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Current Therapy for Epilepsy

Current Therapy for Epilepsy . J. Layne Moore, MD, MPH Professor Neurology Wright State University Boonshoft School of Medicine. Epilepsy. A disease known from antiquity Initially thought to be from the attack of a spirit or demon

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Current Therapy for Epilepsy

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  1. Current Therapy for Epilepsy J. Layne Moore, MD, MPH Professor Neurology Wright State University Boonshoft School of Medicine

  2. 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.

  3. 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. .

  4. Humorism

  5. Humorism

  6. Ohio Hospital for epileptics at Gallipolis Ohio

  7. Ohio Hospital for epileptics at Gallipolis Ohio

  8. Ohio Hospital for epileptics at Gallipolis Ohio

  9. Ohio Hospital for epileptics at Gallipolis Ohio

  10. 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.

  11. 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."

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

  13. Hans Berger

  14. Science to problem

  15. Wilder Penfield

  16. Antiepileptic Drug (AED) Therapy TGB TPM FOS ZNS LTG LVT GBP VPA OCBZ PB PHT CBZ FBM 3rd Generation “2nd Generation”

  17. Newer AEDs

  18. 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

  19. Lacosamide • Approved in 2008 • Voltage-gated sodium channels • UCB • Approved for adjunct therapy for partial onset

  20. Ezogabine • A potassium channel • Therefore unique • Effective in many animal models of epilepsy • Studies underway in neuropathic pain, tinnitus and migraine • TID dosing

  21. Perampanel • acts as a selective noncompetitive antagonist of AMPA receptors. • Being studied in Parkinson’s disease • Half-life 105 hours • 95% protein bound

  22. Brivaracetam • Approval may be early 2015 • it is around 10 times more potent for some models of epilepsy than Levetiracetam

  23. VNS • Approved for partial epilepsy 1997 • Approved for depression 2005

  24. 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

  25. Quality of Life • Side-effects • Mood • Anxiety • Stigma • Isolation

  26. 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.

  27. 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

  28. What’s Next? • Science • Hope

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