[The effect of refractory epileptic seizures on cognitive processes]

A complete definition of all risk factors for intractability and/or mental retardation cannot currently be given because epilepsy is not a disease but a heterogeneous phenomenon from the physiological, clinical and etiological points of view so that no single way of addressing the issue can fit all situations. It is quite possible that some risk factors can be specific for subgroups and do not apply to the majority of cases. Such subgroups may be small enough to escape detection in large prospective studies that uniformly indict a limited number of factors mostly related to characteristics of the disease or patients. Yet, even factors that are at play only in small groups may be extremely important if they can be at the origin of effective preventive measures. This may well be the case for vigorous early treatment of complex febrile seizures as there is increasing evidence of a close, probably causal, relationship between lengthy early convulsions and mesial temporal sclerosis. It may also apply to the prevention of cognitive/behavioural deterioration in children with certain types of epilepsy even though the evidence in this regard is less strong. Exonerating seizures and/or subclinical paroxysmal activity of any responsibility in the production and/or aggravation of brain damage is not justified on the basis of known facts and vigorous although reasonable treatment of the epilepsies may do more, at least in certain forms, than simply decreasing the relapse rate of seizures