Transcript of Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`Argentum Pharmaceuticals LLC v. Research Corporation Technologies, Inc.
`
`Alderson Reporting
`1-800-367-3376
`info@aldersonreporting.com
` http://www.aldersonreporting.com
`
`Alderson Reference Number: 66752
`
`ARGENTUM Exhibit 1048
` Argentum Pharmaceuticals LLC v. Research Corporation Technologies, Inc.
`IPR2016-00204
`
`Page 00001
`
`
`
`October 10, 2016
`
`Argentum Pharmaceuticals LLC v. Research Corporation Technologies, Inc.
`
`Alderson Reporting
`1-800-367-3376
`info@aldersonreporting.com
` http://www.aldersonreporting.com
`
`Alderson Reference Number: 66752
`
`ARGENTUM Exhibit 1048
` Argentum Pharmaceuticals LLC v. Research Corporation Technologies, Inc.
`IPR2016-00204
`
`Page 00001
`
`
`
`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
`
` IN THE UNITED STATES PATENT AND TRADEMARK OFFICE
`
` BEFORE THE PATENT TRIAL AND APPEAL BOARD
`
`Page 1
`
`------------------------------
`
`ARGENTUM PHARMACEUTICALS LLC, :
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` Petitioner,
`
` : Case No. IPR2016-00204
`
` v.
`
` :
`
`RESEARCH CORPORATION
`
` : Patent No. RE 38,551
`
`TECHNOLOGIES, INC.,
`
` :
`
` Patent Owner. :
`
`------------------------------
`
` TRANSCRIPT of testimony of CARL W.
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`BAZIL, MD, PhD, as taken by and before MONIQUE
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`VOUTHOURIS, a Certified Court Reporter, RPR, CRR, and
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`Notary Public of the States of New York and New
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`Jersey, at the offices of COVINGTON & BURLING LLP, The
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`New York Times Building, 620 Eighth Avenue, New York,
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`New York, on Monday, October 10, 2016, commencing at
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`8:29 a.m.
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`Alderson Court Reporting
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`Page 00002
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Page 2
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`A P P E A R A N C E S:
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` ON BEHALF OF THE PETITIONER:
`
` DOWD PLLC
`
` 1717 Pennsylvania Avenue, NW
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` Suite 1025
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` Washington, DC 20006
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` BY: MATTHEW J. DOWD, ESQ.
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` mjdowd@dowdpllc.com
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` ON BEHALF OF THE PATENT OWNER:
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` COVINGTON & BURLING LLP
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` 850 Tenth Street, NW
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` Washington, DC 20001-4956
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` 202.662.6000
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` BY: ANDREA G. REISTER, ESQ.
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` areister@cov.com
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` and
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` COVINGTON & BURLING LLP
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` 620 Eighth Avenue
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` New York, New York 10018-1405
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` 212.841.1000
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` BY: JENNIFER L. ROBBINS, ESQ.
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` jrobbins@cov.com
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`Alderson Court Reporting
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`Page 00003
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Page 3
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` I N D E X
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`WITNESS PAGE
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`CARL W. BAZIL, MD, PhD
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` Examination by Mr. Dowd 9
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` E X H I B I T S
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`IDENT. DESCRIPTION PAGE
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`Bazil-1 2012 Epilepsy Pipeline
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` Update Conference. 80
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`Bazil-2 The Merck Veterinary Manual article
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` "Principles of therapy of
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` Neurologic Disease." 92
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`Bazil-3 BMC Veterinary Research article
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` "Antiepileptic drugs' tolerability
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` and safety - a systematic review
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` and meta-analysis of adverse
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` effects in dogs." 94
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`Bazil-4 Article "Clinical Risk Factors
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` Associated with Anti-Epileptic
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` Drug Responsiveness in Canine
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` Epilepsy," August 2014. 94
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`1-800-FOR-DEPO
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00004
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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` E X H I B I T S (continued)
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`Page 4
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`IDENT.
`
` DESCRIPTION
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` PAGE
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`Bazil-5
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` Article "Assessment into the usage
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` of levetiracetam in a canine
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` epilepsy clinic."
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` 95
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`Bazil-6
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` BMC Veterinary Research article
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` "International Veterinary Epilepsy
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` Task Force consensus proposal:
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` medical treatment of canine
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` epilepsy in Europe."
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`Bazil-7
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` Article "Antiepileptic Drugs in
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` Non-Epilepsy Disorders."
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`Bazil-8
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` Review Article from Indian
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` Pediatrics "Newer Anti-epileptic
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` Drugs."
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` 96
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` 98
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` 107
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`Bazil-9
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` Article "New Antiepileptic Drugs,"
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` by Carl W. Bazil, MD, PhD.
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` 111
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`Bazil-10 PubMed Abstract "Anticonvulsant
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` drug or neuromodulator? The
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` growing case for anticonvulsant
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` uses beyond epilepsy."
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` 116
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`Bazil-11 Article "The adverse event profile
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` of lacosamide: A systematic
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` review and meta-analysis of
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` randomized controlled trials."
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`Alderson Court Reporting
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`Page 00005
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
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`New York, NY
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` E X H I B I T S (continued)
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`Page 5
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`IDENT.
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` DESCRIPTION
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` PAGE
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`Bazil-12 Article "Lacosamide adjunctive
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` therapy for partial-onset
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` seizures: a meta-analysis."
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` 130
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`Bazil-13 Article "The relative effectiveness
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` of five antiepileptic drugs in
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` treatment of benzodiazepine-
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` resistant convulsive status
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` epilepticus: A meta-analysis of
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` published studies."
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` 137
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`Bazil-14 Article "Rufinamide: A Novel
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` Broad-Spectrum Antiepileptic Drug." 152
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`Bazil-15 Article "Pharmacotherapy for Status
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` Epilepticus."
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` 159
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`Bazil-16 Article "Evidence-Based Guideline:
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` Treatment of Convulsive Status
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` Epilepticus in Children and Adults;
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` Report of the Guideline Committee of
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` the American Epilepsy Society."
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` 162
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`Bazil-17 Article "Proposed Algorithm for
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` Convulsive Status Epilepticus."
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` 166
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`Bazil-18 Article "Status Epilepticus: Current
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` Treatment Strategies."
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00006
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
`
`New York, NY
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` E X H I B I T S (continued)
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`Page 6
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`IDENT.
`
` DESCRIPTION
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` PAGE
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`Bazil-19 Article "Development of new
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` treatment approaches for epilepsy:
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` Unmet needs and opportunities."
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` 199
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`Bazil-20 Letter "Lacosamide-Induced Tactile
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` Hallucinations in a Patient With
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` Complex Partial Seizures."
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` 208
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`Bazil-21 Article "The effect of lacosamide
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` on bone tissue in orchidectomized
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` male albino Wistar rats."
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` 211
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`Bazil-22 Article "Systematic Adverse Drug
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` Reaction Monitoring of Patients
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` Under Newer Antiepileptic Drugs
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` Using routine Clinical Data of
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` Inpatients."
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` 212
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`Bazil-23 Article "Recurrent Small Intestinal
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` Ileus Due to Valsartan."
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` 215
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`Bazil-24 Article "Long-term add-on
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` pregabalin treatment in patients
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` with partial-onset epilepsy:
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` Pooled analysis of open-label
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` clinical trials."
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00007
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
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`New York, NY
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`Page 7
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` E X H I B I T S (continued)
`
`IDENT. DESCRIPTION PAGE
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`Bazil-25 Article from "FierceBiotech,"
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` "UCB inches toward the FDA with
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` its latest epilepsy contender." 219
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`Bazil-26 Article "BRIVIACT now available in
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` U.S. pharmacies for epilepsy
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` patients living with partial-onset
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` seizures." 220
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`Bazil-27 Article "New generation
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` antiepileptic drugs: what do they
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` offer in terms of improved
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` tolerability and safety." 222
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`Bazil-28 Article "Thirty Years of Orphan Drug
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` Legislation and the Development of
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` Drugs to Treat Rare Seizure
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` Conditions: A Cross Sectional
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` Analysis." 227
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`Bazil-29 Article "Overview of Drugs Used
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` For Epilepsy and Seizures." 229
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`(continued on next page)
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00008
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`PREVIOUSLY MARKED EXHIBITS REFERENCED
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`Page 8
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`Exhibit 2078 43
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`Exhibit 2038 62
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`Exhibit 1001 67
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`Exhibit 2113 129
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`Exhibit 2111 157
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`Exhibit 2077 181
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`Exhibit 2120 188
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`Exhibit 2121 188
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`Exhibit 2123 188
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`Exhibit 2124 188
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` *****
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`Alderson Court Reporting
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`Page 00009
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`C A R L B A Z I L, MD,
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` having been first duly sworn by the Notary,
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`Page 9
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` testifies as follows:
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`EXAMINATION BY MR. DOWD:
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` Q. Good morning, Dr. Bazil.
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` A. Good morning.
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` Q. Thanks for coming here today. My name
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`is Matthew Dowd. I'm an attorney for the petitioner
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`in this case.
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` And can you tell me your understanding
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`for your being here today?
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` A. My understanding is that I'm going to
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`talk about my clinical experience with the drug
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`lacosamide and its place in the treatment of epilepsy.
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` Q. And you understand that you have been
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`designated as an expert witness by the patent owner in
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`this proceeding, right?
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` A. I do.
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` Q. And the patent owner in the proceeding
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`is Research Corporation Technologies. Can you tell me
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`your understanding of -- or your relationship with
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`that company?
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` A. I don't have any relationship with them.
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`I understand that they are the petitioner and that's
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`about it.
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00010
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Q.
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`Okay. And I understand that you have
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`Page 10
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`been deposed before.
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`A.
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`Yes.
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`Q.
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`Yes. And you have been deposed in
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`relation to the patent that's at issue in this
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`proceeding with respect to the District Court
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`litigation. Correct?
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`A.
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`That's correct.
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`Q.
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`Okay. And now, just so we're on the
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`same page, I'll ask questions, you'll answer them.
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`Your attorney may object, but you generally still have
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`to answer unless your attorney instructs you not to
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`answer. Do you understand?
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`A.
`
`I understand.
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`Q.
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`And give verbal answers, not head nods,
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`so that the court reporter understands and we have it
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`clear on the record. Understand?
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`A.
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`Yes.
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`Q.
`
`Can you tell me who you met with in
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`preparation for your deposition today?
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`A.
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`I met with the attorneys present here,
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`and I think there was one other a while back, I can't
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`remember his name.
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`Q.
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`Okay.
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`A.
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`An attorney.
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00011
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Page 11
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` Q. A different attorney?
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` A. At Covington, yes.
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` Q. And can you tell me when you met with
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`your attorneys?
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` A. Several times over the past couple of
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`months. First time was probably a couple of months
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`ago.
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` Q. Was it before or after you prepared your
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`expert declaration for this proceeding?
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` A. Both.
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` Q. Can you tell me approximately how many
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`hours that you've met with the Covington attorneys?
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` A. I don't know exactly. Probably in the
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`neighborhood of 15, 20 hours.
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` Q. Have you spoken to anybody besides the
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`Covington attorneys about this proceeding?
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` A. No, I haven't.
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` Q. And you are familiar, of course, with
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`the company UCB, right?
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` A. Yes, I am.
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` Q. And can you tell me your relationship
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`with UCB?
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` A. So, I've known about the company for
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`years. As you probably know from my CV, I was
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`involved in some of the research regarding this
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`1-800-FOR-DEPO
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00012
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Page 12
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`compound, although it wasn't UCB at the time, it was a
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`different company. UCB has another drug for epilepsy
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`which I'm familiar with, so I've known -- and so they
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`have been marketing that for years. So I've known
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`about the company for probably since before that
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`compound came out, which was about 15 years ago.
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` Q. And you said another compound. Which
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`compound are you referring to?
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` A. It's a drug called levetiracetam.
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` Q. That's also known as Keppra?
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` A. It is.
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` Q. You don't mind if I call it Keppra, do
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`you?
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` A. That's fine.
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` Q. It's a little easier to pronounce,
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`right?
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` A. Sure.
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` Q. Okay. And I'm correct that you were
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`hired as an expert by UCB in the District Court
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`litigation in Delaware. Correct?
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` A. Yes, I was.
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` Q. And can you tell me -- can you tell me
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`who you met with with respect to the District Court
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`litigation?
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` MS. REISTER: Objection to scope. I'm
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`1-800-FOR-DEPO
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`www.aldersonreporting.com
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`Alderson Court Reporting
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`Page 00013
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Page 13
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`going to instruct the witness not to answer that
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`question.
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` MR. DOWD: On what basis are you
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`instructing?
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` MS. REISTER: On the basis of work
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`product and based upon the scope of what he did in the
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`litigation is not what he's here today to testify
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`about.
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` MR. DOWD: Okay. Well, scope isn't a
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`basis to instruct him not to answer.
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` MS. REISTER: But the work product is.
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` MR. DOWD: Okay. But the fact that he
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`met with people is not work product, so --
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` MS. REISTER: Let me look at your
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`question carefully.
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` MR. DOWD: Sure. I'm happy to re-ask it
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`if you think it should be asked a different way.
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` MS. REISTER: If you could establish
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`some foundation and the scope of who he met with is
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`permissible, but certainly not anything that was
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`discussed with respect to any meetings that he did
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`have.
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`BY MR. DOWD:
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` Q. So, Dr. Bazil, am I pronouncing it --
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` A. Bazil.
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`1-800-FOR-DEPO
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`www.aldersonreporting.com
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`
`
`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
`
` Q. Dr. Bazil, you were engaged by UCB as an
`
`expert in the District Court litigation in Delaware,
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`Page 14
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`right?
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` A. Well, I was engaged by Covington on
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`behalf of UCB, I guess that's the way I understand it.
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` Q. And you testified at trial in Delaware
`
`with respect to the same patent that's at issue in
`
`this proceeding. Correct?
`
` A. Yes.
`
` Q. And at trial you discussed the issues
`
`with respect to the use of lacosamide in your clinical
`
`practice. Is that right?
`
` A. That's correct.
`
` Q. And you were paid for the time that you
`
`spent on that case, right?
`
` A. Yes.
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` Q. And were you paid by Covington or were
`
`you paid by UCB?
`
` A. I was paid by Covington.
`
` Q. And ultimately UCB paid the bills,
`
`right?
`
` A. Honestly, I don't know how that works,
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`but that would make sense to me.
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` Q. Okay. Can you tell me approximately how
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`much time that you spent -- let me re-ask the question
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
`
`New York, NY
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`Page 15
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`just simpler.
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` Can you tell me approximately how much
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`money you earned engaged as an expert for
`
`Covington/UCB in the District Court litigation?
`
` A. That was spread out over a period of
`
`time. I think it's probably in the neighborhood of
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`30, $35,000.
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` Q. What is -- now, you charge an hourly
`
`rate for your time --
`
` A. Correct.
`
` Q. -- with respect to this case, right?
`
`And what's your hourly rate?
`
` A. $750.
`
` Q. Can you tell me approximately how much
`
`time that you've spent working on the current
`
`proceeding?
`
` A. 25, 30 hours.
`
` Q. And do you have an estimate of how much
`
`time that you spent engaged as an expert for the
`
`District Court litigation?
`
` A. Well, I would have to do the math, and
`
`that's hard in my head. So that probably would have
`
`been 50 hours or so, 45, 50.
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` Q. 35,000 divided by 750?
`
` A. Right, whatever that is.
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
`
` Q. While you were engaged as an expert
`
`during the District Court litigation, did you discuss
`
`the matter with anyone other than the Covington
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`Page 16
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`attorneys?
`
` A. No.
`
` MS. REISTER: Objection; scope.
`
` Q. Were you --
`
` A. Actually, at one point there were some
`
`UCB people that I spoke to.
`
` Q. And do you recall who those people were?
`
` A. No, I don't.
`
` Q. Just generally?
`
` A. They worked for the company.
`
` Q. Were they scientists?
`
` A. I don't think so. I don't remember
`
`their positions in the company.
`
` Q. Were they lawyers?
`
` MS. REISTER: Objection; scope.
`
` A. Honestly, I can't tell when -- it was in
`
`the law -- I mean, it was in a group meeting.
`
` Q. Didn't have a big lawyer tag on their
`
`head?
`
` A. There were no tags on them.
`
` Q. I understand. I'm not trying to press
`
`you. I'm just --
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`
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
`
`Page 17
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` A. I honestly don't remember.
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` Q. Sure. Do you know any individuals who
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`work at UCB?
`
` A. I've met a few. Do I know any of them
`
`personally? No.
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` Q. Do you know them on a professional
`
`basis?
`
` A. Yes.
`
` Q. Do you collaborate with them at some
`
`point?
`
` A. Not currently, no.
`
` Q. Have you in the past?
`
` A. As I said, there were some clinical
`
`trials I was involved with years ago. At that point I
`
`was collaborating with them, but I'm not now.
`
` Q. When was the last time that you
`
`collaborated with anyone at UCB?
`
` A. It would have been -- well, the last
`
`trial I did was a phase IV trial, which was after the
`
`approval of Keppra. I think that was the last, last
`
`one. So that was probably close to ten years ago. I
`
`would have to look at my CV.
`
` Q. In looking at your CV, you are an
`
`epileptologist. Is that correct?
`
` A. That's correct.
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`
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
`
` Q. And can you just explain to me exactly
`
`Page 18
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`what that is?
`
` A. That means that I'm a neurologist with
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`specialty training with treating people with epilepsy.
`
` Q. Now, do neurologists who are not
`
`epileptologists generally treat epilepsy patients?
`
` A. Well, epilepsy is a very common
`
`condition, so every neurologist would have treated
`
`people with epilepsy, or most neurologists would.
`
` Q. And you don't have to be an
`
`epileptologist to be able to treat an epilepsy
`
`patient, right?
`
` A. No, you don't.
`
` Q. And would you say it's probably most
`
`common for a patient who has epilepsy to go to a
`
`neurologist who is not an epileptologist, right?
`
` A. Well, I said it's a very common
`
`condition. Depending on where you are, it might be a
`
`primary care physician who treats you, it may be a
`
`neurologist, or it may be an epilepsy specialist. An
`
`epilepsy specialist or epileptologist would be
`
`involved with the more difficult to treat cases of
`
`epilepsy.
`
` Q. Now, so, back to my question, so,
`
`generally, an epilepsy patient generally would go to
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`
`
`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
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`Page 19
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`someone who is not an epileptologist?
`
` A. That's true, I think.
`
` Q. Okay. And you mentioned epilepsy
`
`specialist. Is that something different than an
`
`epileptologist?
`
` A. No. I mean the same thing.
`
` Q. Okay. And you mentioned that a primary
`
`care physician will also generally treat patients who
`
`have epilepsy. Is that right?
`
` A. They may, depending on the place in the
`
`country, there are -- or in the world. But in this
`
`country there are areas that don't have a lot of
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`neurologists, so the patient might be seen by a
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`primary care doctor first. And if they do well, they
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`don't necessarily need to see an epilepsy specialist.
`
` Q. You also mentioned that an
`
`epileptologist generally handles the more difficult
`
`cases of epilepsy. Is that right?
`
` A. That's correct.
`
` Q. And, so, can you just tell me a little
`
`bit about that in terms of what's characterized as a
`
`more difficult case?
`
` A. Okay. So if someone is diagnosed with
`
`epilepsy by whoever that is, the primary care
`
`physician, neurologist, and they are treated for that
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`
`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
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`Page 20
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`condition and they have no more seizures, have no
`
`problems, have no questions, then they may not see
`
`someone else.
`
` There are -- there is a substantial
`
`minority of patients who don't respond to the first or
`
`second drug that they may be prescribed. And I guess
`
`I should say that drug treatment is almost 100 percent
`
`the first treatment of somebody with a diagnosis of
`
`epilepsy.
`
` So if the first or the second drug
`
`doesn't work, or there is something unclear about
`
`their condition, maybe it isn't actually epilepsy, or
`
`maybe they are not responding to the right -- the drug
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`that that person, that primary care doctor, whoever,
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`thinks is appropriate, then they may need specialty
`
`care. And the specialty care would be someone with
`
`more experience in the subtleties of different drug
`
`treatments, possibly some other treatments such as
`
`surgery that might be considered, or other diagnostic
`
`tests that may show that the person actually has
`
`something else.
`
` Q. Can you tell me approximately what
`
`percentage of patients who have epilepsy would see or
`
`generally see an epileptologist versus just a
`
`neurologist?
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
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`Page 21
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` MS. REISTER: Objection; form.
`
` Q. Do you understand the question?
`
` A. Yeah, I do. So, about -- well, again, I
`
`think it very much depends on where you are.
`
` My experience in New York City where
`
`there are a lot of specialists, including
`
`epileptologists, is that people may actually see a
`
`specialist first. I have seen people as their first
`
`contact for diagnosis of epilepsy.
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` Then you can go to the other extreme.
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`If you're in Montana and the nearest epilepsy
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`specialist is at least one state away, then probably
`
`that person is never going to see a specialist.
`
` So it's hard to say what number actually
`
`end up seeing an epilepsy specialist. We do know that
`
`roughly a third of patients will be refractory,
`
`meaning they have not responded to drug treatment,
`
`that they are continuing to have seizures. Most of
`
`those people should at some point see an epilepsy
`
`specialist. But how many of them actually do, I don't
`
`know if that's really known.
`
` Q. Okay. Let me ask you a different
`
`question before I get back to that question.
`
` Approximately how many people in the
`
`United States have -- or a diagnosis having epilepsy?
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`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
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` A. The rough number is 1 percent. So I
`
`think the population is in the neighborhood of 350
`
`million. So it would be about 3, 3 million people.
`
` Q. Okay. But, generally, it's 1 percent of
`
`Page 22
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`the population?
`
` A. Correct.
`
` Q. And then of the -- so, getting back to
`
`my previous question, I'm just trying to get a sense
`
`of what percentage of the patients that have epilepsy
`
`actually see an epileptologist rather than just a
`
`neurologist.
`
` A. Yeah, I understand. But, so, as I said,
`
`about one-third of those people, which would be in the
`
`neighborhood of a million people, have what we would
`
`term refractory epilepsy, meaning they are not
`
`well-controlled by the person they are seeing. Those
`
`people should see an epileptologist. I don't know how
`
`many of them actually do.
`
` As I said previously, there are areas
`
`where access is difficult for various reasons, even in
`
`New York -- well, New York I think most people would
`
`see a specialist. But there are also the other
`
`two-thirds that for other reasons may seek out an
`
`epilepsy specialist.
`
` So my estimate would be, you know, at
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`
`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`New York, NY
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`Page 23
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`some point in their diagnosis, the ballpark may be
`
`about a third of those people would see an epilepsy
`
`specialist for one reason or another.
`
` Q. So you're saying that a third of the
`
`total epilepsy patients or a third of the refractory?
`
` A. A third of the total.
`
` Q. So it's your testimony that a third --
`
`so about a million patients who have epilepsy will see
`
`an epileptologist?
`
` A. At some point.
`
` Q. At some point. And is that because a
`
`person -- or a doctor who is a neurologist is not
`
`capable of providing the needed care, or is there some
`
`other reason?
`
` A. There may be -- well, if you think of
`
`yourself or think about an individual who has
`
`epilepsy, there are a number of reasons why you might
`
`seek specialty care for that, not just for the
`
`treatment, which may be doing -- may be going very
`
`well. You may have a question.
`
` A common one that comes up is a woman
`
`who has epilepsy, is doing well, and wants to become
`
`pregnant or has become pregnant, they may seek out a
`
`specialist with regard to that particular question,
`
`what should I do in this scenario.
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`New York, NY
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`Page 24
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` So, there are lots of reasons why
`
`someone may at one point or another seek out an
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`epileptologist or a specialist. There may be reasons
`
`why a neurologist may want their patient to see a
`
`specialist for a consultation.
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` So there are lots of reasons beyond the
`
`fact that they are not doing well, that at some point
`
`they may see an epilepsy specialist.
`
` Q. Okay. But a neurologist could also
`
`provide the same advice, right?
`
` A. It depends on the question. So, a
`
`neurologist didn't specialize in epilepsy. So they
`
`may be able to take care of that patient very well.
`
`In fact, in a lot of situations that's true.
`
` Q. Okay. So I would like to ask just a few
`
`background questions about epilepsy itself. And from
`
`what I understand, I'm clearly not an expert, but from
`
`what I understand you could classify epilepsy into
`
`various numbers of categories, right?
`
` A. That's correct.
`
` Q. And what's the broadest distinction of
`
`the epilepsies?
`
` A. So, epilepsy is a very diverse
`
`condition. It's not just one condition. The broadest
`
`categories that we think about in terms of types of
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`epilepsy are what's called generalized epilepsy and
`
`what's called partial or focal epilepsy.
`
` For a generalized epilepsy the brain as
`
`a whole seems to be more sensitive than people who
`
`don't have epilepsy, and the way I explain that to
`
`patients is anybody can have a seizure. The brain is
`
`built for that possibility. If you get an infection
`
`in your brain, if you have a fever of 105, if you take
`
`certain drugs or withdraw from certain drugs, anybody
`
`can have a seizure.
`
` But people who have a generalized
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`epilepsy, they may have one spontaneously. There may
`
`be many reasons for that, most of them we don't know.
`
`But in the couple of examples that are known, there is
`
`a difference in the way a particular channel in the
`
`brain is put together that we know is involved in
`
`neurons, neuronal transmission.
`
` Generalized epilepsy also has different
`
`types of seizures. They can be grand mal or
`
`convulsion, which is what most people think of as a
`
`seizure, people lose consciousness, stiffen, fall
`
`down, have violent shaking, and then have a period of
`
`recovery.
`
` There are also other types, such as
`
`absence, or what is known as petit mal seizures, that
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`Carl W. Bazil, MD, PhD
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`October 10, 2016
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`are just a brief staring spell, where, again, however,
`
`the brain as a whole seems to be involved in this
`
`seizure. So that's generalized.
`
` The other broad category is focal or
`
`partial. In that category of seizure there seems to
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`be one part or spot in the brain that the seizures are
`
`coming from and the manifestations depend very much on
`
`where that is. If the seizure is beginning in the
`
`visual area, the patient may first experience wild
`
`colors, they may have hallucination, because that area
`
`of the brain is misfiring.
`
` If it's in the area that controls
`
`movement, that person may have uncontrolled movement
`
`in one part of the body. They can be very small, it
`
`can stay in that area. So the person has this wild,
`
`visual hallucination and they are still sitting here
`
`talking to you, and you don't even know I'm having it
`
`unless I tell you.
`
` However, it can spread to involve more
`
`brain where the person may then be unable to talk,
`
`depending on which side of the brain it's on, may be
`
`unaware of what's happening, or may go on to have a
`
`generalized convulsion that looks very much like the
`
`primary generalized tonic-clonic seizure.
`
` So those are the broad categories of
`
`1-800-FOR-DEPO
`
`www.aldersonreporting.com
`
`Alderson Court Reporting
`
`Page 00027
`
`
`
`Carl W. Bazil, MD, PhD
`
`October 10, 2016
`
`
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