Future of Epilepsy: AES 2016

What does the future hold for epilepsy care? Leading epilepsy researchers speculated on trends in surgery and devices, imaging, medication, bioinformatics, and genetic discoveries, at the 70^th annual meeting for the American Epilepsy Society.

They described an exciting new era for the field-marked by continued technological change and genetic discovery. Here’s what clinicians can likely expect in the next 15 to 20 years.

New surgical approaches and devices

Traditionally, epilepsy surgery had a targeted focus to stop seizures. But there’s growing evidence epilepsy is more of a distributed disorder, explained Dennis Spencer, MD, a professor of neurosurgery at Yale University School of Medicine, and may require a multi-pronged plan of attack. Look for bioelectric intracranial devices to expand our knowledge of epilepsy networks, and improve patient outcomes. Laser ablation will continue to make strides as a less-invasive tool.

Bioinformatics

Health data will be used in increasingly sophisticated ways to diagnose and treat epilepsy. Tracy Glauser, MD, professor of pediatrics and neurology and Director of the Comprehensive Epilepsy Center at Cincinnati Children’s Hospital, described how his team has partnered with computer scientists to create programs that support clinical decisions, identify epilepsy surgery candidates early, determine if patients are eligible for clinical trials, and even track suicide risk in patients. They plan to implement the suicide detection system in their clinics, and are conducting research with 10 Cincinnati schools to validate the system in the school setting. These types of innovations have the potential to transform epilepsy care, Glauser said.

Imaging

Functional magnetic resonance imaging (fMRI) is gradually becoming the study of choice for function mapping during pre-surgical evaluations, said Jerzy P. Szaflarski, MD, PhD, professor and director of the University of Alabama Epilepsy Center. But that’s just the tip of the iceberg. Improvements in the quality of MR sequences and bioinformatics will help clinicians personalize diagnosis and treatment options. Expect to see more hybrid imaging systems, such as MEG/MRI, PET/MRI and SPECT/MRI, higher field imaging systems of 7T or higher, and MRI-guided therapies. And “portability will be very important,” Szarflarski said. He gave examples of a PET imaging device worn as a helmet, and wearable MRI.

New anti-epileptics

The recent explosion of genetic discoveries has, “opened the door for precision medicine in epilepsy,” said Henrik Klitgaard, PhD, vice president and fellow of new medicines at UCB pharma. Drug development is moving away from a blockbuster model targeting a wide population of epilepsy patients to a “mini-buster model.” We are entering a “new fourth generation of anti-epileptic drugs that targets sub populations of patients with treatment-resistant epilepsy,” he says. “These drugs will dominate anti-epileptics in the next 10 to 15 years.” Two new areas that look promising include silencing microRNAs to produce neuroprotective results and suppress seizures, and targeting TrkB kinase to prevent epilepsy and anxiety.

Genetic breakthroughs

Peter B. Crino, MD, PhD, professor and chair of neurology at the University of Maryland School of Medicine suggests a future with genetics fully integrated in both research and patient care. In time, all human epilepsy genes will be known and full maps of genetic variants will be available. Clinicians will routinely screen the whole exomes of patients for genetic variants that lead to disease, and target therapies accordingly. This new knowledge could ultimately lead to the eradication of sudden unexpected death in epilepsy (SUDEP).

The AES 2016 Annual Meeting was held December 2-6 in Houston.

Privitera M, Presidential Symposium: a Futurist’s View, 2016, American Epilepsy Society Annual Meeting, www.aesnet.org.