Researchers at Children’s Memorial Hospital, Chicago, IL, and Yale School of Medicine, New Haven, CT determined the probability of attaining complete remission of nonsyndromic epilepsy in a community-based cohort of 347 children with onset of epilepsy between ages of 1 month and 16 years (average, 5.5 years). None met criteria for well-defined electroclinical syndromes. The average length of follow-up was 14.4 years (maximum 17.9 years), and families were contacted frequently (3-4 times per year). Complete remission was defined as 5 years seizure-free and medication-free. Of 294 (85%) children followed prospectively for >10 years, 170 (58%) achieved complete remission, and 10 (6%) of these relapsed. Another 46 had a 5-year seizure-free, but not drug-free remission. Relapses occurred 0.4 to 7.5 years after attaining complete remission; and the probability of relapse at 1, 5, and 8 years after remission was 1%, 5%, and 8%. The probability of achieving complete remission by 5, 8, 10, and 15 years after diagnosis of epilepsy was 3%, 31%, 46%, and 60%. The average duration of follow-up after attaining complete remission was 6.4 years (range, 0.2 to 11.3). Relapses were marginally associated with underlying cause (0.06). MRIs were obtained in 262 (89%) of participants and were abnormal in 55 (21%), of whom 18 (33%) achieved complete remission. Groups with complete remission for >10 years were distinguished by seizure outcome at 2 years (p<0.0001) and by underlying cause (p<0.0001). Good early seizure outcomes and epilepsy of unknown cause had a higher likelihood of complete remission whereas status epilepticus and older age at onset were associated with a poorer outcome. 
COMMENT. We rarely speak of cure of epilepsy, an outcome desired by both patient and physician. This well-defined study provides evidence of complete remission or cure of seizures in more than 50% of young people with focal or generalized nonsyndromic epilepsy. A medication-free outcome may be predicted by early seizure control and an epilepsy of unknown cause. Negative imaging and metabolic studies performed early have a role in the identification of epilepsies amenable to complete remission and cure.