A life in epilepsy.

Abstract

The symposium Epilepsy at the Cutting Edge, organized by Jean Gotman and FranÅois Dubeau, was for us an extraordinary and unforgettable experience. Seeing so many of our former students and fellows, some of whom came from very far away, and hearing the reminiscences of their experiences at the Montreal Neurological Hospital and Institute (MNH/MNI), followed by accounts of their clinical and scientific achievements, made us very proud. Many of them have taken the original work that they did here and expanded it to higher levels. The only regret that we have is that time did not permit us to speak to all our friends individually and to be brought up to date on their lives and families. We are honored that so many of the participants have agreed to contribute to this supplement, and we will cherish it as a memento of the symposium. The three main themes of the symposium: malformations of cortical development, genetics of idiopathic epilepsies, and investigational and surgical aspects of the epilepsies have been beautifully illustrated in a number of original and imaginative papers. We regret that there was no time at the symposium for two other topics dear to our hearts, on which we have also worked for many years: outcomes of pregnancy in epileptic women and teratogenic effects of anticonvulsant medications; as well as recognition of various neurogenetic syndromes associated with epilepsy, such as the action myoclonus-renal failure syndrome. Between the two of us, we have worked at the Montreal Neurological Hospital and Institute for a total of 95 years, if we include Fred’s residency training and Eva’s PhD thesis work on genetics of focal epilepsies, as well as her EEG training under Peter Gloor. We are both greatly indebted to our mentors: Francis McNaughton, Preston Robb, Herbert Jasper, Peter Gloor, and Julius and Katherine Metrakos, who stimulated our interest in epilepsy, EEG, and genetics. We were very fortunate to have those giants in the field as our teachers and role models, and later as friends. At the beginning of Fred’s training in epilepsy, it was not at all clear that there was scope for a career in this field at the MNI, since everybody including the elevator men and the cleaners seemed to be well versed in the investigation and treatment of people with epilepsy. As the generations turned over, the wisdom of the decision to pursue work in this field became increasingly apparent and it has been a very fulfilling and, we hope, constructive choice. Following her training in medical genetics, Eva founded the first neurogenetics department in Canada at the MNH/MNI in 1973, while continuing her research in genetics of the epilepsies and other hereditary neurologic disorders, as well as her work in EEG and electrocorticography. We have witnessed tremendous changes in the expectations of patients and family members of people with epilepsy, and the advances in medical and surgical treatment have been very gratifying. The days when treatment of epilepsy was initiated without preliminary investigation are fortunately over, never to return. Sophistication on the part of patients and families requires clarification of the problem and educated prognosis, which is now an essential part of the management and treatment of people with seizures. We well remember the days when patients would reappear with recurrent seizures and a zero Dilantin level. This state of affairs is by now quite exceptional, again because of increased understanding and sophistication on the part of patients and improved interpretation of the treatment plan. In recent years, an increasing number of new antiepileptic molecules with fewer side effects and perhaps fewer risks have been developed, and yet much remains to be done. The pharmacologic industry has veered toward a search for ‘‘billion dollar molecules’’ and away from investing in the study of antiepileptic agents, which cannot be expected to produce incomes of that magnitude. There are fortunately some exceptions including particularly UCB, the patron of this symposium. The treatment gap continues to be a major problem. We have been forced to recognize that for economic and financial reasons the use of phenobarbital for control of epilepsy must be encouraged in some parts of the world, whereas in the more affluent countries its utilization has been increasingly discouraged because of side effects. Address correspondence to Frederick Andermann, Montreal Neurological Institute, 3801 University Street, Montreal, QC, H3A 2B4, Canada. E-mail: frederick.andermann@mcgill.ca

DOI: 10.1111/j.1528-1167.2009.02462.x

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Cite this paper

@article{Andermann2010ALI, title={A life in epilepsy.}, author={Eva Andermann and Frederick Andermann}, journal={Epilepsia}, year={2010}, volume={51 Suppl 1}, pages={101-3} }