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Bill Klaproth: So why are at home seizure treatments important? Why do we need this option for children with epilepsy and what is the future of had home treatments for seizure intervention? Let's find out what Dr. James Wheless, Chief of Pediatric Neurology and Co-Director of the Le Bonheur Neuroscience Institute. This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Wheless, thanks for your time. So why are at home seizure treatments important and why do we need this option for children with epilepsy?

Dr. Wheless: So seizure treatments at home. I often tell folks, think of this just like you would a child that has asthma, they may be on a regular medicines, but when they have flare-ups, they always have an option that they can administer at home to help kind of settle things down and get their child through that. This is the same with our epilepsy patients. They may have either well-controlled seizure just like our asthma patients, or they may have an occasional mild seizure, but if they have a flare-up, we need something that they can do at home. And so we're using that kind of same model. But just applying it to our patients with epilepsy.

Host: Right. So before the FDA approved at home seizure treatment, what were the treatment options for children with epilepsy who began to have seizures at home?

Dr. Wheless: Before we had really effective home treatment options, it was really horrible for these families at home because they'd be watching their child have a word seizure or have more seizures and they'd ever seen back to back and there was nothing they could do but watch them and try and keep them safe. So just imagine yourself it's just horrible to watch your loved one and go through that. So for many of our families there were, there was really nothing they could do if they thought it was bad enough. They just have to kind of pick up their child and run to the closest emergency room or a calling ambulance, there really just were not any good options historically.

Host: I could see how that would be terrifying for a parent. So then how do at home seizure treatments change the treatment plan for children living with epilepsy?

Dr. Wheless: The ability to treat these flare-ups at home has really just been a game changer for our families and epilepsy. Just like, you know, the asthma analogy, we use it, it was a game changer for those families too, to have something they could do. Because now our parents are empowered that, okay, I would love my child to not have any seizure, but if they have a worse one, if they have a group of them close together, if there's something that's different, I have something I can actually do at home that, you know, I know is safe, it's effective. And that the vast majority of time works to stop the seizure, preventing them to have to go to the emergency room. So really helps empower that family. And that's huge for some of these families. They were afraid to travel, for example, to grandmas because they live out in the country and if they had a bad seizure, they couldn't get them back to the hospital quick enough. So just think of all the changes in the lifestyle, not just for their patients, but for the whole family. It has a huge ripple effect.

Host: Right. I like how you use the term game changer. So then what are these new at home seizure treatments?

Dr. Wheless: So the ones that have really changed are two products, one introduced at the end of the last year and wanted to be in this year, that are intranasally administered. So basically it's a single score in the nose. Our patient, in this case, the child does not have to be awake, they don't have to breathe it in. The parents can administer it. It's just a single kind of a push, it's an auto injector type thing where they just push it, it goes up in a mist into their nose, it's breathe in, and most of the time it stops the seizures within a few minutes and keeps them from recurring more importantly too. So it's a really easy for the families to use and convenient and it's portable so they can take it with them if they're traveling and it's socially acceptable. So they're out in public and something happens. It's easy to use in that setting too.

Host: Wow. So what's the quick science behind this? How do these medications work so effectively to stop the seizures?

Dr. Wheless: We had always known historically, which of our medicines kind of work quickly, if you will, and could be used this way, which was kind of intermittently, in other words, not as regular seizure medicines that were very effective. And these are medicines that are chemical family, it's called a benzodiazepines. But what really was, again, the game changer here was we knew the medicines. The challenge was how do we get those medicines in a formulation that the family could easily administer that would work quickly. So it was really all about the delivery system here for those medicines and that's what changed the landscape is having this intra-nasal delivery system.

Host: Wow, that totally makes sense. So let me ask you this then. Does this prevent all hospital visits due to at home seizures?

Dr. Wheless: No, we don't want the families to think that this means they will never have to go. In an ideal world, we'd like to think that, gosh, if we have an effective strategy and effective plan, this should get rid of almost all of them. But again, just like our patient with asthma that has a rescue plan, if they have something that's really ticked off their asthma or this case really kicked off their seizures, if they apply their at home treatment and it's maybe better but it doesn't totally work or it calms things down, they flare-up again. They may still need to go to the emergency room. But what we've found with our experiences, the vast majority of these folks, and it may be upwards of even 90% no longer require going to the hospital to help them with their seizure emergency.

Host: Wow. What a great number. 90% this is really an important breakthrough. So who are these seizure treatments appropriate for? I'm wondering about epilepsy type and age groups. Can you explain that to us?

Dr. Wheless: Yeah, so I use this analogy a lot, but our asthma analogy, just if you have a child at any age that has asthma, you probably say, well gosh, we need a backup plan in case they have a worsening of that and an exacerbation. And the same is true for our patients with epilepsy. Once we know that they have epilepsy, we really should identify a plan for probably almost all of our patients and then tailor it to that patient. So we tailor it to what's the patient's age, what's the kind of level of medical sophistication, the family and the caregivers. Because for a lot of our patients it's just not the parents. I mean they may be spending after school time with the grandparents. Is this something that a grandparent could administer and feel comfortable doing? So we have to kind of think through all those things. And then I think more importantly when we see him back in the office, we should be asking every patient that has this kind of what we call rescue therapy available if they've used it. And if they did it, if it worked because that helps us kind of figure out like, okay, we thought this was the best one, did it work out? And if not, do we need to adjust it, tweak it, shift because we want them to have something they can do at home.

Host: And so convenient too. So Dr. Wheless, what should I do if I think my child could benefit from these treatments?

Dr. Wheless: I think if you have a child with epilepsy, every parent should be discussing this with their Doctor, whether it's their pediatrician or a neurologist about the different options. We had one that we had historically that was the only one we had for years. That was a medicine that had to be administered rectally, which for our infants and very young children we still use, it's not a problem, they're still in diapers, but as we've talked about for our older children and adolescents, the idea of giving something in the nose is far superior and far better, just socially accepted, just easier to use. So it's talking to their doctors and kind of figuring out which one would be best for them. But I think that's a conversation that every one of our patients with epilepsy should be having.

Host: And again, you call this a game changer and primarily because of the delivery method. You call it intranasally administered. This seems like the future of at home seizure treatments are there more coming? I mean, what is the future for these at-home seizure treatments?

Dr. Wheless: People are still continuing to look at kind of other ways to administer this family of medicines, I called the benzodiazepines because we know they work really well and again it's a one size did not fit all. So the intra-nasal is then a huge game changer to be able to just kind of squirt it in the nose much like you might do your Flonase for your allergies or something, but people are looking at other ones. People are looking at a simple one that's you just hold up to your mouth and when the patient takes a breath, it's inhaled into the lungs and immediately gets into the blood stream. People are looking at films that are much like kind of Listerine films that you would just stick to the inside of the gums and it's absorbed very quickly for patients that want other options. So, depending on the patient and who's administering it and what setting, you know, it this at home, is it at school? And for some adolescents it might even be at a job after hours. You know, is there one that kind of tailors better to their situation? And I think the key is really individualizing this treatment to our patients.

Host: And then last question, Dr. Wheless, we keep saying at home, but this travels with the child. So if the family is out somewhere, they have this. And you even mentioned a teen with a job. So this is portable too. It's not just for at home use.

Dr. Wheless: Yeah. That's the real advantage of most of our newer options is one, they are easily portable. But two is they're really kind of acceptable socially. So they're easy to use. They can be used in a public setting where it's not embarrassing, if you will, to the patient to have to be, have this administered by a loved one. And the biggest thing for the family we touch on, this really opens up their life to being able to travel, to not feel like, Oh, we've got to be close to a hospital or we only have this route of administration and we want to do it very privately at home. So it's a game changer for the whole family and for our kids in school. It gives the teacher and the coach if they're on a field trip, you know, an option of something that they can feel comfortable doing to us if it needs to be somebody other than the parents.

Host: Yeah. The convenience of it alone is you call it game changing. Dr. Wheless, this has really been informative. Thank you so much for your time. We appreciate it.

Dr. Wheless: All right, thanks so much. Good talking to you. Thanks for having me.

Host: That's Dr. James Wheless, to learn more please visit lebonheur.org/podcast and be sure to subscribe to the Peds Pod in Apple podcasts, Google Play, or wherever you listen to your podcast. You can also check out lebonheur.org/podcasts to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.