Experts Meet to Discuss the Future of Epilepsy
March 30, 2000 (Bethesda, Md.) -- Scientists attending a two-day
international meeting here are talking cautiously about significant
improvements in treating one of mankind's oldest afflictions -- epilepsy.
Backed by the White House and the National Institutes of Health, the conference
is said to be the first focused primarily on curing the 3,000-year-old brain
disorder characterized by seizures that can be violent and even life
"One feels that the science has arrived where we can do something about
it. That's the hope. ... We really do understand the physiology of nerve cells
that are discharging abnormally. So we have good therapeutic targets," says
Gerald Fischbach, MD, director of the National Institute of Neurological
Disorders and Stroke (NINDS), one of the sponsoring organizations.
It's estimated that there are some 2.3 million epileptics in America who
still experience seizures, even though they're getting treatment. In addition
to mainline anti-epileptic drugs such as carbamazapine or phenytoin, there are
newer alternatives such as tiagabine and zonisamide, an anticonvulsant just
approved by the FDA this week.
For epileptics who don't respond to medication, surgeons can often target
areas of the brain responsible for the misfiring neurons, particularly in the
temporal lobes, and remove them. Timothy Pedley, MD, a neurologist at
Columbia-Presbyterian Medical Center in New York, says that about 80% of
epileptics are well controlled, but 50% still have seizures and 30% have side
effects from their drugs. Still, with the progress that's being made, he's not
reluctant to use the word cure.
"If we can use a drug that is convenient to take, it has very low risk
of side effects, and it completely suppresses seizures, then while that's not
technically a cure, it's operationally almost as good as," Pedley tells
Epilepsy can be caused by a variety of infections, a head injury, or
defective genes. For reasons that aren't clear, these triggers can cause a
cascade of destructive events that all look very similar in the end. Pedley
says, however, that within the next few years, new drugs could be discovered
that will hopefully interrupt the chain of events that ends in epilepsy.
"We may be able to prevent the development of epilepsy in the next 10 or
20 years with those cases that develop following a given insult to the
brain," says Pedley. Some of the most promising research is in gene
therapy. It's thought as many as 500 genes may be involved in epilepsy, in some
case simply heightening susceptibility.
However, the repair may not be as simple as inserting a healthy gene into
the brain because the organ is so complex and sensitive. For example, a gene
that turns on a protein to control seizures also may have a big effect on
memory or behavior.