[Pathophysiology of epilepsies: recent progresses]

Epilepsy is often due to an initial aggression (brain trauma etc.). Decades can pass before the appearance of spontaneous recurrent seizures. It is therefore important to understand the mechanisms responsible for the construction of an epileptic brain. Understanding these mechanisms would open the way to preventive treatments.The probability of appearance of epilepsy after an initial insult is rather low. A preventive treatment can only be applied if predictive markers exist. The occurrence of interictal spikes and the presence of cognitive deficits could constitute early markers of epileptogenesis (the process leading to epilepsy). Epileptogenesis can be studied in animal models of epilepsy. In these models, the opening of the brain blood barrier, the neuro-inflammatory response, and the activation of some genes play a pivotal role in epileptogenesis. Therapeutical interventions targeting these candidates have beneficial effects, delaying epileptogenesis, but not preventing them. Future research directions for the early treatment of at-risk patients will be discussed.