Seizures

This excellent New York Times article cites a new study in a group of 38 patients with uncontrolled seizures randomized to either continue with current medication or undergo surgery. Of 23 patients assigned to drug, none became seizure free while 11 of the 15 patients assigned to surgery no longer had seizures.

The study published in The Journal of the American Medical Association (JAMA) advocated earlier surgical intervention then is common today. Rather than waiting, it is suggested patients seek surgery after two drugs have failed. By doing so, the detrimental effects of seizures, including increased risk of death, depression, and progressive memory loss can be stopped. If the wait is too long, even curative surgery will be unable to reverse years of accumulated damage.

Study author Dr. Jerome Engel Jr. notes less than 1% of the afflicted population is even referred to a specialized disease treatment center.

Says Dr. Engel, “Leprosy has been destigmatized. Cancer has been destigmatized. Epilepsy hasn’t been.” He also points out epilepsy just ”does not get the media attention and dollars devoted to other medical conditions.”

For the full story:
http://www.nytimes.com/2012/03/13/health/research/surgery-for-epilepsy-gains-urgency-in-trial.html?smid=tw-nytimeshealth&seid=auto

A newly published article in the journal Neuroscience showed delivery of the hormone somatostatin to the hippocampus with viral vectors potently inhibited seizure activity in Rat models.

Somatostatin was cloned and inserted into an adeno-associated virus to enhance long-term expression. Rats were tested with the widely used ”kindling” seizure model, whereby animals are induced to seizures through electric stimulation. In treated rats, only 30% reached the “kindled” state compared to 100% for untreated.

Although the kindling model has its detractors and the data is certainly early, it is always good to see new progress. Somatostatin has long been known to be associated with epilepsy. As early as the 1990s, it had been shown to affect electrophysiological properties of neurons, modulate classical neurotransmission and have anticonvulsant properties in experimental models of seizures.

Patients with epilepsy had been shown to have lower levels of somatostatin; for a time, companies worked to develop mimetics of the hormone as a novel epilepsy therapy. The efforts haven’t panned out. Hopefully, the gene therapy method will have better luck.

This may be one of the most exciting “new” developments in epilepsy treatment today, in my opinion. It was quite popular about a century ago before the advent of modern medicines led to disinterest in this dietary treatment.

The key to the ketogenic diet is a high fat, relatively low carbohydrate intake, resulting in a shift in the body’s metabolism and increased production of ketones. The mechanism is uncertain, but these ketones are thought to have an anti-convulsive property, with some evidence in animal models of epilepsy.

Placebo-controlled trials of the ketogenic diet in epilepsy are relatively rare. Those that have been performed show it can have a very potent effect on seizure frequency in children, allowing some to discontinue medication after about two years of treatment. There is much more literature on single-armed trials suggesting very good activity in patients who have failed multiple prior treatments.

Yet for all its promise, its use is relatively low- perhaps due to doctors’ unfamiliarity with the treatment or lack of coordination between treating neurologists and dietitians.

Regardless, a revival is afoot as awareness grows. There is interest in using the diet in earlier stages of epilepsy treatment, before patients become refractory to other medicines. And while almost all current studies have been on children, many feel there is no reason why it should not work just as well in adults.

The original ketogenic diets were highly limiting, requiring exact food servings. New methods such as the Modified Atkins and Low Glycemic Index treatment are much less restrictive while retaining the same results. This should allow a greater number of people to participate and adhere to the treatment.

Farther down the line, the hope is to get this diet into pill-form. Now that, would be quite an accomplishment.

For more info: The Charlie Foundation