scope:

Preface

Epilepsy is an episodic neurological disorder that has afflicted humankind throughout recorded history; yet, throughout the millennia, it has never been properly acknowledged as a disease with a biological basis. In ancient times, epilepsy was referred to, somewhat ironically, as the "Sacred Disease," as it was imbued with negative references to the supernatural. Epilepsy was later believed to represent a form of demonic possession and thus resulted in social stigmatization and persecution. It was only late in the 19th century that epilepsy began its long and arduous journey to being justly recognized as a physical illness with complex pathophysiological substrates. Even today, the public is not fully apprised of the true nature of the epilepsies (as they are now considered), and efforts to expand awareness of this condition have been thwarted in large measure by deeply rooted preconceptions promulgated through the ages.

Within the last half-century, significant progress has been made in our basic understanding of the epileptic brain. Pivotal advances in drug development and surgical techniques, as well as the emergence of innovative approaches such as electrical stimulation of the nervous system, have led to a substantial reduction in the morbidity and mortality of patients with epilepsy (both children and adults). At the same time, remarkable developments in the basic neurosciences have enhanced our understanding of brain structure and function at ever finer levels of molecular, cellular, and genetic detail.

The intrinsic complexities associated with attempts at understanding normal brain structure and function lie at the heart of the challenges investigators face in deciphering the epileptic brain. The development of universally effective therapeutic approaches for epilepsy patients has been the elusive goal of clinicians and researchers since the early twentieth century. Yet, despite the availability of many new pharmacological agents within the last generation, at least one third of the people with epilepsy remain refractory to medical therapy, and an even smaller number of these individuals are potential candidates for epilepsy surgery. It is this last frustrating reality that has been the focus of many professionals in the epilepsy field.

Within the research arena, increasing focus has been placed on "translational" research (i.e., that which bridges the gap between the laboratory and patient bedside); however, effective communication and interchange between clinicians and basic researchers have been difficult to achieve on a widespread basis. It is clear that such interaction is paramount in the development of novel treatments based on a detailed knowledge of fundamental mechanisms. This volume incorporates new translational advances in bringing epilepsy therapies from the laboratory bench to the bedside and back again.

We wish to collectively thank our mentors, colleagues, students, and, most of all, our patients and their families for providing the inspiration and encouragement to help facilitate this "translational" dialog. Additionally, we thank the publisher and our families for the support they have given us throughout this project. Finally, we acknowledge the expert editorial and administrative assistance provided by Pat Roberson and Heather Milligan.