Some Aspects of Prognosis in the Epilepsies: A Review

Abstract

The traditional view that epilepsy is usually a chronic condition in which the prognosis is consistently poor has been challenged in the last 2 decades. Evidence from population-based studies and from intervention studies in newly diagnosed patients has produced a wealth of information of a much better prognosis. It is now generally accepted that as many as 70-80% of people developing seizures for the first time will eventually achieve terminal remission, whereas the remaining 20-30% will continue to have recurrent seizures despite all treatment. Despite the high recurrence rate after a first epileptic seizure, remission usually occurs early and for most persons, epilepsy is a short-lived condition. The exact role of antiepileptic drugs (AEDs) in this good outcome, however, remains open to debate, because the natural history of the untreated condition is largely unknown. In this article, factors that may influence the prognosis of the epilepsies, including the problems of diagnosis, are reviewed. Special emphasis is given to the issue of spontaneous remission and the question of prognosis of different epileptic syndromes.

Seizures and disturbed brain potassium dynamics in the leukodystrophy megalencephalic leukoencephalopathy with subcortical cysts

“…An estimated 75% of all MLC patients experiences at least one seizure and 63% of patients older than 6 years has been diagnosed with epilepsy, which is in line with previous reports,12, 35 and confirms that epilepsy is common in MLC. Epilepsy in MLC patients is mostly well controlled with medication compared to the general epilepsy population (only 14% had moderately to poorly controlled epilepsy versus 20–30% of general epilepsy patients) 36, 37. However, occurrence of status epilepticus is high (∼17%) compared to the overall occurrence reported for children and adults with epilepsy during follow‐up (∼10%),38, 39 indicating that once seizures are initiated, restoring neuronal network activity to its normal state is hampered in MLC.…”

Placement of Deep Brain Electrodes in the Dog Using the Brainsight Frameless Stereotactic System: A Pilot Feasibility Study

“…Although antiepileptic drugs (AEDs) continue to form the cornerstone of epilepsy treatment in this species, up to 25% of epileptic dogs remain refractory to medication 6. This compares to a similar proportion in the human epileptic population, among whom approximately one third continue to suffer seizures despite medication 7. For a subset of human patients with hippocampal sclerosis, resection of the mesial temporal lobe will result in a reduction in seizure frequency of 80–90%, but for many patients this is inappropriate because of the location of the seizure focus, unacceptable adverse effects such as memory impairment, or multiple seizure types 8.…”

Prevalência da epilepsia entre os índios Bakairi do estado do Mato Grosso, Brasil

“…Era de se esperar que a prevalência de epilepsia entre os Bakairi estivesse abaixo da encontrada nos países em desenvolvimento, portanto mais próxima à dos países desenvolvidos, mesmo levando-se em conta o viés metodológico inerente a amostragens pequenas 31 . Essa referida expectativa deve-se aos seguintes fatos: a população estudada tem assistên-cia de saúde pública satisfatória, serviços de assistência de natalidade e puericultura; população jovem (idade média de 25,5 anos, com o primeiro quartil em 10 e o terceiro em 37,5 anos), reduzida população de idosos (menos de 2,5% pessoas acima de 70 anos); ausência de acidentes de trânsito e sem guerras tribais há mais de 40 anos como causa de traumatismos cranianos; pelo fato de não haver culturalmente o hábito de se criar porcos para alimentação entre esse povo, a neurocisticercose não constitui fator de risco para a epilepsia como acontece nos estados ao sul do Brasil, segundo Bittencourt et al 8 .…”

“…Estudos em comunidade indígena, por outro lado, abrem a possibilidade de se abordar pessoas epilépticas virgens de tratamento medicamentoso, o que não acontece nas demais comunidades tidas como civilizadas, propiciando o conhecimento sobre evolução natural dessa doença conforme Sander tem alertado 31 . De qualquer forma, o estudo apresentou benefício imediato à população estudada, uma vez que dois índios sem diagnóstico de epilepsia foram diagnosticados e medicados, e o medicamento foi prontamente disponibilizado pelo Instituto Trópicus.…”