Vision and ambition
Epilepsy still poses major challenges. The clinical management of seizures has advanced in the last 100 years due to pharmacological advances and the deployment of surgery. The understanding of aetiology has improved with imaging and genomics. In the future, genome-wide scanning will further advance the elucidation of epilepsy.
It is unrealistic, however, to assume that genomics alone will clarify the causality or architecture of the multiple causes of seizures. Investigative tools like state-of-the-art neuroimaging, various modalities of physiological testing, as well as basic sciences, translational and clinical facilities will also be required. Genomics will be the cornerstone of a rational approach to diseases, which will be defined by their pathophysiological underpinnings. This requires moving beyond a single-condition-oriented focus towards a systems approach.
Complex system interactions are increasingly emerging; the emphasis moves away from the individual molecule, gene or disease. Genomic findings need to be interpreted and understood in terms of functionality and interactions. A strong basic research environment is essential before these findings can be translated into providing personalised treatment for each individual.