Precision Medicine in Epilepsy

Modern Medicine has served patients during the three eras of intuitive medicine (1950s-1980s), evidence-based medicine (1980s-200s) and precision medicine (2010-present). In the intuitive medicine or symptom therapy era, doctors treated symptoms in patients without really understanding or addressing the actual underlying etiology. In the evidence-based medicine or empirical therapy era, science produced from the randomized controlled trials was used to treat the underlying disease as a global entity. For instance, data from RCTs can provide the statistical success rate of a certain treatment X . If the rate is justifiable, treatment X will be used for all patients with that certain disease. However, there is always a small percentage of patients who will not respond to treatment X . Precision medicine investigates how an individual’s unique genome interacts with their unique invioronment and thus focuses on individual patients instead of the disease and the etiology. Therefore, in the case of our given example treatment X , the non-responders will not be neglected. Precision medicine tries to find out why a certain individual is susceptible to a certain disease and how to prevent and cure. It uses, clinical genomics, pharmacogenetics and immunology to achieve this goal. So far, Precision medicine has been mostly used in cancer and genetic disease with success. In epilepsy treatment, it is well known that some patients respond to AEDs better than others. It is believed that the genetics of epilepsy is the most determining factor in how a patient responds to therapy. The best example would be in patients with Dravet syndrome who will respond to stiropentol due to their unique mutation in sodium channel gene. Or, screening for HLAA 3101 in the asian population before initiating carbamazepine, which is another example of using precision medicine in order to prevent a drug adverse effect in certain individuals. Precision medicine has also stepped into the field of epilepsy surgery. There are ever-growing modalities of presurgical evaluation that can be utilized to more accurately define the epileptogenic zone. With precision medicine we can choose from these options according to each patient’s unique characteristics.