Defining early seizure outcomes in pediatric epilepsy: the good, the bad and the in-between.
OBJECTIVE
To examine different approaches to classifying seizure outcomes.


METHODS
In a prospective cohort study of children (N=613) with newly diagnosed epilepsy, seizure outcomes at 2 years were classified as 'good' (> or =1 year remission), 'bad' or 'intractable' (> or = AED failures, > or =1 seizure/month over > or =18 months), and 'indeterminate' (neither 'good' nor 'bad'). Outcomes at 2 years were compared to outcomes in those followed 4 or more years. The associations of three commonly studied prognostic factors, etiology, age at onset, and syndromic grouping with the three-level outcome were assessed.


RESULTS
595 (97.1%) children were followed > or =2 years. A 'good', indeterminate, and 'bad' outcome was present in 314 (52.8%), 235 (38.3%), and 46 (7.7%) children. Problems with treatment were recorded in 64.7% of the indeterminate group. In 390 children followed > or =4 years, early 'good' and 'bad' outcomes persisted in approximately 80%. About half of those with indeterminate 2-year outcomes later achieved remission, 8% met criteria for intractability, and 37% remained indeterminate. Most of the associations with etiology, age, and syndrome were due to variation in the proportion that met criteria for intractability and not remission.


CONCLUSIONS
Many children have indeterminate outcomes, often in association with treatment issues. Clearly 'good' and 'bad' early outcomes can be identified and persist > or =2 years later. In the absence of pharmaco-resistance, lack of early remission (indeterminate outcome) is usually not associated with a bad outcome, at least over the next few years.
Berg
A T
AT
Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115, USA. atberg@niu.edu
Shinnar
S
S
Levy
S R
SR
Testa
F M
FM
Smith-Rapaport
S
S
Beckerman
B
B
Ebrahimi
N
N
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D012074:Remission Induction; D013577:Syndrome; D017211:Treatment Failure; D016896:Treatment Outcome