The temporal aspects of prognosis in epilepsy

A major reason for the conflicting views concerning prognosis in epilepsy has been the failure to account for the temporal aspects of seizure relapse and remission. In this paper prognostic studies in a variety of areas are reviewed to emphasise this point. Most traditional studies (including studies of withdrawal of medication) show a generally poor prognosis for epilepsy. These have been hospital-based and, as such, inevitably over-represent patients with chronic epilepsy. Investigations (both hospital and community based) of patients from the onset of seizures show a much better prognosis, and most patients suffer only a small number of seizures in total over a relatively short period of time and then remit. The longer the epilepsy is active the less likely is eventual remission, but once remission is achieved it is usually permanent. The traditional view of epilepsy as a chronic condition with a continuing tendency to relapse is therefore not tenable for the majority of patients. The patterns of epilepsy are established relatively early in its course in most cases, and long term prognosis might therefore be predictable within a few years of the onset of seizures in most patients. Prior to the introduction of effective treatment, it was said that epilepsy rarely remitted, and it is possible that early treatment may actually improve long term prognosis.