Defining early seizure outcomes in pediatric epilepsy: the good, the bad and the in-between

Purpose: To examine different approaches to classifying seizure outcomes. M ethods: In a prospective cohort study of children (N = 613) with newly diag nosed epilepsy, seizure outcomes at 2 years were classified as 'good' (grea ter than or equal to1 year remission),'bad' or 'intractable' (greater than or equal to2 AED failures, greater than or equal to1 seizure/month over gre ater than or equal to 18 months), and 'indeterminate' (neither 'good' nor ' bad'). Outcomes at 2 years were compared to outcomes in those followed 4 or more years. The associations of three commonly studied prognostic factors, etiology, age at onset, and syndromic grouping with the three-level outcom e were assessed. Results: 595 (97.1%) children were followed greater than o r equal to2 years. A 'good', indeterminate, and 'bad' outcome was present i n 314 (52.8%), 235 (38.3%), and 46 (7.7%) children. Problems with treatment were recorded in 64.7% of the indeterminate group. In 390 children followe d greater than or equal to4 years, early 'good' and 'bad' outcomes persiste d in similar to 80%. About half of those with indeterminate 2-year outcomes later achieved remission, 8% met criteria for intractability, and 37% rema ined indeterminate. Most of the associations with etiology, age, and syndro me were due to variation in the proportion that met criteria for intractabi lity and not remission. Conclusions: Many children have indeterminate outco mes, often in association with treatment issues. Clearly 'good' and 'bad' e arly outcomes can be identified and persist greater than or equal to2 years later. In the absence of pharmaco-resistance, lack of early remission (ind eterminate outcome) is usually not associated with a bad outcome, at least over the next few years. (C) 2001 Elsevier Science B.V. All rights reserved .