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Volume 10 Issue 5, May 2014

Cover image supplied by Carlos Barcia at the Institute of Neuroscience and School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. Glial network in the human cortex. Astrocytes with their long processes are immunostained with GFAP antibodies, and microglia with their shorter processes are visualized with IBA1 antibodies. Glial cells form an extensive and uniform network along the brain parenchyma that is crucial for the correct functioning of the CNS. Research on glial cells provides important insights into the pathogenesis of many neurodegenerative diseases and neurological disorders.

Research Highlight

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Addendum

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Research Highlight

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In Brief

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Editorial

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News & Views

  • Dominant mesial temporal lobe resection for pharmacoresistant epilepsy is frequently associated with verbal memory impairment. More-extensive lesioning improves seizure outcome, but further compromises memory. A better understanding of ipsilateral neural structures and networks for verbal memory could improve selectivity of surgical ablation, thereby holding promise for seizure-freedom without memory impairment.

    • Michael Duchowny
    • Sanjiv Bhatia
    News & Views
  • Responsive neurostimulation (RNS) is an exciting new approach to treating refractory epilepsy. A recent 2 year follow-up study indicates that long-term RNS treatment is safe, and that efficacy improves with time. Although several issues remain to be resolved, RNS is a welcome new arrival in the armamentarium of epilepsy treatments.

    • Elinor Ben-Menachem
    • Gregory L. Krauss
    News & Views
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Review Article

  • Wilmshurst et al. discuss how appropriate terminology can aid in the diagnosis and treatment of paediatric epilepsies. Furthermore, they give an update on key changes to the organization and terminology of epilepsies by the International League Against Epilepsy and an overview of the challenges in implementing new guidelines to treat paediatric patients particularly in low-income countries.

    • Jo M. Wilmshurst
    • Anne T. Berg
    • J. Helen Cross
    Review Article
  • The use of deep brain stimulation as a treatment for various refractory neurological disorders is increasing—perhaps faster than our understanding of this surgical technique. Electrical neuromodulation has been explored in people with epilepsy since the 1950s, and stimulation sites, parameters and results have varied. In this article, Fisher and Velasco review the use of neurostimulation as a treatment for epilepsy, from early experiments in animal models and humans to recent randomized controlled trials.

    • Robert S. Fisher
    • Ana Luisa Velasco
    Review Article
  • Sudden unexpected death in epilepsy (SUDEP) is cited as the cause of nearly 2,000 deaths per year in the USA alone, and accounts for as many as 15% of epilepsy-related deaths. Controversy prevails over the relative contributions of cardiac failure and respiratory arrest to SUDEP. Here, the authors discuss the mechanisms that cause cardiac, respiratory and arousal abnormalities during the ictal and postictal periods, and highlight possible preventive interventions that might reduce the risk of SUDEP.

    • Cory A. Massey
    • Levi P. Sowers
    • George B. Richerson
    Review Article
  • The aetiology of most epilepsies used to be regarded as unknown, but in the past few years, massively parallel gene-sequencing techniques and clinical genetic studies have revealed that many forms of epilepsy—including those formerly labelled as idiopathic or acquired—are likely to have a genetic basis. Increased understanding of the genetic architecture of epilepsies has important implications for genetic testing, treatment selection and counselling. Furthermore, understanding the genetic background of epilepsies can guide neurobiological research for novel therapies.

    • Rhys H. Thomas
    • Samuel F. Berkovic
    Review Article
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Opinion

  • Genetic testing has the potential to revolutionize care for individuals with epilepsy, but its advent is bringing to light important new issues, particularly surrounding the benefits and risks of testing, and the optimal provision of genetic services. Poduri and colleagues describe these challenges, and call for mechanisms to be established to address them.

    • Annapurna Poduri
    • Beth Rosen Sheidley
    • Ruth Ottman
    Opinion
  • Kullmann et al. discuss the need for gene therapy in epilepsy and the challenges of translating experimental research into the clinic. Furthermore, they outline the potential for gene therapy strategies in pharmacoresistant epilepsy, ways to assess therapeutic efficacy, and the need to evaluate long-term safety data.

    • Dimitri M. Kullmann
    • Stephanie Schorge
    • Robert C. Wykes
    Opinion
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Focus

  • Treatment-resistant epilepsy remains a major burden at both global and individual levels. About 1% of individuals have epilepsy and, in over one-quarter of patients, antiseizure medications do not provide sufficient seizure control, which can result in dramatically impaired quality of life and increased mortality. In this special focus issue on epilepsy, cutting-edge investigators from around the world highlight the important challenges and progress in epilepsy research and clinical practice. The topics in this issue include global challenges in paediatric epilepsy, the genetic background of the epilepsies and its implications for genetic diagnosis and personalized medicine, prospects for gene therapy in epilepsy, brain stimulation in refractory epilepsy, and mechanisms of sudden unexpected death in epilepsy.

    Focus
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