Epileptogenesis meets Occam's Razor

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HIGHLIGHTSSignificant confusion surrounds the definition of the term “epileptogenesis.”Two distinct processes initiating and modifying the epileptic state are proposed.The terms “epileptogenesis” and “epileptometagenesis” are proposed for the development and progression of the clinical state, respectively.The “therapeutic window” may only be open for a brief period, as in stroke therapy.Pharmacological treatment to prevent brain injury-induced temporal lobe epileptogenesis has been generally unsuccessful, raising the issues of exactly when the conversion process to an epileptic brain state occurs and reaches completion, and which cellular or network processes might be the most promising therapeutic targets. The time course of epileptogenesis is a central issue, with recent results suggesting that injury-induced epileptogenesis can be a much more rapid process than previously thought, and may be inconsistent with a delayed epileptogenic mechanism. Simplification of the seemingly complex issues involved in the use of epilepsy animal models might lead to a better understanding of the nature of injury-induced epileptogenesis, the significance of the ‘latent’ period, and whether current strategies should focus on preventing or modifying epilepsy.

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