Late-life terminal seizure freedom in drug-resistant epilepsy: “Burned-out epilepsy”

S. Rajakulendran, M. Belluzzo, J. Novy, S. M. Sisodiya, M. J. Koepp, J. S. Duncan, J. W. Sander*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The course of established epilepsy in late life is not fully known. One key question is whether the resolution of an epileptic diathesis is a natural outcome in some people with long-standing epilepsy. We investigated this with a view to generating a hypothesis. We retrospectively explored whether terminal seizure-freedom occurs in older people with previous drug-resistant epilepsy at the Chalfont Centre for Epilepsy over twenty years. Of the 226 people followed for a median period of 52 years, 39 (17%) achieved late-life terminal seizure-freedom of at least two years before death, which occurred at a median age of 68 years with a median duration of 7 years. Multivariate analysis suggests that a high initial seizure frequency was a negative predictor (p < 0.0005). Our findings indicate that the ‘natural’ course of long-standing epilepsy in some people is one of terminal seizure freedom. We also consider the concept of “remission” in epilepsy, its definition challenges, and the evolving terminology used to describe the state of seizure freedom. The intersection of ageing and seizure freedom is an essential avenue of future investigation, especially in light of current demographic trends. Gaining mechanistic insights into this phenomenon may help broaden our understanding of the neurobiology of epilepsy and potentially provide targets for therapeutic intervention.

Original languageEnglish
Article number120043
JournalJournal of the Neurological Sciences
Volume431
DOIs
Publication statusPublished - 15 Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work was undertaken at University College London Hospitals Biomedical Research Centre, which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding. JN was supported by the Swiss National Science Foundation- Fellowships for prospective researchers and the SICPA Foundation, Prilly, Switzerland. JSD is supported by NIHR . Epilepsy Society partly support SMS, MJK and JWS. JWS also receives research support from the Dr Marvin Weil Epilepsy Research Fund and the Christelijke Verenigingvoor de Verpleging van Lijdersaan Epilepsie, the Netherlands .

Publisher Copyright:
© 2021 Elsevier B.V.

Keywords

  • Ageing
  • Pharmaco-resistance
  • Prognosis
  • Seizure outcome

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