This Week in Neurophysiology and Epilepsy

People who use alcohol appear to be more vulnerable to epilepsy. The more they drink, the more likely unprovoked seizures are.

Reading these proceedings of the 17th Epilepsy Therapies and Diagnostics Development conference and struck by the section on trial design. In particular they note a rise in the placebo responder rate from 12% to 23%.

Without a seizure there is no epilepsy. And conventionally epilepsy is defined as a predisposition to recurrent unprovoked seizures. So when is a single seizure enough to diagnose epilepsy? One such scenario is following stroke.

Interictal epileptiform discharges (IEDs) are transient graphoelements (or—more simply—waveforms) found on EEG and MEG corresponding to an increased predisposition to unprovoked seizures. Ebersole continues to cite the 1983 IFCN glossary for its definition; the updated 2017 glossary says that IED “describes transients distinguishable from background activity with a characteristic morphology typically, but neither exclusively nor invariably, found in interictal EEGs of people with epilepsy.”

People with epilepsy may suffer substantially. Beyond the danger of seizures themselves, and the elevated risk of sudden death, these folks have a higher risk of behavioral and cognitive disorders, are more likely than people without epilepsy to be impoverished and jobless, and continue to be affected by stigma and misunderstandings.

Valproic acid (VPA) has multiple mechanisms of action; this is not in dispute.

In this recent paper Morlet and others detected traces of consciousness in 21% of a cohort of comatose, vegetative, and minimally-conscious patients using an auditory-oddball–based ERP task. The assumption in this retrospective case series was that responses to the auditory-oddball paradigm would be similar in brain-injured people with disorders of consciousness (DoC) and normal controls if the former had the ability to mentally follow directions and respond to the environment.

Functional Neurological Disorder (FND) is a clinically heterogeneous disease which manifests as neurological-ish symptoms that are not due to structural change or aberration in the nervous system. (Except that there are actual differences in structure.)

Valproic acid is a remarkable molecule.

It is one of the quintessential examples of a serendipitous antiseizure medication (ASM) discovery. As an amphiphilic molecule it’s an effective solvent and happened to be used in a series of experiments as the carrier for candidate ASMs—and as the unexpectedly effective experimental control.

Antiseizure medications (ASMs) are still the primary way by which we suppress seizures in epilepsy and other “seizure disorders.”