Research and Advances in Epilepsy. Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group
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1 Research and Advances in Epilepsy Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group
2 Epilepsy History Hippocrateson the sacred disease Galen Avicenna Middle ages Renaissance Paracelcus Images German Epilepsy Museum Tissot Jackson
3 History of Epilepsy medical treatment
4 First generation anti-epileptic medications Valproate (Depakote) Benzodiazepines Diazepam (Valium, Diastat), Midazolam (Versed)
5 Second generation anti-epileptic medications Levetiracetam (Keppra) Oxcarbazepine (Trileptal) Zonisamide (Zonegran) Pregabalin (Lyrica)
6 Newer anti-epileptic medications Perampanel (Fycompa) Clobazam (Onfi) Ezogabine (Potiga) Vigabatrin (Sabril) Rufinamide (Banzel) Lacosamide (Vimpat) -2008
7 What do we expect from newer antiepileptic medications?
8 Indication Mechanism of action Analog of Levetiracetam (Keppra) Efficacy SE 10-26%
9 Indication Mechanism of action 3 rd generation carbamazepine Efficacy SE 30-40%
10 Indication Mechanism of action Efficacy Side Effects 19-33% (black box warning)
11 Future advances in medical treatment of epilepsy - Cannabidiol Mechanism of action Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S (2017) Cannabidiol in Dravet Syndrome Study Group.Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. May 25;376(21):
12 Acute Seizures or Status Epilepticus - Treatment Overview Prehospital Treatment Emergent Initial Therapy Urgent Control Therapy Seizures Stop Treatment of Refractory Status Epilepticus
13 Status Epilepticus - Prehospital Studies Leppick et al., JAMA 1983 Treiman et al., NEJM 1998 Silbergleit et al., NEJM 2012
14 Future advances in medical treatment of epilepsy Intranasal Midazolam Mechanism of action Haut SR, Seinfeld S, Pellock J (2016) Benzodiazepine use in seizure emergencies: A systematic review. Epilepsy Behav.Oct;63:
15 Advances in medical treatment of Epilepsy
16
17 Alternatives to medical treatment Devices History of Epilepsy surgical treatment Surgery
18 RNS (Neuropace) First of a kind device to provide targeted responsive stimulation for epilepsy Acute and sustained efficacy in adults with partial onset seizures Provides another treatment option for adults with medically intractable partial onset seizures
19 RNS (Neuropace) Neurostimulator and Leads Programmer Patient Data Management System (PDMS) Remote Monitor
20 RNS (Neuropace) In clinical trials, adults treated with the RNS System experienced significant, long-term seizure reduction and compelling quality of life improvements. 1 Some individuals also showed benefit in memory and language. 2 The chart shows seizure reduction over time for patients treated with the RNS System. By year three, patients reported 60% seizure reduction. 1 This continued to improve, with 72% median seizure reduction by year seven. 4 Long term seizure reduction 1 Bergey GK, et al. Neurology, Loring DW, et al. Epilepsia, Heck, et al. Epilepsia, Morrell et. al American Epilepsy Society 2016 Data at 7 years were presented at the 2016 American Epilepsy Society meeting and are from a more recent data cut-off than those published by Bergey et al. As a result, more patients had completed 7 years of post-implant follow-up. Data are from open label study.
21 Detection ECoG storage Responsive stimulation RNS (Neuropace)
22 RNS (Neuropace)
23 Physician identifies electrocorticographic activity to be detected Detection settings specific to that activity are programmed Stimulation is enabled using standard settings Detection and stimulation is adjusted as needed RNS (Neuropace)
24
25
26
27 Surgical treatment of Epilepsy
28 Surgical treatment of Epilepsy
29 Visualase Hoppe C, Witt JA, Helmstaedter C, Gasser T, Vatter H, Elger CE (2017) Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure. May;48:45-52.
30 Research and Advances in Epilepsy
31 Conclusion
Research and Advances in Epilepsy. Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group
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