Is the underlying cause of epilepsy a major prognostic factor for recurrence?

TLDR

The study examined whether epilepsy type and syndrome predict seizure recurrence. A hospital‑based observational survey of 2,200 adult outpatients followed for 1–7 years assessed the prognostic impact of structural brain abnormalities and epileptogenic zone location. Seizure freedom (>1 year) was achieved in 82 % of idiopathic generalized epilepsy, 35 % of symptomatic partial, 45 % of cryptogenic partial, and 11 % of partial epilepsy with hippocampal sclerosis, while TLE had only 20 % seizure‑free rate versus 36 % for extra‑TLE, and hippocampal sclerosis, cerebral dysgenesis, and dual pathology were associated with the lowest rates, showing that brain abnormalities—especially hippocampal sclerosis—are major progn.

Abstract

We investigated the prognostic value of the type of epilepsies and epileptic syndromes for seizure recurrence. In patients with partial epilepsy, we focused on the prognostic value of any structural brain abnormality and of the location of the epileptogenic region.A total of 2,200 adult outpatients were included in a hospital-based observational survey, with a follow-up of 1 to 7 years. Twenty-two percent of the patients exhibited generalized epilepsy, 62% partial epilepsy, and 16% undetermined epilepsy.Seizure control (>1 year without seizure) was achieved in 82% of patients who had idiopathic generalized epilepsy, 35% of those with symptomatic partial epilepsy, 45% of those with cryptogenic partial epilepsy, and 11% of those with partial epilepsy associated with hippocampal sclerosis (HS). Temporal lobe epilepsy (TLE) was the most refractory partial epilepsy, with only 20% of such patients remaining seizure free, compared with 36% of extra-TLE patients. In partial epilepsy, HS, cerebral dysgenesis, and dual pathology (HS and another lesion) were associated with a low rate of seizure-free patients (11%, 24%, and 3%, respectively). No significant difference in seizure control was found between patients with extra-TLE and those with TLE and no HS.In adults, partial epilepsy is more difficult to treat than idiopathic generalized epilepsy. In patients who have partial epilepsy, the location of the epileptogenic zone does not seem to be a determining factor. Brain abnormalities--especially HS, either alone or associated with another lesion--are a major prognostic factor.