The long-term recurrence risk after a first unprovoked seizure was determined in a prospective study of 407 children, followed for a mean of 6.3 years, at the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Seizures recurred in 42%; the cumulative risk of seizure recurrence at 1, 2, 5, and 8 year follow-up was 29%, 37%, 42%, and 44%, respectively. One-half recurrences had occurred within 6 months, and almost 90% within 2 years. Risk factors for seizure recurrences included a remote symptomatic etiology, abnormal EEG, nocturnal seizures, prior febrile seizures, and Todd’s paresis. Children with the most favorable prognosis (21% recurrence risk after 5 years) had a cryptogenic first seizure while awake and a normal EEG. [1]

COMMENT. This study is important because of the large number of patients included and the long duration of follow-up. In addition to acquired symptomatic etiology and EEG dysrhythmia, factors frequently associated with an increased risk of seizure recurrence in other studies, sleep related seizures, prior febrile seizures, and Todd’s paresis were demonstrated as risk factors. Cryptogenic seizures while awake and a normal EEG were predictive of a good prognosis and a low rate of recurrence.

In a further report, these authors correctly point out that the control of seizures by AEDs and a favorable long-term remission is only part of the goal of therapy. Heightened self-esteem, improved school achievement, and social acceptance by peers are other important considerations. Although the prognosis of epilepsy is determined largely by the underlying cause and associated neurologic abnormalities, the control of seizures by AEDs improves the quality of life and is justification for rational therapy. [2]