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Experts Meet to Discuss the Future of Epilepsy

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WebMD Health News

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 threatening.

"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 WebMD.

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.

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