Medical and Social Prognosis in Epilepsy

SUMMARY The success of medical treatment of epilepsy covering the past century is briefly reviewed. A 2‐year terminal remission rate tends to occur in approximately one‐third of patients. This figure is remarkably constant regardless where or when the studies have been conducted. The 5‐year terminal remission rate tends to be 17 %, and the 10‐year terminal remission rates are around 10%. Specific investigations dealing with the efficacy of the more modern anticonvulsant medications in a controlled clinical setting are relatively few, but they also point out that the best results, defined as “greatly or totally improved”, occurred in only about one‐third of all patients. The importance of attempts to achieve complete seizure cessation is stressed because, not only can the patient's life assume much more normal channels if the threat of recurring seizures is removed, but the intellectual functions of the patient can also increase under these circumstances. The continued need for long‐term treatment facilities, which include schools and workshops, to allow severely disabled patients to lead as useful a life as possible is also emphasized. The reasons for the somewhat unsatisfactory results of current medical treatment are discussed and the importance of the difference between the concepts of seizure threshold and seizure propensity is emphasized. It is also mentioned that fundamentally new discoveries of anticonvulsant agents are not likely to come about if the pharmaceutical industry merely uses seizure threshold as a screening device for new drugs. It is concluded that the long‐term prognosis of epileptic patients does not depend only upon the conduct of the patients themselves, but more importantly upon our conceptualizations about the basic nature of the disorder. A definition of epilepsy which combines neurophysiological demonstrable events with clinical observations is proposed.