Long-term prognosis for children with epilepsy.
In discussions of prognosis that are based primarily on epidemiologic data, it is important to emphasize two issues: first, statistical rates of recurrence or remission apply to groups, not individuals. Whereas important and useful information is obtained from examining the epidemiology of epilepsy, it is the individual child who is the concern of the physician, family, and community. That individual child may do well despite indicators that suggest a risk of poor outcome, or may do poorly, experiencing recurrent seizures or adverse effects of treatment, despite apparent "low risk." It is unimportant to a parent that "90% of children with this type of epilepsy do well" if his or her child is doing poorly. All treatment decisions, including the decision to withdraw anticonvulsants after prolonged seizure-free periods, must be made individually. An adolescent or young adult, seizure-free on treatment, may be unwilling to risk even a 10% to 25% risk of recurrence if it means giving up driving privileges or risking a seizure in school or on the job. In addition, although it is appropriate to reassure most parents of children with newly-diagnosed epilepsy that seizures do not cause cognitive or behavioral deficits, problems do occur frequently and must be addressed. Comprehensive treatment programs for children with epilepsy must include evaluation and treatment of coexisting learning, cognitive, and behavior problems, as well as family education to prevent excessive parental anxiety and overprotection.
Mitchell
W G
WG
University of Southern California, School of Medicine, Childrens Hospital Los Angeles, USA.
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D004522:Educational Status; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009790:Occupations; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D012917:Social Adjustment
D000927:Anticonvulsants