An update on the seizures beget seizures theory

Area of Science:

• Neuroscience
• Epileptology
• Neurology

Background:

• The "seizures beget seizures" theory posits that seizure activity drives epilepsy progression.
• This concept, proposed by Gowers, remains influential in epilepsy pathophysiology.

Purpose of the Study:

• To critically review evidence supporting and refuting the "seizures beget seizures" theory.
• To examine the impact of recurrent seizures on brain networks and epilepsy progression.

Main Methods:

• Literature review of existing data and observations on recurrent seizures and brain networks.
• Analysis of molecular, structural, and functional changes induced by ictal activity.
• Evaluation of factors influencing epilepsy progression, including interictal activity and underlying disease mechanisms.

Main Results:

• Recurrent seizures induce molecular, structural, and functional brain changes (e.g., cell loss, altered connectivity, metabolic changes).
• These changes can lower the seizure threshold, promote disease progression, and expand epileptic networks.
• Conversely, some evidence suggests seizures can increase seizure threshold, and seizure remission occurs in many cases.

Conclusions:

• While seizure activity can negatively impact brain structure and function, the "seizures beget seizures" theory requires cautious application.
• Epilepsy progression is multifactorial, influenced by seizures, interictal activity, and underlying disease mechanisms, not solely by seizure activity.