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Press Releases

Take a look at a selection of our recent media coverage:

Epileptic foci detected without surgery in child with drug-resistant epilepsy

12th July 2023

A minimally invasive procedure to detect epileptic foci in the brain without the need for surgery has been successfully conducted on a child in the Middle East for the first time.

The cutting-edge stereoelectroencephalography (SEEG) technique was performed on an 11-year-old boy with drug-resistant – or intractable – epilepsy, with the aim of locating the epileptic foci in the brain to pave the way for their future removal.

Carried out at the Neuroscience Centre of King Faisal Specialist Hospital and Research Centre (KFSH&RC), the procedure involves creating 2mm holes in the skull to implant electrical monitoring electrodes directly into the brain.

These electrodes enable precise measurement and mapping of electrical activity, allowing specialists to closely monitor the patient and identify the specific regions where epileptic seizures originate.

They can then determine the specific tissues that need to be removed to eliminate epilepsy seizures effectively, ultimately improving the patients’ quality of life and that of their families.

Discussing the technique, Dr Ibrahim Althubaiti, a consultant at the Epilepsy Integrated Practice Unit at KFSH&RC, highlighted the challenges faced when locating epileptic foci in children as opposed to adults. ‘Unlike adults who can easily comply with instructions, children’s movement can be challenging to control for prolonged periods, posing a greater difficulty in executing the medical procedure,’ he said. ‘Nevertheless, the successful implementation of the SEEG technique allowed us to overcome this challenge.’

In practice, SEEG takes 45 minutes to complete, requires no more than 48 hours of recovery and is 60% less expensive when compared to previously used procedures.

Prior to its introduction, procedures took nine hours to complete and involved the temporary removal of a substantial part of the skull to access the brain for the electrode placement. This carried the risks of pain, infections and potential complications from anaesthesia, as well as considerable recovery time.

NHS England launches valproate decision support tools

26th May 2023

Decision support tools to help clinicians and patients decide whether or not valproate is the right option for them have been launched by NHS England.

In efforts to maintain patient safety and curb inappropriate prescribing of valproate during pregnancy, the tools are aimed at women, girls and anyone who could become pregnant, aged between 12 and 55, who are considering or taking valproate for epilepsy or bipolar disorder.

Developed in accordance with the NICE standards framework for shared decision-making support tools, the aim is to help patients understand the benefits and harms of taking valproate, and come to a decision based on what matters most to them.

NICE guidance states that the medication ‘must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the pregnancy prevention programme is in place.’

Sodium valproate is prescribed as a treatment for epilepsy and bipolar disorder and can cause birth defects in around one in 10 babies born to those taking it while pregnant, as well as causing developmental problems in 30-40% of children whose mothers took the medicine while pregnant.

Updated valproate advice

The new tools come after the independent Commission on Human Medicines (CHM) advised in December that two specialists must independently consider that valproate is the only effective or tolerated treatment before a patient under the age of 55 can be initiated on the medication.

The Commission also advised that men under the age of 55 should also be offered the opportunity to have their treatment reviewed. The UK’s Medicines and Healthcare Regulatory Agency is set to release information about additional versions of the tools for men imminently.

According to NHS Digital, between April 2018 and September 2020, 180 females in England were prescribed valproate while pregnant. Some 47,532 females aged 0-54 were given one or more prescriptions for the drug over the reporting period, and 238 females stopped receiving prescriptions of valproate prior to their pregnancy.

A version of this story was originally published by our sister publication The Pharmacist.

ARB therapy associated with reduced risk of epilepsy

24th October 2022

ARB therapy is associated with a lower risk of subsequently developing epilepsy when compared to drugs from other anti-hypertensives classes

Angiotensin receptor blocker (ARB) therapy is associated with a reduced risk of epilepsy development over the next 5 years compared to other anti-hypertensive agents according to a cohort analysis by German researchers.

The epilepsies are one of the most common serious brain disorders and which can occur at any age with different presentations and causes. The World Health Organisation estimates that globally, around 5 million people are diagnosed with epilepsy each year and that across the world, roughly 50 million people are affected.

Interestingly, it has been suggested that based on both preclinical and clinical studies, that hypertension may be a cause of seizures and epilepsy through direct or indirect mechanisms and that the renin-angiotensin system might play a central role. Indeed, animal studies indicate that one class of antihypertensive medicines, ARB therapy and in particular, losartan, might be effective against seizure activity and neuronal damage in co-morbid hypertension and epilepsy.

Moreover, a study on cognition and prognosis in the Elderly with the ARB drug candesartan found that it may also have positive effects on cognitive function and quality of life. Taken to together, these findings would suggest that ARB therapy by protecting cognitive function may also reduce the risk of epilepsy development.

Since there are no data to support the theory that ARB therapy may affect the development of epilepsy, in the present study, the German researchers set out to compare the incidence of epilepsy after patients had been initiated on a range of different anti-hypertensive drug classes.

The team included adult patients with hypertension and an initial prescription for beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEi) and ARB therapy. These four anti-hypertensive classes were propensity matched 1:1:1:1 according to sex, age, index year and diagnosis. The researchers set the main outcome of interest as the incidence of epilepsy associated with ARB therapy compared to the other drug classes.

ARB therapy and epilepsy development

A total of 168,612 patients with a mean age of 62.3 years (48.6% male) were included with 42,153 individuals prescribed a drug from each of the different classes were followed-up for 5 years.

After 1 year, 0.27% of patients prescribed ARB therapy developed epilepsy and this increased to 0.99% after 5 years. In comparison, after 5 years, 1.47% of those prescribed beta-blockers and 1.48% of those given calcium channel blockers developed epilepsy.

ARB therapy was associated with a significantly reduced incidence of epilepsy (Hazard ratio, HR = 0.77, 95% CI 0.65 – 0.90, p < 0.002) compared with other anti-hypertensives drug classes. However, while this reduced risk in comparison to other drug classes was lower for all drugs within the ARB class examined, the association was only statistically significant for losartan.

The authors concluded that there was an association between a lower incidence of epilepsy in hypertensive patients prescribed ARB therapy compared to other anti-hypertensive drug classes. They called for additional research to better understand whether this relationship was causal and suggested that anti-hypertensives may represent a novel approach to the management of epilepsy in hypertensive patients.

Citation
Doege C et al. Association Between Angiotensin Receptor Blocker Therapy and Incidence of Epilepsy in Patients With Hypertension JAMA neurol 2022.

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