What is the Difference Between Resolved and Seizure-Free Epilepsy?

Seizure-free and resolved epilepsy are 2 terms you may hear if you have epilepsy. But what do these words mean?

Epilepsy is a neurological (brain) disease that causes people to have seizures. In some people it is chronic, which means it is long-term. However, it is possible for epilepsy to resolve. This happens when the person with epilepsy no longer needs treatment.^1,2

Epilepsy is a type of seizure disorder in which nerve cells called neurons behave abnormally. Neurons normally create tiny electrical signals in a regular rhythm. These signals tell other parts of the brain and body what to do. With epilepsy, neurons create too many electrical signals, too quickly. Some doctors describe this as an electrical storm in the brain.

Seizures may be provoked or unprovoked. A provoked seizure happens because of a known trigger such as low blood sugar, head injury, high fever, a brain tumor, or other health problem. An unprovoked seizure is one that has no known cause.³

What is resolved epilepsy?

The International League Against Epilepsy defines epilepsy as:⁴

• Having at least 2 unprovoked seizures more than 24 hours apart
• Having 1 unprovoked seizure and a high chance of more seizures after 2 unprovoked seizures over the next 10 years
• Being diagnosed with an epilepsy syndrome

Epilepsy may be active or resolved. The term resolved epilepsy means someone:⁴

• Had an age-related epilepsy syndrome and is now past the age when these seizures occur
• Has been seizure-free for the last 10 years
• Has been seizure-free without taking anti-seizure drugs for the last 5 years

Febrile seizures are a common example of epilepsy that resolves on its own. Febrile seizures are seizures that happen when a baby or small child has a high fever. Febrile seizures usually go away by age 5 or 6.⁵

What does it mean to be seizure-free?

Seizure-free means a person is not having seizures while still taking anti-seizure drugs. However, if they quit taking their medicine or reinjure their brain, the seizures may come back.

Roughly 6 out of 10 people who have epilepsy will be seizure-free within a few years if treated correctly. About half become seizure-free after taking their first anti-seizure drug. Taking a second anti-seizure drug helps about another 1 out of 10 remain seizure-free.⁶

The chances of someone becoming seizure-free varies greatly. Some people can stop taking their anti-seizure drug after 2 to 5 years of being seizure-free. This must be done under a doctor’s close supervision. Others may be able to stop taking medicine after epilepsy surgery.⁶

Who becomes seizure-free or resolved?

Doctors do not fully understand why some people become seizure-free. There are many factors that play a role in whether someone will become seizure-free or if their epilepsy will resolve. These factors include:⁷

• Number of years between a first and last seizure
• Number of years since last seizure
• Number of anti-seizure drugs taken or tried
• Age at epilepsy diagnosis
• Sex
• Family history of epilepsy
• History of febrile seizures in childhood
• Total number of seizures before becoming seizure-free (less than 10 or more than 10)
• Type of seizures
• Intellectual disability
• EEG (electroencephalogram) test results before or after tapering off anti-seizure drugs

No one with epilepsy should stop taking their anti-seizure medicine alone. Stopping epilepsy medicines requires planning and close monitoring under the guidance of a doctor.