Different Prognostic Patterns in Epilepsies and Considerations About the Denotations of Atypical Patterns

Abstract

Epilepsy is a dynamic and heterogeneous neurological disease, and in long-term studies on prognosis, classically 5 basic patterns (early remission, late remission, relapsing-remitting, worsening, and non-remitting) have been identified. The most frequent pattern was relapsing-remitting course, and factors such as the presence of genetic etiology, rare seizures at the beginning of epilepsy and the absence of psychiatric comorbid diseases were found to be related with this pattern as well as reaching 5 years of remission in the follow-ups. Anti-seizure drug resistance (ASD-R) and factors affecting the presence of this resistance (such as symptomatic etiology, abnormal electroencephalographic findings, having multiple seizure types together, status epilepticus and febrile seizure history) decrease the chance of remission, while idiopathic/genetic etiology, generalized epilepsy, and absence of comorbid diseases seem to be associated with achieving long-term remission. Apart from these basic course patterns, there are some patients with an "atypical prognosis" such as drug-resistant juvenile myoclonic epilepsy (JME), benign hippocampal sclerosis-related mesial temporal lobe epilepsy (HS-MTLE), and severe childhood epilepsy with centro-temporal spikes (CESTS), in which the pathophysiological mechanisms underlying these patterns have not been clarified despite the suggestions of various hypotheses. The presence of comorbid diseases such as hormonal factors (as in catamenial epilepsy), autoimmune processes, thyroid disorders and metabolic and psychiatric diseases may also cause an atypical prognostic pattern by affecting the course of the disease. In this review, our aim is to provide the clinician with an up-to-date and questioning perspective on the prognostic markers of epilepsy, by examining in detail some specific epilepsy syndromes that may show atypical prognosis as well as the general prognostic features of epilepsy.

Keywords: Epilepsy; atypical prognosis; drug resistance; prognosis; relapse; remission.

Figure 1

Five basic disease courses defined for epilepsy

Figure 2

Factors reported to affect prognosis in epilepsy positively or negatively Abrreviations: ASD, anti-seizure drug; benign childhood epilepsy with centrotemporal spikes (BCECTS); CAE, childhood absence epilepsy; EE, epileptic encephalopathy; EEG, electroencephalography; GTCS, generalized tonic-clonic seizures; MTLE, mesial temporal lobe epilepsy

Figure 3

Factors affecting prognosis in epilepsy.