The Changing Landscape of Epilepsy Care: Orrin Devinsky, MD

WATCH TIME: 3 minutes

"Our ability to discover epilepsy genes is moving at warp speed, but our ability to develop approved gene therapies has been relatively glacial. Balancing risk and benefit remains critical."

Around 50 million people worldwide live with epilepsy, making it one of the most common neurological conditions. Treating epilepsy has come a long way, with the first pharmacologic breakthroughs coming in the early 20^th century. Over time, during the 1960s-1980s, the drug arsenal expanded with the introduction of carbamazepine, valproate, and ethosuximide, while EEG became more widely used in diagnosis and treatment selection.

In the 1990s and early 2000s, a wave of second-generation antiseizure medications arrived, with a greater focus on reducing adverse events, improving safety in pregnancy, and minimizing drug-drug interactions. Today’s epilepsy care is considered more personalized, genetics-informed, and technology-assisted, with the next frontier being disease-modifying therapies. Orrin Devinsky, MD, director of NYU Langone’s Comprehensive Epilepsy Center, believes a lot of the major advances in epilepsy care have come from new therapeutics and a greater understanding of the genetic aspects of the disease.

In an interview with NeurologyLive®, Devinsky reflected on the way epilepsy care has grown over the years. While the rapid pace of genetic discovery has far outstripped the development of approved treatments, he emphasized the promise of antisense oligonucleotides and gene replacement strategies in rare epilepsies. Furthermore, Devinsky also underscored the importance of tackling premature mortality, particularly sudden unexplained death in epilepsy (SUDEP), by increasing awareness among clinicians and patients, as well as advancing safer pregnancy management for women with epilepsy.