Yasuko Yamatogi and Shunsuke Ohtahara

Most of the epilepsy has long been believed to commence in childhood and thereafter decline with age. However, in developed countries increased incidence of epilepsy in the elderly has been reported with the progressive aging of the popula-tion,1,2 whereas that in childhood has decreased nearly by 40%.3 Two incidence peaks early in the childhood and in the senescence over 60 years of age has been ob-served.3,4 When compared to developed countries the incidence of epilepsy in childhood in developing countries is higher by a factor of 20 to 50%.5-8 Similarly the reported prevalence rates are also one-and-half to three times higher, 3.5 to 17 per 1000 population.7,8 The increased incidence of epilepsy in childhood in developing countries has been attributed to higher incidence of pre and perinatal acquired brain injury, endemic infections of central nervous system (CNS), and poor socio-economic conditions prevailing in these countries.9,10

Etiologically, pre and perinatal factors are involved in the majority of children with epilepsy. Those with onset in adolescence or later life may have causative factors in early stage of life, but it is often difficult to confirm pre and perinatal events precisely. Until recently, causes of perinatal brain damage are considered more important than prenatal factors. However, technological advances in neuroimaging and molecular genetics have attracted the attention of prenatal causes. Even in those with brain damages supposedly caused by neonatal asphyxia, not a few may be vulnerable to perinatal distress because of prenatal cerebral dysgenesis.

In this chapter, pre and perinatal acquired causes of epilepsy with special reference to developing countries are discussed.

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