It's Time We Took the Mystery Out of Epilepsy
Director, Comprehensive Epilepsy Center
In this issue of Research Horizons we profile the research and clinical advances being made in our Comprehensive Epilepsy Center. For years, the talented researchers, neurologists and neurosurgeons of Cincinnati Children’s have been leading efforts nationally and internationally in the study and use of medications and surgical approaches for epilepsy. The formation of a Comprehensive Epilepsy Center will enable us to more effectively coordinate and integrate the efforts of these various disciplines, and bring our findings to bear more quickly in the care of patients.
Many Unanswered Questions
A seizure is an electrical storm on the surface of the brain. Epilepsy, defined as the tendency to have chronic, recurrent, unprovoked seizures, affects 1 percent of all people. Although there are nearly 45,000 children diagnosed with epilepsy every year, many unanswered questions remain about how to optimally treat them. First and foremost, there is little solid scientific evidence for many of the treatments we provide for these children. In 2006 the International League Against Epilepsy published treatment guidelines that identified an alarming lack of adequately powered, randomized control trials to address how we choose the best initial medications for children and adults with epilepsy. Cincinnati Children’s comprehensive epilepsy team is leading a national clinical trial that starts to address this lack of information.
Understanding the Genetics
In addition to the lack of clinical trial evidence, the wide variability in children’s response to anti-seizure medications is another major problem. Some children get complete seizure relief at very low doses, while others suffer significant side effects or get no relief at all. Understanding what causes these variations in response to therapy is critical to better personalizing therapy for these children. One potential cause for these varied responses to therapy is each child’s genetic makeup. Understanding the role that genetics plays in how children respond to therapy can lead to major advances in personalizing care. In this issue of Research Horizons, we describe how researchers at Cincinnati Children’s are leaders in the search to uncover the role that genetics plays in explaining the variability in clinical response to medication therapy.
Easing the Decision Process
Until we make more progress in understanding how genetics is involved in medication response, we can improve care by helping clinicians make better decisions about the anti-seizure medications they choose. How? One way is through a decision support system that incorporates the many variables that influence drug response. We describe in this issue a decision support system developed here at Cincinnati Children’s through a collaboration between the Divisions of Bioinformatics and Neurology.
To help physicians feel more confident about the treatments they choose, the decision support system incorporates all the factors involved in making decisions about medications for epilepsy. This is one way clinicians can optimize care while basic research continues to examine factors that affect children’s response to anti-seizure therapy.
When Medication Doesn’t Work
For some patients, even the most carefully chosen medications are not the answer, and surgical removal of the area in the brain where seizures occur is the best option. This is an extraordinarily complex and precise process. It requires the advanced clinical expertise of neurologists and neurosurgeons working with the latest technology. This issue also features the exceptional work we are doing in the surgical treatment of epilepsy.
Because there is no one cure for epilepsy, a comprehensive center that gives equal attention to all aspects of care was crucial to our progress in making the best possible treatments available.
Our goal is to continue our leadership in conducting clinical trials; to help define evidence-based treatment guidelines; to gain further understanding of genetic factors affecting response to anti-seizure therapy; to provide decision support software to help clinicians optimize medical management; and to offer expert evaluation and surgery for patients whose seizures do not respond to medications.
This issue summarizes some of the remarkable work being done in these areas; I invite you to learn more about what we are doing and to contact us with your questions and observations.
