The prognosis for a child with epilepsy deals with more than just whether their seizures will continue, be controlled by medication or go away. It includes the child’s success in school, whether they are likely to have social or behavioural problems, whether they will be able to work, their family and personal relationships over the long term and their overall quality of life. Most research looks at seizure control, but we have some information about these other outcomes as well.
Factors affecting the prognosis
An individual child’s prognosis depends on many different factors, including:
- the results of any neuroimaging studies that were done, such as a CT scan or MRI, if the child's doctor thinks these are appropriate
- the epilepsy syndrome, if it was identified
- whether the epilepsy is idiopathic, symptomatic or cryptogenic
- the age the seizures started
- whether the seizures are easily controlled on medication
- 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, intellectual disabilities, 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, about half of children with symptomatic epilepsy who are seizure-free on medication will remain seizure-free when the medication is discontinued. Children who do well and remain seizure-free generally have other good prognostic factors, such as a favourable EEG finding.
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 they will continue to be seizure-free once their medication is discontinued.
Response to treatment
If a child’s seizures are easily and quickly controlled on medication, this is a good sign that they will eventually become seizure-free without medication, particularly for children with idiopathic epilepsy (one study found that 92 per cent 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 per cent and 30 per cent, respectively).
If a child has surgery for epilepsy and then becomes seizure-free, this may also be a promising sign.
Other neurological problems
Children with congenital brain malformations, brain tumours, intellectual disability or head injury are less likely to become seizure-free with or without medication. In one study, 42 per cent 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 percent of the study group had been seizure-free for at least five years, with or without medications. Another study found that between 40 per cent and 50 per cent of children with epilepsy later became seizure-free without medication. It is thought that about 13 per cent to 17 per cent 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 of epilepsy
Epilepsy can affect many other aspects of a child’s life, including:
- emotions and behaviour
- social development
- ability to learn
- work.
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.