Epilepsy Treatment: A Futurist View

Abstract

Advances in epilepsy treatment are occurring at a rapid pace, and it is challenging for us to keep up with the latest in our field. As we struggle to keep up with the literature and concentrate on our own research and clinical work, we often fail to exercise our imagination and envision what our field will be like in future decades. This was the assignment to the speakers for the Presidential Symposium at the 2016 American Epilepsy Society Annual Meeting. I challenged the experts to step outside the frame of their usual daily work to imagine what epilepsy treatment would and should look like for the next generation of epilepsy specialists and their patients. As you will read in the following sections, the speakers truly stepped up to the challenge to look into the crystal ball. The following are summaries of each lecture that describe the current state, existing cutting edge ideas, and some surprising predictions for the future. I am grateful for the tremendous effort these experts put into this challenge and hope they stimulate your imagination so you will work to bring these advances to our patients.

Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation

“…Language lateralization was performed using Wada test (one patient) or fMRI (two patients, currently preferable language lateralization technique [7] , [8] ), and was based on handedness only in one patient (his health insurance denied fMRI and Wada test). The SEEG evaluation was recommended based on presence of non-lesional MRI in patients with presumed TLE to exclude the TLE mimics as a reason of potential resective surgery failure [9] , [10] , [11] . Also, according to our institutional SEEG evaluation protocol, all patients with a pre-implantation hypothesis suggesting temporal lobe epilepsy undergo bilateral sampling of the mesial temporal structures with stereo-electrodes [12] .…”

“…According to current pre-surgical evaluation guidelines, MRI and FDG-PET non-lesional TLE is an indication for invasive evaluation to localize the seizure onset zone(s) [9] . An option to replace invasive EEG by RNS in selected patients to record longer durations to record seizures and also provide treatment at the same time was discussed at our surgical conferences.…”

Recent Advances in Epilepsy Surgery

“…Neuropsychological tests demonstrated cognitive deficit in most patients without tumors or cavernomas [77]. Epileptogenic network is partially supported by Microanalysis (elevation of glutamate levels in epileptogenic region and greater increase after ictal onset, 7 T-MR spectroscopy detecting the mitochondrial function in cortico-subcortical area) and electrophysiological connectivity [24].…”

A journey into the unknown: An ethnographic examination of drug-resistant epilepsy treatment and management in the United States

“…Advances in remote long-term video monitoring facilitated by family members or caregivers for identification of nonepileptic seizures could protect patients from undergoing unnecessary treatments [32]. Such technological advances have the potential to create a future paradigm shift by introducing novel epilepsy treatment and management pipelines throughout a patient's journey [33][34][35] (Fig. 3a, dashed yellow lines).…”