Outcome
Seizure syndromes have a generally predictable effect on the child’s developing abilities, strengths and weaknesses. Some children who have seizures will experience little difficulty and develop normally, whereas others will have developmental and/or cognitive problems that can range from subtle to debilitating. Much will depend on the frequency or severity of the seizures, the degree to which seizures are controlled, the dosage and number of anticonvulsants the child takes, and the presence of a disorder of brain function.
Seizure control and remission
Most children with epilepsy fall into four groups based on their type of epilepsy and the likely result of treatment:
- Seizures can be expected to stop after a few years and treatment might not be needed for many children in this group.
- Seizures are well controlled with medication. The child will become seizure-free and treatment is discontinued after several years.
- Seizures do not go into remission and treatment is needed throughout life.
- Seizures continue, although they might be fewer and/or less severe, even with drug therapy.
In general, children who respond early (75 percent–100 percent seizure reduction within the first three months of treatment) have a good chance of achieving long-term remission. However, those whose seizures are due to a structural lesion are less likely to have a favorable outcome.
More than half of children with uncontrolled seizures who are referred to a specialized epilepsy center have some type of abnormality of brain structure. The same structural abnormality may also be responsible for other conditions, such as cerebral palsy or mental retardation, in addition to seizures.
Children whose seizures are well controlled can often be tapered off medication, usually after a seizure-free period of two years. The medications are typically reduced slowly over 3– 12 months, with more time being used with medications that have a higher risk of withdrawal seizures. Families should never stop anticonvulsant medication without consulting the child’s doctor, as prolonged withdrawal seizures can cause severe neurological damage and disability.
The return of seizures after a period of remission is highly variable in different epilepsy syndromes. About 4 in 10 children who experience a first unprovoked focal or generalized tonic-clonic seizure will experience a recurrence in seizures within 8 years, with most occurring within 5 years.
Developmental milestones
Age-appropriate growth and development is variable among all children. In children with seizures, the variability is somewhat greater. Many will reach developmental milestones at a normal pace , whereas children who are severely affected may experience developmental delay. The cause for the delay, whether due to a structural brain abnormality, seizures, or medications, is often difficult to determine.
Cognitive and motor functioning
The long-term outcome for most children with seizures is generally favorable. Disability, when it does exist, can take many forms. Among the areas of potential impairment are language ability; visuospatial ability; memory and learning; motor functioning; attention and concentration; planning, concept formation and problem solving; behavior and social functioning; and mood and personality. Performance in these domains often improves when seizures come under better control or when go into full remission. Rarely is there a regression or loss in the level of ability or functioning once it has been achieved.