TIME: Almanac 1995

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<text id=93TT0217> <title> Aug. 16, 1993: Taming The Brain Storms </title> <history> TIME--The Weekly Newsmagazine--1993 Aug. 16, 1993 Overturning The Reagan Era </history> <article> <source>Time Magazine</source> <hdr> MEDICINE, Page 42 Taming The Brain Storms </hdr> <body> The first new epilepsy drugs in 15 years may turn despair into hope for more than a million Americans By CHRISTINE GORMAN Lynn Tiscia could lose control of her mind and body at any time. Without much warning, her arms and legs would begin to shake and she would babble incoherently for up to five minutes. Coming at least once a week, Tiscia's seizures cost her the job she had held for eight years at a legal firm. The spells were just too upsetting to the office, her boss told her. Friends avoided Tiscia, and holiday dinners became excruciating "because everyone kept looking at me," she recalls, "waiting and thinking, `Is she going to do it? Is it going to happen today?' " It was as if a scarlet E had been embroidered on her chest. Like 2.5 million other Americans, Tiscia, a 38-year-old Connecticut homemaker and mother of two young boys, suffers from epilepsy, in her case the result of brain damage sustained in a car crash. In people with epilepsy the signals that carry messages in the brain sometimes suddenly go haywire, unleashing electrical storms that temporarily disrupt or shut down parts of the organ. While about half of epilepsy patients have been able to control their seizures with drugs such as Dilantin, Tegretol and phenobarbital, Tiscia was one of the other, less fortunate half who could get little relief from medicine. Until now. Tiscia's life changed dramatically last fall when her doctor prescribed an experimental drug called felbamate. For the first time since her accident, she is free from seizures. "I don't even remember that I have epilepsy," she exclaims. "I'm back! It's me. I recognize myself. My sister tells me she finally likes me again. She even lent me her car. My mother yells at me again. It's great." The U.S. Food and Drug Administration last week approved felbamate for general use, making it the first epilepsy drug to pass the government agency's review in 15 years. And two other breakthrough medications, lamotrigine and gabapentin, are close to getting the FDA's nod. The three drugs are the first big payoff from a quest that began in the 1970s, when the National Institutes of Health screened 15,000 compounds in search of better epilepsy treatments. The trio of drugs that emerged are not cure-alls, but they are expected to help many of the more than 1 million Americans with epilepsy who have not responded to standard treatments. Some other patients will switch to the newer drugs because they create fewer side effects than the older medications, which, even when effective, often make people sluggish or overweight. "It's hard to say which one of the three drugs will prove the strongest," says Dr. Ilo Leppik, a professor of medicine at the University of Minnesota who has devoted the past 20 years to developing and testing new epilepsy treatments. "All three have entirely different mechanisms of action." So someone who does not respond to felbamate could well have better luck with either lamotrigine or gabapentin. Because gabapentin is not metabolized by the liver, it does not interact with other drugs--an important consideration for people who are taking multiple medications. Having a versatile medicine chest is crucial, since there is no such thing as a typical case of epilepsy. "Not even most doctors appreciate that epilepsy is a variety of disorders," says Dr. Orrin Devinsky of the New York University School of Medicine. Most seizures affect such a tiny part of the brain that many sufferers are troubled only by what appear to be mild staring spells or nervous tics. The more dramatic grand mal, a seizure in which a person temporarily loses consciousness, occurs regularly in a third of patients. Doctors can find a cause for epilepsy in only about half the cases; of these, most are inherited or result from severe blows to the head. Some children appear to outgrow the affliction. Felbamate is the first drug to show real promise against one of the most severe and difficult-to-treat forms of epilepsy, Lennox-Gastaut syndrome. Affecting 50,000 children in the U.S., Lennox-Gastaut seizures are so powerful and occur so frequently--as often as 200 times an hour--that mental retardation is generally unavoidable. In a 1993 study of 73 youngsters, half of whom received felbamate and half a placebo for 10 weeks, the treated group showed a 34% drop in the number of the most damaging seizures. Learning how the latest drugs calm the brain's internal rages could go a long way toward explaining the biological causes of epilepsy. "We started testing these compounds without having a clue as to how they might work," Leppik recalls. In the past five years, however, researchers have begun teasing out how the drugs affect the brain. Felbamate appears to block chemical signals that stimulate brain cells. Lamotrigine and gabapentin seem to enhance the activity of chemicals that calm the cells. Admits Leppik: "We still don't know precisely how they operate." But the exact biological mechanism is not important to Lynn Tiscia and all the others who will benefit from the drugs. All they want is an end to their brain storms. </body> </article> </text>