The Medical Treatment of Epilepsy
by Siegfried Othmer | August 28th, 2009
An informal survey taken on a public website dealing with epilepsy has found a notable trend in the prescribing of anti-convulsant medication. Most people being treated for epilepsy have been tried on a significant number of different medications. The survey results are shown in Figure 1. Shown is the percentage of respondents who have taken the indicated number of medications over their treatment history. The bin labeled ’10’ includes everyone who has been prescribed at least ten different anti-epileptic drugs. The modal value is ’10,’ so those diagnosed with epilepsy are more likely to have been prescribed ten or more medications than any lesser value. The total number of participants in the survey was 177.
No doubt each of these medications required several visits to the neurologist, plus some blood work and perhaps an EEG every now and then. Also we may assume that most of the ten or more medications will have been abandoned along the way because it is unusual for someone to be on more than three AEDs at a time. So one may judge that at least 70% of the ten or more medications were not worth keeping in the mix. That indicates a fairly low hit rate on the medications.
Two events coalesced recently in my mind—the rehabilitation of Michael Vick and the riot at Chino prison in California. The second of these is tied to a third, namely the directive under which the State of California finds itself to reduce its prison population by 43,000 inmates in short order. Michael Vick hails from my alma mater, Virginia Tech, which for some reason makes his criminal behavior more my issue than it would be otherwise. He has attempted to express contrition about his past behavior, but the statements might well have been prepared by his lawyer. He said everything that he might be expected to say, and he’ll no doubt go forth with his cue cards and speak on behalf of the Humane Society as he promised.
At a town hall gathering, the elderly gentleman pleads: “I like Medicare. Don’t let the government take it over.” Where, then, does one start the conversation about health care? President Jefferson said that it would take an educated populace to secure democracy. That’s grounds to worry. There’s probably nothing one can say to the ranters that would bring them back into the conversation. We do have something to say, however, to the insurance companies that are stealthily fomenting this nonsense while they publicly give lip service to the insurance reform effort.
It goes without saying that mainstream thinking about neurofeedback to date has been mistaken. The original attempts at replication of Kamiya’s work on alpha training for anxiety were misguided in their methodology and in their conclusions. The rejection of Sterman’s and Lubar’s collective body of work was a blunder of the first magnitude. The continued dismissal of the claims of neurofeedback in the face of mounting evidence is indefensible. On the other hand, nothing here really surprises. A paradigm shift of such magnitude will be resisted by the mainstream on all fours. Everything has gone true to the historical pattern with respect to scientific revolutions.
The recent death of Joel Weisman, MD, presents another occasion to reflect upon the process of scientific research at its very early stages, where the usual rules by which knowledge is enshrined are not yet in place. Weisman was a general practitioner in our home town of Sherman Oaks in 1980 when he noticed three patients with a common set of symptoms—fevers, rashes, weight loss, and swollen lymph nodes. An immune deficiency was indicated, so Weisman referred his patients to immunologist Martin Gottlieb at UCLA, who at that moment was treating a patient with the same set of symptoms. All were gay men. Said Gottlieb of Weisman: “In his practice he was alert to unusual symptoms in his patients. He had a sense that something out of the ordinary was happening.” This was, of course, the beginning of the discovery of AIDS. Weisman was never a scientist, but he could serve the process of scientific advance simply through good observation of those who in his own seasoned clinical judgment were outliers. He was in a much better position to do that than most closeted researchers doing formal studies. These fortuitous discoveries are an essential part of the scientific process. But because such anecdotal observations do not by themselves rise to the level of scientifically valid evidence, they are often disparaged, particularly when the data do not fit the prevailing paradigm. As a result, mature scientific disciplines eventually acquire some of the characteristics of a mature religion. They protect themselves against heresy just as religions do. This is no knock on religion. That’s where heresy can be well-defined with respect to established tenets of belief, and that’s where it belongs. The scientific process is supposed to be more open. Heresy should have no place there.