Preventing seizures and complications
Although in the past 30 years we have received approximately 20 new antiepileptic drugs, about a third of patients still suffer from recurrent seizures. Moreover, today’s medications only provide a palliative effect on symptoms, and do not affect the mechanisms behind them.
An important goal of ongoing epilepsy research is to uncover the molecular mechanisms underlying epileptogenesis, for example after head trauma or stroke. We particularly hope that increasing knowledge about the interaction between neurons and glial cells in disease pathogenesis will open new therapeutic attack points with disease-modifying properties. (3). In animal experiments, it has been possible to slow, and even reverse, the development of epilepsy. Such inhibitory therapy is not currently available for humans.
It is also our experience that epilepsy surgery is used very rarely – and often too late
It is also our experience that epilepsy surgery is used very rarely – and often too late. Unfortunately, many patients – and colleagues – view epilepsy surgery as a last resort. This means that obvious candidates for surgery are often referred so late that surgical outcomes become worse and the psychosocial consequences of living with chronic epilepsy become very difficult to reverse.
The basic condition for a good surgical outcome is that the epilepsy does not last for a long time and that the person has been able to identify and identify in advance the network of dysfunctional cells causing the seizures in the brain. (4). Unfortunately, current methods have several limitations despite the increasing use of ictal EEG recordings from electrodes placed stereotactically within the brain. Better methods of source localization will enable more patients to be operated on and provide better surgical outcomes.
Status epilepticus is an epileptic activity that does not stop on its own and affects approximately 10% of epilepsy patients. This condition can also occur without previous seizures and is associated with significant morbidity and mortality. The causes have been little investigated, and there is little support in treatment algorithms for more severe and treatment-resistant forms. Better mapping of the underlying mechanisms of status epilepticus and more good therapeutic studies will be able to improve the prognosis in these patients.
The most tragic complication of epilepsy is sudden and unexpected death. About 30 patients are affected in Norway every year. There is still a lot of research before we fully understand the mechanisms behind such deaths, as tonic-clonic seizures in some appear to “disrupt” vital brain functions. Only when these mechanisms are identified can we hope to prevent these tragedies (5).
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