Response to First Treatment May Predict Epilepsy’s Course

In patients diagnosed with epilepsy, the likelihood that they will continue to have seizures may well depend on their response to the initial anti-seizure medication given after their diagnosis. According to a recent study published in Neurology, researchers found that 50 percent of the people in the study were seizure-free after the first medication they tried; 13 percent were seizure-free after the second drug regimen was tried; and four percent were seizure-free after the third drug regimen was tried. This study continues to back up the finding that patients who will have a difficult-to-control seizure disorder declare themselves early on in the course of treatment. This fact strongly supports timely and early referral to a specialized epilepsy center for further evaluation, including consideration for epilepsy surgery, which is the only disease course-altering intervention available to us at this time.

There are other interesting findings in this study that are extremely thought-provoking. In all the groups that did well initially or eventually, there was a 20-25 percent rate of seizure relapse over the observation period. This is not very reassuring and indicates that even when things seem to be going very well for an epilepsy patient, there is still a good chance that seizures will recur. The reasons for seizure relapse needs to be further explored, but the study results speak to the long-term risk of recurrent seizures, even when there is an initial good response.

Furthermore, the study showed that if the seizure disorder was of unknown or known cause, the chances of doing well or not, were the same. This finding goes against the belief that brain lesions or abnormal magnetic resonance imaging (MRI) findings are associated with more difficult- to-control seizures and supports our impression that epilepsy is a complex brain network disease that cannot be completely understood by current brain imaging technology.

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