Prognostic Studies

Recent prospective and population-based studies have challenged previous views that epilepsy is likely to be a chronic disease in as many as 80% of cases. In a population-based survey in Rochester, 20 years after the initial diagnosis of epilepsy 70% of patients were in 5 years of remission and 50% of patients had successfully withdrawn medication. In an English study, 15 years after diagnosis 81% of patients were seizure free for at least 1 year. In another study of 104 patients who were followed up after onset of treatment, 60% were in 1-year remission after a follow-up period of 24 months. By 8 years of follow-up, 92% had achieved a 1-year remission. It is recommended that antiepileptic drugs be withdrawn after a minimum seizure-free period of 2 years or 5 years in severe cases. Relapses occur in 12-72% of patients after a 2-year remission and in 11-53% after a 3-year remission.

Approximately 5-10% of all patients with epilepsy eventually have intractable seizures despite optimal medication; most of these patients have complex partial seizures. Despite the overall favorable prognosis of epilepsy and the good response to treatment, the mortality rate of epilepsy is 2.3-fold higher than that in the general population, and it is 3.8-fold higher in the first years of the illness. The incidence of sudden unexpected death in epilepsy was estimated to be in the order of 1/525.

The prognosis of epilepsy largely depends on the syndromatic diagnosis. Idiopathic localization-related epilepsies such as Rolandic epilepsy have an excellent prognosis in all respects. Prognosis in terms of seizure remission, social adjustment, and life expectancy, on the other hand, is extremely poor in symptomatic generalized epilepsies such as West syndrome and in progressive myoclonic epilepsies.

Several studies have examined prognostic factors independent of the syndromatic diagnosis. Most studies have consistently shown that diffuse cerebral damage and neurological and cognitive deficits are associated with a poor outcome. There has been less agreement on the significance of other possible risk factors for poor prognosis, such as EEG features and positive family history of epilepsy. Whether early treatment and medical prevention of seizures improves the long-term prognosis as suggested by Gowers and indicated by experimental data from animal epilepsy models is not clear and subject to controversy. A recent Italian study showed that the treatment prognosis risk after a first seizure is not lower in patients treated with antiepiletic drugs (AEDs) compared to patients not treated after a first seizure.

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