosed children and adults with epilepsy can be successfully treated with anti-epileptic drugs. But in Kenya the diagnosis rate is still very poor.</p>
<p>Often medical treatment isn’t sought because some people believe that epilepsy is caused by a person being possessed by supernatural forces or powers. This increases stigma and discrimination. </p>
<p>Some persons with epilepsy express concerns about the negative effects of the available epilepsy drugs, which can discourage medical treatment. This can be addressed by the government investing in newer tolerable drugs.</p>
<p>Kenya has a few epilepsy specialists, about <a href="http://pn.bmj.com/content/6/4/261">25 </a>including neurologists, neurosurgeons and epileptologists- experts in epileptic seizures and seizure disorders. However they’re mostly based in cities. On top of this there aren’t services, like neurosurgeons and imaging facilities, in rural and semi-urban areas.</p>
<p>Kenya can learn from countries like <a href="https://worldneurologyonline.com/article/pediatric-neurology-in-africa/">South Africa</a> which is leading in training epilepsy specialists. <a href="https://www.ncbi.nlm.nih.gov/pubmed/10771243">Zimbabwe </a> and The Gambia are working to incorporate managing epilepsy into primary health care provision.</p>
<p><strong>What is the way forward?</strong></p>
<p>Narrowing the treatment gap in Kenya should be a collaborative effort between the ministry of health, stakeholders of epilepsy care, and research institutions.</p>
<p>As a first step training more health workers would <a href="http://www.nation.co.ke/news/Improve-health-systems-to-manage-epilepsy/-/1056/3214106/-/g8afcj/-/index.html">strengthen</a> primary health care. This would ensure that epilepsy is identified early enough to begin treatment.</p>
<p>Public health education would improve knowledge of the disease and reduce stigma and discrimination. Support groups and community epilepsy clinics could also be supported to increase epilepsy awareness. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24447063">Sustained </a> health education improves knowledge about epilepsy.</p>
<p>Research institutions are critical in setting up epidemiological studies to provide reliable epilepsy data. This would make planning care much easier.</p>
<p>And evaluating the effectiveness of available or new epilepsy drugs is critical. In addition, ongoing research has the potential to quantify the burden of epilepsy in urban areas, and possibly preventable risk factors.</p><img src="https://counter.theconversation.com/content/78857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Symon Kariuki received funding from Wellcome trust between 2012-2016 to support his PhD studies. </span></em></p>Epilepsy affects around 70 million people globally, 80% live in developing countries. A shortage of specialists, equipment and drugs complicates effective treatment and management.Symon Kariuki, Postdoctoral research student, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/500772016-03-15T04:11:47Z2016-03-15T04:11:47ZExplainer: what is Dravet syndrome and how can it be managed?<figure><img src="https://images.theconversation.com/files/111260/original/image-20160212-29198-nclbdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Severe seizures in young children can be terrifying, but they can be managed.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/proimos/7015509987/">Alex Proimos/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>A little baby suffering a seizure is an incredibly distressing event for a family. Epilepsy is the most common neurological disorder in children and it takes the form of recurring seizures. But epilepsy is not a single disease; rather, it is a diverse spectrum of disorders that comprise many types of seizures. </p>
<p>Dravet syndrome, <a href="https://www.researchgate.net/publication/236017804_Les_epilepsies_grave_de_l'enfant">first identified</a> by French psychiatrist and epileptologist Charlotte Dravet more than 30 years ago, is a severe paediatric epilepsy.</p>
<p>Dravet syndrome (previously known as severe myoclonic epilepsy of infancy) starts in early infancy and evolves through different stages to adulthood. It is a rare disease, with an incidence of about <a href="http://www.ncbi.nlm.nih.gov/pubmed/17715273">1.4% in epilepsies</a> of children younger than 15 years (about <a href="https://www.ncbi.nlm.nih.gov/pubmed/21899536">1% of the total</a> global population have epilepsy – about 65 million).</p>
<p>Babies with Dravet syndrome appear normal during the first few months after birth, but typically have their first seizures at five to eight months of age. Subsequently, patients often experience <a href="https://www.unboundmedicine.com/medline/citation/23622210/Dravet_syndrome__severe_myoclonic_epilepsy_in_infancy__">multiple types of seizures</a>. These seizures are particularly difficult because they are frequent, unpredictable and resistant to many anti-epileptic drugs. </p>
<p>Within the second year of life, there are delays in behavioural and other development, mild to severe mental retardation, sleep disturbances and personality disorders (such as social isolation, frequent mood swings). Dravet syndrome is also associated with increased risk of sudden death.</p>
<h2>Genetic cause</h2>
<p>The most significant advance in understanding the cause of Dravet syndrome was the discovery of its genetic background. In 2001, mutations in a gene known as SCN1A were <a href="http://www.ncbi.nlm.nih.gov/pubmed/11359211">identified in seven children</a> with Dravet syndrome.</p>
<p>Subsequent genetic studies revealed about 80% of patients with Dravet syndrome carry a mutation in this gene, which produces a protein called Nav1.1. This protein helps generate and transmit the electrical signals that cells of the nervous system use for communicating with one another. Mutations found in the SCN1A gene in Dravet syndrome patients cause Nav1.1 to malfunction. </p>
<p>In the brain, Nav1.1 exists predominantly in a group of neurons that are responsible for calming brain activity. A malfunction in Nav1.1 inhibits that calming ability, leading to seizures.</p>
<p>The brain begins producing Nav1.1 in the weeks following birth, with production increasing as a baby ages. This may explain why Dravet syndrome does not become apparent until five to eight months after birth.</p>
<h2>What we can do</h2>
<p>Dravet syndrome is incurable and has a significant impact on the development of affected children. As for any other chronic condition, the primary goal is to ensure the best life quality for patients and their families.</p>
<p>The progressive and unpredictable course of Dravet syndrome can cause extreme anxiety for the families of affected children. Early diagnosis is critical to avoid inappropriate treatment and enable timely provision of counselling, rehabilitation and psychological support. </p>
<p>There are drugs to help reduce the frequency and severity of seizures. These include benzodiazepines, valproate, topiramate and stiripentol.</p>
<p>A high-fat, low-carbohydrate diet <a href="http://www.ncbi.nlm.nih.gov/pubmed/20598586">could be considered</a> if anti-epileptic drugs fail to provide seizure control. Overheating is the most frequent seizure trigger in children with Dravet syndrome. Therefore, conditions that might cause hyperthermia – such as summer sun, physical exertion, or a hot bath – should be avoided. </p>
<p>Seizures can also be induced by stressful situations. A general rule of thumb is to keep the optimal balance between seizure reduction, drug load and side effects, while avoiding the use of too many medications.</p>
<p>A child with Dravet syndrome is at risk of developing cognitive and physical deficits but it is <a href="http://www.ncbi.nlm.nih.gov/pubmed/21463289">possible to minimize</a> these with appropriate medication and by offering appropriate educational and rehabilitative opportunities, such as speech and occupational therapies. </p>
<p>Management of behavioural disturbances is not easy, so families should seek as much support as possible from medical staff and support organisations such as the <a href="http://www.dravetfoundation.org">Dravet Foundation</a> and <a href="http://www.cureepilepsy.org">Citizens United for Research in Epilepsy</a>.</p>
<h2>Future prospects</h2>
<p>Despite more than 30 years of research, Dravet syndrome remains a difficult-to-treat epileptic disorder with a major impact on affected children and their families. However, during later life, seizure control generally improves, so prevention of severe seizures in young patients should improve prognosis.</p>
<p>Fortunately, major developments in our understanding of the genetic cause of Dravet syndrome have paved the way for more suitable treatments and the prospect of precision drugs that directly target the root cause of the disorder.</p>
<p>The development of medicines aimed at boosting the function of Nav1.1 in patients with SCN1A mutations is a new and promising direction in Dravet syndrome therapy. These drugs will not only help prevent seizures but might also begin to reverse some of the developmental delays associated with this disorder.</p><img src="https://counter.theconversation.com/content/50077/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dravet syndrome, first identified by French psychiatrist and epileptologist Charlotte Dravet over 30 years ago, is severe pediatric epilepsy.Linlin Ma, NHMRC CJ Martin Fellow, King Group, Division of Chemistry & Structural Biology, Institute for Molecular Bioscience, The University of QueenslandGlenn King, NHMRC Principal Research Fellow, Professor, and Group Leader, Institute for Molecular Bioscience, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/472762015-09-10T07:23:13Z2015-09-10T07:23:13ZEpilepsy: sorting the myths from the facts of a common disorder<figure><img src="https://images.theconversation.com/files/94367/original/image-20150910-27304-it1ffl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Epilepsy is one of the most common neurological conditions in the world.
</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>One of AFL’s biggest stars, Lance Franklin, was briefly hospitalised for a mild epileptic seizure last week. He was also <a href="http://www.sydneyswans.com.au/news/2015-09-08/club-statement-lance-franklin">ruled out of</a> Saturday’s qualifying final, as he is reportedly suffering from an “ongoing mental health condition”. </p>
<p>Although they may coexist, epilepsy is a neurological disorder that doesn’t fall under the umbrella of mental or mood disorders. But the likelihood of mood disorders, such as depression and anxiety, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181864/">increases with chronic brain illnesses</a>. And there may be a slight further increase if you have epilepsy.</p>
<p>People with epilepsy need treatment, but also understanding they are normal, capable people. Unless someone has a noticeable seizure in a public place, you won’t know they have epilepsy. There’s no abnormality, as such, springing from the illness. Nor is there a limit to what someone with the condition can accomplish. </p>
<h2>Understanding epilepsy</h2>
<p>Globally, epilepsy is one of the <a href="http://www.who.int/mediacentre/factsheets/fs999/en/">most common neurological diseases</a>, particularly <a href="http://www.rch.org.au/neurology/patient_information/about_epilepsy/">among children</a>.
Epilepsy is not a single disorder; it has many causes that share the hallmark of a seizure, when brain function is disrupted, often dramatically. When seizures remain isolated in just one part of the brain, they can be very small and can even pass by unnoticed.</p>
<p>But when seizures involve large parts of the brain, the consequent event is what people typically associate with an “epileptic fit”. The person’s muscles stiffen, they lose consciousness and fall to the floor, and their body starts jerking rhythmically. These types of seizures are called <a href="http://www.epilepsy.com/learn/types-seizures/tonic-clonic-seizures">“tonic-clonic” seizures</a> - because the body is first stiff all over (tonic) and then has rhythmic jerking (clonic). </p>
<p>Seizures can be frightening for those who have never witnessed one before. Historically, the loss of control of the body and brain that came with having an epileptic seizure was often <a href="http://onlinelibrary.wiley.com/store/10.1046/j.1528-1157.44.s.6.2.x/asset/j.1528-1157.44.s.6.2.x.pdf;jsessionid=FE40B159FCC219C2F51D6E8E7DDD9AE5.f02t04?v=1&t=iedru2p8&s=4bf1d1073f3657454fb7b4b4c3c75e8c9ca5fabe&systemMessage=Wiley+Online+Library+and+related+systems+will+have+3+hours+of+downtime+on+Saturday+12th+September+2015+from+10%3A00-13%3A00+BST+%2F+05%3A00-08%3A00+EDT+%2F+17%3A00-20%3A00+SGT+for+essential+maintenance.++Apologies+for+the+inconvenience.">misunderstood</a>. The biblical story of Jesus performing an exorcism on a young boy having a seizure, for instance, led some to believe they were a result of <a href="http://brain.oxfordjournals.org/content/125/2/441">demonic possession</a>. Only in modern times has epilepsy been <a href="http://www.who.int/mediacentre/factsheets/fs999/en/">truly recognised</a> as a disease of the brain. </p>
<p>There are still misunderstandings, though. It’s wrong to think, for instance, something should be put into the mouth when someone is in the middle of a seizure; it’s not true that the tongue can be “swallowed”. First aid is applied to prevent injury while the person is stiff and jerking, but when they go limp at the end of the seizure, they should be put on their side to prevent the floppy tongue obstructing breathing. After a seizure, it may take some time for behaviour to return to normal and sleepiness is common.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/94366/original/image-20150910-27304-1ed3gz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Epilepsy is a diverse condition that can have many, different causes.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Treatment options</h2>
<p>Saying someone has epilepsy is a little like saying that they’re ill. Its cause is diverse and can be anything from a brain tumour to an inherited genetic condition, the consequence of injury, or any other disorder that affects the brain. In some cases, epilepsy is associated with other brain problems and intellectual disability. But mostly, people with epilepsy are normal between seizures and can participate in normal activities. If seizures are not controlled, then operating dangerous machines, like cars, or swimming unsupervised must be avoided. </p>
<p>Most epilepsy is well controlled with medications. Options for treatment have expanded with new drugs available, more precise diagnosis based on sophisticated imaging, and better understanding of the mechanism of epilepsy in each individual patient. In some cases, very precise detection of brain lesions can allow for a surgical cure of epilepsy. Even devices used as brain implants have been developed that can <a href="http://www.hindawi.com/journals/ert/2014/582039/">control severe epilepsy</a>. </p>
<p>It’s common for some mood disorders also to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181864/">be present in people with epilepsy</a>. Naturally, the fear of having an unexpected seizure can directly lead to an anxiety disorder, while the stress of coping with chronic illness can contribute to depression. In some types of epilepsy, the brain networks that give rise to the illness may also make people more vulnerable to these co-morbidities. It is important that both problems are properly assessed and diagnosed. </p>
<p>For someone like Lance Franklin, simply “carrying on” if there is a mental or neurological problem would be as bad as “playing on” with a muscle problem that was not recognised and treated. Like the physical side of sport, where an optimised musculoskeletal system is important, so it’s important to recognise that the brain needs just as much care, effort and medical attention.</p><img src="https://counter.theconversation.com/content/47276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graeme Jackson receives funding from the National Health and Medical Council Australia</span></em></p>Saying someone has epilepsy is a little like saying they’re ill. Its cause can vary from a brain tumour to an inherited genetic condition, the consequence of injury or a disorder affecting the brain.Graeme Jackson, Senior Deputy Director, Florey, Neurologist Austin Health, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.