Updates and developments in epilepsy treatment

The Irish Neurological Association (INA) 61st Annual Meeting, organised by the Irish Institute of Clinical Neuroscience, took place in Tralee, Co Kerry, last month.

Approximately 150 attendees gathered at the Rose Hotel on Thursday 15 May for the two-day meeting.

Proceedings began with INA President Dr Helena Moore delivering the opening address.

Following the address, Prof Norman Delanty, Consultant Neurologist, Beaumont Hospital, Dublin, provided a treatment update on important developments in epilepsy.

Prof Delanty outlined a number of new anti-seizure medications that are in development and have been approved for epilepsy.

He observed that cenobamate, a new anti-seizure medication, has shown benefits for patients with previously treatment-resistant epilepsy.

“It can be a very effective drug, but it can be a tricky drug to use and if a person is on multiple other drugs because they have a history of bad epilepsy, they need to proactively start reducing the medications,” according to Prof Delanty.

“…. But it remains to be seen how broad spectrum cenobamate is. It probably is broad spectrum in a certain amount of patients,” he said.

He also highlighted fenfluramine, a niche medication and serotonergic agonist, used in managing seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.

Recently approved for reimbursement under the HSE High-Tech Drug Scheme, the drug requires clinicians to complete a registration and approval process before it can be prescribed.

“This is a very useful drug for patients with Dravet syndrome and Lennox-Gastaut syndrome,” he told delegates.

He went on to discuss another emerging treatment for complex epilepsy, zorevunersen.

Dravet syndrome is most often caused by loss-of-function mutations in one copy of the SCN1A gene, which encodes the Nav1.1 sodium channel essential for brain function. This results in reduced Nav1.1 levels (haploinsufficiency), leading to seizures and other symptoms. Zorevunersen, an antisense oligonucleotide, works by increasing expression from the healthy SCN1A gene copy to restore Nav1.1 levels. It binds to specific RNA sequences, enhancing the gene’s productivity and helping to correct the underlying protein deficiency.

“It has completed early clinical trials in 81 patients and the outcomes so far are very promising,” Prof Delanty said.

“The FDA [Federal Drug Administration in the US] have given Stoke Therapeutics the go ahead to do a multi-centre phase 3 regulatory trial. This is starting around now and will take two years. If this is positive and early indications are promising, we will have the first gene therapy for epilepsy.”

He also informed delegates that individuals of all ages with epilepsy are now eligible for a free travel pass if they are unable to drive or feel uncomfortable doing so. A consultant or GP can complete the necessary form to facilitate access to the pass, he explained.

Following his update, Prof Delanty chaired the session which focused on epilepsy and neurophysiology and featured several presentations.

Over the course of the two-day meeting, presentations were also delivered on a range of other topics, including multiple sclerosis, neurosurgery, movement disorders, and neuromuscular conditions.