Drosophila melanogaster as a rapid in vivo assay system for preclinical anti-seizure medication testing.

Epilepsy represents a significant medical challenge, with a third of patients failing to achieve seizure freedom despite the use of multiple different anti-seizure medications (ASM). Drug resistance is common in genetically caused epilepsies. Patients are faced with repeated, long-lasting, and frequently frustrating drug testing, necessitating targeted therapies and drug repurposing. While in silico tools offer some insight, novel and often genetic epilepsies require preclinical models, which are expensive and time-consuming. Here, we propose Drosophila melanogaster as a rapid in vivo model for preclinical ASM efficacy testing using the sodium channel-associated epilepsies, Dravet syndrome (DS), and generalized epilepsy with febrile seizures plus (GEFS+) as model disorders. We utilize vinegar fly models of DS and GEFS+ that exhibit phenotypic similarities to human patients, including seizures and increased morbidity. Moreover, treatment with ASM effective in humans (clobazam, stiripentol, fenfluramine) reduces seizures, while the application of sodium channel blocking ASM (phenytoin) was deleterious, underlining the model's utility. The utilization of Drosophila as a preclinical model offers a promising avenue for studying genetic epilepsies and assessing ASM efficacy. This approach has the potential to facilitate the development of tailored treatments for patients using a rapidly available in vivo model. PLAIN LANGUAGE SUMMARY: Epilepsy is a challenging condition, with about one-third of patients unable to control seizures despite trying multiple drug treatments. This is especially common in genetic epilepsies. Developing new treatments is expensive and slow, highlighting the need for faster, targeted approaches. This study uses the fly (Drosophila melanogaster) as a rapid, cost-effective model to study genetic epilepsies like Dravet syndrome (DS). These fly models mimic key symptoms seen in humans, including seizures and shorter lifespans. Effective human anti-seizure medications (e.g., clobazam, stiripentol, and fenfluramine) reduced seizures, while sodium channel blockers like phenytoin worsened them. The Drosophila model offers a promising and efficient way to study genetic epilepsies and test treatments, accelerating the development of more targeted therapies.