Evidence-based review on the natural history of the epilepsies

: Schmidt Dieter, Sillanpää Matti

Publisher: Wolters Kluwer Health | Lippincott Williams & Wilkins

: 2012

: Current Opinion in Neurology

: 2

: 25

: 2

: 159

: 163

: 5

: 1350-7540

DOI: https://doi.org/10.1097/WCO.0b013e3283507e73

Purpose of review

The present review discusses clinically important evidence for unstable remission/relapse patterns and for

causes of premature mortality in patients with epilepsy.

Recent findings

Although two of three patients become seizure-free with antiepileptic drugs (AEDs), as many as 20–40% of

newly diagnosed patients with epilepsy become seizure-free without or with minimal AED treatment. Sadly,

the proportion of those not becoming seizure-free despite treatment does not seem to have improved

substantially over the past 50 years. There is emerging evidence that natural history of epilepsies is more

complex than previously thought. Although two-thirds of patients follow stable patterns, that is, become

seizure-free early and remain seizure-free (48%), or have refractory epilepsy all their life (19%), one in

every three patients has an unstable course of epilepsy. Patients with an unstable course will either enter

remission only after many years of having seizures (19%) or will relapse despite continued treatment

(14%). Remote symptomatic epilepsy carries the highest risk of premature mortality. It remains unclear,

however, why sudden unexplained death occurs more often in adults than in children and controversy

exists whether entering remission prevents premature mortality.

Summary

Studies of the natural history of newly diagnosed epilepsy show unexplained fluctuations of remission and

relapse in as many as one in three patients and, sadly, no substantial improvement of epilepsy treatment in

the past 50 years. The premature mortality of epilepsy is high and more work is needed to prevent it.