[Future perspectives in epilepsy treatment]

The primary goal of a causal (= curative) therapy of the epilepsies is the correction of the causes of the epilepsy syndrome. Unfortunately, at present, this is only possible to a limited extent. Recent advances have been achieved in the discovery of the possible causes of resistance to common antiepileptic drugs (increased activity of P-glycoprotein drug efflux-pump in the epileptogenic focus), in the discovery of the pathophysiology of some epilepsy syndromes as autoimmune diseases (Rasmussen encephalitis), as well as in the understanding of a few epilepsy forms as a genetically determined aberrations. Much expectation for a more accurate biochemical in-vivo characterization of epilepsy syndromes presently lies in the noninvasive proton magnetic resonance spectroscopy, with the ultimate goal of a more specific pharmacological therapy with antiepileptic drugs. Technical advances, which might gain importance for epilepsy therapy in the near future, are 'radiosurgery' and probably also gene-therapy, i.e. the treatment of focal epilepsies by intracerebral grafting of GABA- and adenosine-releasing cells developed in transgenic mice.