The Early Prognosis of Epilepsy in Childhood: The Prediction of a Poor Outcome. The Dutch Study of Epilepsy in Childhood

Authors


Address correspondence and reprint requests to Dr. W. F. M. Arts at Department of Pediatric Neurology, Erasmus University Medical Center, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.

Abstract

Summary: Purpose: 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 (≥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 −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.

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