Background The long-term prognosis of seizures that begin inchildhood is uncertain.
Methods We prospectively studied 245 children from the catchmentarea of Turku University Hospital in Turku, Finland, who hadactive epilepsy diagnosed between 1961 and 1964. Sixty-eightpatients (28 percent) had idiopathic seizures (presumed to havea genetic origin), 54 (22 percent) had cryptogenic seizures(occurring in otherwise normal persons with no clear cause),and 123 (50 percent) had remote symptomatic seizures (with noimmediate cause but occurring in persons with a prior braininjury or a static encephalopathy).
Results At the final follow-up in 1992, we had sufficient dataon 220 patients (90 percent), 176 of whom were alive and 44of whom had died; the remaining 25 had emigrated, could notbe traced, or declined to participate. Thirty-nine patientswho died were not free of seizures at the time of death, and33 had remote symptomatic seizures. Among the surviving patients,112 (64 percent) had been seizure-free for at least five years,including 83 (47 percent) who were not taking antiepilepticmedications. The most important predictors of being seizure-freefor at least five years were a rapid response to therapy (definedas a reduction in the frequency of seizures of 75 to 100 percentwithin three months of beginning treatment) and a diagnosisof idiopathic seizures. As compared with a matched control group,99 patients with epilepsy but no other initial neurologic impairmentwere of similar socioeconomic status and had similar rates ofpassing an examination given after 12 years of school. Significantlymore patients, however, had completed only six years of school(relative risk, 2.13), were unemployed (relative risk, 3.76),were not married (relative risk, 3.50), and did not have children(relative risk, 3.00).
Conclusions Although the majority of patients with epilepsyin childhood are free of seizures by the time they become adults,they are at increased risk for social and educational problems.Patients whose epilepsy does not remit also have an increasedrisk of death.
Source Information
From the Departments of Pediatric Neurology (M.S., M.J.) and Biostatistics (O.K.), University of Turku, Turku, Finland; and the Departments of Neurology and Pediatrics and the Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y. (S.S.).
Address reprint requests to Dr. Sillanpää at the Department of Child Neurology, University of Turku Hospital TYKS, 20520 Turku, Finland.
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