EPILEPSY: THE FACTS-THE LONG-TERM OUTLOOK
Many patients, family doctors, and even paediatricians and neurologists, are remarkably pessimistic about the likelihood of seizures stopping—a pessimism which is unjustified by the facts. Pessimism stems from hospital experience. In the past, when neurologists were fewer on the ground, they tended to see only those with the worst epilepsy with the worst prognosis. As they taught the future family doctors, these too were infected with the same pessimism.
What are the facts? The first point to define is what we mean by remission or cessation of seizures. Epilepsy was defined as a ‘continuing tendency to epileptic seizures’. A liability to have a seizure, or a lower than average epileptic threshold, probably does continue throughout life as part of one’s genetic inheritance. A man aged 30, who had some seizures in his teens, cannot be said to be entirely free from the risk of a further seizure right until the end of his life—but his risk may have declined so that it has become, at the age of 30, only a little greater than that of the general population. Regardless of this philosophical discussion, what a person with epilepsy wants to know is whether, for all practical purposes, the seizures will stop. A remission, therefore, can be defined as a certain period free from seizures. The good evidence about the chances of achieving a good long time free from seizures, and, for all practical purposes, permanent freedom, comes from the work in Olmstead county, USA, is redrawn from this study. The upright line on the graph indicates the cumulative chance of achieving a remission of at least five years. It can be seen that, at one year after diagnosis, 42 per cent of the patients had entered a seizure-free period that was to extend for at least five years. The probability of being in remission currently (five years or more and continuing), was 61 per cent at 10 years after diagnosis and 70 per cent at 20 years after diagnosis. The difference between the top two curves represents the small numbers of patients who have one long remission of at least five years with subsequent relapse. The bottom curve refers to those patients in remission without drugs. Data from the National General Practice Study on Epilepsy is very similar. At six years after a seizure of any type (excluding acute symptomatic and single seizures) 92 per cent of people had achieved a remission lasting at least one year, 67 per cent lasting at least three years, and 42 per cent a remission lasting at least five years—this last figure being identical to that from Olmstead County. This latter study has followed up people for rather longer than the UK study, and 20 years after the diagnosis of epilepsy, about 30 per cent of patients continued to have seizures, 20 per cent continued to take anticonvulsant medication but had been free from seizures for at least five years, and about 50 per cent had been free from seizures without anti-epileptic medication for at least five years.
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