With Mark Cook

April 11 / 58

Chair of Medicine and Director of Neurosciences at St. Vincent’s Hospital, Professor Cook specialises in the treatment of epilepsy. He is recognised internationally for his expertise in epilepsy management, particularly imaging and surgical planning. After completing specialist training in Melbourne, he undertook an MD thesis while working as Brain Research Fellow at Queen Square, London. He returned to St. Vincent’s Hospital, Melbourne to continue his interest in neuroimaging in epilepsy.

At least 5 per cent of the population suffer seizures at some time of their life, and at least 1 per cent suffer recurrent seizures.  Most people don't appreciate that seizures in adults don't usually involve collapse and confusion, but rather brief episodes of altered awareness, sometimes accompanied by behavioural changes. Typically they last only 1-2 minutes, but this can be enough to prevent driving, certain types of work, and limit leisure activities such as swimming. Many of the affected are children, and though seizures in later life are increasingly recognised as an important clinical problem, the majority of people with epilepsy are young. Most people have no other neurological problems, and have the quality of their lives restricted by a condition which  usually affects them for only a few minutes per month. The loss of control people feel, and the shame they describe had a profound impact on me. 

Neurology always interested me as a student, though surgery had originally drawn me to study medicine. I didn't decide to go into neurology as a career until Ed Byrne, then director of Neurology at St. Vincent's Hospital, suggested he may have a position for me. The caveat was that the position was to involve the management of epilepsy, but given my father had suffered poorly controlled seizures, the choice was easy. 

Epilepsy suffers from an age-old stigma, and for sufferers this is often the worst aspect of the complaint. In many communities epilepsy is still feared, and sufferers are shunned. Even in modern societies there is much prejudice toward people with epilepsy, particularly in the workplace. Though I had graduated from medicine, my father went to some lengths to conceal his condition from me, so great was his embarrassment, and I think this conveys the shame and humiliation involved. 

There are many more medications for the treatment of epilepsy available now than when I started practice, and although this offers a much greater range of choice and opportunity to tailor therapies to people much better, chronic epilepsy is still not controlled adequately for around 30 per cent of people. Surgery is excellent therapy for many, but still appropriate in a minority of cases. Newer therapies include direct electrical stimulation of the brain, and this shows great promise, but is still in early phases of development. Novel drug delivery systems may offer new ways of providing the benefit without the side effects of medications, but development of these systems is only beginning. The interface between medicine and engineering is likely to be where major insights and developments take place. 

I have been very fortunate in recent years to have had the opportunity to establish research with the Department of Electrical and Electronic Engineering at the University, colleagues at the Bionic Ear Institute, and interstate and overseas collaborators into these fascinating and rapidly evolving areas of neuroscience.


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