Transcript of Audio Interview with Dr. Orrin Devinsky


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MD NetGuide: “This is Bob Enteen reporting for MD NetGuide. Dr. Orrin Devinsky is Director of the Epilepsy Center at New York University School of Medicine. Our topic: comparison of second generation versus first generation epilepsy drugs including a view towards third generation drugs.

MD NetGuide: “Dr. Devinsky can you begin by laying out for us what the first and second generation drugs are and then doing a comparison?”

Dr. Orrin Devinsky: “In the past ten years we’ve seen an enormous improvement in the medications available to internists, pediatricians, neurologists and epilepsy specialists to care for people with epilepsy. And the major advantages of the past decade has been the introduction of medications that offer significantly better safety profiles than the older drugs. None of the information we have truly shows that newer medication are more effective. Although, there’s little doubt in specific patients…we’ve been able to get people seizure-free who have had disabling seizures in the past on the older drugs. For the vast majority of patients, the great benefits offered by the new medications are a reduction in the side-effect burden. So many of the older drugs could cause tiredness and fatigue and many of them depressed mood state. Many of them increase the metabolism of bones by increasing the metabolism of Vitamin D and secondarily decreasing bone density. So that these newer drugs by having better safety profiles have really offered people less sedating options. Options with many fewer drug interactions if they are elderly subjects taking multiple cardiac or other medications and then for women and even young men not having to worry about progressive loss of bone density over the decades in which they may be consuming antiepileptic drugs.”

MD NetGuide: "Dr. Devinsky can we do some crystal ball gazing? Can you discuss where you think research will go in the next two-to-five years?”

Dr. Orrin Devinsky: “As far as the short-term, I think there are many drugs that are in the pipeline several of which will probably come to market. I wish I could say I see any of the drugs on the immediate two-to-four year horizon as things that will be homeruns as far as the impact they will have on the lives of people with epilepsy. I think they will be similar to some of the newer drugs we have out there and offer nice alternatives with fewer side effects but, probably overall similar effectiveness based on the buzz of what information we have. Hopefully, I’m wrong. Hopefully, there will be major breakthroughs in medications. Some of the things that will be out there in the next two-to-four years, which may be somewhat exciting are developments in deep brain stimulations stimulating regions of the cortex in an on-demand basis, that is, when a seizure is about to occur or when a seizure starts focal stimulation could be delivered to the portion of the brain from which the seizure is arising. And if that happens, then we really have a new tool to treat epilepsy which we’ve never had before. I also think refinements and better understanding of appropriate candidates for epilepsy surgery could potentially offer a cure or a dramatic reduction in seizures to a very substantial portion of the epilepsy population that is refractory to current epilepsy medications.”

MD NetGuide: “Dr. Devinsky I want to thank you for joining me.”

Dr. Orrin Devinsky: “Okay Bob, thank you.”

Adapted with permission from MD NetGuide. Interview conducted 1/05.

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