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By Rita Watson, MPH

You know what the latest epilepsy study found, but what do you make of the results and what do other experts have to say? In Hallway Conversations we present perspectives and opinions from epilepsy experts based on their interpretation of findings from new studies and their own experience. What do you think about these issues? What is your approach as a health care provider, and why?

Here are the highlights and links to our 2007 features.

AEDs and Seniors

Recent studies have indicated that persons over the age of 60 are at an increased risk for developing epilepsy compared to younger persons. According to Mark Spitz, MD, University of Colorado, in an article for epilepsy.com/professionals, epilepsy in seniors “presents differently than epilepsy starting at a younger age…The underlying cause seems to be most commonly arteriosclerosis, more specifically the sequelae of cerebrovascular disease.”

We asked two experts in the diagnosis and treatment of seniors with epilepsy -- Ilo Leppik, MD, from MINCEP Epilepsy Care in Minneapolis and Joseph I. Sirven, MD, from Mayo Clinic in Scottsdale -- to talk with us about the issue. To read more, go to: http://profesionnals.epilepsy.com/page/hallway_aeds_seniors.html

Reporting Patients Whose Seizures May Affect Driving

Should physicians be required to report patients with epilepsy to states’ departments of motor vehicles if they believe that seizures or medication effects could affect their driving competency?

To shed some light on the controversy, we asked two experts to share their opinions with us: Kimford Meador, MD, author of the editorial (Neurology 2007;68:1170 –1) that comments on the AAN position statement, and Attorney Michael E. Clark, vice chair of the American Bar Association’s Healthcare Litigation and Risk Management Interest Group. To read more, go to: http://profesionnals.epilepsy.com/page/hallway_driving.html

Rufinamide: The FDA is Reviewing its Use

Rufinamide, the generic name for a medication used to control both convulsive and non-convulsive seizures, is not yet approved for use in the United States. Currently the US Food and Drug Administration (FDA) is seeking to determine whether to approve rufinamide as an add-on therapy for two uses: partial seizures with or without secondary generalization in adults and adolescents 12 years of age and older, and Lennox-Gastaut syndrome in children ages 4 and over.

We asked two experts for their opinions regarding rufinamide: John Pellock, MD, Professor and Chairman, Division of Child Neurology at Virginia Commonwealth University and Rajesh Sachdeo, MD, Department of Neurology at Robert Wood Johnson University Hospital. To read more, go to: http://profesionnals.epilepsy.com/page/hallway_rufinamide.html

Can Dogs Detect Seizures?

Despite the anecdotally reported benefits of dogs for people with epilepsy, many questions remain. While there is little disagreement that dogs can provide emotional support, the actual role they play with regard to predicting seizures is controversial. Two recent reports in the medical literature question the effectiveness of seizure alert dogs in detecting epileptic seizures.

Given the controversy, epilepsy.com asked two experts, Gregory Krauss, MD, Department of Neurology, Johns Hopkins Hospital, and Professor Stephen Brown, Cornwall North Heath Services, United Kingdom to share their views. To read more, go to: http://profesionnals.epilepsy.com/page/hallway_seizure_dogs.html


Should Patients or Their Families be Told of the Risk of Sudden Unexplained Death in Epilepsy (SUDEP)?

Should patients or their families be told of the risk of sudden unexplained death in epilepsy (SUDEP)? There appear to be two considerations. On the one hand, the probability of death is so unlikely that many patients and families will worry unnecessarily if they are told. On the other hand, since there appears to be an association of SUDEP with seizure activity, those who experience frequent seizures might benefit from general preventive measures, even in the absence of definitive evidence that these may prevent SUDEP.

How and when should physicians communicate the risk of SUDEP to patients and families? We asked two experts, Martin J. Brodie, MD, from Glasgow, Scotland, and Elinor Ben-Menachem, MD, from Götenberg, Sweden, to share their views. To read more, go to: http://profesionnals.epilepsy.com/page/hallway_sudep.html

Felbamate: How Safe is It?

Felbamate, a novel antiepileptic drug (AED), has been shown to be an effective treatment for a variety of seizure types in both adults and children. In adults, felbamate has been used for treating partial seizures with and without secondary generalization and in children it has been beneficial in treating seizures that are associated with Lennox-Gastaut syndrome. Serious and potentially life-threatening adverse effects have limited the use of felbamate. John M. Pellock and colleagues reported the findings of an expert panel that evaluated data and reviewed current clinical practices with regard to felbamate (Epilepsy Research 71 (2006) 89-101).

We asked two epilepsy experts about their use of felbamate and their reactions to the report by Pellock et al. Georgia Montouris, MD, is Co-Director of Epilepsy Services and Assistant Professor of Neurology, Boston University School of Medicine and Jim Wheless, MD, Professor and Chief of Pediatric Neurology at the University of Tennessee Health Science Center in Memphis. To read more, go to: http://profesionnals.epilepsy.com/page/hc_felbate.html

We began our Hallway Conversations in October 2006 – Here are links to those stories.

Are there topics that interest you or topics which are creating controversy within the profession that you would like us to write about?

We would be pleased to hear from you with ideas for Hallway Conversations that interest you. Please contact me at rita@epilepsytherapyproject.org

Submitted: January 2, 2008

Edited by Steven C. Schachter, MD

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