Epilepsy is a neurological condition characterized by recurrent, unprovoked seizures—sudden, uncontrolled bursts of electrical activity in the brain. These episodes can manifest in various ways, affecting awareness, muscle control, sensations, and emotions. Managing epilepsy often involves working towards remission, where seizures are significantly reduced or cease entirely, offering individuals the possibility of a life free from these unpredictable events. This goal represents a significant step towards improved well-being.
Defining Epilepsy Remission
Epilepsy remission signifies a period during which seizures are reduced or completely disappear. While remission indicates that the condition is under control, it does not necessarily mean it is cured. The most widely accepted medical definition of seizure remission, provided by the International League Against Epilepsy (ILAE), is being free from all types of seizures for at least one year.
The distinction between “seizure freedom” and “remission” is important. Seizure freedom refers to the absence of seizures for a specific period, while remission implies a reduced likelihood of seizures returning over a longer term. Remission can vary, with some studies defining it as a 5-year period without seizures or symptoms.
Paths to Remission
Achieving epilepsy remission involves a combination of medical strategies and lifestyle adjustments. Anti-seizure medications (ASMs) are the primary treatment, with up to 70% of individuals achieving complete seizure remission through consistent use. Treatment often begins with a single ASM, and if that is not effective, a combination of medications may be considered. Early response to drug treatments can increase the likelihood of future remission.
For individuals with drug-resistant epilepsy, where seizures persist despite trials of two appropriate ASMs, other therapies become relevant. Epilepsy surgery is an option, especially when seizures originate from a specific, removable part of the brain. Surgical resection can lead to long-term seizure freedom, with some studies showing success rates ranging from 40% to 80%, particularly for temporal lobe epilepsy.
Beyond medication and surgery, neuromodulation devices offer additional paths to remission. Vagus Nerve Stimulation (VNS) involves implanting a device that sends mild electrical pulses to the brain via the vagus nerve, aiming to reduce seizure frequency and severity. VNS can lead to a significant reduction in seizures, with some patients experiencing a decrease of over 50%. Responsive Neurostimulation (RNS) is another approach where a device is implanted in the brain to detect abnormal electrical activity and deliver targeted stimulation to prevent seizures. Deep Brain Stimulation (DBS) involves implanting electrodes into specific brain areas to deliver electrical impulses, which can significantly reduce seizure frequency.
Dietary therapies, such as the ketogenic diet, can also be effective, particularly for children whose seizures are not controlled by medications. This high-fat, low-carbohydrate diet alters how the brain obtains energy, and studies indicate it can reduce seizure frequency by more than half, with some individuals becoming seizure-free. Lifestyle factors, including adequate sleep, avoiding excessive alcohol, and managing stress, can also support treatment efforts and contribute to seizure control by reducing known seizure triggers.
Living in Remission
Once epilepsy remission is achieved, the question of medication discontinuation often arises. For children, it is advised to be seizure-free for at least two years before considering tapering off anti-seizure medications. For adults, the timeframe for medication discontinuation is less clear, but some guidelines suggest a seizure-free period of 2 to 5 years. This process should always be done gradually and under the strict supervision of a neurologist, as abrupt cessation can increase the risk of withdrawal seizures.
Despite achieving remission, there is always a possibility of seizures returning, as remission does not equate to a cure. The risk of recurrence varies, with estimates ranging from 30% to 50% after medication discontinuation in adults. Most recurrences tend to happen within the first year or two after stopping medication. Factors influencing this risk include the duration and specific type of epilepsy, and the presence of underlying brain lesions.
Ongoing monitoring and regular follow-up appointments with a neurologist remain important, even when individuals are seizure-free. This allows for continued assessment of well-being, monitoring for any changes in seizure activity, and addressing potential long-term effects of the condition or its treatments. Living in remission leads to an improvement in quality of life, fostering greater independence and reducing social stigma.