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Prognosis in childhood epilepsy: A follow-up study of 148 cases in which therapy had been suspended after prolonged anticonvulsant control

One hundred and forty-eight unselected epileptic children, seizure-free for 4 years on anticonvulsant medication, were followed for 5 to 12 years after drug withdrawal to determine the frequency of seizure recurrence and to discern any prognostic criteria. Thirty-six children (24%) had a recurrence of seizures. Sixty-one per cent of recurrences took place during the first year of gradual discontinuation of therapy. Drug withdrawal at puberty (9–15 yrs) was not associated with increased risk. An analysis of the records revealed no relation of relapse to sex, race, heredity, or seizure frequency. The prognosis was very good in children who had an early age of onset with prompt control (relapse rate 13%). There was at least a two-fold increase in relapse in cases with a late onset, with prolonged duration of seizures, and evidence of neurologic, psychologic, and electroencephalographic abnormalities. The most striking correlate to relapse was seizure type.Best results were obtained in children with grand mal (relapse rate 8%), febrile seizures (12%), and uncomplicated petit mal (12%). In psychomotor attacks the relapse rate was 25%. The highest recurrence was in children with Jacksonian seizures (53%) and those who had seizures of more than one type (40%). It was concluded that these data suggest unquestionable criteria for drug withdrawal in epileptic children after prolonged seizure control with a favorable outcome in a large percentage of selected cases.