Please review and answer questions before proceeding to the activity.
Epilepsy affects approximately 2 million people in the United States. About 40% to 60% of patients with newly diagnosed epilepsy have focal seizures. Epilepsy with focal seizures is an acquired epilepsy that can begin in childhood or adulthood. The primary goal of treatment is to restore each patient’s functional capacity to its maximal potential by achieving freedom from seizures. Despite the development of new antiepileptic drugs (AEDs) in recent years and the availability of practice guidelines, more than 30% of patients continue to experience seizures, even after receiving appropriate therapy. Complicating the management of patients with refractory focal seizures has been a lack of understanding about what constitutes treatment resistance. In 2010, the International League Against Epilepsy (ILAE) published a consensus-based definition of treatment resistance. In addition, emerging AEDs with novel mechanisms of action may provide opportunities for combining agents to achieve synergistic effects. This activity reviews guidelines for diagnosing and treating focal seizures in adults, ILAE recommendations for defining treatment resistance, and current strategies for managing patients with refractory focal seizures.
Since this activity was released in August 2012, perampanel was approved by the FDA as adjunctive therapy for partial-onset seizures in patients 12 years of age or older.
This educational activity consists of a CME-accredited e-Course, narrated by Dr Steven Schachter, which offers 1 hour of AMA PRA Category 1 Credits™. The Regional Neurology Insights are not CME accredited.
To familiarize neurologists with the new consensus-based definition of treatment resistance in epilepsy and to update them on the current and emerging strategies for managing focal seizures in adults.
After completing this activity, participants should be better able to:
- Explain the concept of treatment resistance in patients with focal seizures
- Discuss issues related to treatment strategies for focal seizures
- Describe the mechanisms of action of emerging therapies for treatment-resistant focal seizures
- Evaluate potential roles for emerging therapies in the care of patients with treatment-resistant focal seizures
Steven C. Schachter, MD
Professor of Neurology
Harvard Medical School
Chief Academic Officer
Center for Integration of Medicine and
William A. DeBassio, PhD, MD
Associate Professor of Pediatrics and Neurology
Boston University School of Medicine
Director, Pediatric Sleep Services
Associate Director, Pediatric Epilepsy and EEG
Boston Medical Center
Robert S. Fisher, MD, PhD, Professor of Neurology, Stanford University School of Medicine, Stanford, California
Peter Glusker, MD, PhD, Adjunct Clinical Assistant Professor, Stanford University Medical Center, Stanford, California
John D. Hixson, MD, Assistant Professor of Clinical Neurology, The University of California, San Francisco, San Francisco, California
Thomas R. Henry, MD, Professor of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota
Andres M. Kanner, MD, Professor, Neurological Sciences, Psychiatry, Rush University Medical Center, Chicago, Illinois
Angela Mark, MD, Attending Neurologist, NorthShore University HealthSystem, Evanston, Illinois
Carl W. Bazil, MD, PhD, Professor of Clinical Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
Alan B. Ettinger, MD, MBA, Director of Epilepsy, Neurological Surgery, P.C., Lake Success, New York
Eric B. Geller, MD, Director, Adult Comprehensive Epilepsy Center, Saint Barnabas Medical Center, Livingston, New Jersey
Hayden C. Long, MD, Neurology Child and Adult, P.C., Mobile, Alabama
Charles Scott Markle, MD, Diagnostic and Medical Clinic, Mobile, Alabama
Juan G. Ochoa, MD, Associate Professor of Neurology, University of South Alabama College of Medicine, Mobile, Alabama
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This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Boston University School of Medicine and Continuing Education Alliance. Boston University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Boston University School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Release date: August 17, 2012
Expiration date: August 16, 2013
For continuing medical education questions, please contact: firstname.lastname@example.org.
This activity is supported by an educational grant from Eisai Inc.
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Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve any apparent conflicts of interest. In addition, faculty members are asked to disclose when any discussion of unapproved use of pharmaceuticals and devices is being discussed. This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration.
CME Activity Faculty
Dr DeBassio has nothing to disclose with regard to commercial interests.
Dr Schachter: consultant: BrainScope, Cyberonics, Inc., Insero Health, Sage Therapeutics; stockholder/patent royalties:
Dr Bazil: consultant: Pfizer Inc., UCB.
Dr Ettinger has nothing to disclose with regard to commercial interests.
Dr Fisher: consultant: Jazz Pharmaceuticals; stockholder: Cyberonics, Inc., ICVRx, NeuroVista, SmartWatch.
Dr Geller: grant/research support: National Institute of Neurological Disorders and Stroke, NeuroScience, Inc.
Dr Glusker has nothing to disclose with regard to commercial interests.
Dr Henry has nothing to disclose with regard to commercial interests.
Dr Hixson: consultant: Lumetra Healthcare Solutions Inc.; grant/research support: UCB.
Dr Kanner: grant/research support: Pfizer, Inc.
Dr Long has nothing to disclose with regard to commercial interests.
Dr Mark has nothing to disclose with regard to commercial interests.
Dr Markle has nothing to disclose with regard to commercial interests.
Dr Ochoa has nothing to disclose with regard to commercial interests.
The Planning Committee for this activity included Mike Burke and Ilana Hardesty of Boston University School of Medicine; and Ruth Cohen, Christie Avraamides, PhD, and Christine M. Olsen, PhD, of Continuing Education Alliance. The members of the Planning Committee have no significant relationships to disclose.
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