The early treatment and prognosis of epilepsy.

In the last decade community and hospital-based studies of epilepsy from the onset of the disorder have revealed a much more favorable prognosis for seizure control than previously reported. Approximately three-quarters of newly diagnosed patients can enter a prolonged remission on currently available medication. The natural history of untreated epilepsy is unknown but there is some evidence of an escalating process in the early stages in patients with tonic-clonic seizures. The first two years of treatment seem to be important in determining the subsequent course of epilepsy. The longer seizures continue, the less likely they are to be controlled. Early effective treatment may be important in preventing the evolution of chronic epilepsy. These observations have implications for the management of patients with single seizures.