Correlation of epilepsy syndromes and basic mechanisms.

To combine both clinical and experimental findings into comprehensive nosological theories is a novel approach in epileptology, the adoption of which seems highly advisable for future research. A selection of problems concerning some well-known epilepsy syndromes are presented which could profit from such an approach. In idiopathic epilepsies, both generalized and localization-related, there seems to be an astonishing amount of variability beyond the acknowledged syndromes when these are looked at in detail. Much of this variance seems to be the consequence of regional expression of the genes which are certainly involved in their pathogenesis. Some of the involved genes seem to have not only a spatial but also a temporal limit of action. In symptomatic and cryptogenic 'generalized' epilepsies the rôle of focal etiological factors needs to be clarified as well as the question why their phenotype seems to depend more upon the manifestation age than the etiology. In relation to the symptomatic and cryptogenic focal epilepsies, it becomes more and more intriguing whether they are all due to more or less identical interactions of a set of basic mechanisms or whether foci in different cortical areas differ in this respect. It appears that there are many syndrome-related or syndrome-specific differences in the rôle of basic mechanisms in human epilepsies. A better understanding of these differences could become most helpful for the development of more specific and more effective therapies.