title: Childhood-onset epilepsy five decades later. A prospective population-based cohort study.
abstract: OBJECTIVE
  To study the impact of childhood-onset epilepsy on a variety of outcomes across the life span.
  
  
  METHODS
  A population-based cohort of 245 subjects with childhood-onset epilepsy was assessed for outcomes at 45 years. In addition, 51 of 78 surviving subjects with uncomplicated epilepsy and 52 of 99 originally matched controls participated in a detailed evaluation including electroencephalography (EEG), imaging, and laboratory studies at 50 years.
  
  
  RESULTS
  Of 179 surviving subjects, 61% were in terminal 10-year remission and 43% in remission off medications. At 45 years, 95% of the idiopathic group, 72% of the cryptogenic group, and 47% of the remote symptomatic group were in terminal remission (p < 0.001). Abnormal neurologic signs were significantly more common in subjects with uncomplicated epilepsy than in controls. Mortality during period 1992-2012 was higher in subjects than in controls (9% vs. 1%, p = 0.02). The rate of 3T MRI abnormalities was higher in subjects than in controls (risk ratio [RR] 2.0; 1.3-3.1) specifically including findings considered markers of cerebrovascular disease (RR 2.5; 1.04-5.9). Even subjects with idiopathic epilepsy had higher rates of imaging abnormalities than controls (73% vs. 34%, p = 0.002).
  
  
  CONCLUSIONS
  Long-term seizure outcomes are excellent and a function of etiology. The presence of imaging abnormalities suggestive of vascular disease may put these subjects at higher risk for clinically evident stroke and cognitive changes as they age.
authors.affiliation: Department of Child Neurology, Turku University Hospital, Turku, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Sillanpää
authors.affiliation: Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
authors.forename: Anu
authors.initials: A
authors.lastname: Anttinen
authors.affiliation: Turku PET Centre, Turku, Finland.
authors.forename: Juha O
authors.initials: JO
authors.lastname: Rinne
authors.affiliation: Turku PET Centre, Turku, Finland.
authors.forename: Juho
authors.initials: J
authors.lastname: Joutsa
authors.affiliation: VSKK, TYKS-SAPA, Turku, Finland.
authors.forename: Pirkko
authors.initials: P
authors.lastname: Sonninen
authors.affiliation: Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Erkinjuntti
authors.affiliation: Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Bruce
authors.initials: B
authors.lastname: Hermann
authors.affiliation: Department of Psychology, Abo Akademi University, Turku, Finland.
authors.forename: Mira
authors.initials: M
authors.lastname: Karrasch
authors.affiliation: Department of Public Health, University of Turku, Turku, Finland.
authors.forename: Maiju
authors.initials: M
authors.lastname: Saarinen
authors.affiliation: Turku Teacher Training College, University of Turku, Turku, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Tiitta
authors.affiliation: Departments of Neurology, Pediatrics and Epidemiology and Public Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Shinnar
mesh_terms: D000328:Adult; D017668:Age of Onset; D002648:Child; D015331:Cohort Studies; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D013997:Time Factors
keywords: Childhood-onset epilepsy; Comorbidity of epilepsy; Long-term outcome; Prospective cohort study