The diagnosis of epilepsy is life-changing for children and their parents. It provokes a host of questions (many of which are addressed in my book, Epilepsy: 199 Answers). Two of the most critical questions are “What caused the seizure?” and “Will it happen again?” The answers will define the course of epilepsy for that individual child and assist family members in adjusting their lives accordingly. An accurate prognosis is crucial for parents and caregivers, because waiting for that next seizure can cause significant stress.
Diagnosis and Prognosis
Clinicians approach the question of etiology by obtaining a thorough family and patient history, neurologic examination, brain neuroimaging, electroencephalography, and other tests. Information on seizure type, syndrome, and etiology provides a basis for responding to the important question of prognosis. For example, children with benign rolandic epilepsy invariably outgrow this disorder by their teenage years, whereas those with Lennox-Gastaut syndrome have a much less favorable course.
New Information on Prognosis
Recently published results from a 45-year follow-up study of childhood-onset epilepsy in Finland provide clinicians with updated guideposts for prognosis. Because of the centralized Finnish health system, researchers were able to assemble long-term medical data on seizures and their treatment from 133 patients whose epilepsy began when they were aged 15 years or younger. These included 52 patients who continued to have seizures despite antiepileptic drugs (AEDs), and 81 patients who were seizure-free without AEDs for at least 15 years, which was defined as a “cure.” All patients were examined and evaluated by a single child neurologist and followed for a mean of 39.8 years (range, 11-47 years).
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