Prognosis A The Natural Course of Epilepsy

The natural course of untreated epilepsy is unknown. For obvious ethical reasons no one has ever conducted a controlled study, and there are no systematic data from the days before antiepileptic drugs were introduced. Nineteenth century epileptologists emphasized the poor prognosis in epilepsy, but their experience was limited to institutionalized patients. Gowers (1885) believed that seizures may beget more seizures: "The tendency of the disease is to self-perpetuation, each attack facilitates the occurrence of another, by increasing the instability of nerve elements.'' Gowers studied the recurrence of seizures in 160 cases. A second seizure followed the first within 1 month in one-third of patients and within 1 year in two-thirds.



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