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The future of epilepsy therapy
Q: Hello! I am a Swedish pharmacy student who is looking through the web to find some information about future treatment of epilepsy. My simple question is: What future aspects are there in epilepsy treatment -- what kind of treatments are currently being developed and how do they differ from the old ways of treating it. My main concern, of course, is pharmaceutic, but I would like some information about non-pharmacological treatments as well.
If you would give me an answer I would be most grateful.
A: Well, I'm not a part of the "network for psychic buddies," but since you asked, I'll give you my opinions, grouped by probabilities:
1) Things we'll likely see in the near future:
Over the next 2-3 years we will continue to see a steady stream of new seizure medications. Although none will be the drug to end all other drugs, each addtional medication raises the promise of controlling more persons with epilepsy. The additional numbers of seizure medications may also increase the probability that a less toxic medication can be found for a given individual. There will likely be new devices available for epilepsy - the vagus nerve stimulator (already available in the European Community), and possibly the thalamic stimulator.
More genetic markers and possibly, specific gene products, will be elucidated for persons with family histories epilepsy. This will help to identify persons "at risk."
-- Probable U.S. drug releases for 1997:
- tiagabine
- intravenous valproic acid
- ?? vigabatrin
2) Things that we might see in the not-so-far future:
More data should become available on techniques to improve outcomes from epilepsy surgery by improving seizure control and/or minimize deficits. One promising technique is the subpial transection, that seeks to disconnect epileptic brain tissue rather than remove it. This may be particularly important when seizures start from critical areas of brain, such as the speech areas. Transplantation of cells that secrete brain chemicals into seizure zones are currently feasible from a technologic standpoint, although it is not currently known whether this will help seizure control. Alternatively, it is possible that small devices (pumps) could be used to deliver focal drug delivery to parts of brain that need it.
3) Things that are still down the road:
Although there have been great strides in the understanding of the genetic nature of many epilepsies, implementation of gene therapy in epilepsy will be very difficult. The main obstacles are: 1) how to deliver genes or gene products to the correct place in the brain, 2) to determine how much to give and 3) to be able to control the doses. One particular difficulty is that the brain is very isolated from the rest of the body, and like many drugs, it may be hard to get the genes or gene products into the brain. Nonetheless, there is exciting potential for this type of therapy
4) Things that we need, but don't know when they will come:
We desparately need therapies that will PREVENT epilepsy from occurring in the first place. In persons with genetic tendencies, this could be accomplished by "fixing" the genetic abnormalities in persons with the abnormal genes. However, many of the epilepsies do not appear to be genetic, for example, epilepsy resulting from head injury and stroke. Clearly we need to develop medications that will prevent the development of a seizure focus in persons with high risk.
Overall, the future holds great promise for new epilepsy therapies. But continued research will be necessary for results to occur. The drive for these improvements must come from physicians, health care professionals, and especially, persons with epilepsy.