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Course and outcome of childhood epilepsy: A 15-year follow-up of the Dutch Study of Epilepsy in Childhood

  1. Ada Geerts1,
  2. Willem F. Arts2,
  3. Hans Stroink3,
  4. Els Peeters4,
  5. Oebele Brouwer5,
  6. Boudewijn Peters6,
  7. Laura Laan7,
  8. Cees Van Donselaar8

Article first published online: 14 JUN 2010

DOI: 10.1111/j.1528-1167.2010.02546.x

Issue

Epilepsia

Epilepsia

Volume 51, Issue 7, pages 1189–1197, July 2010

Additional Information

How to Cite

Geerts, A., Arts, W. F., Stroink, H., Peeters, E., Brouwer, O., Peters, B., Laan, L. and Van Donselaar, C. (2010), Course and outcome of childhood epilepsy: A 15-year follow-up of the Dutch Study of Epilepsy in Childhood. Epilepsia, 51: 1189–1197. doi: 10.1111/j.1528-1167.2010.02546.x

Author Information

  1. 1

    Department of Neurology, Erasmus MC, Rotterdam, The Netherlands

  2. 2

    Department of Neurology, Section Paediatric Neurology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands

  3. 3

    Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

  4. 4

    Department of Paediatric Neurology, MCH Westeinde and Juliana Children’s Hospital, The Hague, The Netherlands

  5. 5

    Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

  6. 6

    Department of Paediatric Neurology, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, Utrecht, The Netherlands

  7. 7

    Department of Neurology, Leiden University Medical Hospital, Leiden, The Netherlands

  8. 8

    Department of Neurology, Maasstadziekenhuis, Rotterdam, The Netherlands

*Address correspondence to Ada T. Geerts, Department of Neurology, Ee2293 Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: mail@adageerts.nl

Publication History

  1. Issue published online: 1 JUL 2010
  2. Article first published online: 14 JUN 2010
  3. Accepted January 18, 2010; Early View publication June 14, 2010.

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Keywords:

  • Epilepsy;
  • Children;
  • Course;
  • Outcome;
  • Mortality

Summary

Purpose:  To study the course and outcome of childhood-onset epilepsy during 15-year follow-up (FU).

Methods:  We extended FU in 413 of 494 children with new-onset epilepsy recruited in a previously described prospective hospital-based study by questionnaire.

Results:  Mean FU was 14.8 years (range 11.6–17.5 years). Five-year terminal remission (TR) was reached by 71% of the cohort. Course during FU was favorable in 50%, improving in 29%, and poor or deteriorating in 16%. Mean duration of seizure activity was 6.0 years (range 0–21.5 years), strongly depending on etiology and epilepsy type. Duration was <1 year in 25% of the cohort and exceeded 12 years in another 25%. Antiepileptic drugs (AEDs) were used by 86% during a mean of 7.4 years: one-third had their last seizure within 1 year of treatment, and one-third continued treatment at the end, although some had a 5-year TR. At last contact, 9% of the cohort was intractable. In multivariate analysis, predictors were nonidiopathic etiology, febrile seizures, no 3-month remission, and early intractability. Eighteen patients died; 17 had remote symptomatic etiology. Standardized mortality ratio for remote symptomatic etiology was 31.6 [95% confidence interval (CI) 18.4–50.6], versus 0.8 [95% CI 0.02–4.2] for idiopathic/cryptogenic etiology.

Discussion:  In most children with newly diagnosed epilepsy, the long-term prognosis of epilepsy is favorable, and in particular, patients with idiopathic etiology will eventually reach remission. In contrast, epilepsy remains active in ∼30% and becomes intractable in ∼10%. AEDs probably do not influence epilepsy course; they merely suppress seizures. Mortality is significantly higher only in those with remote symptomatic etiology.

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