MAIN SESSIONS

Chairman’s Symposium: “Addressing Stigma”
Shichuo Li (China), Susanne Lund (Sweden) and Peter Wolf (Denmark)

Introduction: The General Problems of Stigma
Susanne Lund (Sweden)

Stigma with Epilepsy in Asian and Western Countries
Wenzhi Wang (China)

The Indian Perspective of Stigma about Epilepsy
Mandaville Gourie-Devi (India)

Theories of Stigma Reduction
Michael Hills (New Zealand)

Epilepsy was first recognized four thousand years ago and in some parts of the world the perception of the condition has changed little in the intervening centuries. Epilepsy is not only a medical diagnosis; it is also a social label and the social circumstances attaching to epilepsy can be more difficult to deal with than the epilepsy itself. Stigma has no boundaries. In developing countries people with epilepsy are sometimes still denied basic human rights: the right to education, the right to employment and even the right to marriage. In the industrialised world too, people with epilepsy can face stigma at every stage of life.

Fifty million people in the world have epilepsy. Nearly half live in the Asian Oceanian Region. It's therefore relevant to start this congress by addressing this sometimes devastating consequence of epilepsy. The symposium will review research findings on the nature of stigma in epilepsy and the negative affect of stigma on the quality of life of people with epilepsy in different parts of the Region. Clarification of the factors generating stigma of epilepsy and identification of strategies how to cope are crucial parts to address stigma caused by discrimination and lack of knowledge and understanding. The goal of this symposium is to bring new perspectives in the field of stigma, to analyse the impact of stigma within the individual as well as the family, to highlight the role of individuals in the general public and focus on the reasons why isolation and discrimination still are part of our societies.

Diagnostic Issues in Paediatric Epileptology
Ingrid Scheffer (Australia) & Jiong Qin (China)

What is Lennox-Gastaut Syndrome in the Modern Era?
Hirokazu Oguni (Japan)

Are Absence Seizures Syndrome Specific?
Lynette Sadleir (New Zealand)

Febrile Seizures: Translational Research from Mice to Men
Jiong Qin (China)

The clinician is faced daily with the prospect of making complex diagnoses in children presenting with seizure disorders. Epilepsy syndromes underpin the clinicians’ practice and aid in defining the aetiology, management and prognosis for each child. Knowledge about syndromes is constantly evolving and is in subtle ways a “moving target”. In this session, key questions will be addressed. With the advent of improved imaging and neurophysiology studies, what exactly is Lennox-Gastaut syndrome today? Is it rare or common? There is considerable debate about whether absence seizures have features that are syndrome specific. Do absence seizures in Childhood Absence Epilepsy look different to absence seizures in Juvenile Myoclonic Epilepsy? What does the evidence tell us? Drawing upon animal models, what do they tell us that can translate to knowledge regarding febrile seizures in children?
Moving to therapy, what is new or controversial in anti-epileptic therapy for children? This update will cover key topics such as new anti-epileptic drugs (AED), seizure exacerbation and controversies in choosing the best AED for a specific syndrome. Published evidence will be presented about which new AED are indicated for which seizure types and syndromes. When should the clinician be wary about seizure exacerbation? Specific factors regarding AED and syndromes will be discussed. New data regarding efficacy of various AED in the severe syndrome of infantile spasms will be presented. Many countries cannot afford the new AED. What is the best balance where economics limit access to AED for the common scenario of a child presenting with partial seizures? This session will impact on clinical practice in paediatric epileptology.

Surgical Treatment of Symptomatic Epilepsy in Asia
Tatsuya Tanaka (Japan) & Guoming Luan (China)

Basic Concept and Experimental Approach to the Symptomatic Epilepsy
Tatsuya Tanaka (Japan)

Surgical Treatment of Chronic Epilepsy with Intracranial Neoplasm and Vascular Lesion
Jung-Kyo Lee (Korea)

Surgery for Epilepsy due to Malformation of Cortical Development and Other Congenital Lesions
Guoming Luan (China)

Surgery for Epilepsy due to CNS Infection
P. Sarat Chandra (India)

Idiopathic epilepsy has no known cause and the person has no other signs of neurological disease. Symptomatic epilepsy may be the result of an acquired insult or an indication of an underlying process, such as developmental disease, stroke, head injury, infectious disease, brain tumour, poisoning or cerebral palsy. It also may result from a problem within the developing brain due to intrauterine disease. The seizures of symptomatic epilepsy often are focal but can be generalized.

In most large studies of people with epilepsy, 20% of seizures are considered to be symptomatic and the remainder either idiopathic (30%) or cryptogenic (50%). The data and studies of symptomatic epilepsy in Asian Oceanian countries are still lacking. Consequently, actual positioning of surgical treatment including basic study for the symptomatic epilepsy is extremely important in Asian Oceanian regions.

In this session, the following topics will be discussed:
(i) Basic concept and experimental approach to the symptomatic epilepsy
(ii) Migration disorders and congenital lesions
(iii) Tumour and vascular lesion
(iv) Infectious disease in Asia

Epilepsy Genetics – Towards Daily Practice
Patrick Kwan (Hong Kong) & Weiping Liao (China)

Genetics of Common Epilepsies
Samuel Berkovic (Australia)

Genetic Testing for Non-Familial Epilepsies
Weiping Liao (China)

Epilepsy Pharmacogenetics: Promises and Challenges
Patrick Kwan (Hong Kong)

Like other medical disciplines, the impact of genetics in the management of epilepsy is increasingly felt. In recent years, a number of familial epilepsy syndromes caused by single gene mutations have been identified. It is noted that not all monogenetic epilepsies are shown to be familial. Severe myoclonic epilepsy in infancy is an example. Genetic testing is necessary to confirm the diagnosis in such cases. The significance and challenge for genetic testing is what we have to face in clinical practice.

Although the list of putative gene mutations is expanding, they represent only a very small fraction of all epilepsies. For the majority of patients, their epilepsies are thought to be complex disorders with multiple susceptibility genes interacting with various environmental factors. There have been recent attempts to identify the genetic susceptibility for these common epilepsy syndromes using association studies of candidate genes. Overall, the results from these studies have been disappointing so far. In a comprehensive review of over 50 such studies, it was concluded that “no consistent or convincing susceptibility genes have emerged”.

Epilepsy remains uncontrolled by medication in up to 30% of patients. This situation is not expected to dramatically improve despite the availability of newer compounds in the coming years. One possible avenue to unravel the pathogenesis of pharmacoresistance is pharmacogenomics, which holds the potential to inform prescription of existing drugs or develop novel compounds based on the individual patients’ genetic profiles. The discipline is in its infancy in epilepsy research and many conceptual and technical hurdles remain to be overcome before its clinical impact can be anticipated. This is exemplified by the conflicting findings reported for an association between 3435C>T polymorphism of the major CNS drug transporter gene ABCB1 and drug resistant in epilepsy.

In this session, speakers will update the development in identifying susceptibility genetic markers for the common epilepsy syndromes and for prediction of drug response, and discuss how the knowledge can be translated into clinical practice.

Epilepsy and Comorbidities
Satish Jain (India) & Liwen Wu (China)

Neurobehavioural and Neurocognotive Comorbidity
ES Krishnamoorthy (India)

Epilepsy and Autism
Seiji Kugimiya (Japan)

Medical Comorbidities (including HIV/AIDs)
Hasan Aziz (Pakistan)

Epilepsy and Headaches
Leonor Cabral Lim (Philippines)

Comorbidity is the occurrence together of more than one condition in the same patient. Epilepsy being a chronic and recurring disorder in most patients, there can be many co-existing conditions that may precede, co-exist, or follow the diagnosis of epilepsy. Further, a co-existing condition can also be the cause of epilepsy or can be associated with epilepsy via common etiologic or shared risk factors. The existing comorbid condition can also have an influence on the outcome from epilepsy. On the other hand, epilepsy itself may be the cause of an existing co-morbid condition like low social self esteem and depression. Knowledge about the comorbidities in a common disorder like epilepsy helps us to provide better medical care to those having epilepsy. Information on comorbidities among people with epilepsy is also important while planning for the health services for a given population.
There is an increased risk of many conditions to co-exist with epilepsy among children, adults and even the elderly. Non-epileptic disorders of the brain perhaps out number all other conditions among those that are known to co-exist with epilepsy. Various medical disorders are also frequent comorbid conditions as epilepsy is a common condition affecting people of all age groups. The planned session will focus on some of these common comorbid conditions. There will be talks by experts on neurobehavioral and neurocognitive comorbidity, medical comorbidity (to include HIV/AIDS), autism existing with epilepsy and the impact of comorbid conditions on the outcome from epilepsy.