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The course of epilepsy
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It is important for both the
person with epilepsy and his doctor that, as soon as possible in
the course of his illness, something can be said about how the epilepsy
is likely to progress in the future. One calls this making a prognosis. |
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Prognosis
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There are many things which can come
to affect the person's epilepsy positively or negatively. If one
has only had one seizure, the risk of having another is highest
in the following 6 months.
An early start to epilepsy is generally
a bad sign. For example, the prospects are better for a person
with epilepsy which starts late in childhood, than if it starts
in the first two years. If another neurological or psychological
illness is also present, or poor social conditions, the future
prospects are poorer. People with generalized convulsions have
better prospects than those with partial seizures. The duration
of the individual seizure also plays a part, as does the length
of time the person has suffered from epilepsy. When more than
2 years have passed before the seizures have been controlled,
over 50% will have a relapse. If the seizures are brought under
control before 3 years have passed, only 30% will have relapse.
People with epilepsy manage best if they have only one type of
seizure, and if they never have continuous convulsive seizures
or status epilepticus. People with simple or complex partial seizures
with secondary generalized convulsive seizures have a poorer prognosis.
The prognosis for Rolandic epilepsy is always good. In the case
of pyknoleptic petit mal, the shorter the seizures are, the better
the future prospects.
Perhaps the prospects are more closely
related to prompt treatment than to the appearance of other seizure
types before or after the start of absences. In the case of juvenile
myoclonic epilepsy, about 90% will have seizures again, if treatment
is stopped after 5 years without seizures. These people can be
thought of as never becoming free of epilepsy. One must, with
this form, be prepared for life-long medical treatment. On the
other hand it should not be taken for granted that treatment will
continue for a lifetime with the same drug. It can be that a new
drug will be produced with the same effect and fewer side effects.
One should keep in touch with the development of new antiepileptic
drugs by going to control by a neurological specialist.
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Early treatment
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The earlier treatment is started,
the better. If the seizures are brought under control with the
first drug tried, the prospects are better than if they were first
controlled with drug number 2. The prospects are even worse if
control is only obtained with drug number 3.
The number of seizures which occur
before the seizures are brought under control influence the risk
of a relapse. It is likely that swift and effective control of
seizures, as well as good compliance in taking the prescribed
medicine, is all-important in avoiding the development of chronic
epilepsy.
The cause of epilepsy plays a minor
role, apart from brain tumors.
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Age-linked epilepsy forms
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Now that it has become apparent that
there are age-linked epilepsy forms, it has become easier to say
something about the progress of epilepsy. It is known what can
be expected of antiepileptic treatment, as well as for how long
treatment need be continued.
More is also known about the non-age-linked
epilepsy forms. It is important to be able to give some guidance
as to what future prospects the person has. For example, complex
partial seizures are a type of seizure which is often difficult
to control. The prognosis for people with this type of epilepsy
is therefore less good.
As previously described, the cause
of this seizure type is seldom known. It was earlier thought that
it could not be hereditary. Much evidence now points to the fact
that this may be the case in some people. Hereditary epilepsy
has a better prognosis than epilepsy with the same type of seizure,
but where there is no epilepsy in the family.
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Withdrawal of treatment
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Most forms of epilepsy have a tendency
to cause fewer seizures with time, or to disappear altogether.
One talks of the epilepsy "burning itself out". This, together
with the facts concerning age-linked epilepsy, means that we have
a more subtle attitude towards treatment than was the case previously.
In the past, antiepileptic treatment
was something which was continued for the rest of your life. Today
we try to withdraw the treatment after 5 years without seizures
in nearly all persons, and in some forms of epilepsy even earlier.
About 40% have seizures again after
this, and have to start treatment again for a time, before a new
withdrawal can be attempted. Although so many have renewed seizures
after withdrawal of medicine, it is sensible to try to remove
the medicine, as a large number can manage without it. In addition
there are also many problems arising from long-term antiepileptic
treatment to take into account; side effects, control of treatment
and the cost.
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School and work
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About 95% of all children with epilepsy
attend normal schools. 75% of adults with epilepsy can manage
a normal job. About 8% of this group will experience being given
notice because they have a seizure at work. About 5% of persons
with epilepsy will come to need rehabilitation.
When there is a low rate of unemployment,
there is not so much difference between the unemployment rate
amongst people with epilepsy and the rest of the population. When
unemployment is high, however, it is unfortunately more difficult
for people with epilepsy to obtain work than it is for others.
Knowing what we know today about
epilepsy, it can be difficult to understand that people with epilepsy
still suffer discrimination. The two most important causes are
no doubt fear and lack of knowledge.
Many people believe that epilepsy
limits a person's chances in life.
It is worth remembering that many
famous people suffered from epilepsy, Julius Caesar, Peter the
Great, Napoleon, Dostoevski, Nobel and van Gogh. They lived, what
is more, in an age when the possibility of treating epilepsy did
not exist.
It is a fact that the large majority,
over 70%, of people with epilepsy can be satisfactorily helped
by medical treatment, so that they never, or hardly ever, have
seizures. 10% of the remaining group can be helped by means of
surgical treatment. Most people with epilepsy are no different
from the rest of the population, neither as regards intelligence,
nor as far as the ability to carry out a job is concerned.
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