Sillanpää M, Jalava M, Kaleva O, Shinnar S
Department of Pediatric Neurology, University of Turku, Finland.
N Engl J Med. 1998 Jun 11;338(24):1715-22. doi: 10.1056/NEJM199806113382402.
The long-term prognosis of seizures that begin in childhood is uncertain.
We prospectively studied 245 children from the catchment area of Turku University Hospital in Turku, Finland, who had active epilepsy diagnosed between 1961 and 1964. Sixty-eight patients (28 percent) had idiopathic seizures (presumed to have a genetic origin), 54 (22 percent) had cryptogenic seizures (occurring in otherwise normal persons with no clear cause), and 123 (50 percent) had remote symptomatic seizures (with no immediate cause but occurring in persons with a prior brain injury or a static encephalopathy).
At the final follow-up in 1992, we had sufficient data on 220 patients (90 percent), 176 of whom were alive and 44 of whom had died; the remaining 25 had emigrated, could not be traced, or declined to participate. Thirty-nine patients who died were not free of seizures at the time of death, and 33 had remote symptomatic seizures. Among the surviving patients, 112 (64 percent) had been seizure-free for at least five years, including 83 (47 percent) who were not taking antiepileptic medications. The most important predictors of being seizure-free for at least five years were a rapid response to therapy (defined as a reduction in the frequency of seizures of 75 to 100 percent within three months of beginning treatment) and a diagnosis of idiopathic seizures. As compared with a matched control group, 99 patients with epilepsy but no other initial neurologic impairment were of similar socioeconomic status and had similar rates of passing an examination given after 12 years of school. Significantly more patients, however, had completed only six years of school (relative risk, 2.13), were unemployed (relative risk, 3.76), were not married (relative risk, 3.50), and did not have children (relative risk, 3.00).
Although the majority of patients with epilepsy in childhood are free of seizures by the time they become adults, they are at increased risk for social and educational problems. Patients whose epilepsy does not remit also have an increased risk of death.
始于儿童期的癫痫发作的长期预后尚不确定。
我们对芬兰图尔库图尔库大学医院服务区域内的245名儿童进行了前瞻性研究，这些儿童在1961年至1964年间被诊断患有活动性癫痫。68名患者（28%）患有特发性癫痫发作（推测有遗传起源），54名（22%）患有隐源性癫痫发作（发生在其他方面正常但无明确病因的人身上），123名（50%）患有远期症状性癫痫发作（无直接病因，但发生在有既往脑损伤或静态脑病的人身上）。
在1992年的最终随访中，我们获得了220名患者（90%）的充分数据，其中176人存活，44人死亡；其余25人移民、无法追踪或拒绝参与。39名死亡患者在死亡时仍有癫痫发作，33人患有远期症状性癫痫发作。在存活患者中，112人（64%）至少五年无癫痫发作，其中83人（47%）未服用抗癫痫药物。至少五年无癫痫发作的最重要预测因素是对治疗的快速反应（定义为开始治疗后三个月内癫痫发作频率降低75%至100%）和特发性癫痫发作的诊断。与匹配的对照组相比，99名患有癫痫但无其他初始神经功能损害的患者具有相似的社会经济地位，并且在接受12年学校教育后的考试通过率相似。然而，完成仅六年学业的患者明显更多（相对风险，2.13），失业的患者更多（相对风险，3.76），未婚的患者更多（相对风险，3.50），没有孩子的患者更多（相对风险，3.00）。
尽管大多数儿童癫痫患者在成年时无癫痫发作，但他们面临社会和教育问题的风险增加。癫痫未缓解的患者死亡风险也增加。
