Long-Term Prognostic Patterns In Pediatric Epilepsy: A Review Of Literature.

Objective: The aim of this paper is to provide a synoptical review of the evidence generated by recent longitudinal and retrospective cohort studies to assess the long-term prognostic patterns in pediatric epilepsy. Background: Epilepsy is a heterogeneous disease where certain types are self-limiting while others are intractable and may extend for several decades into adulthood. Several reports on the long-term prognosis of early-onset epilepsy have been published that suggest the wide range of possible outcomes and prognostic patterns. Some studies were hospital- or community-based while others were cross-sectional or from administrative datasets. Design/Methods: We reviewed 14 studies published between 2012 and 2017, of which 4 were from secondary or tertiary referral centers and the remaining were essentially population-based studies. Results: The population assessed by these studies was early–onset pediatric age group; three studies focused on infants. The mean follow-up was 16.6 years (Range: 2.0–27.7). Epilepsy prognosis was quite variable and early therapy or remissions were not predictive of the final outcomes in patients in the long term. While etiology was one of the dominant predictors of outcome, it was difficult to establish other consistent predictors. Some resolved epilepsy patients with a ten-year remission were observed to have a subsequent relapse. Different prognostic patterns became evident in cohorts followed for several decades; varying relapsing-remitting patterns were observed on long-term follow-up. Children with complicated epilepsy had higher mortality than those without complications. Definitions of terms like early, late, long-term, terminal or permanent remission are likely to evolve as more evidence is generated. Conclusions: The temporal aspects of remission and relapse associated with treatment in the long-term are extremely important and there is paucity of population-based data that can provide definitive answers about the long-term prognosis of each early-onset epilepsy syndrome. Study Supported by: Goizueta Foundation Disclosure: Dr. Naik has nothing to disclose. Dr. McCallum has nothing to disclose. Dr. DeGrauw has nothing to disclose.