The diagnosis of epilepsy often poses great challenges and changes to everyday life for those affected, but also for those around them. In addition, drug treatment does not lead to seizure freedom in one-third of patients. The approval of a drug as the first in its class is considered a major expansion of the treatment spectrum for patients with focal epilepsy.
Focal epilepsies are the most common type of epilepsy. Shockingly, however, the disease remains uncontrolled in about one-third of these patients despite drug treatment. Due to a suboptimal therapy success, these people are under a high pressure of suffering and have to struggle with massive impairments in everyday life. The presentations at the “News in Epilepsy” event were devoted to these topics.
Promote understanding and facilitate everyday life
PD Dr. med. Fabienne Picard, University Hospital Geneva, first presented her film project “Art & Epilepsy – Conférence, spectacle et reportage”. In this experimental work, the neurologist seeks to improve the understanding of epilepsy. For this purpose, texts by famous personalities with epilepsy, such as Socrates, Molière, Vincent van Gogh or Agatha Christie, which describe or depict seizures, are read aloud, interpreted and accompanied by music.
Susanne Egli, Executive Director of Epi Suisse, presented the reality of the patients and the difficulties they face in everyday life. Epi Suisse is the Swiss association for epilepsy and has been taking care of the psychosocial needs of those affected for ten years. According to Ms. Egli, there are about 70,000 people living with epilepsy in Switzerland, who often face great uncertainties because “on the one hand, the seizures are unpredictable, but on the other hand, dealing with employers or superiors is often unclear.” Do you have to tell the employer that you have epilepsy? Is this grounds for termination? How can the family be relieved? Can a child with epilepsy be taken on a school trip and if so, what should be considered here? This is only an excerpt from the practical examples that Ms. Egli presented from the daily work of the association. Each consultation is individual, the approach often differs immensely. This makes it all the more important to promote an understanding of epilepsy in society and thus make it easier to deal with those affected and their special needs, says Ms. Egli.
The first therapeutic of its kind
Using well-tolerated antiepileptic drugs, seizure freedom can be achieved in 60-70% of patients today. On the one hand, this is a great success, but on the other hand, no fundamental improvement in treatment has been achieved since 1990, even with the new antiepileptic drugs. “Only tolerability has improved greatly with the new medications,” said Thomas Klaus-Dieter Dorn, MD, senior physician at the Swiss Epilepsy Center (EPI), Zurich.
Particularly in focal and symptomatic generalized forms of epilepsy, pharmacoresistance is frequently observed, although in a proportion of pharmacoresistant focal epilepsies seizure freedom can be achieved by epilepsy surgery. With Fycompa® , a drug with a completely new mechanism of action has now been approved for the Swiss market. The therapeutic agent, with the active ingredient name perampanel, is indicated as an adjunctive treatment for focal seizures with or without secondary generalization in epilepsy patients 12 years of age and older. The drug thus offers hope to precisely those 30% of sufferers whose focal seizures can only be controlled to a limited extent despite appropriate drug treatment. Perampanel selectively targets AMPA receptors, making it fundamentally different from antiepileptic drugs currently on the market, as it is a highly selective, non-competitive AMPA-type glutamate receptor antagonist. The AMPA receptor is a protein in the brain that plays a critical role in triggering epileptic seizures. Perampanel has an allosteric effect and blocks the receptor by preventing the neurotransmitter glutamate from binding to the receptor because it is deactivated – as a result, fewer seizures occur. Swissmedic’s approval of the drug was based on consistent results from three randomized, double-blind, placebo-controlled Phase III pivotal trials conducted worldwide. Regardless of whether the mechanism of action of antiepileptic drugs is based on inhibitory, or excitatory synapses, “ultimately, the drugs have to prove themselves in practice through their efficacy,” Dr. Dorn said.
Source: Media Roundtable “News in Epilepsy,” March 19, 2013, Zurich.
