The prognosis of an illness is a forecast of its course and outcome -- what is likely to happen. While it is impossible to
know for certain how things will turn out for your child, we do have quite a lot of information how children with various
epilepsy syndromes do later in life.
The prognosis for a child with epilepsy deals with more than just whether her seizures will continue, be controlled by medication,
or go away. It includes the child’s success in school, whether she is likely to have social or behaviour problems, whether
she will be able to work, her family and personal relationships over the long term, and her overall quality of life. Most
research looks at seizure control, but we have some information about these other outcomes as well.
This page takes a general look at the prognosis for children with epilepsy. Each child is different, so talk to your child’s
treatment team about her particular situation.
Factors affecting the prognosis
An individual child’s prognosis depends on many different factors, including:
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the age the seizures started
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whether the seizures are easily controlled on medication
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whether the child has other neurological problems as well as epilepsy
Syndrome
Some epilepsy syndromes have a better prognosis than others. For example, childhood absence epilepsy and benign epilepsy of
childhood with centrotemporal spikes (BECTS) typically have an excellent prognosis: most children recover completely and many
have few or no learning problems. At the other end of the spectrum, certain syndromes generally have a poor prognosis.
The prognosis for specific epilepsy syndromes is discussed in more detail on the individual syndrome pages.
Cause
In general, children with idiopathic or cryptogenic epilepsy have a better prognosis than children with symptomatic epilepsy.
Children with brain tumours, mental retardation, head injury, or progressive metabolic disease and children born with a brain
abnormality (also called a congenital brain malformation) are less likely to become seizure-free with or without medication.
Even so, approximately half of children with symptomatic epilepsy who are seizure-free on medication will remain seizure-free
when the medication is discontinued.
Age of onset
Epilepsy that begins in childhood often has a better prognosis than epilepsy that begins in adolescence or adulthood, although
the evidence is mixed for children younger than two or three years old. If a child’s epilepsy began before age 12, it is more
likely that she will continue to be seizure-free once her medication is discontinued.
Response to treatment
If a child’s seizures are easily and quickly controlled on medication, this is a good sign
that she will eventually become seizure-free without medication, particularly for children with idiopathic epilepsy (one
study found that 92% of children with idiopathic epilepsy and early response to treatment later became seizure-free without
medication). Children with cryptogenic or symptomatic epilepsy and early response to treatment are slightly less likely to
become seizure-free without medication (67% and 30%, respectively).
If a child has surgery for epilepsy and then becomes seizure-free, this may also be a promising sign
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Other neurological problems
Children with congenital brain malformations, brain tumours, mental retardation, or head injury are less likely to become
seizure-free with or without medication. In one study, 42% of children with neurological problems had a recurrence of seizures
two years after discontinuing medication.
Number of seizures
The relationship between the number of seizures a child has and the child’s prognosis is unclear. Some studies have found
a link between the number of tonic-clonic seizures before the seizures were brought under control and the chance of recurrence,
while others have found no such relationship.
Seizure control
There are various possible outcomes for seizure control in people with epilepsy.
A Finnish study that followed 245 children with epilepsy for nearly 30 years found that 64% of the study group had been seizure-free
for at least five years, with or without medications. Another study found that between 40% and 50% of children with epilepsy
later became seizure-free without medication. It is thought that about 13% to 17% of children with epilepsy have refractory
epilepsy.
In some cases, your child’s doctor will suggest a trial period without medication if your child’s seizures have been well
controlled for at least two years. It is a good idea to discontinue medication if there is a good chance that your child will
be seizure-free without it, because the long-term use of epilepsy medications can affect your child’s self-image, behaviour,
and functioning. However, the medication should be tapered off slowly under a doctor’s supervision; stopping suddenly can
trigger seizures or even status epilepticus.
Other outcomes
Epilepsy can affect many other aspects of a child’s life, including:
We are still learning about the factors that contribute to these outcomes. Seizure control alone is not the only issue. Even
if the child does not have seizures, or if they are well controlled, there is some research which suggests that underlying
abnormalities can cause problems with learning and behaviour. Medication side effects, other disorders, the age at which the
seizures began, and how the child is treated by others may all play a role as well. Some syndromes are more likely than others
to cause difficulties, and these are discussed in more detail later in this section.
