Évolution des syndromes épileptiques au cours du temps

The International Classification of the Epilepsies can be used in patients with newly diagnosed epilepsy. Agreement between independent observers can be excellent. For the most part, one can identify highly specific syndromes at onset. With time, these very specific diagnoses are rarely overturned and usually only when the information at initial diagnosis is problematic. A third or more of pediatric epilepsy falls into categories which, by their definition, are only partially classified or completely nonclassified. Many of these nonspecific diagnoses are eventually replaced with more specific ones. Most likely, there will always be a few cases which remain unclassifiable despite all efforts to find a specific diagnosis. Within a few years of initial diagnosis, one can already appreciate the seizure outcomes expected of idiopathic syndromes (excellent) and of nonidiopathic generalized syndromes (poor). For the nonidiopathic partial syndromes, which are very common, the outcome is not as clearly defined. An important syndrome in this group, mesial temporal lobe epilepsy with hippocampal sclerosis with onset during childhood is hard to recognize from its outset. For some localization-related forms of epilepsy there seems to be an absolute or relative silent period between the onset of seizures and the development of pharmacoresistant seizures. If this is true, then perhaps one day, it will be possible to intervene in the evolution of some forms of epilepsy and prevent them from becoming pharmacoresistant.