There is the evidence that a few types of epilepsy progress over a period, and the important factor of the knowledge was helpful in acquiring through neuroimaging studies. Several authors displayed structural damage in individuals and proved the case as a progressive disease of epilepsy. However, there are also a few others who failed to demonstrate the progression because of the presence of heterogeneity.
Presently, temporal lobe epilepsy, when associated with hippocampal sclerosis, falls under progress of epilepsy diseases. On the contrary, other types of epilepsy do not fall as progressive because of lack of evidence. Additionally, the causes of the damage progression are unknown even though it is clear that the consistent occurrence is due to seizures.
The conflicting data makes it challenging to prove epilepsy as progressive disease. It is necessary to study about homogenous groups and requires a longer follow-up that will help come out with appropriate conclusions to prove epilepsy as a progressive disease. At the same time, using neuroimaging will also be essential that supports the evidence.
Is Epilepsy A Progressive Disease?
One can describe the progress of epilepsy or verify it based on the worsening condition of seizure control, the behavior of the individual, structural abnormalities, cognition, and EEG pattern. A few neurologists also take into account the social interactions over the period. Overall, it is impossible to state that epilepsy is a progressive disease. Although a few syndromes fall under progressive state, others do not appear to be the same. Furthermore, it is unclear whether the damage of the progression depends on an underlying issue or seizure type, frequency of seizure, environmental factors, and the combination of all these elements.
There has always been controversy in studies related to the history of epilepsy. Many of the studies show prognosis of seizure control along with the number of seizures occurred before the treatment and the tendency of progressive reduction in populations that did not receive any treatment. However, several authors/scientists disagree with the statement while emphasizing that the situation occurred due to inheritance. At the same time, community-based cases that received antiepileptic drug after several years displayed similar response than studies that detected new epilepsies.
Apart from this, a few studies displayed an important role of seizures. While a few continue to be progressive, the others did not. For instance, experimental data suggested that the frequent re-occurrence of seizure is responsible for the occurrence of progressive neuronal damage. At the same time, patients with epilepsy and histopathological evidence displayed correlation for the presence of refractory drug seizures due to lower hippocampal neuronal density. However, a study carried out on a post-mortem showed that not all the patients with refractory drug seizures had the hippocampal neuronal loss.
Recently, new data emerged in the process of studying about epilepsy where scientists were able to collect information that inflammation influenced in turning epilepsy into a progressive disease. Both in vitro and in vivo data prove the idea that the inflammation has an impact on the epileptogenic process. Additionally, the uncontrollable inflammation could be an addition to the chronic epileptic process that adds to the neuronal damage over the extended period.
Current knowledge about epilepsy and the types makes it challenging to term it as a progressive disease. However, only TLE-HS at present is the only epileptic progressive disorder. The contradictory data available from different sources, scientists, and authors make it difficult to tell whether epilepsy is a progressive disease. The natural history may have a relationship with the initial epileptogenic process but can also have a relationship with distinctly individual characteristics such as genetic background and environmental factors.