Current Therapy for EpilepsyJ. Layne Moore, MD, MPHProfessor NeurologyWright State University Boonshoft School of Medicine

Epilepsy

A disease known from antiquity

Initially thought to be from the attack of a spirit or demon The name epilepsy is derived from the Greek

word for “to attack” So a person does not “seizure” they are seized.

Rationale of Bloodletting

Bloodletting goes back 3000 years to the Egyptians.

To appreciate the rationale for bloodletting one must first understand the paradigm of disease 2300 years ago in the time of Hippocrates ( circa 460–370 BC).

Hippocrates believed that existence was represented by the four basic elements—earth, air, fire, and water—which in humans were related to the four basic humors: blood, phlegm, black bile, yellow bile. . 

Humorism

Humorism

Ohio Hospital for epileptics at Gallipolis

Ohio

Ohio Hospital for epileptics at Gallipolis

Ohio

Ohio Hospital for epileptics at Gallipolis

Ohio

Ohio Hospital for epileptics at Gallipolis

Ohio

The commission consulted the foremost neurologists and alienists, at home and abroad, especially those experienced in the treatment of epilepsy, and submitted plans for the construction of 36 buildings for the segregation of epileptics in classified colonies, after the method of the Bielefeld Colony in Germany, as the best adapted for the welfare and treatment of those affected with epilepsy.

The Ohio Hospital for Epileptics

In 1892 the General Assembly passed an act changing the name of the institution from " The Asylum for Epileptics and Epileptic Insane " to " The Ohio Hospital for Epileptics."

http://www.asylumprojects.org/index.php?title=Gallipolis_Epileptic_Hospital

Hans Berger

Science to problem

Wilder Penfield

PB PHT CBZVPA

FBM

GBP

LTG

FOS

TPM

TGB

3rd G

ener

atio

n

“2nd Generation”

OCBZ

LVT

ZNS

Antiepileptic Drug (AED) Therapy

Newer AEDs

Rufinamide

developed in 2004 by Novartis and manufactured by Eisai. Approved for marketing 2008.

Approved as adjunct therapy for LGS

MOA uncertain perhaps sodium channels

Lacosamide

Approved in 2008

Voltage-gated sodium channels

UCB

Approved for adjunct therapy for partial onset

Ezogabine

A potassium channel Therefore unique

Effective in many animal models of epilepsy

Studies underway in neuropathic pain, tinnitus and migraine

TID dosing

Perampanel

acts as a selective noncompetitive antagonist of AMPA receptors.

Being studied in Parkinson’s disease

Half-life 105 hours

95% protein bound

Brivaracetam

Approval may be early 2015

it is around 10 times more potent for some models of epilepsy than Levetiracetam

VNS

Approved for partial epilepsy 1997

Approved for depression 2005

Responsive Neurostimulator Device

The RNS System utilizes a neurostimulator implanted in the skull with one or two leads implanted in the brain at focal points of seizures

Quality of Life

Side-effects

Mood

Anxiety

Stigma

Isolation

Genetics

Severe childhood epilepsies: Large international study pinpoints synapse genes with major roles

September 25, 2014

Children's Hospital of Philadelphia

An international research team has identified gene mutations causing severe, difficult-to-treat forms of childhood epilepsy. Many of the mutations disrupt functioning in the synapse, the junction at which nerve cells intercommunicate.

 

What’s New at WSU/PHP?

Looking at new medicines (Brivaracetam) for the treatment of in hospital non-convulsive status epilepticus

Assessment of stigma experienced by our epilepsy patients in clinic

What’s Next?

Science

Hope