Social functioning and seizure status of young adults with onset of epilepsy in childhood. An epidemiological 20-year follow-up study.

The purpose of the present study was to examine the prognosis for epilepsy with a childhood onset by means of a follow-up study with a twenty-year follow-up period. Special attention was paid to the seizure outcome, the acquirement of basic and vocational education, working ability and actual working, social functioning, social adjustment and mortality. The study dealt with patients from a specified area in southwestern Finland who were initially under 16 years of age and who had had recurrent, non-sporadic seizures not caused by an acute infection or a progressive cerebral disease. The original series consisted of 245 patients, followed up retrospectively for approximately ten years. Extreme efforts were made to obtain as large a body of data on the patients and their epilepsy as possible. All patients were then examined clinically and by EEG by the present author personally. This took place in 1972. The first prospective follow-up evaluation was carried out in 1977 and the second in 1982. The method used in these two follow-ups was that of a mail inquiry. By 1982, 29 patients had died, ten were not reached and two refused to participate. The group studied in 1982 consisted of the remaining 204 patients. The shortest follow-up period was 17 years (mean 21.16 +/- 24 years). At the end of the follow-up the age of the youngest was 17 years and that of the oldest 34 years (mean 24.74 +/- 0.33 years). The data obtained on the patients were computerized, and multivariate methods of analysis were applied in addition to usual statistical methods. The seizure outcome was considered good if three years or more had elapsed from the last seizure. In 1982 such patients accounted for 60% of all cases. Stepwise logistic regression analysis showed that good seizure outcome is best explained by the occurrence of one seizure type only and good short-term treatment outcome. The nonoccurrence of status epilepticus, normal psychoneurological development status and the occurrence of grand mal only also contributed to the explanation. These variables predict the disappearance of seizures with a 95-100% probability. Normal compulsory basic education had been completed by 60% of the patients. Only two variables, good short-term treatment outcome and late age (preschool or school age) at onset of epilepsy, contributed to the explanation of this outcome. It appeared from logistic regression analysis that all those who had a normal psychoneurological development status had completed compulsory education.(ABSTRACT TRUNCATED AT 400 WORDS)