International Conference on Epilepsy & Treatment September 21-22, 2015 Baltimore, USA

Chair

Elia M Pestana Knight

Cleveland Clinic, USA

Co-Chair

Long Jun Wu

Rutgers University, USA

Session Introduction

Elia M Pestana Knight

Cleveland Clinic, USA

Title: Increasing utilization of Pediatric Epilepsy Surgery in the United States between 1997 and 2009

Time : 11:30-11:50

Biography:

Elia M Pestana Knight is a Pediatric Epileptologist in the Pediatric Epilepsy Section, Epilepsy Center, Cleveland Clinic Neurological Institute. She has completed her Medical School (1991) and Neuropediatric Training in Cuba (1995). After moving to the United States, she has completed her Training a Fellowship at the Cleveland Clinic (2004), Pediatric residency training at RB & C (2007) and Pediatric Neurology Residency at the University of Michigan (2010). She is board certified in Neurology and Epilepsy. She has more than 20 papers published in peer-reviewed journals. Her areas of research interest include epidemiology, pediatric epilepsy co-morbidities, epileptic encephalopathy and pediatric epilepsy outcomes

Abstract:

Rationale: Despite clear guidelines for referral of patients to epilepsy surgery, no change in the rate of epilepsy surgery has been detected in adults with epilepsy. Few recent studies indicated an increased rate of pediatric epilepsy surgery but the specifics of these changes have not been explored. Objective: To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. Methods: We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Linear regression was used to test for changes in the rates of surgeries over time. Results: The rates of pediatric epilepsy surgery significantly increased from 0.85/1000 in 1997 to 1.44/1000 in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups in both boys and girls and in whites and Hispanics but not in blacks or in children with public insurance. The majority of pediatric epilepsy surgeries were performed in academic Children’s Hospitals. Conclusions: In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery.

Mohamad Sawan

Polytechnic School of Montreal, Canada

Title: Seizure onset detection and subsequent treatment through direct intracortical processing

Time : 11:50-12:10

Biography:

Mohamad Sawan is professor of biomedical engineering in Polytechnique Montreal. He is a holder of a Canada Research Chair in Smart Medical Devices (2001-15), he is leading the Microsystems Strategic Alliance of Quebec, and is founder of the Polystim Neurotechnologies Laboratory. He published more than 700 peer reviewed papers, and 12 patents. He received the Queen Elizabeth II Golden Jubilee Medal, the Bombardier Medal for technology transfer, the medal of merit from the President of Lebanon, and the Barbara Turnbull Award for spinal-cord research in Canada. Dr. Sawan is Fellow of the IEEE, Fellow of the Canadian Academy of Engineering, and Officer of the Quebec’s National Order.

Abstract:

Several types of brain-machine interfaces (BMI) intended for bio-signal recordings such as EEG and fNIRS, and subsequent treatment techniques such as electrical or magnetic stimulation. These wearable and portable devices, built around non-invasive devices, are in majority of cases still little efficient and bulky. Also, more the disease level is deep in a brain layer, more it is complex to be detected and consequently difficult to efficiently treat it. Neurodegenerative diseases require advanced and implantable BMIs for accurate diagnostic and subsequent treatment such local stimulation, drug delivery, or tissue cooling in order to recover complex neural vital functions. This paper covers the various steps usually needed to locate dysfunctions and to apply preferably in real time required treatment. Case study concerns epileptic foci localization and seizure detection, then treatment avoiding seizure grows and abnormal health consequence. The treatment is divided in two main steps; the first is non-invasive for coarse localisation, the second is in situ for efficient benefit. Following wearable system overview, an implantable micro device will be described which is composed of onset seizures detection based on monitoring the exponential grows of both voltage amplitude variation of electrocorticogram (ECoG or iEEG) and its frequency content as well. Multichannel signals are recorded concurrently and custom processor is used to evaluate on real time these dual parameters (amplitude and frequency) and deliver alarm when seizure is detected. Then, a local feedback control is used to trigger a constant-current stimulator intended to stop the seizure before its emergence. Various parts of these microsystems are based on implementing custom circuits which require ultra low-power consumption and reliable wireless energy and data communication building blocks. Also, special attention is paid to face multidimensional design and implementation challenges of the implantable micro device for a mandatory safe operation.

Long Jun Wu

Rutgers University, USA

Title: Microglia-Neuron communication in Epilepsy

Time : 12:10-12:30

Biography:

Long-Jun Wu has completed his PhD from University of Science and Technology of China in 2004. After his PhD study, he was trained as a postdoctoral fellow at University of Toronto (2004-2008) and Harvard Medical School (2008-2010), and promoted to Instructor at Harvard Medical School (2011-2012). Since September 2012, he is an Assistant Professor in the Department of Cell Biology and Neuroscience at Rutgers University. His lab at Rutgers mainly focuses on microglia-neuron communication in normal and diseased brain. He has published more than 72 peer-review research papers, including those in Nature Neuroscience, Neuron, PNAS, Science Translational Medicine, Journal of Neuroscience, Glia, etc.

Abstract:

Epilepsy represents a neurological disorder that can manifest in uncontrolled seizures in patients. Microglia are exquisitely sensitive to disruptions in the central nervous system. Since epilepsy is characterized by neuronal hyperactivity rooted in excessive glutamate release and ionic imbalance, it is conceivable that microglia respond to and regulate neuronal activities during the pathology. Here, we found an increased number of microglial primary processes in the hippocampus during kainic acid-induced seizure activity. Consistently, global glutamate induced robust microglial process extension (MPE) towards neurons making increased contact with neurons in both brain slices and in the intact brain in vivo. The mechanism of the glutamate-induced MPE involves the activation of neuronal NMDA receptors, calcium influx, subsequent ATP release, and microglial response through P2Y12 receptors. In addition, we serendipitously found that extracellular Ca2+ reduction induced microglial processes to converge at distinct sites, a phenomena we termed microglial process convergence (MPC). Our studies revealed that MPC occur independent of astrocytic functions and are not directed towards astrocytes but target neuronal dendrites. Similar to glutamate-induced MPE, extracellular Ca2+-dependent MPC is also mediated by ATP and microglial P2Y12 receptor. Finally, we found that P2Y12 knockout mice exhibited reduced seizure-induced increases in microglial process numbers and worsened kainic acid-induced seizure behaviors. These studies are the first to investigate the microglial dynamics and discovered MPE and MPC during acute epilepsy. Our results elucidate the molecular mechanisms underlying microglia-neuron communication that may be potentially neuroprotective in the epileptic brain. Studying microglia-neuron communication in epilepsy informs the development of novel therapies targeting microglia in the treatment of epilepsy.

Bulent Unay

Gulhane School of Medicine, Turkey

Title: Epilepsy and EEG findings in children with anomalies of the the corpus callosum

Time : 12:30-12:50

Biography:

Bulent Unay has completed his PhD from Gulhane Medical School and currently working as Child Neurology Professor in Department of Pediatrics. He had the position of research fellow in Epilepsy Center, Children’s Hospital; University of Pittsburgh from 2004 to 2005. He is the Director of Department of Child Neurology, Gulhane Medical School, Ankara. He has published more than 60 peer reviewed medical articles and book chapters on many topics including epilepsy, evoked potentials and cerebral palsy.

Abstract:

Anomalies of corpus callosum (ACC) including agenesis and hypogenesis are common congenital brain malformation that may result from genetic or environmental factors. Epilepsy is one of the most common findings in structural brain malformations. Seizure frequency has been reported in small samples of cases. We studied 71 children with ACC with and without epilepsy in order to assess clinical and electroencephalographic features to determine the frequency of seizures and to identify putative electroencephalographic and seizure characteristics useful to address the diagnosis. We investigated 71 pediatric and adolescent patients referred to Pediatric Neurology Department and had the diagnosis of the ACC. Of 71 patients that were reviewed, 12 patients had agenesis of the corpus callosum while 59 had hypogenesis of the corpus callosum. Forty-two (59%) patients had epilepsy and 54 patients had electroencephalography. Of the 42 epileptic patients, 10 had agenesis of the corpus callosum and 32 had hypogenesis of the corpus callosum. Twenty of 42 (48%) epileptic patients were responsive to antiepileptic drug and 22 (52%) children were intractable epileptic patients. Of the 54 EEG recordings, 8 were normal while 46 were abnormal. Percentage of the intractability of epilepsy in patients with hypogenesis and agenesis of the corpus callosum were 40% and 90% respectively. Our study showed that the high incidence of epilepsy in children with anomalies of corpus callosum. Moreover intractable epilepsy had a higher incidence in patients with agenesis of the corpus callosum.

Break: Lunch: 12:50-13:50@ Eden's Landing Restaurant

Chair

Nick Kane

North Bristol NHS Trust, UK

Co-Chair

Radcliffe Durodami Lisk

Allied Health Sciences in the University of Sierra Leone, UK

Session Introduction

Durodami  Lisk

Allied Health Sciences in the University of Sierra Leone, UK

Title: The Challenges of Managing Epilepsy is resource poor countries in Africa- Experience from Sierra Leone

Time : 11:40-12:00

Biography:

D R Lisk later worked in the College of Medicine and Allied Health Sciences at the University of Sierra Leone and was Associate Professor and Head of department of Medicine. In 1991-2 he was Visiting Professor of Neurology and the stroke fellow at the University of Texas Health Science Centre in Houston. He returned to England in 2002 and was Consultant Neurologist and epilepsy lead at Basildon University Hospital. He won a National Health Service Gold award for his work on epilepsy in Basildon. He is now directing a link project on epilepsy between Basildon and Sierra Leone.

Abstract:

In developed countries, epilepsy is accepted as a medical condition and patients submit themselves to the various method of treatment available. Sierra Leone is a small West African country with poor infrastructure and health services.56% of people with epilepsy believe that epilepsy is caused by demons and witchcraft and seek treatment from traditional healers. It is also widely believed that epilepsy is transferable.We have looked at knowledge, attitudes, and practices of health workers towards epilepsy as well as the impact of epilepsy on school attendance of affected children. We further investigated the co-morbidities of depression and anxiety in our patients. Education, awareness raising and sensitization are important strategies in changing the attitudes of the community and improving service uptake. We have used innovative methods as well as standard media such as radio, television and posters in getting our primary messages across that epilepsy is a manageable medical condition and it is not transferable. With the use of basic antiepileptic drugs and outreach clinics, we have been able to reach thousands of patients throughout the country but a lot more needs to be done.

Guy Bar-Klein

Ben-Gurion University of the Negev, Israel

Title: Magnetic resonance imaging of blood-brain barrier dysfunction as a biomarker for Epileptogenesis

Time : 12:00-12:20

Biography:

Guy Bar-Klein has completed his PhD from Ben-Gurion University of the Negev and is currently a Postdoctoral Associate at the Howard Hughes Medical Institute. He has a B.Sc. in biophysics and M.Med.Sc in neurophysiology. In his research, Guy focuses on in-vivo electrophysiological recordings and molecular assays of epileptogenic processes and pathologies associated with blood-brain barrier (BBB) dysfunction. Studying the mechanisms regulating BBB permeability and the following effects, will hopefully lead to potential therapeutic treatments for BBB-related processes, emphasizing on post-traumatic epilepsy and other epileptogenic syndromes.

Abstract:

Acquired epilepsy is frequently followed brain insults. Interestingly, these insults are frequently associated with dysfunctional blood-brain barrier (BBB). We recently showed that BBB injury lead to albumin-mediated activation of transforming growth factor β (TGF-β) signaling in astrocytes, astrogliosis, local inflammatory response followed by epileptiform discharges and delayed seizures. Importantly, the FDA-approved AT1 antagonist, losartan, blocked albumin-induced TGF-β signaling and prevents epileptogenesis. Here we performed a longitudinal study in rats exposed to paraoxon to induce status epilepticus (SE) and epileptogenesis and executed repeated magnetic resonance imaging (MRI) to quantitatively monitor BBB integrity. Continuous video-electrocorticographic (ECoG) recordings were acquired to monitor for seizures. Analysis of the ECoG signals revealed that 13 out of 22 of the rats presented ≥2 spontaneous seizures and therefore were defined as epileptic. Signal analysis in 13 defined brain regions using logistic regression and forward selection suggested that focal BBB breakdown in olfactory structures increases the likelihood of a rat to become epileptic while diffuse damage decreases this likelihood. We thus were able to predict epilepsy with high sensitivity and specificity (92.3% and 77.8% respectively) with 12 out of 13 epileptic rats classified correctly and only 2 out of 9 non-epileptics falsely classified as epileptic. Our results demonstrate that increased BBB permeability in specific brain regions may serve as a reliable biomarker for SE-induced epileptogenesis and together with our findings showing losartan as anti-epileptogenic drug, highlight the potential of specific anti-epileptogenic treatment for patients identified with high risk to develop epilepsy.

Chair

Michele Jacob

Tufts University School of Medicine, USA

Co-Chair

Paul H Mc Cabe

Geisinger Health System, USA

Session Introduction

Paul H Mc Cabe

Geisinger Health System, USA

Title: Can we predict Seizure response from Anti-epilepsy drug combination therapy based on clinical features of a patient’s Epilepsy?

Time : 13:50-14:10

Biography:

Paul H Mc Cabe has received his MD degree from Thomas Jefferson University School of Medicine. He completed his Neurology Residency and Epilepsy/Neurophysiology Fellowship at Penn State’s Milton S Hershey Medical Center. He is currently an Associate Neurologist at Geisinger Health System in the Epilepsy Division. He has presented abstracts at national meetings and has published in peer-reviewed journals. He recently served on the Corporate Advisory Committee for the American Epilepsy Society. He has participated in multiple clinical trials.

Abstract:

When choosing an anti-epilepsy drug (AED) for a patient, we initially will determine if a patient has a focal seizure disorder or primary generalized epilepsy. Following this with few exceptions, we will typically then decide on drug choice by things such as pregnancy, side effects, concomitant illness or drug interactions. When choosing the first drug, this is very appropriate. However, once a patient fails to respond to the first 2-3 drugs, it raises the question if this is still the way to determine best treatment for our intractable patients. Current practice is to use “rational polytherapy” in selecting combinations. The only thing this mandates however is that the drugs have a different mechanism of action (MOA). Isobolography in animal models may suggest “superiority” of one combination over another but does not necessarily equate to clinical practice. Another option to choosing how to combine AEDs in intractable patients may be based on clinical characteristics of one’s epilepsy. Features such as clinical semiology, imaging results and suspected area of onset may be clues as to which combination of drugs may work best. Some possible observations may be subsets of temporal lobe epilepsy (TLE), frontal lobe epilepsy and post-traumatic epilepsy. These proposed patterns of response however are based on clinical observation. To attempt to study every possible combination of AEDs and every clinical scenario is not realistic. Having data in large populations can help support or refute such observations. Thus, having a national data base could provide significant information.

Hana Malikova

Epilepsy Centrum Na Homolce Hospital, Czech Republic

Title: Stereotactic radiofrequency amygdalohippocampectomy for the treatment of mesial Temporal Lobe Epilepsy: Clinical Seizure and Neuropsychological outcomes

Time : 14:10-14:30

Biography:

Hana Malikova is a Neuroscientist, Radiologist and Anatomist. She completed her graduation at 1th Medical School of Charles University in Prague in 1993. And she has done her Post gradual training at Neurosciences of 1th Medical School of Charles University Prague. Her research interest is on Radiology. Currently, she is an Associated Professor of Radiology at Na Homolce Hospital, Prague and Institute of Anatomy 2nd Medical School of Charles University, Prague.

Abstract:

Stereotactic radiofrequency amygdalohippocampectomy (SAHE) is an alternative, minimally invasive method for the treatment of mesial temporal lobe epilepsy. We used the Leksell stereotactic system with the coordinate frame attached to the patient’s head and MRI neuronavigation. SAHE was performed from the occipital access using one trajectory and typically 2-4 thermocoagulative lesions were produced in 7-10 segments in the long axis of the amygdalohippocampal complex. SAHE is provided in our institution since 2004 and altogether 61 patients were treated by this technique; 45 patients were indicated, treated and followed-up in our institution (the others were sent only for the SAHE procedure). Patients treated in our institution reached following 5 years seizure outcome comparable with open surgery approaches: 76% of them were classified as Engel Class I, 15% of patients were classified as Engel Class II and in 9% treatment failed. Neuropsychological outcomes one year after SAHE are impressive: Memory in left sided patients remained stable, right sided patients improved in Global and Verbal memory. MRI volumetry studies confirmed partial destruction of target structures: The mean volume reduction of the hippocampus, the amygdala and entorhinal and perirhinal cortices were about 50-60%. We hypothesize that good neuropsychological results were achieved by the incomplete destruction of target structures, sparing the lateral temporal neocortex and also partially by practice effect. The explanation for good seizure outcomes may be in the occipital access of SAHE modified technique. This access enables to target the amygdalohippocampal complex in the longitudinal axis and the intrinsic hippocampal connections display the same orientation. Therefore, the functional integrity of the whole complex and their desintegration could led to the reduction of epileptic hyperactivities and their transmission to entorhinal and perirhinal cortices and to the neocortex.

Michele Jacob

Tufts University School of Medicine, USA

Title: b-catenin networks as a new molecular target in infantile spasms and Seizures

Time : 14:30-14:50

Biography:

Michele Jacob has obtained her PhD from Yale University and conducted Postdoctoral studies at Columbia University and the University of California, San Diego. She had an independent research lab at the Worcester Foundation for Biomedical Research and moved to Tufts University in 1997. She has published 48 papers and serves as a Reviewing Editor for Frontiers in Synaptic Neuroscience. Her studies are defining molecular mechanisms in vivo that are critical for the proper maturation and function of neuronal and sensory cell synapses. She is also identifying mechanisms responsible for synaptic dysfunction in autism, intellectual disabilities, hearing loss and infantile spasms/seizures.

Abstract:

Infantile spasms (IS) constitute a devastating childhood epilepsy syndrome. Effective treatments are largely lacking because Infantile Syndrome is molecularly ill-defined. Using genetic manipulations in mice, we show here that deregulation of β-catenin networks leads to characteristics of human IS. We conditionally deleted the adenomatous polyposis coli gene (APC cKO) or conditionally overexpressed β-catenin (β-cat cOE). APC is a major negative regulator of β-cat levels. β-cat has dual roles in cadherin synaptic adhesion complexes and the canonical Wnt pathway both are critical for normal brain circuit formation and function. APC cKO and β-cat cOE mice both display high amplitude spastic movements at neonatal ages and spontaneous seizures at adult ages compared with control littermates. They also exhibit cognitive and autism-like disabilities known co-morbidities of human IS. EEG recordings show abnormal cortical circuit activity and seizures. Cortical hyperexcitability is suggested by increased spontaneous and evoked excitatory electrical activity and increased synaptic spine density in cortical layer 5 pyramidal neurons. β-cat protein levels are elevated as are canonical Wnt target gene expression and β-cat association with N-cadherin suggesting altered synaptic stability and plasticity. We identify APC cKO and β-cat cOE mice as new models of IS. We propose a novel molecular etiology of IS that is centered on aberrant β-cat networks. As further support, several genes implicated in human IS (ARX, FoxG1, TSC1/2 and Magi2/S-SCAM) are predicted to affect β-cat and its associated pathways. Defining new molecular targets is essential for developing new and effective interventions to ameliorate IS.

Viji Santhakumar

Rutgers New Jersey Medical School, USA

Title: Effect of Experimental Epilepsy on Inhibition of GABAergic Interneurons: Implications for Co-morbidities and Therapeutic Failures

Time : 14:50-15:10

Biography:

Viji Santhakumar completed her MD in India and PhD from the University of California at Irvine. Following successive Postdoctoral studies at UCLA, she joined NJMS as an Assistant Professor in 2008 and was promoted to Associate Professor in 2014. Her lab exploits physiological and computational techniques to study inhibitory and neuro-immune plasticity in epilepsy and brain injury. She has over 20 peer-reviewed publications in leading journals and Heads a vibrant research group with active collaborations.

Abstract:

Strong perisomatic inhibition by fast-spiking basket cells (FS-BCs) and two classes of accommodating interneurons (AC-INs) regulate propagation of activity through the hippocampal dentate gyrus. Activity patterns of these interneurons are in turn governed by homotypic connections between similar neurons and heterotypic inhibitory inputs from other interneuronal classes. We have examined whether inhibitory control of dentate FS-BC and AC-INs is altered in experimental epilepsy. We find that pilocarpine-induced status epilepticus leads to functional changes in synapses from AC-INs to FS-BCs and strengthening of synapses between AC-INs. However, characteristics of synapses from FS-BCs remain unaltered. Additionally, we find cell-type specific changes in extra synaptic inhibition of FS-BCs following seizure induction. Thus, the nature of the perisomatic inhibitory network is altered after seizures. In computational simulations, the experimentally identified changes in interneuronal inhibition compromise network oscillations proposed to underlie memory function. Implication of the observed changes to memory dysfunction and therapeutic failures in epilepsy will be discussed.

Sridevi V Sarma

Johns Hopkins University, USA

Title: Novel computational tool for localization of the Epileptogenc zone from intracranial EEG recordings

Time : 15:10-15:30

Biography:

Sridevi V. Sarma (M’04) received the B.S. degree in electrical engineering (EE) from Cornell University, Ithaca NY; and an M.S. and Ph.D. degrees in EECS from Massachusetts Institute of Technology (MIT) in, Cambridge MA, in 1997 and 2006, respectively. She was a Postdoctoral Fellow in the Brain and Cognitive Sciences Department at the MIT, from 2006-2009. She is now an assistant professor in the Institute for Computational Medicine, Department of Biomedical Engineering, at Johns Hopkins University, Baltimore MD. Her research interests include modeling, estimation and control of neural systems using electrical stimulation. She is a recipient of the National Science Foundation graduate research fellow, a L’Oreal For Women in Science fellow, the Burroughs Wellcome Fund Careers at the Scientific Interface Award, the Krishna Kumar New Investigator Award from the North American Neuromodulation Society, and a recipient of the Presidential Early Career Award for Scientists and Engineers.

Abstract:

Epilepsy is a neurological disorder characterized by abnormal electrical activity in the brain, called seizures. The region of the brain that causes the seizures is called the epileptogenic zone (EZ), and may differ for each patient. Epilepsy affects 60 million people worldwide, of whom over 30% of cases do not respond to medication or have medically refractory epilepsy (MRE). There are currently two treatments for patients with focal MRE: surgical resection, in which the EZ is removed in hopes of stopping seizures, or neurostimulation, in which the EZ is electrically stimulated to suppress seizures. Both treatments depend on accurately localizing the EZ, and when successful, both treatments are life-changing. EZTrack is a novel computational tool that generates a simple-to-read heat map overlaid over the patient’s brain scan that displays to clinicians which regions of the brain are highly likely to be in the EZ. EZTrack implements network-base data analytics and was tested in a retrospective study that included 42 patients who had resective surgeries. To test its efficacy, we compared EZTracks red-hot regions (ROI) to resected regions using electrocorticographic data per patient. If the complete ROI was resected, then we predicted a successful surgery; else we predicted a failure. For 42 patients, EZtrack achieved a prediction accuracy of 95%. It also correctly predicted all 17 failed surgeries, which is especially important to indicate to clinicians whether to resample different areas of the brain before deciding to resect.

Break: Networking and Refreshment: 15:30-15:50@ Foyer

Parastoo Kordestani Moghadam

Lorestan University of Medical Science, Iran

Title: Linguistic performance in Epileptic patients under treatment with old generation of anti-epileptic drugs

Time : 15:50-16:10

Biography:

Parastoo Kordestani Moghadam has completed her MSc in Medical-Surgical Nursing at the age of 24 years from Tehran University of Medical science. She is a Faculty Member of Nursing Department at Lorestan University of Medical Science (LUMS) for 14 years. She is a PhD student of Cognitive Neuroscience at Institute for Cognitive science Studies (ICSS).

Abstract:

Introduction: Epilepsy is one of the most common disorders that a patient may experience, disrupting his or her social roles. Generalized epilepsy can damage his or her cognitive performance which is essential for communication and human relationships. Linguistic skills are an important field of cognitive performance, influencing vital communications in social interactions. Methods: In this section of research, the cognitive performance has been studied in thirty generalized epileptic patients (10 men and 20 females) who had taken the old generation of antiepileptic drugs. In this report, one field of the cognitive performance, the linguistic field will be present. The subjects have taken carbamazepine or valproate sodium or phenobarbital. Result & discussion: All of the subjects had a decreasing score in both verbal fluency and naming. Attending to different mechanisms of the drugs in this study, we observed the linguistic skill damages of 100% of the subjects and the disconnection of the linguistic pathway that occurred in them. Based on neuroanatomy studies that were performed, we can extend the result of the research. Nevertheless, for detection of the exact sites of the disconnection, we need to design and perform the study investigating the functional activity of the linguistic cortex that is specifically involved in verbal fluency and naming.

Sylvain Haba

Spiritual Care Centre médico tradi talithakoumi, Guinea

Title: The Traditional treatment Epilepsy in West Africa specifically in Guinea Conakry

Time : 16:10-16:30

Biography:

Sylvain Haba was born on seventh of October 1963 in Kpoulo (Region N'Zerekore).He got his Admission to Bachelor in 1984, later completed his orientation to school nurses. After that he started his Internship in a medical post at Sèbètèrè Gaoual Prefecture where he went on Remote Training on medical semiology. In 1998 he admitted to the public service test, and later Training in traditional medicine in DR Congo foundation for his Back Guinea led in 2006 for the establishment of the Centre Medico-Spiritual Tradi koumi Talitha (Marc5: 41-42) to (Labe) Guinea 2008 and Transferred to the center in Conakry.

Abstract:

Epilepsy is a neurological disease characterized by abnormal functioning of brain activity. It results in the repetition of unexpected crises and often very brief. These attacks can take many forms and vary in intensity. This long regarded disease as compounds devils. - The Water Devil (it kills the patient in the water as soon as the crisis) - The devil fire (it kills the patient in the fire when the crisis) - The devil upper palms and legs (when the victims climb the palm trees or pick oranges or mangoes) Thanks to modern medicine, she was defined. The causes are usually malaria, meningitis, syphilis, HIV and others. It is processed with plant and animal origin. Maceration composed of three (3) plants: 1) Newbouldia Leavis. f: 10g Bignoniacée 2) Akeben 5g 3) 5g Balanbilin All packaged in a container placed diluted with one liter of water a day for four days during this 60 days with control of monitoring elements. Decoction made: 1) Raphiostilis bénénien icacinacé 10g 2) V.canne 10g 3) Nauclea latifolia rubiaccé 2g 4) Koyalakele (10g root) All boiled with the viscera of a wild animal. After monitoring elements, recommended that the patient drink 3-5 liters of decoction in the range of one hour (1) which causes vomiting and diarrhea causes but effective against seizures. Nasal Goute: 1) Microglossa pyrifolia 1g sheet 2) Citrus medica fruit juice 1ml 3) Oecophylla smaragdina F: Formicidae (yellow ant 20) 6 nasal costs and deposit 3 times daily for 3 days for a period of three weeks especially in the case of petit mal epilepsy.

Session Introduction

Nick Kane

North Bristol NHS Trust, UK

Title: The Occurrence of Non-Epileptic Events (NEE) in a Pediatric Population with Medically Intractable Epilepsy enrolled on a Pediatric Epilepsy Surgery Program

Time : 12:20-12:40

Biography:

Nick Kane MBChB, MSc, MD (Hons), FRCS, FRCP (by election) trained in Neurophysiology at the Burden Neurological Institute, the National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children in Londona full time NHS Consultant Clinical Neurophysiologist, Honorary Senior Clinical Lecturer at Bristol University and current President of the British Society for Clinical Neurophysiology. He is a former winner of the International Jubilee Gower Epilepsy prize and has 20 publications in peer reviewed Journals.

Abstract:

Over a 5 year period (2008 to 2014) 150 consecutive pediatric patients (age range 6 months to 17 years, mean 10.3 years, 76 males) were enrolled in our Pediatric Epilepsy Surgery program. Patients had been diagnosed with epilepsy on clinical and routine EEG grounds, and were deemed pharmaco-resistant based on their failure to respond to 2 or more anti-epileptic drugs at adequate doses for 6 months or more. As part of their pre-surgical work-up patients were admitted for 3 to 5 days of Video EEG (VEEG) monitoring. We prospectively identified epileptic seizures in 124 children (83%), confirming the clinical diagnosis, and/or stereotypic non-epileptic events (NEE) without electrographic changes in 82 (55%). The videoed NEE were reviewed with the patient’s parents or carers, confirmed as habitual and erroneously attributed to ictal activity. This gave a VEEG-confirmed co-existence of epileptic seizures and NEE 50%, compared to 10% to 50% in the Non-Epileptic Attack Disorder literature. We conclude that it is common to encounter concurrent epileptic and non-epileptic events in pediatric patients with medically intractable epilepsy. Our figure of 50% is higher than the reported occurrence of psychogenic nonepileptic seizures in recent retrospective VEEG series of pediatric populations, when the clinical question was the differential diagnosis of epilepsy (33%), including pre-surgical evaluations (19%) Whilst not a contra-indication to epilepsy surgery per se the co-existence of NEE (or PNES) should be borne in mind when managing and counselling pediatric patients.

Shripad Hebbar

Manipal University, India

Title: Epilepsy and Oral Hormonal Contraception - Indian Perspective

Time : 12:40-13:00

Biography:

Shripad Hebbar has completed his Masters in Obstetrics & Gynaecology at the age of 28 years from Karnataka University, India. He is currently working as Additional Professor of Obstetrics and Gynaecology a Kasturba Medical College, Manipal, University, one of the top recognized universities in India. He has authored several text books, research articles (more than 50) and has special interest in undergraduate and postgraduate teaching.

Abstract:

There are about 50 million people with epilepsy in the world and a quarter of them are in the reproductive age group. These women like others are highly fertile and frequently need to adopt effective and safe contraceptive measures to avoid unplanned pregnancy. There are several concerns regarding the efficacy and safety of natural methods or barrier methods in women who are taking antiepileptic drugs (AED), failure of which poses a great risk to the developing fetus as most of the AEDs have teratogenic effect. Oral hormonal pills are prescribed to epileptic women not only for birth control but also in certain situations such as polycystic ovaries, irregular menstruation, acne and dysfunctional uterine bleeding. There are major bidirectional interactions between reproductive hormones and antiepileptic drugs which the physician should be aware of while dealing with these women. This extensive review focusses upon potential drug interactions between constituents of various oral pills and anti-epileptic drugs, the formulations available in India with special note on ormeloxifene which is exclusively marketed for birth control in Rural India.

Break: Lunch: 13:00-14:00@ Eden's Landing Restaurant

Sara Eyal

The Hebrew University of Jerusalem, Israel

Title: Effects of Anti-epileptic drugs on carriers for drugs, hormones and nutrients: Implications for foetal exposure

Time : 14:00-14:20

Biography:

Sara Eyal has completed her PhD from the Hebrew University and Postdoctoral studies from The University of Washington. She is a Senior Lecturer at the Hebrew University's Institute for Drug Research and the Head of Research of the University's Pharm D program. She has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of Frontiers in Pharmacology: Drug Metabolism and Transport.

Abstract:

Our aim is to explore a novel mechanism of potential teratogenicity of antiepileptic drugs (AEDs), altered expression of placental and systemic carriers for hormones, nutrients and medications. We have recently demonstrated that AEDs affect the expression of folate placental uptake carriers (reduced folate carrier-RFC, folate receptor α-FRα) and efflux transporters (breast cancer resistance protein-BCRP and multidrug resistance protein 2) and thyroid hormones uptake transporters (L-type amino acid transporter-LAT1 and organic anion transporting polypeptides-OATPs) in a human placental cell line. Our findings from studies in mice provide further evidence for additional effects of AEDs on fetal exposure to xenobiotics through modification of their systemic pharmacokinetics. Identification of AED effects on the placental barrier and fetal exposure to xenobiotics and endogenous compounds could be a first step towards a more rational pharmacotherapy and supplemental therapy in pregnant women with epilepsy.

Mahnaz Asgharpour

Azad university, Iran

Title: A New Bifurcation Parameter in a Modified Huber-Braun Model

Time : 14:20-14:40

Biography:

Mahnaz Asgharpour received the B.S. in biomedical engineering from Jondishapoor University of Medical Sciences, Ahwaz, Iran and the M.S. degree in biomedical engineering from the Department of Biomedical Engineering of the Science and Research branch of Azad University, Tehran, Iran. She is a Ph.D. candidate in electrical engineering, control and system design at the department of electrical engineering, Tehran Science and Research branch of Azad University. She has been a lecturer at the Technical and Engineering Department of Azad University for up to four years. Her research interests include computational neuroscience, nonlinear dynamics and chaos.

Abstract:

Thermally sensitive neurons represent a bursting-spiking activity which is characterized by fast repetitive spiking trains of action potentials followed by quiescent periods. Synchronization of this activity in a network of coupled spiking neurons such as the epileptogenic zone in the brain may cause some neurological disorders such as epileptic seizures. The aim of this paper is to introduce a new algorithm for prediction the spiking onset in a model of an epileptic neuron and we try to use some parameters for feature extraction in our simulations which are potentially applicable in the non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS). In this regard, a modified Huber-Braun model of a thermally sensitive neuron exposed to external rTMS-induced voltages is presented. Applying the Chaos theory, the bifurcation diagram of a modified Huber-Braun model with a novel bifurcation parameter has been represented. Then we used the time at which the period doubling bifurcation is started in order to approximate the seizure onset in the modified model.

Saeideh Salehpour

Lorestan University of Medical Science, Iran

Title: Neural pathway damage of retrograde memory in Epileptic patients with older Anti-epileptic drugs

Time : 14:40-15:00

Biography:

Saeideh Saleh Pour has completed her Diploma at the age of 18 years. She is an Intern of Medicine at Lorestan University of Medical Science (LUMS). She is interested in research specially in Neurology.

Abstract:

Introduction: Memory is a very important field of cognitive function. Retrograde memory is the past memory that makes the information treasure of life for every person. With regard to the importance of memory, it seems that the evaluation of it in patients with risk of memory deficit is necessary. Epileptic patients are at a high risk of memory decline. Methods: In this study, our subjects were thirty grand mal epileptic patients under treatment with the older generation of epileptic drugs (carbamazepine or valproate sodium or phenobarbital). The types of memory are evaluated by Persian version of Addenbrook’s cognitive examination. Result & Discussion: In the study, all types of memory are definitely damaged but they have the variety of 20 until 100 percent of our subjects. Only one type of memory that has a decline for 100% of subjects was retrograde memory. Prefrontal and temporal cortex is two essential sites for that. It seems that the pathway between the prefrontal cortex and the hippocampus involve some kind of disconnection. Researchers in this study have some suggestions for the future study of epileptic patients who have taken older antiepileptic drugs. These suggestions will be discussed in this congress.

Session Introduction

Sloka Iyengar

Northeast Regional Epilepsy Group, USA

Title: Exploring Synaptic Plasticity in the Epileptic hippocampus in Epilepsy

Time : 15:00-15:40

Biography:

Sloka Iyengar received her PhD from the University of South Carolina, School of Medicine where she used electrophysiology to study synaptic plasticity in epilepsy. During her Postdoctoral work at the Nathan Kline Institute in New York, she studied the role of adult neurogenesis in seizures. Presently, she works as a Clinical Researcher and manages the brain tumor-related epilepsy research consortium. She is also a Science Writer and Advocate and regularly writes articles to make basic science more accessible to non-scientists.

Abstract:

Temporal lobe epilepsy (TLE) is a neurological disorder that can be caused due to stroke, traumatic brain injury or meningitis and is characterized by spontaneous, recurrent seizures. Medications used to treat TLE are called anti-epileptic drugs (AEDs) and can be associated with side-effects and refractoriness. It is important to better understand the changes that place in the brain that enable and sustain epileptic seizures in order to provide better therapies for people with epilepsy. The process by which a normal brain becomes ‘epileptic’ is called epileptogenesis and I have been studying epileptogenesis using experimental rodent models for the past ten years. All my studies have focused on the temporal lobe mainly the hippocampus because of its role in seizure generation and propagation. Using electrophysiology, we found differential regulation of synaptic plasticity by a neurotrophic factor called neuregulin (NRG) in the epileptic brain as compared to the non-epileptic brain. In another project, we focused on a process called adult neurogenesis in the hippocampus. Using mice, we found that a reduction in adult neurogenesis increased susceptibility to seizures. Currently used AEDs are associated with substantial side-effects because they act on both the healthy non-diseased tissue and the epileptic tissue. Exploring differences between the epileptic and non-epileptic circuitry could ultimately lead to development of more efficacious therapies for people with epilepsy.

Break: Networking & Refreshment: 15:40-16:00 @ Foyer

Session Introduction

Ann Marie Gillie

Epilepsy Advocate - Public speaker, Canada

Title: Lets talk about Epilepsy

Time : 16:30-17:00

Biography:

Ann Marie Gillie is an Education Assistant for Grades K-12, where she works primarily with students who suffer from FAS/ADHD and ODD. She is also a Canadian Advocate for Epilepsy and the Vice President for the Edmonton and Northern Alberta Epilepsy Association. She has published two books and had several articles written on her behalf (Surgical Neurology International/Your Health Magazine/Spruce Grove Examiner) as well as she has been interviewed on Global Edmonton and Breakfast Television Edmonton. Her topics of discussion are Women and Epilepsy/Sex and Seizures/Depression/Side effects of RX/Her surgery/Books published.

Abstract:

In Canada alone, an average of 42 people a day learn that they have Epilepsy and over 50 million people worldwide suffer from the disorder. I can say that I Beat Epilepsy. It was 6:30 AM on December 03, 2002. I remember being wheeled down the hall at the University of Alberta Hospital in Edmonton, Alberta, Canada by the porter with the silence it felt like we were the only ones in the building. You could hear a pin drop. I had lived with epilepsy for almost 20 years of my life and that was about to change. Left Selective Amygdalo-hippocampectomy is the surgery I was about to undergo and it is what cured me of my seizures. The left parahippocampal gyrus, left amygdale and left hippocampus were removed; structures within the left temporal lobe. I had 6 seizures 2 days before the surgery and I have not had one since. Since my surgery, I have accomplished some amazing tasks in my life. I have written two books, was asked to be a Canadian Advocate for Epilepsy in 2012 and have been a motivational speaker for over 8 years. Helping others is my passion, is my calling. I want to educate others internationally from a patient’s point of view, help them understand that they are not alone when it comes to living with epilepsy.

Session Introduction

Abbas Alnaji

Al Sadir Medical City, Iraq

Title: Dormant and sub-clinical bacterial infections of brain may be the cause behind all epilepsies including that due to post-traumatic or associated with space occupying lesion SOL

Time : 16:00-16:30

Biography:

Abbas Alnaji completed his Degree in Neurosurgery FICMS NS from University of Baghdad 1999. He is interested in research work and have twelve papers published in the field of Surgical Pathology Causations.

Abstract:

As neurosurgeon, I had an ambition to open unit for surgical treatment of epilepsy in our department like those in other parts of the world. I started my personal efforts to make myself more and deeper knowledgeable in this field. This maneuver yielded in interpretation of a fact that epilepsy simply is a Global Brain Dysfunction (GBD), the burden of it may be more in this or that part of the brain to be presented as a certain mode we term it with some known clinical entity. As results to this fact, epilepsy to be launched clinically it needs: A time to reach or exceeds certain threshold by this it had been called idiopathic and or it needs an added precipitating factors like head trauma by this it termed post traumatic. This GBD has other potential (needs added factor like motion sickness) or overt central clinical signs and symptoms if we put them in our consideration this fact will become clear or explains why patients with epilepsy suffers from chronic head ache, vertigo, memory impairment, weakness in concentration and many others. In short, I want to say epilepsy is not the only one who sits on the sofa it over-rides the other manifestations both socially and clinically. Another fact, this GBD is a complication or secondary to a chronic general systemic illness GSI. Again, as a result to this fact, you may find 1 history of signs and symptoms refered to a systemic chronic or sub-acute infectious disease. The patient may had been treated for systemic review referring to a general chronic health problems. Thorough physical examination picks up what refers to some long standing sufferings however, mild. 4 investigations are of some controversy, like PCR in this study which is positive 33% for blood, 66% for CSF and 66% for tissue in 15 patients all had been treated successfully with anti-neurobrucellosis whom being diagnosed clinically according to the above criteria. So, we have two interdigitated diseases; neurobrucellosis and epilepsy, one disease is a complication to the other (epilepsy is a complication of the neurobrucellosis). What’s new in this issue is, if we forget about the 15 patients with PCR study for Brucella as causation for epilepsy treated in Iraq, 2015. I had more than 100 patients over the period of 2006-2014 of all age groups and both genders treated in Iraq, Jordan and Libya for all what can be termed as modalities of idiopathic epilepsy (details for post traumatic and due to SOL in the full text), these patients either newly diagnosed by me or come with different anti-epileptic/s but uncontrolled, not forgetting a boy of nine years old presented to my private clinic with a troublesome un-controlled grand mal in spite of the three anti epileptics in maximum doses. I say those 100 patients had been treated depending on the above criteria for neurobrucellosis as a cause for their seizure modalities with excellent success whatever the duration of their affection. This was prior to PCR era at least in the aforementioned countries. The group with no antiepileptic/s starts to have a noticeable gradual improvement over the beginning 10-15 days both quantitatively and qualitatively (with care for precipitating factors). While those come already on antiepileptic/s but uncontrolled, they kept on their regimens and withdrawn gradually as they getting better on the same upper principle. Due to the poor long lasting follow up. Only 30% witnessed their full recovery until these words being written, May 2015. In conclusion; epilepsy, if we put the above facts in our consideration, we find that epilepsy is one manifestation of a chronic systemic infectious disease, the others are precipitating or co-factors, in my career this chronic systemic disease is mostly chronic Brucellosis.