Prognosis

Prognosis varies greatly depending on the epilepsy syndrome, but can also vary for different patients with the same syndrome. There is generally a good prognosis for children with idiopathic epilepsy and late onset of seizures, and in those without neurologic dysfunction.[171] Rapid response to therapy is an important predictor of lasting remission. The most important prognostic factor is the etiology of seizures.[172]

Around one third of all pediatric patients with epilepsy will have a poor long-term outcome in terms of persistent seizures after remission, or no remission at all.[173] Epilepsy with onset in infancy and early childhood often runs a more severe course.[32]

Treatment with anticonvulsants after the first seizure reduces the risk of seizure recurrence, but there is no evidence of a difference when treatment is started after the first versus second seizure in achieving long-term seizure remission.[45]

The risk of relapse after discontinuation of anticonvulsant treatment is higher in patients with brain structural lesions or intellectual disability, and in some epilepsy syndromes (e.g., juvenile myoclonic epilepsy).

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