Long-term outcome of epilepsy

Few prospective, population-based, long-term follow-up studies exist on peo ple with epilepsy. Still fewer reports cover social outcome. Overall mortal ity is two to three times higher than expected. The contribution of epileps y is variable. Importantly, the type of epilepsy syndrome and gender must b e considered in the estimation of mortality rates in epilepsy. Sudden unexp ected death and its mechanisms also need. further consideration. mortality is two to three times higher than expected. The contribution of Approximate ly. two thirds of surviving patients will be in terminal remission twenty y ears after onset of epilepsy and half of them are seizure-free without medi cation. The best independent predictors of remission are absence of organic brain damage, low intensity seizure propensity and good early effect of dr ug therapy. The long-term outcome is often predictable by observation of th e early outcome of seizures. One third of children with epilepsy are mental ly retarded. Poor social outcome is related to associated neurological disa bilities, drug resistant seizures and polytherapy. However, even patients w ith uncomplicated epilepsy, idiopathic etiology and terminal remission with out medication do less favourably than their matched controls in basic and vocational education, and reproductive activity. The employability of this subgroup, however, does not differ significantly from that of controls, com pared with approximately 60% of all people with epilepsy. Further research is needed particularly to enable a better determination of predictors of lo ng-term outcome, recurrence of seizures after drug withdrawal and the role of drug therapy in long-term prognosis.