October 2015

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OCTOBER 2015 FACES E-NEWSLETTER

  1. RECIPE OF THE MONTH
  2. FACES FISCAL YEAR 2016 RESEARCH PROJECTS
  3. WELCOME ABOARD NEW CEC PHYSICIANS
  4. MICROGLIA
  5. EPILEPSY FOUNDATION WALK
  6. TEAM FACES
  7. ATTITUDE OF GRATTITUDE
  8. NOTEWORTHY NEWS

1) RECIPE OF THE MONTH

By: Pegah Jalali MS, RD, CNSC, CDN

CLICK HERE TO VISIT THE NUTRITION SECTION OF OUR WEBSITE!

Pegah Jalali is a certified dietitian who gives nutritional guidance to pediatric and adult epilepsy patients. She attended University of Toronto and received a BS in Nutrition Science and an MS in Management of Innovation. She also attended New York University and received an MS in Clinical Nutrition. She completed her internship at Mount Sinai Medical Center. She joins us after 2 years of caring for patients at New York Presbyterian Weill Cornell Medical Center. Pegah is working on becoming a certified lactation consultant. In her free time, Pegah likes to travel, read, eat, cook, and visit farmers’ markets and food markets.

We welcome back dietician, Courtney Glick. Courtney and Pegah will give joint nutrition counseling to the epilepsy community starting this month.

APPLE SALAD

This is a great salad for Fall since its crunchy, fresh, and a little reminiscent of the past season. Apples are mostly used for desserts, but it is a great fruit for putting in a salad. You can dress up this salad with some quinoa and salmon for a meal.

INGREDIENTS:

2 tablespoons extra-virgin olive oil
2 tablespoons fresh lemon juice
1/4 teaspoon sea salt
1/4 teaspoon pepper
2 cups thinly sliced Honey Crisp apples
2 cups sliced celery
1/2 cup loosely packed fresh flat-leaf parsley
1/3 cup thinly sliced red onion

Makes 4 servings as a side, each serving has 105 calories, 7.3 g fat, 10.6 g of carbohydrates (2.6 g fiber) and 1 g of protein.

DIRECTIONS:

Combine the first four ingredients and set aside (this is your dressing). Slice the apple, cut the apple in half, de-core and de-seed, then use a mandolin to cut even slices. Cut celery in even pieces then thinly slice the red onion. Mix apple, celery, onion and toss with dressing and sprinkle parsley and mix.

Substitutions/additions: Ambrosia apples can be used as well. Lime and ciliantro can be used instead of lemon juice/parsley. You can also add walnuts, spinach, or avocados.

2) FACES FISCAL YEAR 2016 RESEARCH PROJECTS

DESIGN AND IMPLEMENTATION OF REAL TIME SEIZURE DETECTION ALGORITHMS USING SINGLE CHANNEL EEG

PI: Daniel Friedman, MD

Because seizures can interfere with awareness and memory, people with epilepsy are often poor reporters of their own seizures. This presents a significant challenge to patients, family members, clinicians and researchers because seizure rate is the marker of disease activity that informs changes in therapy or driving restrictions. In addition, there is some evidence that unrecognized seizures, especially nocturnal tonic-clonic seizures, may increase SUDEP risk. Therefore, there is a need for reliable and accurate seizure detectors that patients can use at home to quantify seizure activity and alert caregivers of ongoing seizure to improve disease management and safety. Wearable sensor and portable computing power has evolved significantly such that long term, real time measurement and analysis of physiological signals such as EEG is practical. However, long term recording of EEG signals for months to years can lead to a massive amount of data that has to be analyzed to identify seizures, preferably in real time so physicians, patients and caregivers can act upon them. Current clinical EEG systems often come with seizure detection algorithms but many rely on analysis of a full array of scalp EEG electrodes and sacrifice specificity for sensitivity. While this is a reasonable approach in the epilepsy monitoring unit where these algorithms aid data review and alert staff of seizures, even a modest significant false detection rate (1 per hour) in chronic use would generate excessive data to verify and lead to alarm fatigue. Instead, highly specific and sensitive new algorithms are needed that can detect seizures from a small number of wearable EEG sensors that are feasible for long-term use. We have been developing seizure detection algorithms designed to detect seizures in recordings from just 2 strategically placed electrodes, which could be incorporated in a long-term, non-invasive or minimally invasive device. In this preliminary project we will continue to work to develop novel seizure detection algorithms using machine-learning tools that are able to accurately detect seizures from single EEG channels. We will design and test detection algorithms that can be tuned to the specific seizure signature of the patient with minimal input from the patient or clinician. Finally, we will develop and test a custom program to apply these detectors and tuning algorithms in real time to patients undergoing surgical evaluation in the epilepsy monitoring to test their performance. Such a program can be ultimately run on a smartphone or embedded microprocessor in future generations of wearable EEG sensors.

A PILOT STUDY OF TMS ENHANCEMENT OF FMRI BASED ASSOCIATIVE MEMORY NETWORKS IN HEALTHY SUBJECTS AND EPILEPSY PATIENTS

PI: Anli Liu MD MA, Heath Pardoe PhD (Co-PI)

Memory difficulty, slowed processing speed, and attention deficits are the most common complaints of epilepsy patients. Problems with memory, particularly for long term storage of verbal information and events, is the most common cognitive complaint in patients with temporal lobe epilepsy and other partial onset epilepsies.

This project seeks to develop a technology with significant therapeutic potential for memory remediation: non-invasive transcranial magnetic stimulation (TMS). TMS involves a series of pulses of magnetic fields to the scalp surface, which may excite underlying brain activity. A recent study demonstrated that TMS guided by functional MRI (fMRI) imaging can increase activity in the hippocampus, a structure critical to long-term memory storage, in healthy subjects (Wang, Rogers et al. Science 2014). This project will explore whether repeated TMS guided by fMRI can be used for memory remediation in patients with well-controlled temporal lobe epilepsy.

STRESS, ANXIETY, & TEMPORAL LOBE EPILEPSY: EFFICACY OF A MINDFULNESS BASED INTERVENTION PROGRAM

PI: Steven Pacia, MD and Melissa Russell, N.P.

Mindfulness Training (MT) has emerged as an important non-pharmacological tool to help reduce the impact of psychological stress on the brain and body. Patients with temporal lobe epilepsy (TLE) consistently report stress and anxiety as major influences on seizure control and quality of life. We intend to analyze objective and subjective measures of stress and anxiety in both healthy subjects and in those with TLE. Salivary alpha amylase (sAA) and cortisol (sCort), spectral scalp EEG, and standardized neuropsychological surveys will be collected at baseline and following exposure to a medically supervised stressor, the Trier Social Stress Test. We will evaluate the efficacy of a four-week phone-application based MT program in reducing subjective and objective measures of stress, and improving self-reported quality of life. The results will serve as pilot data for a larger study of the effects of MT on seizure frequency in TLE.

 

NEUROANATOMICAL AGE PREDICTION AS A MARKER FOR SEIZURE-RELATED BRAIN CHANGES

PI: Heath Pardoe, PhD

One of the ongoing problems of epilepsy research is determining if structural brain changes associated with epilepsy exist before seizures, or are caused by seizures themselves. In this study we address this problem by using magnetic resonance imaging (MRI) to compare the brain structure of individuals with recent onset epilepsy with people that have severe, treatment resistant epilepsy. We will use advanced image analysis of brain scans to determine if ongoing seizures cause accelerated aging of the brain. The outcome of the project will be a method for assessing if medical treatment is protecting epilepsy patients from seizure-related brain changes.

 

 

EPILEPTIC PHENOTYPE OF THE GAMMACAMKII KNOCKOUT (KO) MICE

PI: Alejandro Salah, MD, PhD

Preliminary data from our laboratory suggests that the levels of the protein kinase gammaCaMKII in patients suffering from autism is dramatically low compared to normal people. Since autism often co-exists with epilepsy, I am proposing to use a mouse model where the gammaCaMKII is not present (gamma CaMKII knockout) to investigate the seizure tendency on these animals. Electrical activity of the brain will be studied by performing long-term video-EEG. The EEG procedure tracks and records brain wave patterns in the living animals and will be assessed at baseline and in response to seizure inducing (pro-convulsant) drugs, such as kainic acid. These experiments are critical for a better understanding of the relationship between autism and epilepsy.

 

 

3) WELCOME ABOARD NEW CEC PHYSICIANS

JOSIANE LAJOIE, MD

A native New Yorker, raised on Long Island, New York. Dr. Josiane Lajoie became fascinated with language processing while in college and graduated from Swarthmore College with a B.A. in Biology and Linguistics. She graduated from the Medical College of Pennsylvania in Philadelphia and completed her pediatrics residency at The New York Hospital-Cornell Medical Center. She then entered and completed two fellowships, one in Child Neurology and the other in Clinical Neurophysiology at the Albert Einstein College of Medicine in the Bronx. As a fellow, she became the Co-director of the Muscular Dystrophy Clinic. In July 2002, she joined the faculty at NYU Langone Medical Center where she was an attending physician at the Comprehensive Epilepsy Center for about 10 years. She was the Co-director of Pediatric Epilepsy there as well as the Director of the Tuberous Sclerosis Center.

In 2011, Dr. LaJoie became the Chief of Pediatric Epilepsy at Cohen Children’s Medical Center of New York of the North Shore-LIJ Health system. In July 2015, she rejoined the faculty here at NYU Langone Medical Center and resumed her position as the Director of the Tuberous Sclerosis Center. Dr. LaJoie is board certified in General Pediatrics, Neurology with special qualification in Pediatric Neurology and Clinical Neurophysiology. She is the published author of numerous book chapters and peer reviewed articles on the subject of pediatric epilepsy. She has been an invited guest on radio and television as a commentator on special aspects of pediatric epilepsy. Her research interests include epilepsy surgery in children as well as alternative epilepsy treatments.

Dr. Lajoie serves on the Physician Advisory Board for the Epilepsy Foundation of Long Island, the Epilepsy Foundation of Metropolitan New York, and has served the National Epilepsy Foundation of America. One of her passions is advocacy rights for children with epilepsy. She also serves as a Mentor in the Pipeline Program for high school students interested in careers in the health profession at Hofstra-North Shore-LIJ School of Medicine. She has been an invited lecturer at Princeton University to young women interested in pursuing a career in medicine.

Dr. Lajoie has been named to the Castle Connolly “Top Doctors” and “Super Doctors” in Long Island and New York City for the last several years. Please join us in welcoming back Dr. Josiane LaJoie!

AMY JONGELING, MD, PHD

Dr. Amy Jongeling has recently joined the NYU Comprehensive Epilepsy Center as an Assistant Professor in Neurology. Amy grew up in a small town in southern Michigan. A graduate of Notre Dame, she studied medicine at the University of Iowa, where she also completed a PhD in neuropharmacology, studying chronic pain and opioid dependence. She soon realized that she was much happier interacting with people one-on-one and bringing the knowledge gleaned in the laboratory into practical application. She continued her medical training in a neurology residency at Columbia University Medical Center followed by a clinical neurophysiology/epilepsy fellowship. She is committed to engaging in a multi-faceted approach to treating epilepsy, from stress-management, diet, and other lifestyle adjustments, to medications, responsive neurostimulation, and surgery. She has a particular interest in patients who have epilepsy related to brain tumors, traumatic brain injury, and infections. She is excited to be spending part of her time with our growing epilepsy program at NYU Lutheran Medical Center in Brooklyn.

4) MICROGLIA

By: Sloka Iyengar, phD

Epilepsies can be genetic or acquired, the latter meaning the epilepsy is caused by something ‘acquired’ after an event e.g. meningitis, stroke or a traumatic head injury. The initiating event can be followed by a latent period of called ‘epileptogenesis’, after which seizures and comorbidities may ensue. Hence, the process by which a normal brain becomes epileptic is called epileptogenesis; and needless to say, is the source of active scientific investigation. Scientists think that inflammation in the brain may contribute to epileptogenesis. But, how does this happen?

We know that the brain is made up of neurons and supporting cells called glia. Glia come in many sizes and shapes; glia that play an active part in inflammation are known as ‘microglia’ (see picture). They are named this because these cells are extremely small. Microglia are important because they form the first line of defense in the brain. They have unique capabilities to do this because they are extremely sensitive to changes in environment, and can change their form quickly and can recognize and destroy foreign bodies. Seizures can cause brain injury that microglia respond to by becoming ‘activated’ as opposed to ‘resting’ microglia in the normal condition. This can be seen in the accompanying picture: on top left is a picture of normal microglia, whereas the image on the bottom left shows ‘activated’ microglia after an injury. One way of studying epilepsy is by using experimental animals like rats and mice, and administering injections of convulsants (drugs that mimic epilepsy). Scientists have found that even in these experimental models, there is an increase in activated microglia right after a seizure. Whether this activation is good or bad for epilepsy is not completely understood but scientists are using a variety of tools to figure it out.

Sloka S. Iyengar, PhD has a background in basic science where she used animal models of epilepsy to understand what makes the epileptic brain susceptible to seizures and various comorbidities. She recently switched to clinical epilepsy at the Northeast Regional Epilepsy Group, where she conducts clinical trials for people with epilepsy and established the Brain Tumor-related Epilepsy Research Consortium. She is also a science writer and advocate.

 

 

5) EPILEPSY FOUNDATION WALK

FACES at NYU Langone Medical Center was a sponsor of the Epilepsy Foundation of Metropolitan New York's 4th Annual “Into the Light Walk”. This year's event was held at South Street Seaport on Sunday, September 20th. The walk was preceded by music, entertainment, and display tents by all participating foundations. All proceeds went to epilepsy awareness, education and empowerment programs. These include the Foundation's epilepsy 101 and seizure first aid trainings which staff provide free of charge to area schools, companies, school nurses, first responders, and throughout the community by request. FACES has supported the Epilepsy Foundation of Metropolitan New York’s walk as a sponsor since it started 4 years ago.

For more information about the Foundation's programs and services, visit www.efmny.org or call 212-677-8550.

ENJOY SOME PHOTOS

 

 

 

 

 

6) TEAM FACES

TeamFACES Runs the 2015 TCS New York City Marathon

“There is not one giant step that does it, it’s a lot of little steps”, Peter A. Cohen

This year we are proud to have 11 runners in the 2015 TCS New York City Marathon representing TeamFACES. On November 1st, these runners will hit the pavement for 26.2 miles to raise funds and awareness for FACES!

Each step TeamFACES takes in the 2015 TCS New York City Marathon will honor the families and individuals affected by epilepsy every day. Through their strength and determination, they will not only cross the finish line in Central Park, but they will let the millions of spectators and thousands of other athletes know just how important it is to support and fund the FACES mission.

Each of our athletes has committed to raising $5,000 in support of FACES.

FACES is extremely grateful to our runners and wishes them the best of luck with their remaining weeks of training.

Follow this link and read about our runners. Please consider making a donation to show your support of their journey to the finish line! Every dollar counts in taking steps to improve the lives of our community. If you would like to join us at the FACES Cheering Station on November 1st (Manhattan location TBD), please contact Marisa Maltese at marisa.maltese@nyumc.org

7) ATTITUDE OF GRATITUDE

“I would like to thank the FACES Dr. Blanca Vazquez Summer Camp Scholarship Program for allowing my son to enjoy summer time once again.

My son recognized the farm, the smell, and the landscape, every time we arrived for the sessions. He seemed to be excited, although it was hot, he finished every lesson happily. The person that walked with Diego every ride,

told me that he has got stronger, and well acquainted with the instruction to stop the horse and/or proceed by touching the horse every time.

The movement of the horse is something that he enjoys a lot; he extraordinary work by keeping his balance and posture while riding that made me very proud.

We are very grateful for this opportunity you have granted to my son, and wish you all the best for the rest of the year”

“Thank you so much to the FACES Apartment Program for treating us with hospitality. You cannot believe how much this has helped us out financially!! It made my wife cry that your organization took the time to help us out!!! She has been through a long road since her battle with epilepsy began 22 years ago. I told her this was a positive omen for better things to come our way!! Thank you once again, YOU MADE OUR DAY!!!!!”

8) NOTEWORTHY NEWS

Top 10 National Press Articles

1) Degenerative Brain Disease Nearly Universal Among NFL Players

2) Legalize It: Medicine Struggles with Marijuana Epilepsy Cures

3) Independent Review Excludes Many Patients from AED Trial

4) It’s Time to Rethink Resting After Concussions

5) Researchers: Marijuana Works on Epilepsy

6) Drug Laws Continue to Inhibit Cannabidiol Research for Epilepsy

7) Pot Chemical Shows Promise Against Epilepsy

8) Service Dogs Help People with More Than Blindness

9) This Could Be The Most Medically Valuable Pot — & It Doesn't Get You High

10) Six Condiments to Avoid If You’re Trying to Eat Healthy


First Ever Teen Chat About

Join the Epilepsy Foundation and FACES (Finding a Cure for Epilepsy and Seizures) for a series of chats for teens with seizures or epilepsy. Teens between the ages of 13 and 17 are encouraged to apply.

This private, web-based, text only, chat group is limited to 20 participants.

Completed applications will be considered on a first come, first served basis. Accepted participants will receive an email with instructions for joining the chat.

Teens: here's a chance to connect with others like you, ask questions, and learn how they manage their seizures with school, friends, sports, and other interests.

"It's amazing when you talk with other kids who understand what you are talking about. They really get what it's like to have seizures and I don't feel so alone."

Parents: help your teens meet others with seizures and learn effective ways to cope with epilepsy. The first meeting will require your participation in a chat room where epilepsy.com moderators will provide an orientation and demonstrate the technology.

Please click here to view application/ due Tuesday, October 13

Parent's Orientation: Tuesday October 20 - 7:30 - 8:30 p.m. EST

Teen Chat About All 7:30 to 8:30 p.m. ET

Tuesday, October 27

Tuesday, November 10

Tuesday, November 24

Tuesday, December 8

Tuesday, December 22

To participate in "Teen Chat About ...," both the teen and a parent must complete the attached form. Return your completed form by email to epihelp@efa.org or by fax to 301-731-8719 no later than October 13.

Please call Pamela Mohr, Executive Director of FACES with any questions at 646-558-0824
 


Keto Kids Club

Michelle Sanders and her 12 year old daughter, Olivia, share their journey with epilepsy and the ketogenic diet on Doctor Radio. Please click here to learn more about the Keto Kids Club and register for their upcoming event on October 22nd.


“From right to left: Michelle Sanders, Olivia Sanders, Dr. Josiane Lajoie,
Doctor Radio’s Jonathan Whitson, MD, and Pegah Jalali MS, RD, CNSC, CDN.