How Biomarkers will Transform epilepsy care in the 2020s

We asked Professor Deb Pal, from King’s College London, who was awarded an ERUK pilot grant in this year’s funding round, to give us his view on where the biggest advances will be made in epilepsy research over the next few years.  Here is his response.

At my primary school in the 1970s, we had an old lady music teacher with short grey hair who always wore the same dark green woollen skirt and lilac cardigan to work. She hung reading glasses on a beaded string around her neck and was perpetually growling at us boys and girls in her posh north Yorkshire accent. She would bang out the accompaniment to hymns at assembly as we marched in and out of the school hall. When I was about seven she handed out a box of recorders to the class. Seeing as the mouthpieces hadn’t been cleaned from the last lesson I was reluctant to put one in my mouth and copy the notes she was playing on the keyboard. By the end of the lesson she delivered her opinion that – I was “tone-deaf” and “needn’t bother with music”.

Fast forward a few decades and you’ll find that anyone can learn an instrument, and many learn just by watching videos on YouTube. The idea of perfect pitch as a prerequisite for learning music has been dismissed as a harmful prejudice. In medicine too, we have used “rules of thumb” for decades in the place of proper evidence to decide on diagnosis and prognosis, and “trial-and-error” to find suitable treatments. Both patients and doctors realise that these approaches are time-consuming, often inaccurate, sometimes hazardous and at times demoralising. But help is at hand, not from YouTube this time but from all kinds of technology ranging from devices to stimulate the brain to molecules in the blood combined with artificial intelligence.

Last month, the first clinical trial of a new anti-epilepsy drug from Xenon, an American pharma company, was successfully completed in volunteers who had their brains stimulated by transcranial stimulation (TMS). The device sends a magnetic pulse to the surface of the brain and the brain’s response to the pulse is measured. Researchers at King’s College London can now measure how much inhibition the brain can produce and how this is altered by experimental drugs like the one developed by Xenon. The same technology could predict the response of individual patients to different anti-epilepsy drugs before they are actually prescribed. TMS could then predict response to treatment or in other words act as a “biomarker” and hopefully avoid that trial and error.

In our own laboratory, we are working on a set of genomic markers (or variations in different genes in our DNA makeup) that when used in combination with some basic medical information can make a diagnosis of what type of epilepsy you have. We have fed all this information into an artificial intelligence programme to make a diagnostic prediction and at the moment we have about 70% accuracy with one type of epilepsy. In the near future, we hope to be able to improve this figure to more than 90% and extend the use of diagnostic biomarkers to other common types of epilepsy. In other words, a single blood test to make an epilepsy diagnosis – what could be simpler!

So keep your ear to the ground (get it?) for news about biomarkers – they are all the rage at the moment in the scientific community – as they are set to make life simpler for people with epilepsy in the next decade. And that tone-deaf kid? His guitar playing has come on very well thanks!

With many thanks to Professor Deb Pal.  If you would like to read more about his research to investigate the feasibility of a UK-based trial using nicotine patches to treat a rare genetic epilepsy called sleep-related hypermotor epilepsy (SHE), then please use the link here: 

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