Commentary on Asato et al., "Epilepsy and comorbidities--what are we waiting for?".

The neuropsychiatric comorbidities of the epilepsies impact longterm outcomes of childhoodand adolescent-onset epilepsies more so than seizures themselves. This point begs for an answer to the question that entitles the article by Drs. Asato, Caplan, and Hermann of “Epilepsy and comorbidities—What are we waiting for? [1]” Health-care decision-makers must recognize that the patient is not adequately treated if the comorbidities are not treated. The communities of those affected by tuberous sclerosis complex (TSC) and many other rare disorders associated with epilepsies are acutely aware of the need for integrated and coordinated care. However, we have yet to find an ideal solution, and lack of comprehensive care is not unique to TSC or even the epilepsies in general. Neurologists, cardiologists, and oncologists, for example, know the importance of neuropsychiatric and behavioral intervention when treating stroke, cardiovascular disease, cancer, and the like. Yet, as the authors describe, the health-care system remains fragmented for a variety of reasons. To adequately treat the patient, we need to understand the biology driving seizures and the comorbidities. The bidirectional relationship appears unrelated to the severity of seizures or the associated epilepsy syndrome, if any. Therefore, there may be advantages to using certain syndromes or disorders as “model systems” inwhich the interindividual variability in underlying biologymay be lower because of shared genetics and biological pathways. For example, TSC is caused by mutations in one of two genes, TSC1 or TSC2, which encode proteins that regulate