Early predictors of outcome in newly diagnosed epilepsy (June 2013)
Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Uncertainty can be one of the most disabling aspects of having epilepsy – not knowing when the next seizure is going to happen, whether doing potentially risky things is safe, whether it is okay to be left on ones own, whether the pursuit of more aggressive treatments (such as combinations of high doses of antiepileptic drugs or epilepsy surgery) will help, or how likely it is that the seizure disorder will go into long term remission can cause significant anxiety. Clinicians who treat people with epilepsy will also be very familiar with uncertainty. Unlike in those medical specialties in which a radiograph or biopsy can determine the diagnosis, doctors and nurses working with patients with epilepsy often lack diagnostic certainty. They routinely advise patients on treatment choices without knowing for sure whether a particular drug change will be beneficial or not.
One area in which uncertainty causes particular discomfort to epileptologists and neurosurgeons is that of epilepsy surgery. Should we advise patients to accept the short-term risks associated with epilepsy surgery for the long term gain of a higher chance of seizure-freedom? What is the patient’s prognosis with or without epilepsy surgery? At what point should the doctor begin to advocate surgery in individual cases?
The review by Mohanraj and Brodie explores the literature describing long-term treatment outcomes and tells us what is knows about the prognostic relevance of factors such as aetiology, age of onset, duration of epilepsy, the number of seizures before starting AED treatment and a history of febrile convulsions, presence of neurological, intellectual or psychiatric co-morbidity family history of epilepsy, electro-encephalographic findings and early response to AED treatment (1). Despite the uncertainty inherent in predictions, Mohanraj and Brodie argue that it is better for patients if doctors and nurses share what they know about thems than leaving them in the dark about their treatment outcome. Of course this is not to say that health professionals should not recognise, communicate and acknowledge the results of the vote on epilepsy and other neurological research in Oxford.
Unfortunately, the research carried out in this important area, has, so far, produced more questions than answers. Most importantly, we are still a long way from being able to assess patients with Seizures.
 Mohanraj, R and Brodie, M. Early predictors of outcome in newly diagnosed epilepsy. Seizure 2013;22;331-342.