Thoughts About How Antiepileptic Drugs Work

We are extraordinarily fortunate to have more than a dozen potential new epilepsy treatments in development, as well as a few nearing approvals for prescribing to patients.

Will this present us with a bowl of cherries that look and taste equally delicious or the difficulty of choosing one piece of chocolate from a variety box?

The antiepileptic drugs (AEDs) nearing approval have novel mechanisms of action – ways to affect brain signals leading to seizures. Some AEDs affect the flow of sodium, potassium, calcium in brain cells; some alter neuro-transmitters (such as GABA) that pass signals across gaps between cells; some bind to proteins or affect other molecules. We may have information from laboratory experiments on how the AEDs affect brain cells, but we don’t know whether one mechanism is better than another for people with epilepsy, or for a specific individual. That’s why I welcome the addition of every new AED in hopes of finding the perfect treatment for each individual.

At this time, doctors have to alternate various AEDs and combinations of AEDs to find the best seizure control with least side effects for each person. It’s not a simple task, and does not always result in finding a perfect solution. The concept of personalized medicine is a new approach that uses genetic testing to determine the optimum treatment for an individual. We have not made much headway with this concept in epilepsy, but we have researchers working on this now.

We have not made much headway with using genetics to optimize epilepsy treatment, but we have researchers working on this now. That’s why I urge everyone with epilepsy to volunteer to consider participating in the Epilepsy Phenome-Genome Project (EPGP). This study is ongoing all over the USA, enrolling people who have epilepsy along with a bother or sister who also has epilepsy. The information will give us greater insight into the individual characteristics that make some people respond to drugs with certain mechanisms of action but not to others. This is your opportunity to help everyone with epilepsy.

Please review details about EPGP by listening to the Dr. Daniel Lowenstein discuss the program or read about it on their website. EPGP is our path to the future of epilepsy treatment.

I wish you “freedom from seizures” as soon as possible!

Joyce Cramer,
President
Epilepsy Therapy Project