Published by UC News
A new clinical trial at the University of Cincinnati will study a new treatment for the most severe and deadly form of epilepsy.
Brandon Foreman, MD, is the site principal investigator at UC for the Researching Established Status Epilepticus Treatment (RESET) study, a trial being conducted across approximately 50 hospital emergency departments across the country.
The trial focuses on a condition known as status epilepticus (SE), a disorder Foreman described as “seizures that don’t stop.” SE is the second most common neurologic emergency in the United States, and more than 150,000 Americans experience SE each year. Based on factors including age and the cause and duration of the seizures, between 20% to 30% of patients with SE do not survive.
About half of patients who have SE have a previous history of epilepsy and seizures, but the other half have no history of seizures. When a seizure goes on for more than five minutes, Foreman said it enters a “dangerous territory” where the seizure may not stop on its own without medication.
The current standard treatments for SE include paramedics administering drugs on the way to the hospital that activate specific GABA receptors in the brain that sit on the ends of neurons. These receptors communicate to slow down other neurons, so strengthening that connection helps suppress seizures.
A large dose of anti-seizure medication is then given once a patient reaches the hospital. But about a quarter of patients’ seizures still do not stop after receiving these initial medications.
“Right now the only way to manage them is to put them on anesthetic medications, so it’s a continuous drip medication to induce coma,” said Foreman, associate professor and associate director of neurocritical care research in the Department of Neurology and Rehabilitation Medicine in UC’s College of Medicine and a UC Health physician. “And that’s been associated with some bad outcomes. It’s not a good thing to come into the ICU and then be put into a coma, and there’s nothing to fill the gap.”
If we can avoid patients not progressing to the need for IV anesthesia, intubation and an ICU stay that can sometimes be prolonged, that’s going to be lifesaving.
Foreman said the RESET study will test a new medication that will be administered after the first anti-seizure medication in emergency departments for those patients whose seizures persist.