[Epilepsy. Classification and genetics]

Abstract

A common symptom of epilepsies are recurrent unprovoked epileptic seizures. These can be classified as focal or generalised. Thus, we can speak of focal or generalised epilepsies. Considering the rest of the medical history and the results of EEG and brain imaging the terms idiopathic, symptomatic and cryptogenic (i.e. probably symptomatic) are used to further characterise an epilepsy in a single patient. These classification scheme which is used since the end of the eighties allows decision making in therapy and an estimation of prognosis. Due to progress in epileptology during the last decade a more sophisticated approach is required. Thus, semiology of the single seizure becomes more important. The evolution of signs and symptoms during a seizure tells us something about the seizure onset zone and the mode of seizure propagation. The knowledge of them is a prerequisite for surgical treatment. Furthermore, semiology of seizures should determine social implications of epilepsy by far more than the fact that they are epileptic. Beside seizure semiology we have to consider the underlying neuropathological condition since it determines treatment and prognosis. Epilepsy is a consequence of acquired or genetic brain diseases. In case of the latter it becomes more and more possible to characterise and diagnose the genetic syndromes and to understand their pathophysiology. In epileptology the exact knowledge of an underlying genetic disease is not only of scientific interest. Beside being a condition sine qua non for adequate genetic counselling it influences the choice of anti-epileptic drugs and determines whether surgical treatment is indicated. Thus genetics are an important part of comprehensive care in epilepsy.