In Context

984 www.thelancet.com/neurology Vol 8 November 2009

Profi leMartin Brodie: epilepsy expertise and whisky wisdomAlthough he is director of the Epilepsy Unit at Glasgow’s Western Infi rmary, UK, and has published more than 350 articles, book chapters, and reviews on epilepsy (including one in this issue), Martin Brodie is not, he claims, a neurologist. “[Although] I’ve got nothing against neurologists”, he jokes. “Some of my best friends are neurologists.”

So how does Brodie classify himself then? “I’m a clinical pharmacologist gone wrong”, he says. After qualifying in medicine at Glasgow University, UK, Brodie trained in clinical pharmacology, initially in Glasgow and then at the Hammersmith hospital in London, UK.

“Have you ever been to the Hammersmith?” he asks. “You know, Wormwood Scrubs Prison is next door.” Being, as he describes himself, “a hick from the sticks”, he went up to the main entrance of the prison, thinking it looked the more impressive of the two buildings, before realising his error.

Once he’d found the Hammersmith, he stayed there for 4 years studying how the liver metabolises drugs. He then returned to Glasgow to continue his work on drug metabolism, but this time specifi cally focused on drugs for epilepsy. “For 15 years we hadn’t had any new antiepilepsy drugs. And I became aware that there were a number of new agents in the pipeline”, he says. Brodie decided to work on those new drugs and set up the fi rst epilepsy service in Glasgow in 1982.

He saw epilepsy as a fi eld in which he would have the potential to improve the quality of life for a large number of people. “It’s a miserable thing to have epilepsy. And it doesn’t just aff ect the individual; it aff ects the whole family”, he says.

After establishing this clinic, Brodie was sent a lot of diffi cult cases—patients who were on several drugs, but who still had seizures (refractory epilepsy). His initial thought was “maybe if they’d come to see me earlier, they wouldn’t be in this state”. As more and more newly diagnosed patients came through his clinic, however, he began to realise that his initial assumption was wrong. “Most of the patients with refractory epilepsy are refractory de novo”, he explains. “They did not respond to antiepileptic drugs from the beginning.” Brodie reported this discovery in the New England Journal of Medicine in 2000.

Such pharmacoresistant patients made up 36% of Brodie’s newly diagnosed population back then. Now, Brodie is pleased to report, they make up a little less than 32%. This is largely thanks to new drugs, he says, or to drugs being used in combination. He is enthused that the number is dropping, but knows there is still a long way to go.

The problem, Brodie says, is that the cause of seizures in individual patients is most often unknown. “Epilepsy is like

a whale”, he says, “you see the spouts [the seizures] but you don’t see the whale [the cause]. Sometimes you see a bit of the whale; sometimes it breaches, and you see a bit more of the whale. But what we have is anti-spout drugs, we don’t have anti-whale drugs”.

Brodie says that basic, genetic, and clinical research will be the best bet for eventually catching the whale. “I think we’re making headway. But it’s slow”, he says. “Maybe it’s not possible to have a eureka moment for epilepsy because epilepsy is not one condition but thousands of conditions. That’s the problem.” He adds: “The amazing thing is that we can get 70% of patients seizure-free without knowing what we’re doing.”

Brodie hopes that by gathering enough genetic and biological information about individual patients, drug tailoring might be improved. “[If] we can fi gure out where roughly the problem is—is it a GABA problem, a sodium channel problem, a calcium channel problem, a potassium channel problem?—then we have a number of drugs that we can try that work in that area”, he explains.

Along with his clinical and research endeavours, Brodie has recently set up a charity called the Scottish Epilepsy Initiative. He hopes that the charity will raise enough money to be able to build an epilepsy centre for Scotland—a place where people will be able to go for information, treatment, and counselling. “What we’re trying to do is something much more personal for people with epilepsy”, he says. “The treatment is part of the process, but it’s not the whole process, and dealing with the individual and the family is, to me, the interesting bit.”

It is Brodie’s personable quality as much as his hard work and intellect that has made him one of the leading fi gures of the epilepsy world. He does, however, have another expertise. He is a proud member of the Scotch Malt Whisky Society, and announces unabashedly, “I am a major authority”, going on to say that he would be more than willing to off er tutelage.

The single malts from Islay, Orkney, and Skye are among his favourites, and he generally buys them at cask strength (about 60%). “It works very quickly”, he says, but adds, “it does interfere with the chess”. As a teenager, Brodie was an avid chess player and even played for Scotland. Now though, his main opponent is his computer. The problem, he says, is that his computer doesn’t make mistakes. “I normally win the fi rst game, but when I get to my second whisky…” he laughs. “I’m looking for a computer that drinks!”

Ruth Williamsruth.williams@absw.org.uk

See Review page 1019

For more on early identifi cation of refractory epilepsy see

N Engl J Med 2000; 342: 314–19