Abstract
The long-term prognosis of childhood-onset epilepsy has rarely been studied in a general
population. We examined the long-term medical, educational, and social outcomes in
individuals with a history of childhood-onset epilepsy aged 20 years or older in a
defined area of Japan. Furthermore, the patients’ recognition of epilepsy as well
as the parents’ concerns about the prognosis of epilepsy were also surveyed. After
a mean follow-up period of 18.9 years, we had sufficient data on 148 surviving patients
aged 20–38 years (mean, 26.0 years) and seven dead patients. The follow-up rate was
92.8%. In the overall group, the percentages of those who had had each of the following
were as follows: (a) 5-year remission, 62.8%; (b) a relapse of seizures, 17.4%; (c)
psychiatric complications, 2.7%; (d) mortality, 4.5%; (e) attendance at regular classes
of an ordinary school during compulsory education, 71.6%; (f) entrance to high school,
65.5%; (g) employment, 67.4%; (h) marriage, 23.0%; and (i) acquisition of a driver's
license, 54.7%. The educational and social variables of the control population were
as follows: (e) 99.1, (f) 97.0, (g) 96.6, (h) 51.9, and (i) 94.8%. In the 99 patients
of normal intelligence, the results of the same analysis were as follows: (a) 75.8,
(b) 10.7, (c) 0, (d) 0.6, (e) 100, (f) 96.0, (g) 95.2, (h) 33.3, and (i) 77.8%, in
contrast to the corresponding variables of the 49 patients with mental retardation,
that is, (a) 36.7, (b) 44.4, (c) 8.2, (d) 12.2, (e) 14.3, (f) 6.1, (g) 20.4, (h) 2.0,
and (i) 4.1%, respectively. The best predictors of seizure remission included an early
response to therapy, a low frequency of seizures or an absence of status epilepticus
prior to therapy, and normal mental development. As for the current awareness of epilepsy
and its prognosis, nearly 40% of the patients did not know the true name of their
illness, and the same proportion of parents were still anxious about the prognosis
even if their children had been taken off medication. Our data show that the majority
of patients with childhood-onset epilepsy have a favorable long-term medical prognosis
in terms of seizure remission and psychiatric complications, whereas they have a higher
mortality rate and lower levels of educational background as well as employment and
marital status compared with the general population. However, except for the low marriage
rate for the younger age group and the low rate of holding a driver's license, patients
of normal intelligence appear to have more favorable long-term prognoses in terms
of educational and social aspects as well. In Japan, individuals with epilepsy may
not seek a driver's license because of the law.
Keywords
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Article info
Publication history
Accepted:
March 21,
2000
Received in revised form:
February 17,
2000
Received:
November 12,
1999
Identification
Copyright
© 2000 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
