50 Years Ago in The Journal of Pediatrics:

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Lundervold A, Jabbour JT. J Pediatr 1962;60:220-3

When Lundervold and Jabbour studied childhood epilepsy, there were only a handful of anticonvulsants, some of which have since been abandoned because of inefficacy or toxicity. Despite these limited treatment options, the authors reported seizure remission in 32% of pediatric patients with epilepsy, and seizure reduction in another 51%. Fifty years later, do today’s children fare better?

By current estimates, we have approximately doubled the rate of seizure remission in children with epilepsy.¹ Progress in multiple areas has made this improvement possible. Although electroencephalography has retained its methodology and is integral to the field of epileptology, advancements in epilepsy syndrome classification have made pivotal contributions. We have also seen the introduction of more than 20 new anticonvulsants, novel techniques in epilepsy surgery, and new diagnostic imaging. Pneumoencephalography, the painful and relatively low-yield imaging technique used by Lundervold and Jabbour, was replaced clinically with computed tomography in the mid-1970s and magnetic resonance imaging in the 1980s, enabling the identification of structural anomalies. Consequently, we are now more precise about whom we diagnose with epilepsy, and can prognosticate and treat epilepsy in a more targeted fashion.

But despite this significant progress, many children still have intractable seizures or seizures that recur after remission. Clearly, there remains ample room for progress in the understanding of epilepsy and its treatment. Hopefully, within the next 50 years we will (1) further refine epilepsy syndrome classification to include relevant clinical and genetic information, allowing more targeted therapy; (2) improve neuroimaging to enable identification of subtle cortical malformations, as well as functional seizure foci without structural correlates; and (3) develop medications not only to suppress seizures, but also to treat the underlying excitation-inhibition electrical imbalance and thus cure the seizure disorder. We must join Lundervold and Jabbour in their pursuit of clinical, electrographic, and radiographic correlates of childhood epilepsy, now with the goals of refining prognostication, individualizing treatment, and ultimately curing epilepsy.

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1. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B, et al. Two-year remission and subsequent relapse in children with epilepsy. Epilepsia. 2001;42:1553–1562
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