[Unexpected changes in long-term follow-up of pharmacoresistant epilepsies. Case reports].

Background and purpose: There is few naturalistic evaluation on the spontaneous plasticity in the long-term follow-up of pharmacoresistant epilepsies. The author aims to answer the following questions: What are the trends and characteristics in spontaneous clinical development (amelioration or worsening) of these patients? Which external circumstances can influence the outcome - with special concern to seizure precipitating/ provoking factors?

Methods: The author summarizes the history of 4 patients from the 14 ones with pharmacoresistant epilepsy presented consecutively between 1th January to 30th June 2024 at his out-patient clinic in whom he observed meaningful 'spontaneous' improvement in the follow-up without any modification of pharmacotherapy, and that of further 3 patients in whom unwanted seizure occurred after a long lasting seizure freedom. In their short case-reports he pointed the presence of some actual life events of physical, mental or emotional nature which possibly acted on the outcome.

Results: During the long-term follow-up of pharmacoresistant epilepsies the author found that i./ The clinical course can show 'spontaneous' improvement concerning both in the frequency and intensity of seizures. ii./ In the majority of patients it shows close relation to the changes in life circumstances and to the presence of transient life events. iii./ The increased risk for relapse has been still remaining after a seizure-free life period lasting longer than that of established for the cured state.

Conclusion: Occurrence of habitual seizures can be in closer connection with precipitating factors even is pharmacoresistant epilepsies. So, decrease or lack of some of them can lead to spontaneous recovery. The applied pills did not play significant role. On the other hand, the pharmacoresistant epilepsies can temporarily fulfill the conditions of 'cured epilepsy' but the risk of recurrence still remains higher. Based on these observations, a more detailed evaluation of precipitating and provoking factors of seizure is recommended in pharmacoresistant patients for achieving their optimal care. This may also include some new concepts in the definition of pharmacoresistant epilepsy.