Epilepsy treatment still facing barriers of efficacy, access
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ORLANDO — Although effective treatments have been established for those with epilepsy, there is a need for more and novel therapies, which face barriers of efficacy and access, according to a presenter.
“Epilepsy really is a collection of rare diseases,” Kelly G. Knupp, MD, MSCS, associate professor of pediatrics and neurology at the University of Colorado, Anschutz Medical Campus, said at the American Epilepsy Society annual meeting. “Answering how many people have epilepsy is pretty straightforward; it really hasn’t changed significantly over time.”
Knupp cited statistics that revealed the incidence of epilepsy worldwide is 61.44 per 100,000 person-years and the prevalence is 6.38 per 1,000 people, meaning more than 50 million people worldwide are dealing with the condition. In the United States, epilepsy impacts more than 200,000 individuals and does not reach rare disease status; however, Lennox-Gastaut syndrome, a rare childhood epilepsy, impacts 13.2 children per 100,000 and Dravet syndrome is counted in 1 out of every 15,700 live births nationwide.
As the epidemiologic course of epilepsy has been charted through the last 150 years and the individual epidemiology of the condition remains constant, Knupp noted, there are about as many antiseizure medications to treat epilepsy as there are varieties of the condition.
With the issues of consistent seizure reduction and side-effect management still to be solved, newer treatments such as electrode stimulation and surgery have become more common and have led to seizure reduction and higher response rates among the pediatric population. Nonetheless, Knupp said, the bulkiness of the apparatus as well as lack of access to this specialized care, along with fears from patients, families and providers about surgical procedures prevents it from taking more of a foothold.
As with many specialties, health inequalities present a barrier to effective epilepsy treatment. Black adults have increased rates of uncontrolled epilepsy compared with white and Hispanic populations, and Black individuals have a lifetime epilepsy prevalence 1.9 times higher than all other groups, as well as a higher incidence of status epilepticus. Medication adherence and rates of follow-up with neurology professionals also plague effective treatment, as well as increased dependence and use of certain medications, such as phenytoin compared with levetiracetam.
Caregivers are also unduly burdened, with a majority in one survey cited by Knupp reporting that continuance of seizures, sleep disturbances and injuries from seizures as top concerns within the care continuum when treatment is sought and applied.
“I think we have so many treatment options and we’re allowed to partner with our patients and families and that is more important than ever,” Knupp said. “We haven’t made a lot of progress in our drug-resistant epilepsy patients, so there’s a lot of room for improvement.”