Current Series: Aes 2018 Highlights

Trevor Resnick, MD: I think there [are] always interesting additions or clarifications of data on a year-to-year basis. So something happens that...a physician or [a] researcher discovers, and it has an impact. And then as more and more data [come] out in [relation] to that piece of data, [they clarify] how we use that data, how [they impact] our treatment. And I think a lot of that did occur at the [American Epilepsy Society Annual] Meeting in the area of genetics, in the area of epilepsy surgery, in the area of different drug indications for different epileptic disorders.

This is a question that we are tortured by over and over and over again because it would be nice if we could say that the unmet needs are decreasing. And I think the unmet needs have to be directed at that one-third of patients [whom] we are unable to control with our current armamentarium of medications. I mean, what I think, what has helped, is [that] we have more choices [and] the tolerability profile is better. But we still start with having about one-third of our patients in whom, even with all the newer antiepileptic drugs, we still can’t control their seizures. I think that is the greatest unmet need, that we haven’t pushed that limit from one-third to maybe one-quarter or one-tenth. We’re still sitting with that group of patients in whom we can’t control their seizures. We can make their lives a little easier, just in terms of tolerability issues. But they still have epilepsy, and we’re still having problems managing them.

I think some of the other issues that [we’re] focusing on is having not an anti-seizure drug but an antiepilepsy drug. I was trying to identify the evolution of epilepsy earlier and trying to treat it or truncate the disease earlier. That’s a theory. The areas of research are progressing, but we haven’t gotten to the point where there’s any impact of that yet. I think the area of genetic research may be able to create a situation [in which] there are disease-modifying genes, and that’s probably the area that has the greatest likelihood of having an impact over the next few years.

And then finally unmet needs also applies [to] not just antiepileptic drug treatment but also how we direct our treatment in a multimodal fashion looking at the patient. So [if a] patient has epilepsy, [we] put them on medication. But very frequently they have comorbid conditions such as depression, anxiety, the effect on their relationships, the effect on the work issues, school issues. And I think paying attention to that and making sure that we are asking those questions and providing support for those issues is also very important, and I think [it’s] still an unmet need.

I think awareness of some of the newer medications is important because many of them have better tolerability and advantages, such as [a] long half-life, [and] specific treatment indications—for example, for generalized seizures or for specific syndromes, such as Dravet syndrome. Some of the other issues are relating to the comorbidities and being aware of the comorbidities. And fortunately, there are epilepsy centers that have great experience in terms of using these medications or having alternative techniques. And I think most of the community neurologists are aware of those issues, but those would be the core thought processes.