Epilepsy: Clinical Trials at MUSC

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Epilepsy: Clinical Trials at MUSC




Guest:  Dr. Jonathan Halford – Neurology 

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Jonathan Halford who is Assistant Professor of Neurosciences here at the Medical University of South Carolina.  Dr. Halford is an expert both clinically and in research in the area of epilepsy, so that’s what we’ll focus on today.  Dr. Halford, I know you’re involved in a number of clinical trials looking at new medications for the treatment of epilepsy.  What are some of the clinical trials that are most interesting to you?


Dr. Jonathan Halford:  We have been involved in several clinical trials over the last several years at MUSC testing new medications for epilepsy in patients who have partial seizures.  There are type main types of epilepsy.  There’s partial epilepsy, in which the seizures come from one area of the brain and spread, and there’s generalized epilepsy.  Our clinical trials, so far, have focused on partial epilepsy which is the most common cause of epilepsy in the population. 


We’re very excited to be involved in this clinical trial’s effort because it enables us to provide new state of the art medication to patients without cost.  It takes some investment of time for patients to drive to MUSC more frequently than they would usually come in order to get medications, but it enables patients to get new epilepsy medications without having to pay for them.  There are, in general, two different types of epilepsy medications.  There’s the older medication which are very cheap but have a lot of side effects and potentially have long-term toxicity problems.


Dr. Linda Austin:  Such as Dilantin, for example?


Dr. Jonathan:  Right.  Dilantin, Tegretol, Phenobarbital, Depakote, those medications.  They’re very effective for epilepsy but they have a lot of side effects and there are some long-term toxicity problems.  And they’re more teratogenic, that is, they’re more likely to cause birth defects in women who may get pregnant.


The newer anti-epileptic medications have fewer side effects, do not have as much long-term toxicity concerns and are preferred by patients, but they tend to be very expensive, costing between $200 and $600 a month on average.  And this is a frustrating problem for certain patients who don’t have insurance.  So, our being able to provide these types of medications to patients who don’t have insurance is very exciting.


Dr. Linda Austin:  How many different clinical trials are you involved with, with these new medications?


Dr. Jonathan Halford:  We’re currently involved in clinical trials involving two types of medications, one from Johnson & Johnson and one from U C B Farmer. 


Dr. Linda Austin:  Tell us about those protocols and who might qualify for them.


Dr. Jonathan Halford:  Patients who qualify for clinical trials need to have a documented history of epilepsy and have at least one seizure every three months.


Dr. Linda Austin:  Even on their current medication?


Dr. Jonathan Halford:  Right.  On their current medications.  They can be on other medications, up to three other medications, and they can have a vagus nerve stimulator.  Some clinical trials require patients to have up to three seizures per month and some require them to have less.  But we’re currently testing these two medications, which are twice-daily medications with very few side effects, and they’re turning out to be very well tolerated by patients. 


Dr. Linda Austin:  Now, are these placebo-controlled trials or are they open, that is, will a patient be sure that they are getting the medication, or might they get a placebo?


Dr. Jonathan Halford:  There are two different types.  We have done two placebo-controlled trials in which, in the initial part of the study, the patient could be getting a placebo or the study medication added to their regular medications for a period of time, usually two to three months, then everyone gets the study medication.


Dr. Linda Austin:  So, in other words, the patients are not taken off their medication regimen, this is an add-on medication?


Dr. Jonathan Halford:  Exactly, it’s an add-on medication which they may or may not get within the first few months, but they will eventually get the medication, which is matter of when they get it as opposed to not treating them.  We’re definitely treating them throughout the course of the trial for their epilepsy.


Dr. Linda Austin:  I see.  And you started to say there’s another type of trial as well.


Dr. Jonathan Halford:  We’re also starting a new tolerability trial.  Instead of patients getting placebo or study medicine, they’ll be getting a study medicine or two other commonly used newer seizure medications to assess which medication is the best tolerated. 


Dr. Linda Austin:  Now, once the study is over, can the patients stay on the study medication if they’ve had a good response?


Dr. Jonathan Halford:  Yes.  If patients have a good response, the company pledges to continue to provide them the medication free until the medication is fully FDA approved and available in pharmacies, which, for these study medications we’re testing now, is within one to two years from now.


Dr. Linda Austin:  So, it’s really another bonus for patients?


Dr. Jonathan:  Sure.  And we have patients in these studies who have been on medications for almost two years.


Dr. Linda Austin:  Now, if a patient is interested in this, should they first discuss it with their neurologist?


Dr. Jonathan Halford:  They should discuss it with their neurologist.  They’re also welcome to call the Department of Neurosciences to get more information.


Dr. Linda Austin:  Can you tell us the number?


Dr. Jonathan Halford:  Sure.  For clinical trials:  (843) 792-9174.


Dr. Linda Austin:  And if somebody doesn’t get that, they can call the main MUSC number and ask for the Neurosciences division, and then, from there, ask for a program coordinator for the clinical trials, is that right?


Dr. Jonathan Halford:  Right.  For the clinical trials center in our department.


Dr. Linda Austin:  Well, good luck!  It sounds like very exciting research.


Dr. Jonathan Halford.  It is.  It is very exciting.


Dr. Linda Austin:  I hope it works out. 


Dr. Jonathan:  Thanks.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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