Recurrence, remission, and relapse of seizures

BACKGROUND Approximately 6% of the population will experience at least one afebrile seizure in their lifetime.

OBJECTIVE To review the prognostic factors and clinical implications for recurrence, remission, and relapse of seizures.

SUMMARY Antiepileptic drug treatment reduces the risk of recurrence after a first seizure by about half, but these drugs cause a variety of adverse effects. The risk of recurrence is higher in the presence of neurologic or electroencephalographic abnormalities or if the seizure is partial as opposed to generalized. Neurologic abnormalities and partial seizures also reduce the probability of remission. Gradual drug withdrawal can be considered if the patient has been in remission for 2 years in the absence of any negative prognostic indicators.

CONCLUSIONS When deciding whether to begin or discontinue antiepileptic drug therapy, clinicians should consider the risks and possible benefits for the individual patient.