New hope for the treatment of epilepsy

This scientific commentary refers to ‘Targeting pharmacoresistant epilepsy and epileptogenesis with a dual-purpose antiepileptic drug’ by Doeser et al. (doi: 10.1093/brain/awu339). Compared to many other chronic neurological diseases, epilepsy can be regarded as relatively amenable to treatment, given that about two-thirds of patients become seizure-free with available medications. However, there are two major problems with current treatment using antiepileptic drugs. First, about one-third of patients with epilepsy are resistant to the available antiepileptic drugs, and second, the treatment is purely ‘symptomatic’, i.e. when the drugs are stopped, epileptic seizures usually recur, as the underlying cause of the seizures is still present. Epileptogenesis describes the process of development of epilepsy after an initial brain insult, such as trauma or a prolonged febrile seizure (Fig. 1) (Pitkanen and Lukasiuk, 2011). However, there are currently no treatments that target the process of epileptogenesis in an effort to prevent or at least modify the disease. There is only one possibility to cure epilepsy, namely epilepsy surgery, a treatment that can only be applied to selected patients in whom the epileptic focus can be surgically removed. Thus, new therapeutic approaches are urgently needed. In this issue of Brain , Doeser et al. (2014 a ) report that an existing AED, eslicarbazepine acetate (ESL), has unexpected effects with the potential to address both pharmacoresistance and epileptogenesis. Figure 1 Schematic of epileptogenesis. After an initial insult (such as status epilepticus, trauma or stroke), chronic epilepsy develops during a latent period without seizures. This process is called epileptogenesis. It is induced and maintained by many factors, some as yet unidentified, including inflammatory and epigenetic mechanisms. The goal of anti-epileptogenic treatment is to intervene as early as possible to stop or at least attenuate the process of epileptogenesis. This is in contrast to currently available anti-epileptic drugs, which only suppress …