The value of early seizure frequency and etiology in the prediction of long-term seizure and mortality outcome in a population-based cohort of 102 children was determined in a study at University of Turku, Finland, and Epilepsy Research Group, Berlin, Germany. Follow-up was a median of 40 years after the first seizure before the age of 16 years. One-year remission (1YR) had occurred in 95 (93%) of the group, and 7 (7%) never experienced a 1YR, their epilepsy considered drug-resistant. Patients with weekly seizures in the first year of treatment had a 8-fold risk of developing drug resistant epilepsy (P=0.0125), and a 2-fold risk of never entering a terminal 1YR (P=0.001). Weekly seizures prior to treatment carried a slight risk of never entering terminal 1YR (P=0.035). Mortality during follow-up was 13%, and long-term mortality was 9-fold higher for patients with symptomatic epilepsy (P=0.0071). Weekly seizures prior to or during the first year of treatment did not increase mortality. Virtually all (51/52, 98%) children with low seizure frequency and non-symptomatic etiology entered 1YR during 40 years follow-up, and almost all (49/52, 94%) entered 1-year terminal remission. A combination of frequent pretreatment seizures and symptomatic etiology is predictive of intractable epilepsy. 
COMMENT. The long-term outcome of epilepsy in children may be predicted after one year of treatment. Patients with frequent seizures in the first year of treatment, especially those with symptomatic epilepsy, are at increased risk of intractable epilepsy, and should be considered for aggressive therapy.