Epilepsy: basic steps to lasting remission

Epilepsy is a chronic disease, one of the most common diseases. In the world, about 40 million people suffer from epilepsy. But at the same time, in 65% of patients, the disease is in a state of drug remission, with no seizures against the background of drug therapy. In children, the frequency of pathology is noted with a frequency of 1%. Can you refuse treatment and what are the risk factors for recurrence of seizures? 

Epilepsy: features of the disease and seizures

Epilepsy is called the pathology of the functioning of the parts of the brain, in which seizures are observed with impairment of various functions: movement, sensations, the autonomic system, thinking abilities. The reason – the excessive amount / intensity of neural discharges that occur in the cortex of the brain. A characteristic difference: outside of attacks, patients, as a rule, feel healthy and do not differ from others.

It is important to know that a single attack is not a reason for a diagnosis, only with repeated attacks a basis for diagnosis appears. Another important aspect: epileptic seizures are usually spontaneous and not always provoked by something. For example, febrile seizures associated with a high fever, seizures during fright, and blood sampling are generally not epilepsy.  

Causes of the disease in children and adults, depending on age

In the factors influencing the onset of epilepsy, an important aspect is distinguished – the patient’s age.

Young children, as a rule, suffer from epilepsy due to hypoxia during intrauterine development, congenital malformations of the central nervous system, intrauterine infection with toxoplasmosis, cytomegalovirus, rubella virus, herpes, etc. Injuries during childbirth are more rare causes, although are also observed in the etiology of the disease.

In older children, adolescents and adults, the causative factors are more diverse. These include the consequences of severe traumatic brain injury, strokes, tumor formations in the tissues of the brain, exposure to toxic substances, including alcohol.

There are also forms of the disease in which the predisposition is hereditarily transmitted from close relatives, in particular, this form is the juvenile myoclonic form of epilepsy. With such options, the probability of having a child with this form of the disease in a sick parent is about 8%. With multiple intrafamilial relationships, however, the coefficient of predisposition to epilepsy increases, passing into a progressive hereditary form. There are ethnic groups and families where children are born with a 50% chance of developing epilepsy.  

• On the basis of the etiology of diseases, several forms are distinguished:
• symptomatic epilepsy is characterized by the possibility of detecting structural disorders of brain regions and tissues (cystic, tumor formations, hemorrhages, developmental defects, etc.);
• idiopathic epilepsy develops without obvious structural changes in the tissues of the brain in the presence of a hereditary tendency;
• the cryptogenic form of epilepsy is diagnosed in cases where the cause of the disease cannot be identified.

Achieving sustained non-drug remission is the main goal of epilepsy treatment. However, drugs can be canceled only after assessing the potential risk of recurrence of the disease, which is influenced by many factors.

Long-term remission (from 3 years) is a prerequisite for the transition to a life without antiepileptic drugs. The absence of seizures is considered remission. It should also be borne in mind that the duration of the required period depends on the form of the disease.

• In the absence forms, persistent drug remission should be at least 3 years.
• In the presence of a severe form, the duration of the seizure-free period before discontinuation of therapy should be 3-4 years.

In accordance with the results of numerous studies, the risk of recurrence of epileptic seizures after discontinuation of treatment against a background of two or more years of remission reaches 40% for adults and 20% for children.

What factors should be taken into account when predicting the risk of relapse during therapy withdrawal? First of all, the likelihood of recurrence depends on the etiology and form of the disease, the age of manifestation of the disease, the severity of the course. It is also necessary to take into account the peculiarities of the functioning of the brain, detected using an electroencephalogram (EEG), and sensitivity to antiepileptic drugs.  

A reduced likelihood of seizures after discontinuation of drug support is detected on average in patients with the following characteristics:

• long-term remission (2-5 years);
• normal neurological status;
• normal EEG readings during ongoing therapy;
• uniformity of the type of seizures.

How do these factors affect the prognosis of remission without medication?

• The risk of seizure recurrence is calculated based on the duration of epilepsy prior to treatment.
• The prognosis worsens if at first the disease was characterized by a reduced sensitivity to drug treatment.
• Duration of remission before discontinuation of therapy.
• Type of seizure: Idiopathic epilepsy has a better prognosis compared to symptomatic epilepsy (with the exception of juvenile myoclonic epilepsy).
• The presence or absence of concomitant neurological pathologies.

Although EEG data are taken into account when predicting the likelihood of relapse, but in modern neurology, their value is recognized as ambiguous. There are research results indicating the predictive value of EEG examinations, but there are also studies that reject such a factor. It has been proven that the correlation between the survey data and the prognosis of relapse is higher in childhood than in adults.

The most dangerous period of relapse is recognized as the first 12-14 months after the cessation of antiepileptic therapy, especially the first six months: 80% of relapses were noted within 6 months.

It should also be remembered that when therapy is resumed, 15% of patients have difficulty controlling seizures with drugs.