current therapy for epilepsy j. layne moore, md, mph professor neurology wright state university...
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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