14 - Introduction to the concept of symptomatic epilepsy  pp. 113-118

Introduction to the concept of symptomatic epilepsy

By Simon D. Shorvon

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The concept of “symptomatic epilepsy” might, at first glance, seem fairly straightforward, but in fact this is not the case. There are conceptual issues, problems with definition, and difficulties in assessing frequency and in differentiating causes. These problems are indeed, given our current level of knowledge, to a large extent insurmountable. The purpose of this chapter is to clarify terminology, to highlight some of the issues surrounding this topic, and to set the clinical context for the chapters that follow. Questions are more easily posed than answered, but what is clear is that more emphasis on etiology in epilepsy would change fundamentally our conceptual approach to the condition.

Definitions

The definition of symptomatic epilepsy has changed over time. As discussed in Chapter 1, for most of the nineteenth century symptomatic epilepsy (often previously known as organic epilepsy) was not considered to be a “genuine epilepsy” at all, and was rather ignored. The pendulum swung, and by the middle of the twentieth century, it had become axiomatic that most epilepsies were in fact symptomatic – in the sense that the epilepsy was a symptom of an underlying cause, even if the cause could not be identified (as Wilson [1940] called this, cryptogenic epilepsy). In more recent times, a new meaning has been assigned to the term, largely because the meaning of its opposite, idiopathic epilepsy, has changed.

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