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intractable epilepsy

Will epilepsy be completely cured?

It is said that epilepsy can be controlled by antiepileptic drugs or surgery with a probability of 70 to 80%, but there are various types of epilepsy, so it is difficult to control the symptoms in some cases. ..

  • Benign childhood epilepsy
  • Pediatric absence epilepsy

The above two types of epilepsy can be said to be a type of epilepsy that is completely cured because the symptoms disappear and there is almost no recurrence by the time of adulthood. However, in juvenile myoclonic epilepsy, drug treatment can control the symptoms, but if the drug is stopped, there is a 90% or higher chance of recurrence.
Epilepsy does not completely heal after becoming an adult, and treatment is aimed at remission, which is a condition in which symptoms can be suppressed and daily life can be carried out without problems.
The guideline for the end of treatment is that more than 3 years have passed since the seizures disappeared and the brain waves were normalized. Doctors will consider reducing or discontinuing the antiepileptic drug.

The recurrence rate of seizures after the end of treatment for epilepsy is said to be around 30% in children. Recurrence often occurs within 1 year of the end of treatment, and the risk of recurrence decreases after 2 years or more.
In adults, the seizure recurrence rate tends to be 50%, which is higher than in children. Reducing antiepileptic drugs slowly over a year will reduce the recurrence rate.

Can Epilepsy Get Better with Surgery?

Epilepsy begins with medication, but surgery may be an option if seizures cannot be controlled after taking multiple types.

There are two main types of surgery for epilepsy.

  • Surgery to prevent a seizure fundamentally by removing or blocking the part that causes the seizure
  • Surgery to reduce the frequency of seizures or reduce symptoms

If the area where the seizure occurs is limited, it is possible to remove the causative site, but if there is a wide range of abnormalities or if the causative site is unclear and cannot be resected, the symptoms of epilepsy are suppressed. Palliative surgery is performed.

The rate of seizure elimination from epilepsy surgery depends on the type of epilepsy and the site of the epilepsy.
With temporal lobe epilepsy, the probability of having no seizures after surgery is 80-90%, which is the highest compared to other epilepsy. It is said that the seizure disappearance rate is 50 to 80% in epilepsy surgery when other causes are widespread or unclear.

There are also surgeries to relieve symptoms if resection is not possible. Vagal nerve stimulation, one of the surgeries to relieve the symptoms of seizures, is said to reduce the frequency of seizures by half in half of the patients.
It is important to note that antiepileptic drugs cannot be stopped immediately even if the symptoms subside after surgery for epilepsy. In most cases, the drug should be reduced or discontinued every few years.

Cases and causes of epilepsy recurrence

The older the onset of epilepsy, the higher the recurrence rate.

There is also a report that the recurrence rate exceeded 50% for people over 30 years old even if their symptoms were cured and they stopped drug treatment. In addition, if the number of seizures is quite high, if there are psychological symptoms, or if two or more antiepileptic drugs are required to suppress the seizures, the severity is high and the recurrence rate increases.

Care should also be taken when discontinuing antiepileptic drugs.

In a study of patients who had seizures disappeared for more than 2 years after using antiepileptic drugs, patients with seizures disappearing for 4 years or more compared to patients with seizures less than 2 and a half years. There is a report that the recurrence rate was only 67%. The longer the seizure disappearance period, the lower the recurrence rate after discontinuation of antiepileptic drugs.

Recurrence often occurs within 1 year of discontinuation of antiepileptic drugs, and the risk of recurrence is low after 2 years or more.

From these facts, it can be said that there is a very high possibility that recurrence will occur if the patient does not take the drug at his / her own discretion because the symptoms have subsided after taking the antiepileptic drug.

Even if it recurs, resuming antiepileptic drugs can control the symptoms, so it is important to continue treatment patiently.

What measures can be taken from now on for epilepsy?

In most cases, epilepsy does not limit your daily life, but if you have a sudden disturbance of consciousness or a seizure that causes you to lose your physical freedom, you may fall to a high place or have a serious accident. Please note that there is a possibility. You need to consult your doctor because the conditions for getting a driver’s license will change depending on whether you have seizures.

Even if you work, you should report to the workplace if a seizure can cause a serious accident.

In daily life, it is better to create an environment so that you will not be injured if you suddenly collapse.

You should avoid using bunk beds and avoid placing sharp-edged objects or stoves. By getting proper sleep time, you can rest your brain well and your brain will work more stably.

It is said that exercise suppresses epileptic seizures, so it is important to exercise moderately. Don’t forget to take your medicine and be aware of your regular life.

 

References

Epilepsy Center Q & A-Hiroshima University Hospital

Guidelines for the termination of drug treatment for adult epilepsy-National Hospital Organization Shizuoka Epilepsy and Neurological Medical Center

End of epilepsy treatment

What is epilepsy-think epilepsy in the plural

To live with seizures-epilepsy net

Today’s Therapeutic 2018-Nervous System Drugs-Antiepileptic Drugs. P-906-9

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