Prognosis

The long-term outcome of patients depends primarily on the underlying disorder; prognosis is better in idiopathic than in symptomatic cases. If it is not a question of a progressive brain disorder, epilepsy is quite easily treatable in patients with mental retardation. Thus, about 70 per cent may obtain good seizure control with appropriate antiepileptic drug therapy or epilepsy surgery. The outcome of patients with specific disorders may vary considerably. For instance, the outcome of patients with Doose syndrome is variable but basically better than that of patients with Lennox-Gastaut syndrome. If hemispherectomy is not undertaken in time in Rasmussen syndrome type 2, the course of the disease, including neurological deficits, other types of seizures, and mental impairment is progressive.

Epileptic seizures themselves, and frequent epileptiform discharges, may produce brain damage and play a part in producing progressive decline in the intellectual functioning of patients(17> probably through at least two mechanisms: exicitatory glutamate storm within cerebral neurones(39) and opening of the blood-brain barrier(40ยป during and after epileptic seizures.

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