Looking for A Solution to Epilepsy

By Jane Farrell

Most people associate epilepsy with intense seizures and resulting loss of consciousness. But according to experts from the National Institutes of Health, most epilepsy may be hard to recognize. These little spells can be an early warning sign of epilepsy, a brain disorder that strikes an estimated 1 in 26 Americans at some point in their lives.

Even though it’s the fourth most common neurological disorder in the U.S. (behind migraine, stroke and Alzheimer’s), most people don’t know much about it. Most people know surprisingly little about epilepsy, even though it’s the nation’s 4th most common neurological disorder, after migraine, stroke, and Alzheimer’s disease.

“Epilepsy can strike people of all ages, from the moment of birth—even in the delivery room—up to older ages,” says Dr. Jeffrey Noebels, an epilepsy expert at Baylor College of Medicine. The condition is most likely to first arise in children and in adults over age 60. “Most types of epilepsy last a lifetime, but some…can go away on their own,” Noebels adds.

Epilepsy has more than one cause. “Defects in genes are probably responsible for the largest fraction of epilepsy cases,” Noebels says. Scientists so far have linked more than 150 genes to epilepsy. “Other types of epilepsy can be acquired through trauma (such as head injury or stroke), infections, brain tumors, or other factors.”

Whether the seizures last for seconds or minutes, they are caused by from abnormal bursts of electrical activity in the brain. That in turn triggers jerky movements, falls, fainting or even strange emotions.

The condition is sometimes called a spectrum disorder, because there are many kinds of seizures. At one end of the spectrum, a patient can have occasional seizures. Other people have literally hundreds of seizures per day.

Subtle seizures (called partial or focal) can cause hallucinations or feelings of déjà vu. “These little spells or seizures can sometimes occur for years before they’re recognized as a problem and diagnosed as epilepsy,” says Dr. Jacqueline French, who specializes in epilepsy treatment at the New York University Langone Medical Center. “They can be little spells of confusion, little spells of panic, or feeling like the world doesn’t look real to you.”

Partial seizures affect particular areas of the brain, but untreated they can become more serious and affect the whole brain. It’s crucial to get treatment as soon as possible.  “If you notice a repeating pattern of unusual behaviors or strange sensations that last anywhere from a few seconds to a few minutes, be sure to mention it to your doctor or pediatrician,” French says.

Scientists funded by NIH have been working to develop better approaches for diagnosing, treating, and understanding epilepsy. The agency says that the condition can now be diagnosed through imaging tools like MRI or CT scans, blood tests, or by measuring the brain’s electrical activity. And it can often be controlled via medications, diet, surgery, or implanted devices.

But there’s still room for improvement.

“Traditional medications for treating epilepsy are effective but problematic,” says Dr. Ivan Soltesz, who studies epilepsy at Stanford University. “About 1 in 3 patients has drug-resistant epilepsy, meaning that available drugs can’t control the seizures. In these cases, surgical removal of brain tissue may be the best option.” When the drugs do work, he explains, they can also cause numerous side effects, including fatigue, abnormal liver function, and thinking problems.

Soltesz says that current medications are problematic because they don’t specifically target malfunctioning brain cells. Instead, he says, they are likely to affect the entire brain.

He and other researchers are working to create highly targeted epilepsy therapies that are delivered only to malfunctioning brain regions. So far, according to the NIH, they have found a way to stop epilepsy-like seizures as the start to occur. They’ve developed an experimental approach that can stop epilepsy-like seizures as they begin to occur in a mouse. The scientists hope to eventually translate those findings for use in people who have epilepsy.

In another line of NIH-funded research, a team of scientists is studying a deadly and poorly understood condition called SUDEP (for sudden unexpected death in epilepsy). “Most people with epilepsy live long and happy lives. But SUDEP is the most common cause of the shorter lifespan that can occur with epilepsy,” says Noebels. “It’s been a real mystery.”

“We’ve made exciting advances to date in our understanding of epilepsy, its prevention, and treatment,” says Jacqueline French of NYU. “But there’s still much we have to learn, and much we’re actively working to improve.”