2011 AES Annual Meeting - 301.01 - Annual Course: Overcoming Barriers to Successful Epilepsy Management
Program Length: 510 minutes
This year’s Annual Course will delve into obstacles that preclude successful epilepsy management. Three large categories of barriers will be explored: 1) Diagnostic and physiologic barriers, including seizure and epilepsy classifications; diagnostic barriers such as misreads or limitations of both the electroencephalogram and magnetic resonance imaging; pathophysiological barriers such as drug resistance genes; 2) Therapeutic barriers as exemplified by limited translational epilepsy animal models, clinical trial designs, medication adverse effects and compliance barriers, and surgical barriers; 3) Public health barriers, including stigma, psychiatric comorbidities, health system issues and driving will be explored in terms of how they obstruct the care of the patient with seizures. The goal of the course is not just to itemize barriers but to provide practical ways in which individuals who care for others or research the issue of epilepsy can help to overcome these barriers.
• Apply the proposed changes for the epilepsy and seizures classification system clinically
• Review new information regarding the genetics of epilepsy that may serve as a barrier towards epilepsy treatment and how to use this information in daily clinical practice
• Demonstrate EEG and imaging misinterpretations which may lead to mismanagement and define the limitations of both EEG and imaging in obtaining good clinical outcomes in the patient with epilepsy
• Given problems with existing animal models for epilepsy drug development, evaluate the utility of current clinical trial design when developing management strategies
• Assess the impact of adverse effects on compliance associated with antiepileptic drug therapy when managing patients with difficult to control epilepsy thereby improving clinical outcomes
• Recognize psychiatric comorbidities of epilepsy and utilize newly-acquired strategies which can be employed for these conditions
• When considering resective surgery, recognize which patients may fail a surgical approach; when planning surgery, make use of published data that demonstrate that that the extent of surgical resection plays an important role in successful outcomes
• Examine the social barriers such as stigma and public healthcare systems play in outcomes for patients and refer patients for appropriate intervention
• Define how public policy regarding to driving impacts the successful management of a patient with seizures and the role of the physician in addressing these issues.
Intermediate: Epilepsy fellows, epileptologists, epilepsy neurosurgeons, “mid-level” providers with experience in epilepsy care (e.g., advanced practice nurses, nurses, physician assistants), neuropsychologists, psychiatrists, basic and translational researchers.
Advanced: Symposium will address highly technical or complex topics (e.g., neurophysiology, advanced imaging techniques, advanced treatment modalities, including surgery).
Chair: Joseph I. Sirven, M.D.
1. Diagnostic and Physiological Barriers
Case Presentation: How to Classify the Patient
Tobias Loddenkemper, M.D.
Classification as Barrier
Anne T. Berg, Ph.D.
Panel Discussion: Classification System
Anne T. Berg, Ph.D., Jerome Engel, Jr., M.D., Ph.D., Hans O. L?ders, M.D., Ph.D.
Resistance Genes / Genetic Barriers
Samuel F. Berkovic, M.D.
Case Presentation: Diagnostic Tests Mislead the Neurologist
Jonathan C. Edwards, M.D.
EEG Misreads / EEG Barriers
John M. Stern, M.D.
William H. Theodore, M.D.
2. Therapeutic Barriers
Case Presentation: Medical Therapeutics as Barrier
Lisa M. Bateman, M.D.
Animal Model and Clinical Trials Barriers
Jacqueline A. French, M.D.
Panel Discussion: What Do Clinical Trials Really Tell Us?
Gregory L. Krauss, M.D., Jacqueline A. French, M.D., Elinor Ben-Menachem, M.D., Ph.D.
Adverse Effect and Compliance Barriers
Avani Modi, Ph.D.
Panel Discussion: Psychiatric Comorbidities
Frank G. Gilliam, M.D., M.P.H., Andres M. Kanner, M.D., Page Pennell, M.D.
Case Presentation: Surgical Therapy as Barriers
Matthew T. Hoerth, M.D.
Lara E. Jehi, M.D.
Debate: Amygdalohippocampectomy vs. Larger Resections
Guy M. McKhann II, M.D., Greg D. Cascino, M.D.
3. Public Health Barriers
Case Presentation: System or Stigma-Related Barriers
Jerzy P. Szaflarski, M.D., Ph.D.
Health Disparities / Referral System Barriers
Charles E. Begley, Ph.D.
Panel Discussion / Stigma as Barrier to Successful Treatment
David M. Labiner, M.D., Gretchen Birbeck, M.D., M.P.H., Patricia O. Shafer, M.N., RN
Debate: Physician Mandated Reporting Driving Laws vs. Non-Reporting Driving Laws
Robert S. McLachlan, M.D., Joseph Drazkowski, M.D.
Joseph I. Sirven, M.D.