New breath test to adapt the dosage of drugs administered to patients with epilepsy

Epilepsy affects some 50 million people worldwide and the pharmaceutical treatment of the disease is a tightrope walk, because the dose must be adapted precisely to each patient: “A little too little and it is not effective. A little too much. and it becomes toxic “. explains Professor Pablo Sinues.

Sinues is Botnar Research Professor of Pediatric Environmental Medicine at the University of Basel and the University Children’s Hospital Basel (UKBB). He is also a member of the Department of Biomedical Engineering at the University of Basel. Together with colleagues at the University Hospital Zurich (UHZ), he spent two and a half years looking for a way to tailor the dosage of drugs to patients with epilepsy as precisely as possible. They ultimately achieved that goal with the help of a breathalyzer. The advantage is that the follow-up does not require a blood test, which can still be a stressor for children. And since the sample does not need to be sent to the laboratory first, the results are available immediately.

In search of the smallest concentrations

“You can think of it as the blood alcohol test that the police use when they stop drivers,” says Sinues. The difference is that this breath meter is actually a big machine. “Because alcohol is present in high concentrations in the breath, all it takes is a small device. But we are looking for a droplet in 20 swimming pools,” he says. The researchers want to use the results to determine whether the active substances are present in the right concentrations in the body and whether they are having the desired effect on the disease.

Their efforts were not in vain: both in young UKBB patients and adults in the reference group at Zurich University Hospital, breathalyzer tests produced the same results as conventional blood tests, as reported. the research group in its study published in Communications medicine. This means that in addition to blood tests, there is a second way to monitor treatment for epilepsy – and the method also provides additional information about the patient’s metabolism that doctors can use in therapy.

Interdisciplinary collaboration is the recipe for success

The special feature of this research project is the unique interweaving of science and medical practice at the University of Basel, says Sinues: “Thanks to this favorable initial situation, we are able to build machines that are precisely matched. to the needs of physicians. “

At UKBB, the rapid availability of test results is a particular advantage of the new method: young patients require constant adjustments to their medication as their metabolism changes as they grow older. The new technology provides doctors with a non-invasive test that gives them immediate clues about the progress of treatment. This allows them to react quickly if the dose needs to be adjusted.

It took four years to achieve this breakthrough and the technique is not yet suitable for widespread use – but that is the goal Sinues has set for itself. Indeed, the start-up “Deep Breath Intelligence” was created specifically for this purpose and now aims to obtain a license for the measurement technique.


Journal reference:

Singh, KD, et al. (2021) Personalized therapeutic management of epilepsy patients guided by pathway-guided respiratory metabolomics. Communications medicine.

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