Can Epilepsy Be Fatal?

Sudden, unexpected death in epilepsy (SUDEP) has been recognized for years and is recently better understood. The risk of sudden death is 20 times higher in people with epilepsy than in the general population. Patients with intractable epilepsy (who do not respond to medications) have an estimated 35% lifetime risk. In the US, 3000 cases of SUDEP occur each year. Risk factors are early age of onset, young adult age, poor seizure control, especially grand mal seizures. Some of these factors are modifiable.

Should patients and family be informed of this risk? Would it cause them needless anxiety? The answer to this question is not clear. Most likely, patients with difficult-to-treat epilepsy who are at high risk should be informed. SUDEP can occur in epilepsy monitoring units. It is triggered by a grand mal seizure, followed by rapid breathing, and then cardiorespiratory collapse. There are urgent needs for methods to predict and prevent sudden death in these patients.

For more information, see Lancet Neurology, 2015, page 125.

Jack Florin, MD
Neurologist

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Does Levodopa Harm Parkinson’s Patients When Used as Early Therapy?

Some studies have shown increased motor fluctuations in patients treated early in their course with levodopa. One strategy is to use medication such as Azilect and dopamine agonists until symptoms worsen. A new study concludes that this reasoning is faulty. Mobility in patients receiving initial levodopa over many years was equal to or even better than the mobility in other groups. This argues against avoiding levodopa, particularly in the treatment of older Parkinson’s patients. See Lancet Neurology, Volume 14, January 2015, page 10.

Jack Florin, MD
Neurologist

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Lower Your Trans Fat Consumption

A study presented at the 2014 Meeting of the American Heart Association by Dr Beatrice Golomb from UCSD involved 1000 healthy men. Those consuming the most trans fats showed worse performance on a word memory test. The author noted that the effects were the strongest in young and middle-aged men during their working and career-building years. She emphasized that trans fat consumption has also been linked to higher body weight, more aggression, and heart disease. She counsels her patients that while trans fats increase the shelf life of foods, they reduce the shelf life of people.

Trans fats are artificially produced to turn liquid oils into solids at room temperature and extend food shelf life and are found in margarines, fast foods, baked goods, snack foods, frozen pizza, coffee creamers, and some refrigerated dough.

Her group did a previous study that found that chocolate, which is rich in antioxidants and positively impacts cell energy, is linked to better word memory in the same group.

Dr. Jack Florin, MD
Neurologist

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Mothers’ Weight Before Pregnancy Affects Offspring’s Risk of Death Decades Later

Also presented at this meeting was a report from the Framingham Heart Study in Boston, showing that adults whose mothers were overweight before pregnancy have a much higher risk of dying from heart disease or stroke. It was previously shown that children of obese mothers have a higher risk for themselves of having obesity, diabetes, and elevated cholesterol, and this study showed that that risk indeed translated into higher rates of cardiovascular disease and death. The increase was 90%.

More than half of pregnant women in the US are overweight or obese. This study adds to a growing body of evidence linking maternal health to later life cardiovascular health in children.

Dr. Jack Florin, MD
Neurologist

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Does Tylenol Even Work?

Maybe not, according to a study published in Lancet 2014, with lead author Dr C. M. Williams. This was a Class I, high-quality, double-blind randomized controlled trial for use of Tylenol in acute low back pain. Up 2 Extra Strength pills 4 times a day, for a total of 4000 mg a day, were allowed. Whether used on a daily or on an as-needed basis, recovery time was the same in treated versus untreated placebo patients.

The results of this study are similar to those in osteoarthritis, dysmenorrhea, or rheumatoid arthritis. Given risk of liver damage, there is increasing evidence that it is not a first-line treatment for these disorders.

Dr. Jack Florin, MD
Neurologist

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