Before the first seizure: The developmental imprint of infant epilepsy on neurodevelopment

Epilepsy and neurodevelopment in infants are undergoing extensive research. In terms of this link, the International League Against Epilepsy recognizes two broad categories: developmental encephalopathy with epilepsy (DEE) and epileptic encephalopathy (EE). An epileptic encephalopathy is a developmental disorder mainly caused by visible aspects of epilepsy (seizures, electroencephalogram abnormalities, treatment). Controlling this visible part of the epilepsy allows for return to a normal or previous developmental trajectory. In contrast, the cause of the encephalopathy plays a major role in the occurrence of the neurodevelopmental disorder in DEE. Symptoms of epilepsy aggravate the condition, but they do not explain it or explain only a small composent [1], [2].

More generally, seizure frequency, drug resistance, and neurodevelopmental disorders are significantly linked in infantile epilepsies [3]. For example, when focal epilepsy begins before age five, children are more likely to have neurodevelopmental problems. It is correlated with the frequency of seizures, with drug resistance, and with treatment. These are three elements that are directly associated with the visible manifestations of epilepsy [3].

Despite the fact that these definitions are consistent with the complex relationship between infantile epilepsy and development, they do not provide a monolithic view of it. In fact, we do not know why, in some cases, the visible part of epilepsy plays an important role in neurodevelopmental disorders, while in others, it plays a much less important one.

Our review outlines the work that has established the concept of developmental encephalopathy with epilepsy, as well as the concept of encephalopathic action of epilepsy in infants. We will look at some factors that may explain why we have difficulty determining whether seizures, electroencephalograms, treatments, etiology and other factors contribute to the developmental disorder. Using the developmental imprint of epilepsy as a developmental disorder of brain activity, we propose a model linking epilepsy and development in children.

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