Epilepsy: an ancient brain disorder without a cure

2014 has been declared European Year of the Brain by the European Brain Council. It also marks the one hundred and tenth anniversary of the first description of the term ‘epileptologist’ by US doctor, William Spratling, who is also considered the US’s first epileptologist. For the first time, the treatment of epilepsy was designated a specialism. This, together with the first descriptions of epilepsy being associated with the brain, ushered in the modern era of epilepsy.

Prior to this, epilepsy, one of the most common brain disorders seen across the world, which affects more than half a million people in the UK was misunderstood, misdiagnosed and treated incorrectly. This was due to poor scientific and physiological understanding of the condition. The unfortunate but widely held view of epilepsy being linked to occult or evil influences was common in ancient times, even among medical practitioners.  Primitive treatments advised prescribed diets or altering living conditions, occasional surgery such as bloodletting or skull trephination and medicinal herbs.

Attitudes towards epilepsy began to change during the Enlightenment (mid 17th-19th century), with the condition viewed along more modern lines. The first medical treatments for epilepsy were described in 1857 by Charles Locock who began to use bromide to treat women with ‘hysterical epilepsy’.
Great strides were made in the 20th century in the understanding, diagnosis and management of epilepsy. In 1912 the anticonvulsant phenobarbital was discovered by accident: it was developed as a sedative, but it was also found to be effective in the treatment of seizures. The invention of the electroencephalogram (EEG) in 1929 by a German psychiatrist enabled the brain’s electrical current to be recorded without opening the skull. EEGs helped doctors and researchers understand the changes which took place when people with epilepsy experienced seizures.
Epilepsy in the modern world: Challenges
Stigma - Epilepsy continues to be a serious health problem across the world. Many people with the condition experience substantial social stigma and discrimination. Two thirds of people living with epilepsy are concerned about public attitudes to seizures.
Inadequate control of symptoms - Despite advances in treatment, it is estimated more than 30% of people taking medicine for their epilepsy obtain inadequate control of their symptoms. As such, there is a significant need for new treatments to prevent or reverse refractory epilepsy or alter the course of the disease.
Flaws in screening new drug candidates - 2012 saw the publication of a landmark paper in Epilepsia, discussing flaws in traditional screening tests. The article recommended that new preclinical screening strategies are needed to identify new antiepileptic drugs that target unmet medical needs including people with epilepsy that does not respond to current treatments. 
The future
2014 is the ‘European Year of the Brain’ and in the 21st century and over the last 150 years, there has been a great deal of progress in the development of medicines that can successfully treat the symptoms of epilepsy. Yet modern medicines for epilepsy continue to focus on treating symptoms rather than the condition itself. Now a paradigm shift in the way scientists think about the condition has led to research which aims to find better treatments and ultimately a cure.


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Pharmacology/ Therapeutics


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