J Layne Moore MD MPH Professor Neurology Wright State University Boonshoft School of Medicine Epilepsy A disease known from antiquity Initially thought to be from the attack of a spirit or demon ID: 611459
Download Presentation The PPT/PDF document "Current Therapy for Epilepsy" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Current Therapy for Epilepsy
J. Layne Moore, MD, MPH
Professor Neurology
Wright State University Boonshoft School of MedicineSlide2
Epilepsy
A disease known from antiquity
Initially thought to be from the attack of a spirit or demon
The name epilepsy is derived from the Greek word for “to attack” So a person does not “seizure” they are seized. Slide3
Rationale of Bloodletting
Bloodletting goes back 3000 years to the Egyptians.
To
appreciate the rationale for bloodletting one must first understand the paradigm of disease 2300 years ago in the time of Hippocrates
( circa 460
–370 BC).
Hippocrates believed that
existence was represented by the four basic elements—earth, air, fire, and water—which in humans were related to the four basic humors: blood, phlegm, black bile, yellow bile.
.
Slide4
HumorismSlide5Slide6Slide7
HumorismSlide8
Ohio Hospital for epileptics at Gallipolis OhioSlide9
Ohio Hospital for epileptics at Gallipolis OhioSlide10
Ohio Hospital for epileptics at Gallipolis OhioSlide11
Ohio Hospital for epileptics at Gallipolis OhioSlide12
The
commission consulted the foremost neurologists and alienists, at home and abroad, especially those experienced in the treatment of epilepsy, and submitted plans for the construction of 36 buildings for the segregation of epileptics in classified colonies, after the method of the Bielefeld Colony in Germany, as the best adapted for the welfare and treatment of those affected with epilepsy. Slide13
The Ohio Hospital for Epileptics
In 1892 the General Assembly passed an act changing the name of the institution from " The Asylum for Epileptics and Epileptic Insane " to " The Ohio Hospital for Epileptics."Slide14
http://
www.asylumprojects.org/index.php?title
=
Gallipolis_Epileptic_HospitalSlide15
Hans BergerSlide16
Science to problemSlide17
Wilder PenfieldSlide18Slide19
PB
PHT
CBZ
VPA
FBM
GBP
LTG
FOS
TPM
TGB
3
rd
Generation
“
2nd Generation
”
OCBZ
LVT
ZNS
Antiepileptic Drug (AED) TherapySlide20
Newer AEDsSlide21
Rufinamide
developed in 2004 by Novartis and manufactured by Eisai. Approved for marketing 2008.
Approved as adjunct therapy for LGS
MOA uncertain perhaps sodium channelsSlide22
Lacosamide
Approved in 2008
Voltage-gated sodium channels
UCB
Approved for adjunct therapy for partial onsetSlide23
Ezogabine
A potassium channel
Therefore unique
Effective in many animal models of epilepsy
Studies underway in neuropathic pain, tinnitus and migraine
TID dosingSlide24
Perampanel
acts as a selective noncompetitive antagonist of AMPA receptors.
Being studied in Parkinson’s disease
Half-life 105 hours
95% protein boundSlide25
Brivaracetam
Approval may be early 2015
it is around 10 times more potent for some models of epilepsy than LevetiracetamSlide26
VNS
Approved for partial epilepsy 1997
Approved for depression 2005Slide27
Responsive Neurostimulator
Device
The RNS System utilizes a
neurostimulator
implanted in the skull with one or two leads implanted in the brain at focal points of seizuresSlide28
Quality of Life
Side-effects
Mood
Anxiety
Stigma
IsolationSlide29
Genetics
Severe childhood epilepsies: Large international study pinpoints synapse genes with major roles
September 25, 2014
Children's Hospital of Philadelphia
An international research team has identified gene mutations causing severe, difficult-to-treat forms of childhood epilepsy. Many of the mutations disrupt functioning in the synapse, the junction at which nerve cells intercommunicate.
Slide30
What’s New at WSU/PHP?
Looking at new medicines (
Brivaracetam
) for the treatment of in hospital non-convulsive status epilepticus
Assessment of stigma experienced by our epilepsy patients in clinicSlide31
What’s Next?
Science
Hope