Many parents wonder if their child will eventually be free from seizures. While it is a complex condition, scientific evidence indicates that a considerable number of children diagnosed with epilepsy can achieve sustained seizure freedom.
What “Outgrowing” Epilepsy Means for Children
For children with epilepsy, “outgrowing” the condition refers to achieving a state of long-term seizure freedom, commonly defined as being seizure-free for a significant period, typically several years, while also being off medication. The International League Against Epilepsy (ILAE) suggests “resolution” of epilepsy involves remaining seizure-free for at least 10 years, with the last five years being off medication.
Approximately two-thirds of children diagnosed with epilepsy may outgrow the condition by their teenage years or early twenties. Some studies indicate that up to 75% of children can become seizure-free within two years of diagnosis.
Factors Influencing Remission
Several factors play a role in determining a child’s likelihood of achieving remission from epilepsy. The specific type of epilepsy syndrome is a major determinant, with some forms having a higher probability of resolution than others. Epilepsy that is considered idiopathic, meaning without a known cause, generally carries a more favorable prognosis compared to symptomatic forms linked to structural brain abnormalities.
The age at which seizures begin can also influence the outcome. A younger age of onset is often associated with a better chance of remission in certain syndromes. Conversely, onset after 10 years of age, or very early onset before one year of age, may sometimes be associated with a less favorable outlook. Additionally, the absence of other neurological issues, such as developmental delays or intellectual disabilities, is a positive indicator for remission.
How quickly and effectively seizures are brought under control with medication also impacts the prognosis. Children whose seizures respond well to the first or second anti-seizure medication often have a higher chance of achieving remission. Findings from electroencephalograms (EEGs) can offer clues; a normal EEG or one that normalizes over time is generally associated with a better prognosis, whereas persistent abnormal brain wave patterns may suggest a higher risk of seizure recurrence. The need for multiple anti-seizure medications to control seizures can indicate a more complex form of epilepsy, potentially reducing the likelihood of remission.
Common Childhood Epilepsy Syndromes with Favorable Outcomes
Certain childhood epilepsy syndromes are known for their high rates of remission, often allowing children to outgrow the condition entirely. Benign Rolandic Epilepsy (BRECTS), also known as self-limited epilepsy with centrotemporal spikes, is a common example. This syndrome is characterized by seizures that typically occur during sleep and affect the face and mouth. Nearly all children, about 95% to 100%, with Benign Rolandic Epilepsy stop having seizures by age 15, often without needing ongoing medication.
Childhood Absence Epilepsy (CAE) is another syndrome with a generally favorable prognosis. Children with CAE experience brief, staring spells that can be mistaken for daydreaming. A significant majority, approximately 65% to 79%, achieve remission, often by mid-adolescence. However, some children with CAE may later develop other seizure types, such as generalized tonic-clonic seizures, or transition to Juvenile Myoclonic Epilepsy.
Juvenile Myoclonic Epilepsy (JME) typically emerges in adolescence and involves sudden, brief muscle jerks, often in the morning. While seizures in JME can often be well-controlled with medication, it is generally considered a lifelong condition for many individuals. Studies indicate high relapse rates, around 70% to 80%, if medication is withdrawn. However, a smaller percentage, approximately 16% to 28%, may achieve long-term remission without medication.
Febrile seizures, which are seizures triggered by fever in young children, are common. Most children who experience febrile seizures do not develop chronic epilepsy. However, complex or prolonged febrile seizures, or those occurring in children with pre-existing developmental delays or a family history of epilepsy, may slightly increase the risk of developing epilepsy later in life.
Infantile Spasms, a more severe epilepsy syndrome of infancy, can have varying outcomes. Early and appropriate treatment is associated with better chances of seizure control and developmental outcomes. While spontaneous remission is relatively low, effective treatments can lead to remission in a higher percentage of cases.
Ongoing Care and Monitoring
Even if a child achieves seizure freedom and enters remission, continued medical supervision remains important. Regular check-ups with a neurologist are typically recommended to monitor the child’s progress and assess for any potential return of seizures.
The gradual reduction or discontinuation of anti-seizure medication is a significant step. This process is always undertaken under the close guidance of a medical professional, usually after a child has been seizure-free for at least two years. Many children successfully come off medication, but there is a possibility of seizure recurrence, with rates ranging from 12% to 66%, commonly cited around 30% to 40%. Most relapses, if they occur, happen within the first one to two years after medication withdrawal.
Electroencephalogram (EEG) tests may be performed during the medication tapering process to help assess the risk of relapse. Beyond medical monitoring, focusing on a child’s overall well-being, including healthy lifestyle factors and providing appropriate support, contributes to their long-term health and development.