Epilepsy is a neurological disorder characterized by the recurring presence of unprovoked seizures. For many people diagnosed with this condition, particularly those with childhood-onset forms, achieving long-term seizure freedom is a realistic goal. This outcome, often described colloquially as “growing out of it,” represents a significant shift in a person’s prognosis and quality of life. The likelihood of this positive turn depends on the specific type of epilepsy and individual patient characteristics.
Defining Remission and Seizure Freedom
The concept of “growing out of” epilepsy is formally addressed in medicine through the terms “remission” and “resolved.” Seizure remission is generally defined as a prolonged period without any seizures, typically achieved with the help of anti-seizure medication (ASM). In many clinical studies, two years of uninterrupted seizure freedom is often used as a benchmark for remission. This designation suggests that the condition is controlled, but it does not declare the disorder permanently gone.
The International League Against Epilepsy (ILAE) provides a more definitive term, considering epilepsy “resolved” under specific conditions. Epilepsy is considered resolved for individuals who had an age-dependent syndrome but are now past the applicable age where seizures typically cease spontaneously. The condition is also deemed resolved if an individual has been seizure-free for ten years, with the last five years of that period being completely off all anti-seizure medications. This distinction is important because while remission is common—with up to 70% of people eventually achieving seizure freedom—a complete cure, where the underlying predisposition is entirely gone, is a rare declaration.
Epilepsy Syndromes Commonly Outgrown
Certain epilepsy syndromes, particularly those that begin in childhood, are known as self-limited or age-dependent, meaning they have a high probability of spontaneous resolution as the child matures. Childhood Epilepsy with Centrotemporal Spikes (CECTS) is the most common of these self-limited syndromes, accounting for about 15% of all childhood epilepsies. The seizures in CECTS typically involve twitching or numbness of the face, tongue, or throat, often occurring during sleep. Children with this syndrome usually stop having seizures by adolescence, often between 12 and 15 years of age.
Childhood Absence Epilepsy (CAE) is another age-related syndrome with a favorable prognosis, characterized by brief episodes of staring or unresponsiveness. The seizures in CAE usually begin between the ages of four and ten and often resolve by late adolescence. These age-dependent epilepsies are distinct from structural or genetic epilepsies, where the underlying cause creates a chronic predisposition for seizures. The spontaneous resolution in age-dependent syndromes is related to the maturation of the central nervous system, which naturally suppresses the seizure-generating activity.
Clinical Predictors of Long-Term Remission
Beyond the specific epilepsy syndrome, several clinical characteristics can predict a favorable long-term outcome and the likelihood of sustained remission.
Baseline Status
A strong predictor of better prognosis is a normal neurological examination and normal cognitive development at the time of diagnosis. Normal results on brain imaging, such as an MRI or CT scan, suggest the absence of a structural cause for the seizures, which is associated with better remission rates.
Treatment Response
The patient’s response to the initial treatment is also a powerful indicator of future success. Individuals who achieve seizure control quickly and effectively with a single anti-seizure medication (monotherapy) have a much higher probability of long-term remission. Conversely, a high frequency of seizures before treatment, the need for multiple medications, or a history of status epilepticus are all factors associated with a lower chance of achieving sustained seizure freedom. Specific electroencephalogram (EEG) patterns, particularly the normalization of the EEG over time, further suggest a trajectory toward eventual medication discontinuation.
The Process of Stopping Medication
The decision to discontinue anti-seizure medication is a careful, shared process between the patient, their family, and a neurologist. It is typically considered only after a patient has been seizure-free for a substantial period, commonly two to five years. The specific duration often depends on the patient’s individual risk factors, such as the initial type of epilepsy and any abnormal findings on their EEG.
Once the decision is made, the medication must be withdrawn gradually, a process known as tapering, which can take several months. This slow reduction minimizes the risk of withdrawal symptoms and reduces the chance of a sudden seizure recurrence, which is most likely to happen within the first six to nine months after stopping the medication. Patients must never abruptly stop taking ASMs without medical supervision, as this carries a significant risk of withdrawal seizures or a life-threatening condition called status epilepticus. Even after successful withdrawal, a risk of seizure recurrence remains.