Some excitatory and inhibitory factors involved in the epileptic state

Many factors are involved in the determination of the epileptic threshold and the precipitation of epileptic seizures. The balance between the underlying excitatory and inhibitory mechanisms are often imperfectly understood. However, some of these factors must be fully considered if the management of those with epilepsy is to be effective. This applies especially to children. Certain types of epilepsy are genetically determined, and others are age-related. Development of the brain plays a crucial role in the changing liability to epilepsy. If these processes are disturbed by various lesions and diseases, such as metabolic and toxic disorders, protective mechanisms may suffer. Kindling and mirror foci, the role of the cerebellum, and reflex epilepsy will be discussed. There are some seizure-inducing factors which are susceptible to change, and can be as important as anti-epileptic drugs in controlling seizures. The use and limitations of these measures, and of drugs, will be considered.