Purpose of review: The possibility that recurrent seizures in patients with poorly controlled epilepsy may produce neuronal damage and contribute to progressive functional and cognitive declines observed in some patients with epilepsy has major clinical and therapeutic implications for urgency of treatment and effective intervention to achieve complete control.
Recent findings: Advances in magnetic resonance imaging techniques, technical and conceptual advances in experimental analysis of neuronal death at the cellular and molecular level, and long-term neuropsychological observations have provided substantial new data and insights into phenomena of seizure-induced plasticity in neural circuitry that address the question "Do epileptic seizures damage the brain?"
Summary: The emerging perspective is that seizure-induced damage should be regarded not only as neuronal loss but as adverse long-term behavioral and cognitive consequences. This perspective provides a strong rationale for development of neuroprotective treatments to forestall adverse long-term consequences of repeated seizures, and for the importance of prompt, effective intervention that achieves complete seizure control.