1615 PROGNOSIS IN CHILDHOOD EPILEPSY: A 15 TO 23 YEAR FOLLOWUP

Abstract

In a 5 to 12 yr followup, 36 of 148 epileptic children (24%) who had been seizure-free for 4 yrs on anticonvulsant medication (ACM) relapsed after drug withdrawal (W) (N Engl J Med 286:169, 1972). This report concerns a 15 to 23 yr followup of the same children. There were only 5 new relapses, increasing the relapse rate to 28%. Fifty-four percent of the relapses occurred in the first yr after W of ACM; 83% before 5 yrs (91% of the jacksonian cases relapsed within 2 yrs). There was no significant overall relation of relapse to sex, race, heredity, age at onset of seizures, age at W of ACM (puberty) or total number of seizures. Seventy-four percent of EEGs showed paroxysmal activity (focal or non-focal) at the time of W of ACM; the presence and degree of EEG abnormalities were not significantly related to relapse. Relapse rates varied significantly among seizure types (jacksonian, 58%; multiple seizure types, 43%; psychomotor, 31%; grand mal, 14%; petit mal, 12%; simple febrile seizures, 12%); among those with and without neurologic and/or psychologic deficits, 43% vs 23% (P<0.05); and in those with a seizure duration of more than 6 yrs, 89% vs 22% with a shorter duration (P<0.001). The data suggest helpful prognostic clues as to the likelihood of relapse after W of ACM and its timing. With the exception of those who have jacksonian or multiple seizure types, most epileptic children “outgrow” their seizures (84% in this study).