Does epilepsy ever truly go away? For many, achieving a state where seizures stop is a real and attainable outcome. This article explores epilepsy remission, the factors that influence it, and what living with epilepsy entails.
Understanding Epilepsy Remission
Epilepsy can enter a state known as remission, meaning seizures have ceased for a significant period. Long-term remission often involves being seizure-free for two to five years, sometimes even after discontinuing anti-seizure medication.
Remission is distinct from a “cure,” as the underlying predisposition to seizures may still exist. A significant portion of people with epilepsy achieve remission; studies suggest 50-70% of children and 30-50% of adults with newly diagnosed epilepsy may experience it.
Remission offers a significant improvement in quality of life. However, it does not mean medication can be stopped without medical guidance. The decision to withdraw medication is a careful process, always undertaken under the supervision of a neurologist.
Factors Influencing the Likelihood of Remission
Several variables influence the probability of achieving epilepsy remission. The specific type of epilepsy syndrome plays a role; certain syndromes, such as childhood absence epilepsy or benign rolandic epilepsy, often resolve by adolescence.
The underlying cause also impacts remission. Idiopathic epilepsy, with no known cause, generally has a better outlook than symptomatic epilepsy, which stems from brain injury, abnormality, or genetic mutation.
Epilepsy onset in childhood often has a greater chance of remission than in adulthood, partly due to more responsive syndromes prevalent in younger populations. How an individual responds to initial treatment also influences remission.
Quick and effective seizure control with the first anti-seizure medication increases the likelihood of maintaining remission. Conversely, if seizures are difficult to control from the outset, the path to remission may be more challenging.
The specific seizure type and frequency affect prognosis. Generalized absence seizures, for example, may have a better prognosis than certain focal seizures, which can be more resistant to treatment.
Managing Epilepsy When Remission Isn’t Achieved
When long-term remission is not achieved, epilepsy management focuses on optimal seizure control and enhancing quality of life. For individuals with drug-resistant epilepsy, where seizures are not adequately controlled by initial medications, other treatment options are considered.
These include trying different anti-seizure medications, often in combination. Surgical intervention, such as resective surgery to remove the seizure-generating area, may be an option for selected individuals with focal epilepsy resistant to medication.
Neuromodulation devices like vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) deliver electrical impulses to reduce seizure frequency. Dietary therapies, such as the ketogenic diet, can also benefit some individuals, particularly children, with drug-resistant epilepsy.
Living with chronic epilepsy involves treatment adherence, lifestyle adjustments, and managing seizure triggers. Maintaining open communication with healthcare providers and engaging with support networks are important for overall well-being.
The Possibility of Seizures Returning
Even after achieving remission, seizures can return, a phenomenon known as recurrence. About 20-30% of individuals who achieve remission, especially those who discontinue medication, may experience a recurrence.
Factors increasing this risk include abnormal electroencephalogram (EEG) findings, structural brain lesions, or a longer history of epilepsy before remission. Certain seizure types or epilepsy syndromes may also carry a higher risk of recurrence upon medication withdrawal.
Individuals in remission should remain under regular medical supervision. Decisions about discontinuing anti-seizure medication are complex and should never be made without consulting a neurologist. Abruptly stopping medication significantly increases the risk of seizure recurrence, potentially leading to more severe seizures.