[Epilepsies from the neurologic viewpoint]

A retrospective view of the last 25 years of clinical epileptology in this 100th anniversary year of the Clinic for Epileptics Bethesda, Tschugg, leads to the following conclusions: A generally accepted classification of epilepsies has still not been reached. Several new pathophysiological aspects of epilepsy have emerged. Of special importance are the elucidation of PDS, the application of the Kindling-phenomenon, the Ca-ion influx theory and the analysis of intracerebral metabolic processes in epileptogenesis, the spreading and limitation of convulsions. Seven new diagnostic methods have been introduced over the last 25 years. Five new antiepileptic drugs have become available over the past quarter of a century. During this period 30 other drugs were withdrawn from clinical use. The most significant advance in the treatment of epilepsy in recent years has been the determination of anticonvulsant concentrations in body liquids. A deeper understanding of the pharmacokinetics of anticonvulsants has led to increased competence in recognizing drug interaction, in treating pregnant epileptics and in the concomitant use of other medications. Monotherapy is generally preferred to combination regimes. Slow-release preparations and calcium-influx blockers have reached the phase of clinical trials. Further advances have been attained in the pre-operative preparation and the operative therapy of drug-resistant epilepsies.