Recent advances in childhood epilepsy

Recent advances in pediatric epileptology are the consequence of the explosive advance of medical technology in recent years. In this manuscript, some of the major highlights of these technology driven advances will be presented. Recognition of a typical EEG spike pattern leads to the identification of benign focal epilepsy of childhood, an extremely frequent electro-clinical syndrome of excellent prognosis. The development of CT scan and particularly of high resolution MRI, has led to the easy identification of a variety of pathologies which were previously recognized only by pathologists. These include, among others, neuroblast migrational disorders, mesial temporal sclerosis, forme fruste of tuberous sclerosis, and slow growing small temporal neoplasms. PET scanning has also shown to be particularly sensitive in the detection of subtle pathological lesions, which may remain undetected by MRI. This is particularly true in infants in whom the PET scan may uncover an unsuspected focal lesion in patients with hypsarrhythmia, indicating that hypsarrhythmia may be a form of a secondary generalized epilepsy. Advances in surgical techniques have also decreased significantly the risks of callosotomies and hemispherectomies, techniques that are now widely used to improve seizure control in patients with catastrophic seizure disorders. A better understanding of neurotransmitters involved in the generation or inhibition of seizures has led to the development of a variety of new drugs which promise to improve our ability to control seizures conservatively. Finally, advances in molecular biology have also had an impact on epileptology, leading to the discovery of gene abnormalities underlying a number of epileptic syndromes.