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Abstract
Epilepsy is one of the most common serious brain conditions, affecting over 70 million
people worldwide. Its incidence has a bimodal distribution with the highest risk in
infants and older age groups. Progress in genomic technology is exposing the complex
genetic architecture of the common types of epilepsy, and is driving a paradigm shift.
Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition
rather than a condition with a single expression and cause. These advances have resulted
in the new classification of epileptic seizures and epilepsies. A detailed clinical
history and a reliable eyewitness account of a seizure are the cornerstones of the
diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances
in brain imaging are helping to identify the structural and functional causes and
consequences of the epilepsies. Comorbidities are increasingly recognised as important
aetiological and prognostic markers. Antiseizure medication might suppress seizures
in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy
surgery is the most effective way to achieve long-term seizure freedom in selected
individuals with drug-resistant focal epilepsy, but it is probably not used enough.
With improved understanding of the gradual development of epilepsy, epigenetic determinants,
and pharmacogenomics comes the hope for better, disease-modifying, or even curative,
pharmacological and non-pharmacological treatment strategies. Other developments are
clinical implementation of seizure detection devices and new neuromodulation techniques,
including responsive neural stimulation.