Key SUDEP Findings, research on sleep and epilepsy, healthcare disparities, and more in this issue Epilepsy Research News.

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CURE Epilepsy is dedicated to funding patient-focused research to find a cure for the 65 million people with epilepsy worldwide. This month, we share the following articles and abstracts which are furthering the study of epilepsy and bringing the world closer to a cure.

This issue of Epilepsy Research News includes summaries of articles on:
* University of Iowa Study Uncovers Key Findings in Sudden Unexpected Death in Epilepsy (SUDEP) ([link removed])
* “Awake Yet Dreaming” – How Sleep’s Brain Waves Guard Against Epilepsy ([link removed])
* Seizures Associated with Earlier Decline to Mild Cognitive Impairment in Cognitively Healthy Adults ([link removed])
* Life-Extending Epilepsy Surgery Performed Less Often in Black Children ([link removed])
* Expert Panel Provides Updated Data for Epilepsy and Pregnancy ([link removed])
* The Mozart Effect Myth: Listening to Music Does Not Help Against Epilepsy ([link removed])


** University of Iowa Study Uncovers Key Findings in Sudden Unexpected Death in Epilepsy (SUDEP)
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Recent findings from a study have brought scientists one step closer to understanding SUDEP, a rare but fatal complication of epilepsy. The exact cause of SUDEP is unknown, but studies point to prolonged apnea that persists following a seizure as a major culprit. Neuroscientists found that activating a particular area of the brain called the amygdala induces prolonged loss of breathing that persists even after a seizure has ended. “This is the first study to identify a site in the brain that can cause persistent apnea after the seizure ends,” said Brian Dlouhy, University of Iowa Associate Professor of Neurosurgery and Pediatrics, and senior author on the new study. “These new findings are a critical step in developing our understanding of what causes SUDEP and identifying those individuals at highest risk and ways to prevent SUDEP,” said Vicky Whittemore, Program Director at the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health, which
contributed funding for the study.
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** “Awake Yet Dreaming” – How Sleep’s Brain Waves Guard Against Epilepsy
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Researchers find that slow brain waves which are common in sleep, also occur in awake epilepsy patients and may protect against seizures. The research examined electroencephalogram (EEG) scans from electrodes in the brains of 25 patients with focal epilepsy (a type of epilepsy characterized by seizures arising from a specific part of the brain), while they carried out an associative memory task. The electrodes were placed in the patients’ brains to localize abnormal activity and inform surgical treatment. After reviewing the EEG data, the team found that the brains of people with epilepsy were producing slow waves – lasting less than one second – while they were awake and taking part in the task. There was a decrease in the “firing” of nerve cells, which the researchers say might protect against epileptic activity. “This study unveils a potential protective mechanism, specifically ‘wake’ slow waves, employed by the brain that may counteract epileptic activity. This mechanism takes advantage
of protective brain activity that normally occurs during sleep, but in people with epilepsy, can occur during wakefulness,” senior author, Professor Matthew Walker of UCL Queen Square Institute of Neurology, said. “Our study suggests that a naturally occurring activity is employed by the brain to offset pathological activities; however, this comes with a price, since ‘wake’ slow waves have been shown to impact memory performance.”
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** Seizures Associated with Earlier Decline to Mild Cognitive Impairment in Cognitively Healthy Adults
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In cognitively healthy adults, the presence of seizures predicted earlier change from normal cognition to mild cognitive impairment (MCI) but was not associated with change from MCI to dementia, according to a preliminary report of research shared at the 2023 American Epilepsy Society meeting in Orlando, FL. Comorbid seizures are common in those with dementia and are associated with accelerated cognitive decline. Ifrah Zawar, MD, lead study author and Assistant Professor in the Department of Neurology at the University of Virginia and colleagues sought to examine the impact of seizures independent of cardiovascular risk factors on cognitive decline, as well as their impact on cognitively healthy individuals, patients with MCI and on patients with MCI progressing to dementia. Their multicenter, longitudinal study analyzed data from 44,713 individuals recruited prospectively from 39 Alzheimer’s disease centers in the United States. According to the results, seizures predicted earlier
conversion time from normal cognition to MCI but were not associated with MCI to dementia conversion. “While epilepsy itself is associated with [MCI] and dementia, this risk is substantially magnified in those who also have high blood pressure, diabetes, or other cardiovascular risk factors,” Zawar said in a related release. Early screening and targeted interventions towards modifiable cardiovascular risk factors may also help delay the onset of dementia.
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** Life-Extending Epilepsy Surgery Performed Less Often in Black Children
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Children with drug-resistant epilepsy who are Black or insured through Medicaid may be less likely than white and privately insured patients to receive surgical treatments that can end or minimize their seizures and extend their lives, according to new research presented at the American Epilepsy Society’s annual meeting in Orlando, FL. The study of 18,000 children who were treated at 49 pediatric hospitals in the United States found that those who had surgery to remove or disconnect the area of the brain where seizures occur were 83% more likely to be alive after 10 years. Children who received vagus nerve stimulation (VNS) were 35% more likely to be alive. But the surgeries were not received equally. While 57.8% of the children in the study were white and 14.6% were Black, 63.6% of those receiving surgery were white and 10.1% were Black. Of those receiving VNS implants, 66.5% were white and 9.6% were Black. Black and publicly insured patients were more likely to be treated only with
anti-seizure medication and to have shorter life spans than white children, said Sandi Lam, lead author of the study and Division Chief of Pediatric Neurosurgery at Lurie Children’s Hospital.

Lam said it was well known that racial and ethnic disparities exist ([link removed]) in epilepsy care — for example Black and Hispanic patients are also less likely to get newer anti-seizure medications ([link removed]) — but said not enough was being done to get better care to all patients; she hoped the new findings would help prompt more people who provide epilepsy care to push for solutions.
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** Expert Panel Provides Updated Data for Epilepsy and Pregnancy
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The Epilepsy & Pregnancy Medical Consortium, an expert panel of leading epileptologists and OB-GYN researchers/practitioners, announced updated best practice recommendations for people with epilepsy who are considering pregnancy, are pregnant, or are postpartum. These best practices are based on the findings of the groundbreaking study Maternal Outcomes and Neurodevelopment Effects of Antiepileptic Drugs (MONEAD) and its predecessor study Fetal Antiepileptic Drug Exposure and Cognitive Outcomes at Age 6 Years (NEAD study). MONEAD followed 565 women, including pregnant women with epilepsy, non-pregnant women with epilepsy, and pregnant women without epilepsy to explore the impact of various anti-seizure medications on seizure frequency, maternal outcomes, breastfeeding, and child outcomes (such as verbal and intellectual abilities) through six years of age. Based on the results, the MONEAD study asserts that with proper planning and therapeutic monitoring of pregnancy-suitable anti-seizure
medication people with epilepsy can have safe, healthy pregnancies and healthy babies. The data also show that neurodevelopmental outcomes at age six were better in children exposed to anti-seizure medications in utero who were breastfed compared to those who were not breastfed. “It’s important that when it is time to have children we have everything in place, and then we have a planned pregnancy,” said Dr. Pennell, M.D., F.A.E.S., Department Chair of Neurology at the University of Pittsburgh School of Medicine and co-investigator of the MONEAD study. We emphasize that for most anti-seizure drugs, we have strong evidence that there is a low risk of breastfeeding.”
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** The Mozart Effect Myth: Listening to Music Does Not Help Against Epilepsy
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Over the past 50 years, there have been remarkable claims about the effects of Wolfgang Amadeus Mozart’s music. Reports about alleged symptom-alleviating effects of listening to Mozart’s Sonata KV448 in people with epilepsy attracted a lot of public attention. However, the empirical validity of the underlying scientific evidence has remained unclear. Now, a new comprehensive research synthesis by Sandra Oberleiter and Jakob Pietschnig from the University of Vienna, based on all available scientific literature on this topic, showed that there is no reliable evidence for such a beneficial effect of Mozart’s music on epilepsy. The origin of these ideas can be traced back to the long-disproven observation of a temporary increase in spatial reasoning test performance among students after listening to the first movement allegro con spirito of Mozart’s sonata KV448 in D major. “Mozart’s music is beautiful, but unfortunately, we cannot expect relief from epilepsy symptoms from it”, conclude the
researchers.
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