This year’s Annual Course focused on the evaluation and management of the “worst of the worst,” super-refractory patients with epilepsy. Four cases are presented which span the age spectrum from infancy to old age. In addition to case-based scenarios, lectures, debates and counterpoints, plus question-answer breaks are employed regarding the recommended approaches to diagnosing and treating these challenging cases. The first section starts with the case of an infant with epileptic encephalopathy, followed by lectures on neuroimaging beyond MRI, genetic etiologies for children and the value of palliative surgeries. A case of a teenager with seizures from autoimmune disease is then used to discuss autoimmune etiologies, how to treat, dietary management for adolescents and adults and then a counterpoint on the transition of care from pediatric to adult providers. In the third section,there is a case of an adult with progressive myoclonic epilepsy, followed by lectures on genetic conditions for adults, neuropsychiatric strategies to improve quality of life, new drugs in the pipeline and a debate regarding the true value of the newest anticonvulsant drugs. A case of an elderly patient who has failed surgeries, followed by lectures on the causes of surgical failure, use of herbs and botanicals and a closing debate on when, in the course of treatment, care should be more palliative.
Following participation in this session, learners should be able to:
- Delineate the appropriate role of genetic testing and advanced neuroimaging in diagnosing refractory epilepsy.
- Discuss the impact of severe epilepsy on the patient’s family.
- Recognize when immunotherapy and dietary management would be appropriate treatments for refractory epilepsy.
- Describe “best practices” for transitioning pediatric patients to adulthood.
- Select the appropriate anti-epileptic medication(s) and herbs for the treatment of refractory epilepsy.
- Delineate the causes of surgical failure.
- Compare and contrast the newest anti-epileptic drugs (AEDs) available and in the pipeline with standard AEDs in terms of efficacy, side effects and cost.
- Restate whether or not these newer AEDs are truly changing the percent of patients in the refractory category.
- Discuss strategies neuropsychologists can use to improve the quality of life for patients with refractory epilepsy.
Intermediate and Advanced
Chair: Eric Kossoff, M.D.
Eric Kossoff, M.D.
Case One: Infant with Epileptic Encephalopathy (Ohtahara) Due to Multiple Cortical Malformations
Jack Lin, M.D.
Lecture: Diagnostic Neuroimaging Beyond MRI
Fernando Cendes, M.D., Ph.D.
Lecture: Genetic Causes of Severe Refractory Epilepsy
Annapurna Poduri, M.D.
Lecture: The Role of Palliative Surgery in 2016: Callostomy, MST
Howard Weiner, M.D.
Lecture: Impact on the Family: What Topics Should Be Discussed and When (Prognosis, SUDEP, Siblings, etc)?
Katherine Junger, Ph.D.
Case Two: Seventeen-Year-Old with Refractory Seizures from Autoimmune Encephalitis
Robert Bollo, M.D.
Lecture: Algorithm for Evaluating Patients for Presumed Autoimmune Disease
Nicolas Gaspard, M.D., Ph.D.
Lecture: Immunotherapy for the Refractory Patient
Eric Lancaster, M.D.
Lecture: Diets for Older Adolescents and Adults with Highly Refractory Seizures
Mackenzie Cervenka, M.D.
Counterpoint: Transition of the Adolescent with Severe Epilepsy to Adult Providers —How Best to Accomplish This
Sarah Kelley, M.D. (Pediatrics), and Elizabeth Felton, M.D., Ph.D. (Adult)
Case Three: Adult with Progressive Myoclonic Epilepsy
David Ficker, M.D.
Lecture: Important Genetic Conditions to Consider in Adults (recording not available)
David Goldstein, Ph.D.
Lecture: Beyond Epilepsy — Neuropsychiatric Strategies to Improve Quality of Life
Jay Salpekar, M.D.
Lecture: Exciting New Drugs in the Pipeline
Steve White, Ph.D.
Debate: The Newer Drugs Are Changing the Landscape and Helping These Patients
Daniel Friedman, M.D.
These New Drugs Have NOT Improved the Outcomes for Refractory Patients (recording not available)
Michael Rogawski, M.D., Ph.D.
Case Four: Elderly Adult Who Has Failed Multiple Surgeries: Johnny Returns
Michael Gelfand, M.D., Ph.D.
Lecture: Anticipating Surgical Failures
Elaine Wyllie, M.D.
Lecture: Herbs and Botanicals —Can They Help?
Dana Ekstein, M.D.
Debate: There Is Always Hope! Keep Trying!
Frank Gilliam, M.D., M.P.H.
There Are Times to Be Helpful, but Times to Stop
Lara Jehi, M.D.
Eric Kossoff, M.D.
COMMERCIAL SUPPORT ACKNOWLEDGEMENT
Supported in part by educational grants from Eisai Inc. and GW Pharmaceuticals.
Attendees of the 2016 Annual Meeting have free access to recordings.