Prognosis of Epilepsy- Disease definition, Mortality, Relapse risks explained

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Epilepsy is a neurological disorder marked by recurrent sudden episodes of convulsions, sensory disturbances, loss of consciousness correlated with an abnormal electrical activity in the brain.

Prognostic factors of epilepsy may include recovery period, survival rates, probable outcomes, death rate, chances of complication or if any other possibility of outcome in the overall prognosis. Around 70% of patients with epilepsy can achieve near to complete or complete seizure control with proper and early epilepsy treatment, around 50% of these patients can also stop their treatment. The recurrence rate of chronic epilepsy in patients is around 5 per 1000 population. It has been determined that about 5% of the normal population can also experience non-febrile seizures at some point in their life. So, up to one-tenth of all these people with non-febrile seizure are at a high risk of developing chronic epilepsy in future.

Mortality Facts

  • The mortality rate in epileptic patients is 2-3 times as compared to the general population.
  • Mostly the deaths occur due to the underlying causes i.e. epilepsy and some due to accidents, suicides and sudden unexpected deaths in epilepsy (SUDEP)
  • There is no clear cause for SUDEP
  • In patients with frequent or medically uncontrollable seizures, SUDEP is most common.
  • In patients with mild epilepsy, SUDEP is around 1 in 2500 and in severe epilepsy, it is 1 in 250.

The patient must never lose contact with the environment abruptly as it can turn out to be very dangerous. Some of the adverse events with Epilepsy might include:

  • Accidents during bathing, swimming, driving or using any machinery
  • Aspiration of vomit leading to choking
  • Burns
  • Injuries from falling or trauma to any body part

There are some severe cases known as Status Epilepticus in which the seizures do not stop and consciousness is not recouped, metabolic and respiratory failures occur, and mortality rate increases even after intensive care treatment. The mortality rate of patients (adults) with Status Epilepticus is 20% approximately. Also, the patients with their first episode of Status Epilepticus are at a considerable risk of having future episodes and later on may develop chronic epilepsy. The prognosis of patients with long-term Status Epilepticus is worse. Worsening or poor prognosis includes:

  • Longer duration of seizures
  • Multiple seizure types
  • Mental Retardation

 

Risk of Relapse

It is estimated that about 40% of the patients are at a risk of relapse even if the withdrawal of drugs happens after a long-term control. But on the other hand, 60-70% of patients can expect seizure-free status without major side effects. Some of the major factors leading to the increase in the risk of relapse include

  • Seizure onset at adolescence or later
  • An abnormal neurological examination
  • A definite symptomatic etiology
  • Two or more different types of seizures
  • Status Epilepticus
  • The occurrence of seizures within days after a head injury
  • Excessive intake of cocaine or alcohol
  • Poor eating habits
  • Nutritional deficiencies: minerals and vitamins
  • Psychological stress

Prognostic factors

Some of the probable predictors of epilepsy prognosis include:

  • Gender
  • Demographic features
  • Co-morbidity
  • Age of onset
  • Seizure type
  • Etiology
  • EEG patterns
  • Recurrence rate after treatment
  • Early response to treatment

Although epilepsy is a long-term condition, but if the seizures are controlled by the epileptic drugs in an early stage of the course of treatment, the future prognosis becomes excellent. The patient can lead to a seizure-free life with an effective and proper management. A person with epilepsy must be considered as an indispensable part of society and must be motivated to lead an ordinary life.

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