RECENT ADVANCES IN CHILDHOOD EPILEPSY

Recent advances in pediatric epileptology are the consequence of the e xplosive advance of medical technology in recent years. In this manusc ript, some of the major highlights of these technology driven advances will be presented. Recognition of a typical EEG spike pattern leads t o the identification of benign focal epilepsy of childhood, an extreme ly frequent electro-clinical syndrome of excellent prognosis. The deve lopment of CT scan and particularly of high resolution MRI, has led to the easy identification of a variety of pathologies which were previo usly recognized only by pathologists. These include, among others, neu roblast 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. T his is particularly true in infants in whom the PET scan may uncover a n 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 th e risks of callosotomies and hemispherectomies, techniques that are no w widely used to improve seizure control in patients with catastrophic seizure disorders. A better understanding of neurotransmitters involv ed in the generation or inhibition of seizures has led to the developm ent of a variety of new drugs which promise to improve our ability to control seizures conservatively. Finally, advances in molecular biolog y have also had an impact on epileptology, leading to the discovery of gene abnormalities underlying a number of epileptic syndromes.