The changing landscape of epilepsy treatments: what does the future hold?

Submitted by krupa.mistry on Mon, 21/02/2022 - 11:29
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Epilepsy affects approximately 50 million people worldwide and The WHO estimates that up to 70% (1) of them could live seizure-free if properly diagnosed and treated. Epilepsy is a chronic disease of the central nervous system which affects people of all ages, ethnicities, locations and socio-economic backgrounds. It is characterised by recurrent, unprovoked seizures, resulting from abnormal neural activity in the brain (2). Seizures can range in severity, type and cause, making the diagnosis and selection of the right treatment particularly difficult for physicians. 

The past two decades have seen a growing number of potential treatments for epileptic seizures being developed, many of which have advantages over older-generation anti-seizure medications (ASMs). Significant developments in the treatment of epilepsy in recent years, have positively transformed the clinical management of epileptic seizures and associated cognitive, psychological and social consequences of the disease (3, 4).  

As of 2021, there were approximately 30 ASMs available for epilepsy patients (4). While ASMs share the common property of suppressing seizures, their pharmacologic profiles can be wildly different and there are multiple factors to consider when selecting which medication is optimal for a patient. Pharmacokinetic properties, propensity for drug-drug interactions, comorbidities that the medication may affect, efficacy profiles, adverse effect profiles, possible toxicities and dosing frequency are all factors which require consideration (5, 6).  

Older generation ASMs are generally less well tolerated than newer-generation ASMs (7, 8, 9) and, until around 25 years ago, patients had to choose between a life of intolerable adverse effects or a life of seizures – so as to avoid the serious adverse effects that old-generation ASMs inflicted. Fortunately, since that time, ASMs with superior efficacy, reduced adverse effects and improved tolerability and safety have been approved, such as cenobamate, perampanel, lacosamide, topiramate, pregabalin, lamotrigine and cannabidiol (3, 4, 5). As well as having the advantage of being more tolerable, the new generation of ASMs affords physicians a greater opportunity to tailor treatments to individual patients (10). A comprehensive understanding of novel and established treatments, and their interactions, is imperative for physicians to provide optimal care for their patients. 

One medical need which remains unmet, though, is the need to prevent and overcome drug-resistant epilepsy. It is estimated that approximately one third of epileptic patients still fail to respond to treatment, despite the growing availability of a broad range of ASMs. It is worth mentioning that non-pharmacological treatments, such as surgery and neuromodulation therapy, are already available and have proven successful at reducing seizures (11, 12). These procedures are, however, highly invasive. 

The mechanisms underlying drug-resistant epilepsy are being researched and hopefully, with time, will reveal potential targets. There are early signs of potential in animal studies which focus on epileptogenesis (13), but success in clinical trials is not yet assured. 

New data pertaining to epilepsy management continues to be published at a remarkable rate, meaning it is all the more important for healthcare professionals to be continually educated on advances in the field. 

If you would be interested in sponsoring a series of medical education meetings focussed on the changing landscape of epilepsy treatments, get in touch with the Corpus team via email at: communications@the-corpus.com, or call us on +44 (0)207 428 2903. 

References 

1. https://www.who.int/news-room/fact-sheets/detail/epilepsy 

2. Beghi E. Neuroepidemiology 2020; 54(2): 185-191.     

3. Powell G et al. BMJ Open 2019; 9(12): e032551 doi: 10.1136/bmjopen-2019-032551 

4. Privitera M. Epilepsy Currents 2017; 17(4): 204-213 

5. Löscher W. and Klein P. CNS drugs 2021; doi: 10.1007/s40263/s40263 021 00827 8 online ahead of print 

6. Devinsky O et al. Nature Reviews Disease Primers 2018; 4: 18024 doi: 10.1038/nrdp.2018.24.    

7. Perruca E Therapeutic drug monitoring 2002; 24(1): 74-80 

8. Beghi E. Lancet Neurology 2004; 3(10): 618-621 

9. French JA. Therapeutic Advances in Drug Safety 2011; 2(4): 141-158 

10. Perucca E et al. Lancet Neurology 2020; 19(6): 544-556 

11. Davis P and Gaitanis J. Clinical Therapeutics 2020; 42(7): 1140-1154    

12. Anyanwu C and Motamedi G. Brain Sciences 2018; 8(4): 49 

13. Lerche H. Nature Reviews Neurology 2020; 16(11): 595-596

Intro paragraph

As the arsenal of available epilepsy therapies continues to grow, could more informed treatment choices lead to improved patient outcomes? We take a look at what future treatments might look like and why continued medical education is so crucial.  

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