Prognosis of intractable epilepsy: is long-term seizure freedom possible with medical management?

Until recently, very little data existed on long-term seizure prognosis of patients with intractable epilepsy. We review recent work that assessed seizure remission in patients with intractable epilepsy during medical management. Recent prevalence cohort studies among adults with longstanding intractable epilepsy have demonstrated notable proportions of patients attaining at least 1-year seizure freedom, ranging from more than 10% to nearly 30% of patients, when followed for mean duration of 18 months to 6 years. Additionally, a recent prospective cohort study of pediatric-onset intractable epilepsy (followed prospectively for seizure outcome from onset of intractability) revealed minimum 1-year seizure remission among more than half of study patients. Despite the notable rates of remission seen among patients with intractable epilepsy, many individuals experienced subsequent seizure relapse. These findings highlight the continued importance of surgical therapy for those who are good candidates and the need for further development of effective therapeutic interventions.