VIEWPOINTS Produced in association with ACNR Wednesday / Thursday / London Lecture – Friday / Expert-led 23 Refractory Epilepsy 24 what’s new in status epilepticus? 25 poster session Improving the treatment of refractory In The London Lecture, Professor Simon Highlights included the latest research epilepsy was a key focus of this meeting, Shorvon reviewed progress in our into SUDEP, hospitalisation rates, with topics ranging from dietary treatments, understanding of status epilepticus and AED use in clinical practice, and new to new surgical techniques and outcomes, highlighted some of the most promising data with eslicarbazepine acetate, and recent developments in AED treatment. new treatment approaches in development. perampanel, and other drug treatments. The 2015 Annual Scientific Meeting of the epilepticus (see page 6) and Professor Ingmar report of this well-attended symposium can be ILAE British Chapter, held in London on 23–25 Blümcke reviewing the latest analysis of surgical found on pages 4 and 5 of this newsletter. September 2015, brought together more than 300 outcomes in adults and children from the European We hope you enjoy this issue of VIEWPOINTS, epilepsy researchers and healthcare professionals Epilepsy Brain Bank (see page 2). Dr Jim Morrow which offers a selection of meeting highlights, and from across the British Isles. In a varied and from the Belfast Health and Social Care Trust was provides an update on some of the latest and most busy programme that included plenary sessions, awarded this year’s ILAE Excellence in Epilepsy exciting research underway across the country. sponsored satellite symposia, a debate, and an Award at the meeting and, in his award lecture, expert-led poster session, delegates heard news he presented encouraging new data on the risk of of the latest research from across the country in major congenital malformations associated with ILAE meetings give a chance a broad range of epilepsy topics. Opening the some of the newer antiepileptic drugs (AEDs) “ for all the groups in the epilepsy meeting, President of the ILAE British Chapter, (see page 3). community to come together, Dr John Paul Leach, described the annual event To mark the granting of a new indication in the UK including neurologists, nurses, as ‘one of my favourite meetings’, encouraging for the novel AED, perampanel (Fycompa®) as everyone to get involved in the discussions and psychologists, psychiatrists and an adjunctive treatment for primary generalised take an active part in the event. basic scientists. It is important tonic-clonic (PGTC) seizures in adults and that we all have a Several keynote presentations were made at the meeting by world-renowned epilepsy experts, generalised epilepsy (IGE), Eisai sponsored a broad outlook… with Professor Simon Shorvon delivering The satellite symposium entitled, ‘Do we need a new ” Dr John Paul Leach, London Lecture, focusing on what’s new in status therapeutic approach for our IGE patients?’. A President of the ILAE British Chapter Produced in association with Advances in Clinical Neuroscience & Rehabilitation (ACNR). Initiated and funded by Eisai Ltd. Prescribing information can be found on the last page. Epilepsy surgery continues to offer hope to patients with medically- Also new refractory epilepsy: new European and UK data presented at this Epilepsy surgery remains an important treatment Surgical outcomes data from 6899 adults and option for adults and children with medically- 2707 children were presented demonstrating refractory epilepsy, achieving seizure freedom in overall seizure-freedom rates at 12 months of meeting… many individuals. In the ILAE 2015 British Chapter 64.1% (Table 1). Rates were reported to be Annual International Lecture, Professor Ingmar similar in adults (74.0%) and children (65.1%). Walton Centre study suggests many patients Blümcke from the University Hospital Erlangen do not remain seizure-free in the long term in Germany presented the latest analysis of Table 1: 12-month seizure-freedom rates data from the European Epilepsy Brain Bank, reported in a recent (unpublished) analysis of A new study by The Walton Centre for to which three UK centres have contributed. data from the European Epilepsy Brain Bank Neurology and Neurosurgery and Liverpool University reported similarly good initial Onset of Age of outcomes of epilepsy surgery in 284 % patients Neuropathological spontaneous patients n (%) seizure-free at patients with medically-refractory epilepsy findings seizure activity at surgery 12 months (Wieshmann et al., 2015). In this study, a (years) (years) seizure freedom rate of 45% at 12 months Hippocampal sclerosis 3405 (35.4) 9 34 64.7 after surgery was reported, however, this Tumours 2189 (22.8) 13 25 71.3 reduced to 42% at 2 years, 29% at 5 years and 19% at 10 years post-surgery. In Malformations of 1873 (19.5) 3 15 63.5 cortical development his presentation to the meeting, Dr Udo Wieshmann from The Walton Centre said No lesions 739 (7.7) 11 28 51.7 that although surgery resulted in a dramatic Vascular malformation 564 (5.9) 21 35 65.8 reduction of seizures in many patients, long- Glial scars 473 (4.9) 8 25 52.0 term outcomes appeared less favourable. He proposed that surgery could potentially Dual pathology 223 (2.3) 6 28 61.3 convert a medically-refractory epilepsy to Encephalitis 135 (1.4) 5 12 60.4 a medically-treatable form and that better patient selection and new surgical techniques Double pathology 5 (0.1) 20 32 100 might improve outcomes in the future. Total 9606 12 28 64.1 According to Prof. Blümcke, the decision to operate tended to come sooner after seizure onset in Low complication rates reported by the children than in adults, with earlier surgery delivering better outcomes. He reported that epilepsy duration, localisation and histopathological diagnosis appeared to predict surgical outcomes, however, National Hospital for Neurology and he said, this had not yet been confirmed statistically due to the relatively small sample size. Neurosurgery A team from the National Hospital for Neurology Encouraging results with RTG RUF and Neurosurgery in London reported the ESL 2% the use of newer AEDs in 5% 2% results from a 25-year retrospective study of physical complications in 911 epilepsy a nurse-led community PER surgical procedures (Gooneratne et al., 17% epilepsy service ZNS 2015). Most (84%) procedures reviewed 48% were temporal lobe surgeries. No peri- LAC operative deaths were reported. A total of Newer AEDs are being used more frequently with 26% encouraging results, according to the findings of 131 (14%) of surgeries were complicated a recent audit of a nurse-led community epilepsy by persistent neurological complications; the service in mid-Staffordshire (Tittensor et al., 2015). most persistent anticipated complication was ESL, eslicarbazepine acetate; LAC, lacosamide; The audit included data from approximately 800 PER, perampanel; RTG, retigabine; RUF, ru!namide; a quadrantanopia (77 patients; 8%), which ZNS, zonisamide. patients under regular review by the service and occurred in 10% of patients who had temporal reported that 133 of these patients had been offered Figure 1: Percentage of treatment-refractory patients lobe surgery. Surgical complications occurred receiving one of the six newer AEDs (n=133) in a nurse-led treatment with one of the newer AEDs (Figure 1). community epilepsy service in mid-Staffordshire (Tittensor in 83 patients (9%). The group concluded Most patients trying these drugs had failed to have et al., 2015) that complication rates in their study were their epilepsy controlled with older medications. became seizure free in this study) despite being the similar to those reported in the literature and Zonisamide (n=63), lacosamide (n=35) and most treatment refractory (Tittensor et al., 2015). The that the risk of physical, neuropsychiatric and perampanel (n=22) were reported to have reduced research group from the Royal Wolverhampton NHS neuropsychological complications needed to seizure frequency by at least 50% in 62%, 76% and Trust and Keele University reported ‘encouraging be made clear to individuals considering this 65% of patients, respectively. Patients receiving statistics’ that, they concluded, supported the use treatment option. perampanel were most likely to achieve seizure of the newer AEDs in the treatment-refractory freedom of at least 6 months (18% of patients population being studied. 2 Produced in association with ACNR High rates of unscheduled admissions and readmissions in epilepsy cost the NHS millions al., 2015). A total of 177 1 year and one-third reattending five or more 350000 318768 admission episodes were times. The group called for further research to 300000 captured belonging to 120 characterise the clinical features of this cohort of 250000 200000 patients. These patients patients and to design alternative care pathways 146801 150000 were hospitalised for a total aimed at reducing costs and improving the quality 95758 100000 of 548 days and 13 patients of care. 39581 38666 35457 50000 28403 25576 24801 21039 7098 6445 6016 5232 4970 4506 4072 2483 2038 (10.8%) were admitted to Number of admissions 0 ITU. The length of disorders Ataxias h o s p i t a l i s a t i o n Meningitis Stroke or TIA Encephalitis Sleep disorders Multiple sclerosis ranged from 1 to 25 Cranial nerve disorders 25 Migraine and headaches Nervous system atrophy days (mean 4.55 Parkinson’s disease and dystonia Intracranial abscess or phlebitis Other disorders of nervous system Epilepsy including !t or seizure NOS Myopathies and myoneural disorders days) (Figure 3). Cerebral palsy and paralyticNerve syndromes root disorders and neuropathies Hydrocephalus and toxic encephalopathy Disorders of the autonomic nervous system Thirty-one patients 20 Alzheimer’s disease and other degenerative had a further 57 Figure 2: Neurological diagnoses ranked by number of emergency hospital r e a d m i s s i o n s 15 admissions between 31 April 2007 and 31 March 2013 (Hick et al., 2015) (Figure 4) – the Percent High rates of unscheduled admissions for adults majority due to 10 with suspected seizures are costing the NHS uncontrolled epilepsy.