Can epilepsy be cured?

The International League Against Epilepsy (ILAE) defines epilepsy as a disease characterised by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition.

The term “enduring” is currently widely discussed in the scientific community, because epilepsy should be described as a dynamic pathology, in which epileptic seizures represent only a part (albeit a significant one) of the clinical spectrum. During the course of the disease, neurological disorders may present with different symptoms and severity, including variable and difficult-to-catalogue pre-crisis symptoms, behavioural and mood disorders, cognitive and motor deficiencies. Epileptic seizures, in essence, are just the tip of the iceberg of the pathological condition: in most cases, patients and medical teams have to manage several comorbidities in epilepsy.

Is it possible to fully recover from epilepsy?

We have already addressed the causes, symptoms and remedies for childhood epilepsy in a previous article, and we have seen how the possibility of “outgrowing” the disease depends on various factors, first and foremost, the type of epilepsy. However, there are other elements to consider, for example the underlying cause of the pathology (brain injury, metabolic or immune disease, etc.), but also the age of the patient and the timeliness of pharmacological therapy.

Spontaneous, full recovery from epilepsy has sometimes been known to occur, especially when the condition manifests during childhood and resolves without significant intervention. But this is not always the case, and most people require long-term treatment.

Now is the time to make a necessary clarification: the term “recovery” is used incorrectly when speaking of epilepsy, because this is a chronic disease. Once diagnosed, with the exception of sporadic cases in which the disease resolves spontaneously or there is a surgical intervention, there is no “recovery”. The term “resolution” is preferred, including for patients who are disease-free, i.e. their epilepsy is resolved. The symptoms, in these patients, disappear and, sometimes, therapy is stopped; however, this does not mean that their risk of having a new crisis is the same as that of the general population. Nowadays, however, there are many therapies, both pharmacological and surgical, that can help patients live a normal life and manage symptoms effectively.

Therapies and treatments for epilepsy

As hinted above, there are several therapies to manage and potentially “cure” epilepsy. Drug therapy is the most common and may help control seizures in most patients. Some of the drugs used include anticonvulsants such as valproic acid, carbamazepine, clonazepam, phenytoin and topiramate. Discontinuation of antiepileptic drugs may be assessed after a minimum period of 2 years without seizures. This process is generally carried out slowly and gradually. However, the decision to discontinue therapy and the timing of discontinuation should be carefully discussed and agreed with each patient.

For some forms of epilepsy, especially drug-resistant forms, surgery may be necessary: the procedure often involves the removal of the brain area responsible for seizures – provided, of course, that this is possible without causing neurological deficits.

Other options, which are less common and only used in specific cases, include:

• nutritional approaches, such as the ketogenic diet;
• Vagus Nerve Stimulation (VNS), which involves the subcutaneous insertion of an electrical stimulator;
• neurostimulation and Deep Brain Stimulation (DBS) therapies.

The role of scientific research and innovation

Scientific research plays a crucial role in improving epilepsy treatment options. Thanks to advances in genetics, neurophysiology and pharmacology, new treatments are being studied. Research, in particular, is very active in the development of new therapies to treat drug-resistant epilepsy. A significant example is the discovery of the importance of vitamin B6 deficiency in the treatment of drug-resistant childhood epilepsy and, in particular, in pyridoxine-dependent epilepsy caused by rare autosomal recessive conditions.

In addition, technological innovation has made surgical procedures more accurate and less invasive, significantly increasing the chances of successful surgery and improving the patients’ quality of life. Recently, as part of dietary integration, research carried out by Cor.Con. International has led to the study of a new food supplement developed for the treatment of childhood epilepsy, effective in the management of disease-related comorbidities, with the aim of improving adherence to therapy and the general well-being of the patient.

When is epilepsy considered resolved?

Epilepsy is considered to be resolved when a patient has had no seizures for an extended period of time, usually at least 10 years, with no seizure medication for the last 5 years. However, it is important to stress that each case is unique, and the path to recovery can vary greatly between individuals.

Ultimately, while some pathological forms may resolve spontaneously, others require complex and prolonged therapeutic interventions. Recovering from, or better, the resolution of childhood epilepsy is possible, but it depends on many factors and often requires a multidisciplinary approach. Considering the above, it is therefore clear that continuous research and innovation are essential.