Jerry J Shih: Improved Epilepsy Understanding

AUGUST 02, 2017
MD Magazine Staff

Shih:
So there's been quite a few development in the field of epilepsy over the last several years, and I think I can break it down into a couple of different aspects. I think first and foremost for other physicians who are not in the field of epilepsy it's important to understand that the definitions have actually changed or have evolved over the years.

So within the last couple of years for example, the definition of epilepsy itself has evolved. 20 years ago in order to be diagnosed with epilepsy you had to have two or more unprovoked seizures, okay so if you had one you don't have epilepsy. But within the last couple of years there have been several guidelines that have come out that really emphasize the fact that you don't need to have two seizures in order to have epilepsy and they've given several examples of how that could be so.

So the concept is, is that even if after one seizure if it's become pretty obvious that your brain is predisposed to having more seizures then by definition you have epilepsy, so that's sort of a little bit of a shift in terms of definition.

The other aspect is in terms of cure. So most people think of epilepsy as if you become seizure-free then your quote ‘cured’. But within the last couple of years we've codified it so that you have to be seizure-free for 10 years and to be off of medications for 5 years in order to really be considered quote ‘a cure’. So
I think that that's one of the changes in that regard.

There are also a number of other specific avenues that the field of epilepsy has gone to. For example, neural inflammation that's one of the big areas. Inflammation occurs whenever the body has some sort of injury and it's actually fairly well known that after seizures the brain produces markers for inflammation.
One of those markers is for example a marker called interleukin-1 beta. Interleukin-1 beta has been shown in animal models and mice and rats that when you inject this compound, this molecule into the rats brains you actually can provoke seizures or induce the rats to have seizures. The flipside is that when you inject markers into the rat’s brain, that is an antagonist or counteracts the influence of that interleukin-1 beta seizures tend to stop, so suggesting that an inflammatory process may help drive seizures the reason why that may be important in terms of humans and seizures in humans is that if we have certain medications that can be developed to decrease inflammation and if they work then that could potentially be a game-changer.

So just to give you an example something that we take all the time for example, nonsteroidals, like ibuprofen or any of those things so there actually was a study in a type of animal called zebrafish in which these animals as a model they produce seizures and when they were given this anti-inflammatory agent the frequency of their seizures went way down so if that's something that can be translated to humans, that would you know potentially be very significant.

We have a number of anti-inflammatory agents. For example one as an example would be, as I said Ibuprofen. It's cheap, its ubiquitous and if ibuprofen can be shown to really help manage or control seizures then that could be a fairly inexpensive way of helping patients who have epilepsy.

Another very common anti-inflammatory agent is cortical steroids, so prednisone, decadron things like that. And again if those are shown to be effective then that would be a powerful tool to treat seizures.

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