Factors predictive of remission of epilepsy were evaluated in 504 patients followed for an average of 7 years at the Departments of Pediatrics and Mathematics, Dalhousie University and Children’s Hospital, Halifax, Nova Scotia, Canada. At the end of follow-up, 55% of the total cohort were off medication and in remission. Approximately 70% of those stopping medication remained seizure free. At the time of diagnosis, the best predictors of remission, determined by a multivariate analysis scoring system, were 1) age <12 years at onset, 2) normal intelligence, 3) no prior neonatal seizures, and 4) fewer than 21 seizures before treatment. Prediction was improved after 12 months follow-up, when a score for the seizure frequency between 6 and 12 months was included. Patients with absence and minor motor seizures were excluded from the study. Seizure type and the EEG were not of predictive value. [1]

COMMENT. During the study period, 1977-1985, the number of seizure-free years required before mediction withdrawal was attempted changed from 4 to 2 years. The authors endorse the stopping of medication after 2 seizure-free years, regardless of the predicted prognosis.

A social outcome of epilepsy study in 337 intellectually normal children included in this Nova Scotia population found school failure in 34%, mental health consultation in 22%, psychotropic medication used in 5%, unemployment 20%, and criminal conviction in 2%. Learning disorders and more than 21 seizures before treatment for epilepsy were predictive of an unfavorable social outcome, but seizure control and EEG were non-predictive. [2]