DO SEIZURES BEGET SEIZURES - AN ASSESSMENT OF THE CLINICAL-EVIDENCE IN HUMANS

For more than a century, epilepsy was characterized as a chronic disea se, with little chance of remission or cure. It was also considered a progressive disease in which seizures led to more seizures. Experiment al work in animals provided additional support for the notion that sei zures could beget seizures. However, the earliest clinical observation s in humans were based on highly selected, largely refractory patients . Furthermore, the experimental work in animals bore little relation t o naturally occurring seizures and epilepsy in humans. Evidence from m ultiple sources regarding the nature and natural history of seizures a nd epilepsy in humans has repeatedly demonstrated that in most cases t he occurrence of seizures itself does not influence the long-term outc ome of epilepsy. Consequently, interventions to prevent seizures early in the course of a seizure disorder do not alter the natural history of seizure disorders with respect to whether remission will occur in t he long term. That outcome is largely predetermined by other factors, many of which are not currently amenable to intervention. In some rare syndromes, deterioration is progressive, In these instances, it is th e underlying syndrome, not the seizures, that is primarily responsible for the deterioration. In addition, extremely prolonged seizures (whi ch are rare) may also directly cause damage. These are exceptions rath er than, as previously believed, the rule. The available human data st rongly suggest that seizures do not beget seizures and that epilepsy i n humans is usually not a progressive disorder.