COMMENTARY

Childhood Epilepsy: New Data on Prognosis

Andrew N. Wilner, MD

Disclosures

October 22, 2014

Four Predictive Factors

Multivariate analysis revealed four independent factors associated with a cure:

Pretreatment seizures less than weekly vs weekly (P = .002);

Early treatment seizure frequency less than weekly vs weekly (P = .002);

Higher IQ (P = .021); and

Idiopathic or cryptogenic vs symptomatic etiology of epilepsy (P = .042).

These prognostic factors were powerful. For example, the 60 patients who had an idiopathic or cryptogenic etiology and seizures less than once a week during the first year of AED treatment were nearly nine times more likely to remain seizure-free while off AEDs compared with 29 patients who had a symptomatic etiology and at least weekly seizures on AEDs (risk ratio, 8.7; 95% confidence interval, 2.0-37.0; P < .001). Of note, 59 (73%) of the 81 individuals who became seizure-free did so on their first AED.

Although status epilepticus was of borderline significance in the univariate model, it did not survive as a significant predictive factor in the multivariate analysis. A history of febrile seizures also failed to achieve prognostic significance.

Conclusions

The exceptionally long follow-up of this study by Sillanpää and colleagues[4] lends considerable weight to its findings. All four favorable prognostic findings (children with fewer seizures before and after treatment, higher IQ, and nonlesional etiology) are compatible with clinical experience. Of interest, epilepsy syndrome was not a risk factor, perhaps because it was overshadowed by seizure frequency and etiology.

Although these four prognostic criteria are important clinical tools, prognostication of the course of seizures in an individual patient remains an imperfect science. Additional research will further refine prognostic factors to guide the care of children with new-onset epilepsy.

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