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Predicting the Course of Childhood Epilepsy: More Uncertain than Ever

Commentary An almost universal question to physicians from parents who have a child who experienced a first seizure(s) is some variation of “will my child grow out of his/her seizures?” The question regards prognosis and is laced with the hope that this will be a self-limited condition, disappearing as abruptly and inexplicably as it began. Currently, the most reliable means of answering that question with any degree of certainty is to identify a recognized syndrome that has a known prognosis. (However, it should be recognized that even the best-described syndromes have a range of potential outcomes ranging from seizure freedom to continued seizures with or without cognitive and behavioral co-morbidities.). Despite the existence of an ever-increasing number of syndromes—as described on the International League Against Epilepsy website (http://www.epilepsydiagnosis.org)—a meaningful syndromic diagnosis is not always possible. The clinician is then left to integrate a wide variety of studies from various populations (population-based, referral clinic, hospital), differing lengths of follow-up, and patient-related factors, such as ages of onset, seizure types, cognitive/developmental status, EEG, MRI, and other laboratory findings. Where can guidance be found to provide our families with accurate, if not always comforting, information? Multiple reports have documented population-based outcomes using a variety of durations of follow-up (cited in the references provided) and criteria for terminal remission (e.g., years since last seizure, whether on or off medication treatment, or both). It is remarkable that the older as well as the newer publications cite seizure-freedom occurring in 60 to 70 percent with lack of remission in the remainder (1–4). It has been only in the last few years that additional important questions regarding outcome have been approached: What are the patterns of remission and relapse over time? What are the risk factors that predict outcome? The course of epilepsy over time has been addressed in several very recent studies, although appreciated previously (5). In the same cohort in whom 67% of 144 patients followed for an average of 37 years (recruited 1961–1964) were in termiThe Course of Childhood-Onset Epilepsy Over the First Two Decades: A Prospective, Longitudinal Study.