Childhood epilepsy is a neurological condition marked by recurrent seizures, sudden bursts of abnormal electrical activity in the brain. It is the most common brain disorder affecting children in the United States, impacting nearly 470,000 individuals under 18. Epilepsy can manifest with various seizure types, ranging from temporary confusion or staring spells to uncontrolled muscle movements. This article explores factors influencing whether childhood epilepsy can return in adulthood.
Understanding Childhood Epilepsy Remission
Many children diagnosed with epilepsy achieve remission, often described as “outgrowing” the condition. Remission means a child has stopped experiencing seizures and may eventually discontinue anti-seizure medication. Approximately two-thirds of children with epilepsy will outgrow the condition by their teenage years or early twenties.
Remission criteria typically involve being seizure-free for several years and potentially being off medication for a defined duration. The International League Against Epilepsy (ILAE) suggests “resolution” of epilepsy includes being seizure-free for 10 years and medication-free for at least 5 years. While many children achieve long-term seizure freedom, seizures can sometimes return days, months, or even years later, even after medication has been stopped.
Key Factors Influencing Recurrence
The likelihood of childhood epilepsy returning in adulthood is influenced by several factors, including the specific type of epilepsy and underlying brain abnormalities. Some epilepsy types have a more favorable prognosis for remission, while others carry a higher recurrence risk. For instance, benign rolandic epilepsy and childhood absence epilepsy often resolve by adulthood, with up to 90% of children with childhood absence epilepsy becoming seizure-free as adults. In contrast, symptomatic epilepsies, stemming from known causes like brain injury, or certain genetic epilepsies, tend to have higher recurrence rates and may persist into adulthood.
Structural brain lesions or genetic abnormalities can significantly increase the risk of seizures returning. Patients with identified structural abnormalities have a higher chance of recurrence. Conversely, children without a known cause for their epilepsy, a normal neurological exam, and normal EEG results have a better chance of achieving seizure freedom.
The duration of remission also plays a role in predicting recurrence; a longer seizure-free period often correlates with a lower recurrence risk. The risk of relapse decreases over time, especially after several years of being seizure-free and medication-free. Additionally, the age at which epilepsy began can influence the prognosis, with an older age at onset potentially associated with a poorer chance of achieving complete remission.
Adherence to prescribed treatment during the initial phase of epilepsy management is important. Poor adherence to anti-seizure medication is a common reason for persistent or recurrent seizures and can lead to breakthrough seizures even after long periods of control. A family history of epilepsy can moderately increase the risk of recurrence, indicating a potential genetic predisposition.
Recognizing Recurrence and Next Steps
Recognizing the signs of epilepsy recurrence in adulthood is important, as seizure manifestations can differ from those experienced in childhood. Symptoms may include temporary loss of awareness, uncontrolled muscle movements, staring spells, or confusion. Some adults might experience subtle signs like repetitive lip smacking, hand movements, or brief jerking. Seizures can also manifest as changes in sensation, emotions, or even a sudden, unexplained fall.
If a recurrence of seizures is suspected, seeking prompt medical evaluation is the next step. Consulting a neurologist or healthcare provider is important for an accurate diagnosis and to determine the best course of action. The medical professional will assess changes in seizure patterns, any new symptoms, and review the individual’s medical history. If recurrence is confirmed, a new, tailored treatment plan will be developed, which may involve medication adjustments or exploring other therapeutic options.