Seizure—into the new millennium

Neither the sun, nor death, can be looked at with a steady eye Duc de La Rochefoucauld (Maxims) In the Editorial which accompanied the mini supplement on the 'Patients Voice', I looked back into the past and made some brief speculations about what the next thousand years might bring. There is no doubt that epilepsy is moving forward; we have gained a great deal of knowledge in the last 10–20 years about its aetiology and its mechanisms, about how the epileptic brain differs from the non-epileptic brain, about how to investigate it and how to treat it. Molecular genetics in particular is offering us an insight into brain mechanisms which will be profound and which will probably radically change the way we manage and conceptualize epilepsy. There is no doubt, too, that there have been recent changes in social attitudes to epilepsy; on the whole, it is less stigmatized and less stigmatizing. People with epilepsy themselves— particularly those who have just acquired it—are more positive in their attitude towards it. And yet, and yet, we still have so much to do. The more we learn the less we know: the more we learn from research, the more new questions are thrown up. In some ways the more we understand the causation and mechanisms of epilepsy, the more difficult is seems to try to explain to people with epilepsy what is actually going on in their brains. (How simple to explain was the old simile—extant in my youth—of the disordered telephone exchange—and how wrong!) Despite all the promise of new medication, new understandings of mechanisms and new surgery, we still seem to see the same number of patients in the clinic whose epilepsy has not got better and who continue to be troubled by seizures. It is right to be optimistic: it is right to be able to say to people in the clinic 'Well I don't have the answer for you now but I know that within 5 or 10 years we probably will'. However, epilepsy will be around for a long time to come—that is a fairly safe prediction. In my Presidential address to the Millennium Conference of the British Branch of the International League Against Epilepsy (last century, 1999), I made some light-hearted predictions about the future of epilepsy care extrapolating from our present knowledge and our present Government's views on, and attitudes to, health care. I forecast …