The natural history of epilepsy: an epidemiological view
Better information of the natural history of epilepsy has important implications for understanding the underlying neurobiology, evaluating treatment strategies, and planning healthcare resources. The traditional pessimistic view has been dispelled by results from modern community based prospective s...
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Published in | Journal of Neurology, Neurosurgery and Psychiatry Vol. 75; no. 10; pp. 1376 - 1381 |
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Main Authors | , |
Format | Journal Article Book Review |
Language | English |
Published |
London
BMJ Publishing Group Ltd
01.10.2004
BMJ BMJ Publishing Group LTD BMJ Group |
Subjects | |
Online Access | Get full text |
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Summary: | Better information of the natural history of epilepsy has important implications for understanding the underlying neurobiology, evaluating treatment strategies, and planning healthcare resources. The traditional pessimistic view has been dispelled by results from modern community based prospective studies, showing that over 60% of newly diagnosed patients will enter remission upon treatment. Recent outcome studies suggest that medical intractability may be predicted after failure of two antiepileptic drugs. Poor prognostic factors include a high initial seizure density, symptomatic aetiology, and presence of structural cerebral abnormalities, all of which can be identified early on. Among patients who have entered remission, many will remain seizure-free after antiepileptic drug treatment is withdrawn, suggesting that the underlying seizure generating factor has remitted. Whether some of these patients have entered remission “spontaneously” is contentious because, with effective pharmacotherapy for epilepsy in use for over 100 years, the natural history of untreated epilepsy is largely unknown. Circumstantial evidence, mostly arising from resource poor countries where antiepileptic drug treatment is not readily available, indicates that spontaneous remission may occur in up to 30% of cases. Observations from these complementary sources suggest that, at the population level, prognosis of newly diagnosed epilepsy may be broadly categorised into three groups: remission without treatment, remission with treatment only, and persistent seizures despite treatment. As understanding of the prognostic factors improves, the potential of a “prognostic group specific” management approach should be explored so that effective treatments may be used in a more rational and targeted fashion. |
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Bibliography: | ark:/67375/NVC-MSDNJMXT-Z istex:19BC9596206FDF8AE60C5CA4FB1F3721BA1563B1 local:0751376 href:jnnp-75-1376.pdf Correspondence to: Professor J W Sander Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG; lsander@ion.ucl.ac.uk PMID:15377680 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 ObjectType-Feature-3 ObjectType-Review-1 |
ISSN: | 0022-3050 1468-330X |
DOI: | 10.1136/jnnp.2004.045690 |