Epilepsy - Outlook and Effects

Highlights	Diagnosis	Surgery
Introduction	Treatment	Lifestyle Changes
Causes	Long-Term Treatment	Resources
Outlook and Effects	Medications	References

Outlook and Effects

General Outlook for Patients with Epilepsy

Most patients can control their seizures with a single drug and stop drug treatment completely after two seizureless years. In fact, the sooner patients achieve remission using an anti-epileptic drug (AED), the better their chances for remaining seizure-free in the future. If epilepsy is not effectively treated, and if the patient has continuing seizures, changes in the neurons may eventually cause intractable, or refractive, epilepsy. This type of epilepsy is hard to control. Early treatment is extremely important.

text continues below

Effects of Epileptic Seizures on the Brain. Some studies have reported changes in brain structures in epileptic patients, but it is unclear if such changes are a cause or result of seizures. A reassuring 2003 study found no indication that seizures cause any progressive abnormalities in the brain. However, a 2005 study suggested that people with a history of epilepsy have a higher risk of later developing schizophrenia or schizophrenia-like psychosis.

Acute Repetitive Seizures. Some patients occasionally experience seizures called acute repetitive, serial, or cluster seizures; these are two or more seizures occurring over minutes to hours separated by periods of consciousness. Left untreated, they can develop into status epilepticus, a very serious condition.

Status Epilepticus. Status epilepticus is a serious, potentially life-threatening condition that can lead to chronic epilepsy. It occurs in 100,000 to 150,000 people in the US each year, over half of whom are children. Permanent brain damage or death can result if the seizure is not treated effectively; the longer the seizure lasts, the greater the danger. Mortality rates from this condition are about 10%. (This high mortality rate is most likely due to a high incidence of myoclonic SEs in elderly adults after cardiac arrest. One study reported much lower mortality rates from SE when cardiac arrest in elderly epilepsy patients is excluded.)

The condition is often defined as recurrent convulsions that last for more than 20 minutes and are interrupted by only brief periods of partial relief. Some experts believe these criteria are too strict, and that the condition should be diagnosed if seizures last at least five minutes or more, or when the patient does not fully recover consciousness between two or more seizures. Although any type of seizure can be sustained or recurrent, the most serious form of status epilepticus is the generalized convulsive or tonic-clonic type. In more than a third of cases, status epilepticus occurs with the first seizure. The trigger is often unknown, but can include the following:

Failure to take anti-epileptic medications (makes up about a third of status epilepticus events).
Abrupt withdrawal of certain anti-epileptic drugs, particularly barbiturates and benzodiazepines.
High fever.
Poisoning.
Electrolyte imbalances (imbalance in calcium, sodium, and potassium).
Cardiac arrest.
Stroke. In one study, about 9% of stroke patients with seizures had status epilepticus, which resulted in higher disability after the stroke, particularly if these severe seizures occurred within a week of the stroke.
Low blood sugar in people with diabetes.