Commentary: A Skeptical View of Experimental Gene Therapy to Block Epileptogenesis

F Edward Dudek

Gene therapy offers exciting new options for treating epileptic seizures, and even for blocking the development of epilepsy (i.e., epileptogenesis) after a brain insult. Although the available studies provide interesting new data, the experiments discussed in this issue also have limitations and raise concerns. The criticisms offered in this commentary center around the nature of the experimental testing (e.g., changes in seizure threshold), the animal models (e.g., kindling), and the measures of epileptogenesis in those animal models with spontaneous seizures (e.g., the latent period after pilocarpine-induced status epilepticus). Another set of criticisms relate to the relative lack of positive controls showing that the actual mechanism purported to be activated via the gene-therapeutic approach has in fact been upregulated in the specific animals that show the hypothetical antiepileptic result. This commentary takes the con side in the debate, to generate constructive criticism to help direct future studies to provide increasingly stronger data to support the view that gene therapy approaches may be useful in the treatment of epilepsy.