Editorial - Epilepsy in Israel - 2008

The relatively high percentages of patients with epilepsy, in whom seizures are uncontrolled in spite of optimal anti-epileptic drug use, lead to continuous struggles to improve the treatment of epilepsy. The advances in defining the genetic basis of epilepsy can potentially lead to better understanding of the disorder as well as to more effective treatment. An example is the finding of SCN1A gene mutations in association with a large spectrum of neurological diseases, from generalized epilepsy with febrile seizures plus (GEFS+) to severe myoclonic epilepsy of infancy and to vaccine-induced encephalopathy and Rasmussen encephalitis, Panayiotopoulos syndrome and familial hemiplegic migraine. In parallel, throughout the world, imaging modalities of very high technology are being used to define the epileptogenic focus. A description from The Hospital for Sick Children in Toronto, of a topographic movie of high frequency oscillations on the brain surface, which allows visualization of the dynamic ictal changes, is remarkable. The ketogenic diet is a significant treatment option. The John Freeman Epilepsy Center in Johns Hopkins Hospital leads the way in using the diet in very young infants, including West syndrome. The vagus nerve stimulation is being used as another relatively safe and effective treatment, while epilepsy surgery continues to be applied. Better matching of patients to each modality can be expected with increased success in seizure control.