Dynamic Epileptic Systems Versus Static Epileptic Foci?

Abstract

In 1881 William R. Gowers published his seminal book “Epilepsy and Other Chronic Convulsive Disorders” [102] . Since that time a major emphasis in clinical epileptology has been determining the site of origin of the epileptic discharge. Indeed the concept that a very limited area of brain is capable of producing and maintaining the epileptic discharge forms the cornerstone of current neuro-surgery procedures that treat epilepsy by either total resection [191–208] or stereotactic destruction [191,209–221] of the offending cortical region. However, the limited success and even failure of epilepsy surgery in a number of patients has drawn attention to the possibility that the nature of epileptic generators may be much more sophisticated than initially suspected, especially in patients with long-standing medically refractory epilepsy [40,191,210,222–229] . This chapter reviews the reasons for failure of epilepsy surgery and introduces the concept of epileptic systems [191,230], i.e. networks involving many distinct regions of the brain that are active in the brains of patients with medically refractory epilepsy.

This research was supported by grants from the National Institutes of Mental Health and the Brain Research Foundation.