Epilepsy Treatments: Present and Future

Any person, of any age and gender, may suffer from epilepsy at some point in their life. It is considered one of the most common neurological disorders and affects tens of millions of people worldwide. In honor of Epilepsy Awareness Day, researcher Noa Guzner discusses existing treatment alternatives for epilepsy, as well as innovative treatments currently in development.
What is epilepsy?

Epilepsy is a neurological disorder caused by abnormal electrical activity in the brain, which may result in seizures expressed as convulsions, behavioral changes, various sensations, and sometimes even changes in consciousness. This disorder may develop for various reasons among people of any age, gender, or ethnicity. 


What are the existing treatments for epilepsy?

For most patients, life with epilepsy is made possible due to medication which aids in controlling seizures and, in other cases, surgical intervention. Some patients would require continuous, lifelong treatments, while others would enjoy prolonged periods of peace, even without treatment. Medication is still the most common treatment, but surgical intervention is sometimes required to remove the focus from which the disorder originates when seizures cannot be maintained with other means. 


In cases where surgery is impossible, there is a focused laser method that destroys the brain tissue that causes seizures. During this treatment, a thin optical fiber is inserted, and the laser beam forms at its tip. The fiber is inserted using a sophisticated and innovative navigation system, which performs high-resolution, real-time MRI scans.


Some methods are more innovative and less invasive than surgery, which constitutes additional therapeutic options. Deep brain stimulation utilizes a small device, a pacemaker of sorts, that sends regular electrical signals to the brain, thus preventing excess electrical activity. Another brain stimulation system is responsive neurostimulation, which monitors brain activity rather than sending periodic signals. 


Which innovative treatments for epilepsy are currently in development?

 Many advanced pharmacological treatments are developed to aid patients with drug-resistant epilepsy. For example, pre-clinical studies point to the option of using anti-epileptic drug-conjugated nanoparticles. These particles allow active ingredients to cross the blood-brain barrier more efficiently. This technology may increase the effectiveness of the drugs and will ideally allow for attaining a therapeutic effect with much smaller dosages.

Another promising treatment currently in a pre-clinical study focuses on peptides – short amino acid chains – derived from animal venom. The operation mechanism is not entirely clear yet, but the anti-epileptic activity of this substance has already been observed in tests. The venom molecules strongly bind to target receptors in the body, and this quality seems to strengthen the therapeutic effect.  

A notable percentage of epilepsy cases remain unexplained. In some patients, it constitutes a part of a genetic syndrome occurring due to changes in specific genes, and to treat it, we turn to the development of gene therapies. This newly emerging field uses the insertion of genes into the appropriate cells for these to be expressed instead of faulty genes. A pre-clinical study demonstrated a decrease in the frequency of seizures in mouse models of this type of epilepsy following gene therapy. We note that such therapies, which have vast potential, are still in the preliminary stages of development and require significant control of treatment safety, as they may result in irreversible changes to brain tissues.

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