Why does epilepsy become intractable? Prevention of chronic epilepsy.

Community-based and our own hospital-based studies suggest that the prognosis for seizure control is very good in most patients with epilepsy. However, chronic epilepsy develops in about 25%. The pattern of chronicity is established early in the course of treatment. Factors associated with a high risk of chronicity include additional neurological, psychological, and social handicaps and also partial seizures. In addition a process of evolution of chronic epilepsy may occur by a mechanism proposed by Gowers a century ago. Chronic epilepsy is very difficult to control and may best be prevented by more effective treatment at the onset of the disorder.