PROGNOSIS OF CHILDREN WITH A FIRST UNPROVOKED SEIZURE

DESCRIPTION: (Adapted from Investigator's Abstract) This application is to continue an ongoing prospective study of 407 children identified at the time of their first unprovoked seizure between 1984 and 1992 and prospectively followed for a mean of 9.5 years to date. Childhood seizures are a common event. Unprovoked seizures occur in approximately 2% of children, and epilepsy in 1%. With extended follow-up, the investigators state they can now address the long-term outcome of these children, including both remission and its predictors as well as the long-term educational and social outcomes. The research plan will continue the follow-up of this fully recruited cohort. A comprehensive reevaluation after 10 or more years of follow-up is planned, including a structured interview of educational and social outcomes, a physical and neurological exam, neuroimaging with an MRI, and a battery of instruments that measure quality of life, behavioral and psychiatric problems, and educational achievement. The interview and test instruments will also be administered to sibling controls. Primary analysis will focus on the following: 1. Seizure outcomes including risk of late recurrences (>2 and >5 years), probability of attaining 2 and 5 year remission and risk of relapse after attaining remission. Risk factors for these outcomes, late recurrence, remission and relapse will also be examined. The incidence of neuroimaging abnormalities such as heterotopias will be determined and the effect on prognosis analyzed. 2. Long term social and educational outcomes of childhood seizures compared with sibling controls as well an internal comparison of those with one seizure to those who experience recurrent seizures. They hypothesize that while the majority of subjects in this cohort will attain remission, more than 30% will have neuroimaging abnormalities and that the long term social and educational outcomes of the subjects will be worse than that of their sibling controls. They further hypothesize that etiology, age of onset and the specific epilepsy syndrome rather than the number of seizures will be the key determinants of outcome. The investigators state that the results from this study could substantially increase understanding of the natural history of childhood seizure disorders in terms of their evolution and prognosis which is a prerequisite for designing medical, educational and social interventions targeting those at risk for adverse long term outcomes.