From Lab to Clinic
Researchers are looking forward to translating their animal experiments into clinical investigations, said Dr. Pitkänen. “Currently, we are at proof-of-principle studies,” she said. “But as you have seen, we have plenty of evidence that actually we can modify the epileptogenic process. So the question is, ‘What will the disease-modifying treatment look like?’”
Although the optimal starting point for and duration of such treatment is an unresolved clinical issue, some research suggests that short-term treatment may be beneficial, according to Dr. Pitkänen. For example, recent research found that in neurogenesis, newly born neurons take about two months to be integrated into epileptogenic circuitry. “What this could suggest is that to modify the brain circuitry, we don’t need to treat for years,” Dr. Pitkänen said. “It might be a question of days or weeks.”
Other unresolved clinical issues include whether disease-modifying treatments should involve monotherapy or polytherapy and whether they will carry the risk of adverse events, she added.
“How do we get further?” Dr. Pitkänen asked. “I guess the key is to understand that we have a large number of different etiologies, and each etiology has its own specific mechanism. We should aim at understanding the mechanisms in one syndrome at a time—that would probably provide us the fastest way to find targets for the mechanisms of epileptogenic circuitry and their repair.”
—Jack Baney