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Targeted Research Initiative for Morbidity and Mortality

Gordon Buchanan, M.D., Ph.D.
Assistant Professor
The University of Iowa
Iowa City, IA, United States

Award Amount $50,000

Application Title:
Norepinephrine & serotonin in seizure-induced respiratory arrest and death

General Audience Summary:
SUDEP is the leading cause of death in patients with refractory epilepsy. Seizure-induced respiratory arrest (SIRA) is frequently implicated in SUDEP. The neurotransmitter serotonin has been implicated in SUDEP, especially in the respiratory consequences of seizures. Other neurotransmitters, such as norepinephrine (NE), can also be released during seizures and influence breathing. Preliminary data suggest that fluoxetine, a selective serotonin reuptake inhibitor that also has activity at NE receptors is able to prevent SIRA and death in mice that do not have serotonin neurons in the brain. This suggests a role for NE receptor activation. Here we propose to further characterize a role of NE in SIRA and death in a mouse seizure model. Previous work shows that many mice that experience such seizures suffer SIRA and die. It is also known that pharmacological up-regulation of the serotonin system prior to the seizure can prevent SIRA and death. We propose to use a similar approach to examine a role for NE in SIRA and death. Gaining a better understanding of ways to support breathing and prevent death following seizures in animal models that are relevant to SUDEP may reveal preventive strategies to employ in patients with epilepsy.

New Therapy Grant

Michael Gelfand, MD, PhD
University of Pennsylvania
Title: Safety of the Hovding Inflatable Helmet in Seizures

Award Amount: $63250

Summary Statement

The purpose of this study is to pilot the use of a novel helmet made by Hovding Inc. which has the potential to prevent head injuries caused by seizures. Ultimately, this study will be used to power and design a larger study to determine if the device is safe and effective. Patients with epilepsy often sustain head injuries during their seizures. While neurologists often advise patients with frequent seizures to wear helmets to prevent injuries, adults with epilepsy almost universally refuse because of social stigma and impracticality. A new, less obtrusive, inflatable helmet has been designed by Hovding that may encourage increased helmet use and therefore potentially decrease head injuries.

Fewer seizure-induced head injuries would lead to substantially decreased morbidity in patients and costs to the healthcare system. This helmet was the recipient of the Epilepsy Foundation’s Epilepsy Innovation Seal of Excellence Award in 2013.

We propose to recruit patients with Drug Resistant Epilepsy (DRE) who suffer from frequent seizures and have had a prior history of head injury. Those with the highest seizure frequency will be given a helmet to wear in their everyday lives. We will aim to capture at least 5 seizures from standing where the helmet inflates and 5 seizures from standing where the helmet either does not deploy or was not worn. We will ask subjects to keep a calendar of their seizures and to fill out questionnaires about their seizures. The questionnaires will record any injuries sustained and the circumstances of the helmet’s deployment as well as a previously validated scale to assess post concussive symptoms to be administered 48 hours after a seizure where a head injury or a fall with helmet deployment occurs. We will compare rates of injuries, post concussion syndromes, in falls where the helmet deployed versus falls where the helmet did not deploy and observe the helmets behavior in everyday life.

NEXT: epilepsy.com

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