Ley Sander

Ley Sander
UCL Queen Square Institute of Neurology · Department of Clinical and Experimental Epilepsy

MD PhD FRCP FEAN

About

1,138
Publications
138,775
Reads
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45,485
Citations
Introduction
I am an academic neurologist and my main research interest is epilepsy including epidemiology, outcomes, genetics, surgical and pharmacological treatment. I am also interested in epilepsy management in resource-poor settings and the global health aspects of epilepsy. I am a Consultant Neurologist at the National Hospital for Neurology & Neurosurgery. I am the Medical Director of Chalfont Centre for Epilepsy & R&D Director of Stichting Epilepsie Instellingen Nederland.
Additional affiliations
December 2018 - present
UCL Queen Square Institute of Neurology
Position
  • Head of Department
February 2012 - October 2015
University College London Hospitals NHS Foundation Trust
Position
  • Consultant
February 2012 - present
Epilepsy Society
Position
  • Managing Director
Education
October 1989 - September 1994
University of London
Field of study
  • Clinical Neurosciences
March 1976 - December 1981
Universidade Federal do Paraná
Field of study
  • Medicine

Publications

Publications (1,138)
Article
Diabetes mellitus may arise abruptly and decompensate suddenly, leading to a hyperglycaemic hyperosmolar state. Coma often ensues, although this usually reverses after the metabolic abnormalities have resolved. Acute symptomatic seizures can also occur in patients who are conscious, although these usually resolve after osmolarity and glycaemia have...
Article
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The takeover of Afghanistan by the Taliban in August, 2021, and the associated collapse of governmental institutions has led to innumerable security and humanitarian concerns, particularly for women and girls.1 Even before this event, more than 550 000 Afghans had been internally displaced during 2021.2 At the end of 2020, 3 million Afghans were in...
Article
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OBJECTIVE: Resistance to anti-seizure medications (ASMs) presents a significant hurdle in the treatment of people with epilepsy. Genetic markers for resistance to individual ASMs could support clinicians to make better-informed choices for their patients. In this study, we aimed to elucidate whether the response to individual ASMs was associated wi...
Article
Purpose of the review: Malaria, Chagas Disease and Human African Trypanosomiasis are vector-borne protozoan illnesses, frequently associated with neurological manifestations. Intriguing but ignored, limited mainly to resource-limited, tropical settings, these disorders are now coming to light because of globalisation and improved diagnosis and tre...
Article
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Objective: To ascertain whether adverse effects experienced by people taking carbamazepine or oxcarbazepine could be attributed to carbamazepine- or oxcarbazepine-induced hyponatremia (COIH). Methods: We performed an observational study, collecting data between 2017 and 2019 on serum sodium levels and adverse effects retrospectively in people wi...
Article
Objectives: This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: / Primary objectives: To provide an accurate estimate of the proportion of individuals going on to have further unprovoked seizures and the development of epilepsy at any subsequent time point, following a single unprovoked seizure (or cluster of epilep...
Article
Objectives: This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: / Primary objectives: To identify which prognostic factors predict whether individuals will go on to have further unprovoked seizures and the development of epilepsy at any subsequent time point following a single unprovoked seizure (or cluster of epile...
Article
The COVID-19 pandemic has caused global anguish unparalleled in recent times. As cases rise, increased pressure on health services, combined with severe disruption to people’s everyday lives, can adversely affect individuals living with chronic illnesses, including people with epilepsy. Stressors related to disruption to healthcare, finances, menta...
Technical Report
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Foreword Epilepsy is more common in people with a learning disability and/or autism than the general population. It is more likely to be difficult to control too. Seizures can have a profound impact on a person’s ability to live and enjoy their life. It also impacts on their level of learning disability and functional interaction with others. Poo...
Article
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Objectives To describe clinical characteristics of a community‐based epilepsy cohort from resource‐limited communities in Punjab, Northwest India. Methods The cohort was gathered following a two‐stage screening survey. We cross‐sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes,...
Article
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The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evi...
Article
Background: Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs. Aims: The aim of the study was to describe factors associated with and mortality consequences...
Article
Purpose We attempted to identify cultural aspects of epilepsy among the Roma community in Bulgaria by elucidating cultural beliefs, traditional treatments, and potential markers of stigma. Methods We established representative discussion groups among five distinct Roma subgroups (Lom, Kalderas, Thracian Tinsmiths (Tinkers), Kyustendil Xoroxane and...
Article
Objective To assess the prevalence of brain MRI abnormalities in people with epilepsy in rural China and to compare this with individuals in the United Kingdom. Methods Brain MRI scans were obtained in people with epilepsy who participated in a rural community-based program in China between July 2010 and December 2012. Individual epileptogenic les...
Article
Purpose To determine the burden of non-epilepsy drugs on people with epilepsy, using administrative health care data Methods The Achmea Health Insurance Database (AHID) contains health claims data from 25% of the Dutch population. From the AHID, we selected all policyholders with coverage for at least one full calendar year between 2006-2009. We i...
Article
Objective To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). Methods A retrospective multicenter cohort study conducted between 18 January and 20 March 2020 including people with confirmed COVID-19 from 56 hospitals officially designated in three Chinese regions; data were extracted from medical re...
Preprint
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Objectives: COVID-19 is spreading in long-term care facilities with devastating outcomes worldwide, especially for people with chronic health conditions. There is a pressing need to adopt effective measures prevention and containment of in such settings. Design: Retrospective cohort study assessing the effect of enhanced surveillance and early prev...
Article
Purpose of review: To review the latest evidence concerning the epidemiology, clinical implications and management of psychiatric disorders in epilepsy. Recent findings People with epilepsy have a 2 to 5 times increased risk of developing any psychiatric disorder and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. Psychiatric...
Article
Epilepsy, a common neurologic condition, is associated with a greater prevalence of type 2 diabetes mellitus (T2DM). We examined potential drivers for the comorbidity of epilepsy and T2DM in an attempt to elucidate possible biological mechanisms underlying the development of processes in individuals. We searched PubMed and Medline up to December 20...
Article
The Integrated Epilepsy Classification was recently proposed to merge the 2017 International League Against Epilepsy classification and the four-dimensional epilepsy classification updated in 2019. The efforts in developing the concept of an Integrated Epilepsy Classification scheme are encouraging. However, consideration of brain age, validation i...
Article
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Zoonotic and vector-borne parasites are important preventable risk factors for epilepsy. Three parasitic infections — cerebral malaria, Taenia solium cysticercosis and onchocerciasis — have an established association with epilepsy. Parasitoses are widely prevalent in low-income and middle-income countries, which are home to 80% of the people with e...
Article
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Objectives To provide information on the impact of the COVID-19 pandemic on people with epilepsy and provide consensus recommendations on how to provide the best possible care for people with epilepsy while avoiding visits to urgent care facilities and hospitalizations during the Novel Coronavirus pandemic. Methods The authors developed consensus...
Article
Aim: Pharmacoresistance is a major burden in epilepsy treatment. We aimed to identify genetic biomarkers in response to specific antiepileptic drugs (AEDs) in genetic generalized epilepsies (GGE). Materials & methods: We conducted a genome-wide association study (GWAS) of 3.3 million autosomal SNPs in 893 European subjects with GGE – responsive or...
Article
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Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 (COVID‐19). This multicenter retrospective study enrolled people with COVID‐19 from 18 January to 18 February 2020 at 42 government‐designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and...
Article
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Objectives We ascertained the prevalence of ictal arrhythmias to explain the high rate of sudden unexpected death in epilepsy (SUDEP) in Dravet syndrome (DS). Methods We selected cases with clinical DS, ≥6 years, SCN1A mutation, and ≥1 seizure/week. Home‐based ECG recordings were performed for 20 days continuously. Cases were matched for age and s...
Article
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Objective: Drug resistance is a major concern in the treatment of individuals with epilepsy. No genetic markers for resistance to individual antiseizure medication (ASM) have yet been identified. We aimed to identify the role of rare genetic variants in drug resistance for three common ASMs: levetiracetam (LEV), lamotrigine (LTG), and valproic aci...
Article
This commentary is on the original article by Andreasson et al. on pages 793–798 of this issue.
Article
The Global Burden of Epilepsy Report estimates that there are 13 million disability adjusted life years due to epilepsy each year. Estimates of years lived with disability attributed to uncontrolled and untreated epilepsies are particularly raised in comparison to controlled epilepsies in countries with low sociodemographic indices. There are 50 mi...
Article
Introduction: Scaling up the involvement of primary care providers in epilepsy management in low- and middle- income countries (LMICs) requires an understanding of their epilepsy knowledge, attitudes, and practices (KAP). Aim: The aim of the study was to document levels of knowledge about, attitudes towards, and practices regarding epilepsy among d...
Article
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying...
Article
Background: Repeat attendances to emergency departments for seizures, impacts on the individual and burdens health care systems. We conducted a review to identify implementable measures which improve the management of people with epilepsy reducing healthcare costs and their supportive evidence. Methods: A scoping review design using suitable sea...
Article
Objective: To review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome parameters in relation to epilepsy care in these countries. Methods: A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identi...
Article
Central apneas occurring in the aftermath of epileptic seizures may lead to sudden death. Contact-sensors currently used to detect apneas are not always suitable or tolerated. We developed a robust automated non-contact algorithm for real-time detection of central apneas using video cameras. One video recording with simulated apneas and nine with r...
Article
Objective Sudden unexpected death in epilepsy (SUDEP) is a leading cause of epilepsy-related mortality in young adults. It has been suggested that SUDEP may kill over 20 000 people with epilepsy in China yearly. The aetiology of SUDEP is unclear. Little is known about candidate genes for SUDEP in people of Chinese origin as most studies have ascert...
Article
Purpose: We attempted to determine the nationwide in-hospital mortality rate in people with status epilepticus (SE) in China. Methods: Using the database of the Chinese Hospital Quality Monitoring System (HQMS), we identified people hospitalised from 2013 to 2017 with an ICD-10 code G41 for SE as the primary diagnosis. HQMS was developed by the...
Article
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Familial Adult Myoclonic Epilepsy (FAME) is characterised by cortical myoclonic tremor usually from the second decade of life and overt myoclonic or generalised tonic-clonic seizures. Four independent loci have been implicated in FAME on chromosomes (chr) 2, 3, 5 and 8. Using whole genome sequencing and repeat primed PCR, we provide evidence that c...
Article
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Objective: To determine the incidence of clinically relevant arrhythmias in refractory focal epilepsy and to assess the potential of postictal arrhythmias as risk markers for sudden unexpected death in epilepsy (SUDEP). Methods: We recruited people with refractory focal epilepsy without signs of ictal asystole and who had at least one focal seiz...
Article
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Objective: Clinical and genetic predictors of response to antiepileptic drugs (AEDs) are largely unknown. We examined predictors of lacosamide response in a real-world clinical setting. Methods: We tested the association of clinical predictors with treatment response using regression modeling in a cohort of people with refractory epilepsy. Genet...
Article
In drug-resistant epilepsy, periods of seizure stability may alternate with abrupt worsening, with frequent seizures limiting the individual's independence and physical, social, and psychological well-being. Here, we review the literature focusing on different clinical scenarios related to seizure aggravation in people with drug-resistant epilepsy....
Article
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In this issue of the journal, Liu et al report on risk factors and prognosis related to early epileptic seizures after trauma (EPTE). This is important as it may increase further the risk of PTE over the years. The incidence of TBI in the young and the elderly is increasing and PTE is one of the few preventable forms of epilepsy. So the work of Liu...
Article
Introduction: Few drugs are available for migraine prophylaxis in children. Levetiracetam is a broad-spectrum anti-seizure drug that has been suggested to be effective in reducing adult migraine episodes. We assessed the safety and efficacy of levetiracetam in the prevention of pediatric migraine. Methods: A randomized double-blind placebo-contr...
Article
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Objective: To study the effectiveness and tolerability of antiepileptic drugs (AEDs) commonly used in juvenile myoclonic epilepsy (JME). Methods: People with JME were identified from a large database of individuals with epilepsy, which includes detailed retrospective information on AED use. We assessed secular changes in AED use and calculated r...
Article
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Purpose of Review Caffeine is the most widely consumed central nervous stimulant. For people with epilepsy, it is often unclear whether drinking coffee carries a risk of triggering seizures. Recent Findings The relationship between caffeine, seizures, epilepsy, and anti-seizure drugs is not fully understood. Clinical studies are scarce. In animal...
Article
Neurocysticercosis, or brain infestation with the larval stage of Taenia solium, is the most common risk factor for epilepsy in many endemic regions of the world. Hardly any cases are seen in Western developed countries, including Britain. However, a sizeable number (n = 450) was seen among British soldiers returning from deputation to India, then...
Article
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Importance A functional area associated with the piriform cortex, termed area tempestas, has been implicated in animal studies as having a crucial role in modulating seizures, but similar evidence is limited in humans. Objective To assess whether removal of the piriform cortex is associated with postoperative seizure freedom in patients with tempo...
Article
Objective To evaluate the prevalence of epilepsy and to assess secular trends in the life-time prevalence of epilepsy in rural China over a 12-year period. Methods In 2000-2002 and in 2012-2013, two independent cross-sectional epidemiological surveys, using an identical protocol, were conducted in rural areas in Shanghai, Shanxi Province, and Ningx...
Article
There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low- and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy, and the risk seems determined mainly by...
Article
Background: Epilepsy surgery is an important treatment option for people with drug-resistant epilepsy. Surgical procedures for epilepsy are underutilized worldwide, but it is far worse in low- and middle-income countries (LMIC), and it is less clear as to what extent people with drug-resistant epilepsy receive such treatment at all. Here, we revie...
Article
Objectives Sudden death is a recognised consequence of epilepsy. Little is known about the practice of confirming the cause of sudden death from most nations. We sought to determine how often autopsy is undertaken, clinician confidence in cause of death, and identify the factors which may influence autopsy utilization. Materials & Methods An onlin...
Article
Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epileps...
Article
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Objectives A cluster‐randomized trial of home‐based care using primary care resources for people with epilepsy has been set up to optimize epilepsy care in resource‐limited communities in low‐ and middle‐income countries. The primary aim is to determine whether treatment adherence to antiepileptic drugs is better with home‐based care or with routin...
Article
IMPORTANCE: Predicting the duration of poststroke dysphagia is important to guide therapeutic decisions. Guidelines recommend nasogastric tube (NGT) feeding if swallowing impairment persists for 7 days or longer and percutaneous endoscopic gastrostomy (PEG) placement if dysphagia does not recover within 30 days, but, to our knowledge, a systematic...
Article
The epilepsies affect around 65 million people worldwide and have a substantial missing heritability component. We report a genome-wide mega-analysis involving 15,212 individuals with epilepsy and 29,677 controls, which reveals 16 genome-wide significant loci, of which 11 are novel. Using various prioritization criteria, we pinpoint the 21 most lik...
Article
The risk of epileptic seizures seems increased in several systemic autoimmune disorders including systemic lupus erythematosus, type 1 diabetes mellitus, myasthenia gravis, celiac disease, rheumatoid arthritis, Hashimoto's encephalopathy, psoriasis, multiple sclerosis, neuromyelitis optica, and bullous pemphigoid. Immune dysfunction may be partly r...
Article
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Objective To ascertain the clinical and genetic factors contributing to carbamazepine and oxcarbazepine induced hyponatremia (COIH), and to carbamazepine (CBZ) metabolism, in a retrospectively collected, cross‐sectional cohort of people with epilepsy. Methods We collected data on serum sodium levels and anti‐epileptic drug levels in people with ep...
Article
Purpose: We evaluated the oral health and dental status of people with epilepsy, and their relationship to seizure frequency, in a community cohort in rural China. Methods: A cross-sectional study of people with epilepsy was carried out in areas in Henan, Shanxi and Ningxia provinces of China. All participants underwent a specially designed “Oral h...
Article
Introduction: Depression is the most frequent psychiatric comorbidity among people with epilepsy. It can impact on quality of life and increases the risk of morbidity and premature mortality. Areas covered: The authors review the available data on current and emerging drug treatments for depression in epilepsy. Sources have been identified through...
Article
Background The International League Against Epilepsy (ILAE) updated the classifications of seizures and epilepsies in 2017. We compared the 2017 classifications with the 1980′s classifications in rural China. Methods People with epilepsy were recruited from rural areas in China receiving treatment under the National Epilepsy Control Programme. The...
Article
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Objective: Neurocysticercosis is one of the most common risk factors for epilepsy but its association with drug-resistant epilepsy remains uncertain. Conjectures of an association with drug-resistant epilepsy have been fueled by reports of an association between calcific neurocysticercosis lesions (CNL) and hippocampal sclerosis (HS) from speciali...
Article
Objective: To estimate the incidence of sudden unexpected death in epilepsy (SUDEP) in people with intellectual disabilities in residential care settings and to ascertain the effects of nocturnal seizures and nocturnal supervision on SUDEP risk. Methods: We conducted a nested case-control study reviewing records of all people who died at 2 resid...
Article
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Background Juvenile myoclonic epilepsy (JME) is a common epilepsy syndrome for which treatment response is generally assumed to be good. We aimed to determine the prevalence and prognostic risk factors for refractoriness of JME. Methods We systematically searched PubMed and Embase and included 43 eligible studies, reporting seizure outcome after a...
Article
To compare between the 1981 and 2017 International League Against Epilepsy (ILAE) classification of seizure types based on an outpatient setting. We retrospectively reviewed 200 patients from our outpatient epilepsy registry. Based on clinical information, their seizure types were classified according to ILAE official reports, and differences betwe...
Article
Background: We conducted a systematic review to ascertain the overall mortality and causes of premature mortality in epilepsy. Methodology: We searched PubMed and Embase to identify relevant articles reporting mortality in epilepsy. An assessment of the methodological quality and overall quality of evidence of the identified studies was done usi...
Article
BACKGROUND: Genetic generalised epilepsy is the most common type of inherited epilepsy. Despite a high concordance rate of 80% in monozygotic twins, the genetic background is still poorly understood. We aimed to investigate the burden of rare genetic variants in genetic generalised epilepsy. METHODS: For this exome-based case-control study, we used...
Article
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Objective With the exception of specific metabolic disorders, predictors of response to ketogenic dietary therapies (KDTs) are unknown. We aimed to determine whether common variation across the genome influences the response to KDT for epilepsy. Methods We genotyped individuals who were negative for glucose transporter type 1 deficiency syndrome o...
Article
Background Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death among people with chronic epilepsy. People with intellectual disability (ID) are overrepresented in this population. The SUDEP and Seizure Safety Checklist (“Checklist”) is a tool to discuss risk factors influencing seizures and the risk of SUDEP. It includes questio...
Article
Purpose: Children exposed to antiepileptic drugs (AEDs) in utero are at risk for developmental problems. Maternal epilepsy, its impact on the family system, and other family factors may also contribute. We reviewed the possible associations between family factors and developmental outcome in children who had been exposed to AED during pregnancy....
Article
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Objective To pool observational data on the routine use of perampanel to obtain information on real‐world outcomes and data in populations typically underrepresented in clinical trials. Methods Individual‐level data of people with epilepsy treated with perampanel at 45 European centers were merged into a single dataset. Prespecified outcomes were:...