Despite it being the fourth most common neurological disorder, with no less than 65 million people in the world having it, epilepsy is one of the most misunderstood conditions around.
If it wasn’t for advocates and researchers who discuss it, speak openly about it and dedicate their days and nights researching a cure and effective medicine, we would know much less about how its adverse effects can be minimised, and about how most persons with epilepsy can lead a normal and fulfilling life.
Through its Department of Clinical Pharmacology & Therapeutics, the University of Malta is also playing a role in improving our understanding of epilepsy. Newspoint interviewed clinical pharmacologist Prof. Janet Mifsud, who has recently been awarded the International Epilepsy Ambassador Award by the International Bureau for Epilepsy (IBE) and International League Against Epilepsy (ILAE).
What is the role of the Department?
In our Department, we study how medicines work.We lecture to practically all those professionals who will in some way come in contact with medicines – doctors, pharmacists, dentists, all types of health care professionals (medical lab scientists, radiographers, nurses, nutritionists etc), chemists, psychologists and even lawyers.
My area of research is in chronic neurological disorders, but I am also interested in pharmacokinetics which basically means the study of the movement of the medicine in the body with time. We study what the body does to the medicine and how the body handles the medicines. We try to understand which medicine to give, how to give it, how often to give it and for how long to achieve optimal care. My other areas of research are in pharmacotoxicology (that is how to treat overdoses with medicines) and various aspects of the impact of gender in the use of medicines. I am also interested in various ethical issues in medical research.
How common in the condition of epilepsy in Malta?
From some preliminary studies carried out, and from estimates taken from worldwide and European data, slightly less than 1% of the population in Malta, that is around 4,000 persons, have epilepsy.
4,000 persons in Malta have epilepsy.
Anyone can develop epilepsy, but it often begins in children or in older persons over the age of 65. Unfortunately, it is rarely spoken about and it is a greatly misunderstood condition because beyond the common knowledge that it involves having seizures, there are huge misconceptions and a large stigma associated with epilepsy, not only in Malta but also worldwide. Yet it is relatively quite common.
Can you tell us a little bit about the different types of seizures that exist?
Seizures can also be caused by other underlying medical conditions, but epilepsy is diagnosed when a person has at least two unprovoked seizures.
There may be various causes for these seizures. Sometimes epilepsy is caused by a genetic change in the person’s genes, a structural or brain injury from a head trauma, stroke, infection, or tumour, or some damage in the brain. There may be triggering factors such as in photosensitive epilepsy, alcohol or drug abuse. In several cases, no underlying cause for the epilepsy is ever discovered.
There are over 40 types of seizures depending on the part of the brain affected by the abnormal discharge of electrical activity and what that area of your brain controls. The symptoms seen during a seizure depend on which part of the brain is affected and thus which wrong messages are sent to specific parts of the body
The most widely-recognised seizure is called a generalised tonic-clonic seizure (previously known as grand mal seizures). This is a seizure that affects all of the brain and thus the abnormal movements seen generally affect the entire person. The person will lose consciousness and fall down and their arms and legs will begin to shake. Another type of generalised seizure are the absence seizures (previously known as petit mal seizures). These occur mostly in children and cause them to stare blankly for a few seconds.
When only part of the brain is affected, then the person experiences focal seizures. These can be simple focal seizures which generally involve simple abnormal movements, or complex partial seizures where a person can act confused or behave in an unusual way.
Many times, people will have a single seizure and then never have one again. However, if there is a second seizure, investigations need to be made in order to determine a diagnosis. If a person loses consciousness during a seizure, then a detailed eyewitness description of the event is very important to the doctor. Sometimes, even after these tests, the diagnosis is unclear and the physician will need to rely on the person’s history so keeping records and a diary is crucial.
What kind of medicine or treatment is currently available to those who have this condition?
About 70% of persons with epilepsy will be controlled with medicines called anti-epileptic drugs (AEDs).
In Malta, we are lucky that as soon as a new medicine for epilepsy is approved for use by the European Medicines Agency, very often it becomes available for locally-based patients.
The range of medicines available in recent years has greatly improved. We have excellent adult and child neurologists in Malta who really follow their patients closely.
From the medicines we have available today, around 70% of persons with epilepsy have their seizures controlled, however for 30% of persons their seizures remain refractory and thus urgent research is needed to understand more about why these epilepsies do not respond to medicines we have available.
We thus need to find new molecular targets and thus design new medicines to treat these types of epilepsies.
What are the latest advancements in epilepsy research worldwide?
A great deal of work is being done to discover a potential cure for epilepsy. Medicines we have today control seizures but do not cure them.
Research is being carried out on potential drugs which could modulate seizure activity in the brain.
There is also a great deal of research on pharmacogenetics of epilepsy, i.e. how our genetic make up can determine the efficacy (or lack of efficacy of a medicine). In fact, I had the opportunity to work with colleagues in University College London in this very interesting and transdisciplinary field during my recent sabbatical, with colleagues in bioinformatics, modelling and simulation.
I have been invited to join a research group established by the international Bureau for Epilepsy on epilepsy and pregnancy. In addition, there is a great deal of research being carried out to find new molecular targets for medicines in epilepsy, the development of seizure monitors which can be used to predict seizures, and novel therapy that can be administered after traumatic brain injury to prevent seizures.
What matters are you hoping to tackle in the near future?
We are hoping to keep on carrying our research on how we can improve the use of medicines use in epilepsy in Malta. We are keen to study how the availability of new formulations such as buccal midazolam can be used in acute care of seizures in children. We also hope to carry out research on how to improve patients’ acceptability and use of medicines, together with various professionals such as general practitioners and pharmacists and also having specialised epilepsy nurses available.
In this regard, we work closely with the patient organisation on Malta – the Caritas Malta Epilepsy Association.
Why is International Epilepsy Day celebrated on 8 February?
It is celebrated every year on the second Monday in February, to raise worldwide awareness on epilepsy.This year, it will fall on Monday, 8 February, and the date was chosen because St Valentine is the patron saint of persons with epilepsy since it is said that he cured several persons with the condition.
We are really very pleased that this year the University of Malta is supporting International Epilepsy Day together with the Caritas Malta Epilepsy Association (CMEA) and Caritas Malta, in collaboration with the International Bureau for Epilepsy.
There is still such a great deal of unclear information about the condition, myths, lack of knowledge and stigma about epilepsy. Many people with epilepsy can live a normal life, work, have a family and contribute to society.
For the occasion of International Epilepsy Day, Auberge de Castille, Palazzo Castellania and Palazzo Ferreria in Valletta will be lit in purple along with other important buildings around the world on the 6, 7 and 8 February 2021, to highlight the importance of more information on this condition.
On February 8, people will also be encouraged to share photos, videos or stories on various media using the hashtag #EpilepsyDay. The University of Malta will thus form part of a worldwide community through highlighting epilepsy in its social media, on the occasion of this important day for us.