The early prognosis of epilepsy in childhood: the prediction of a poor outcome. The Dutch study of epilepsy in childhood.
OBJECTIVE
To examine which variables available early in the course of childhood epilepsy are associated with a poor short-term outcome and to develop models to predict such an outcome.


METHODS
We prospectively followed up 466 children with newly diagnosed epilepsy for 2 years. Variables were collected at intake and after 6 months. Outcome was defined as the duration of the terminal remission (TR): poor (<6 months) and not poor (> or =6 months).


RESULTS
Of the subjects, 31% had a poor outcome. Multivariate analysis based on the intake variables identified number of seizures, seizure type, and etiology as risk factors for a poor outcome. With the intake and 6-month variables combined, seizure type, etiology, the number of seizures, and not attaining a 3-month remission during these 6 months, and the EEG at 6 months were predictive variables. A predictive model based on the multivariate logistic-regression analysis with the intake variables was correct in 56% of the children in whom it predicted a poor outcome and in 73% of the children in whom it predicted a not-poor outcome. With the intake and 6-month variables together, these percentages were 66 and 79%, respectively. The sensitivity of these models was low (29 and 47%, respectively); the specificity was good (90 and 89%).


CONCLUSIONS
The 2-year outcome of childhood epilepsy is closely related to its early course. The prognosis is poor in approximately 30% of patients. By using our data, the prediction of a poor outcome is correct in almost two thirds of the patients; however, the models produce many false-negative predictions.
Arts
W F
WF
Department of Pediatric Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Geerts
A T
AT
Brouwer
O F
OF
Boudewyn Peters
A C
AC
Stroink
H
H
van Donselaar
C A
CA
D000367:Age Factors; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors