Epilepsy is a general term used for a convulsive disorder with repeated episodes of symptoms ranging from momentary loss of consciousness, the repetitive movement of a particular limb or other part of the body, to an overall body convulsion. There may or may not be warning signs prior to the episode ("aura"). Epilepsy is due to one or more areas of brain damage; in a large proportion of instances, the specific reason for the brain damage is unknown. A definitive diagnostic test is the electroencephalogram (EEG) which demonstrates a specific pattern of "brain waves" associated with the convulsive episode.

About 30% of persons with cerebral palsy also have an associated developmental brain damage manifesting itself as epilepsy, a learning disability or mental retardation. Whether the same event caused both cerebral palsy and epilepsy or whether they were due to separate events is rarely understood; this is particularly true if the symptoms of both occur either at the time of birth or in the first months of life. If the symptoms of either or-both first occur later in infancy or childhood, the cause can generally be identified.

What are the long term outcomes of epilepsy with onset in childhood? A team of scientists in Finland and the USA recently published information on this question."¹ The long term outcome in 245 children with active epilepsy (usually between ages 3-4) were studied clinically over a period of 30 years. 28% had seizures presumed to be due to a genetic origin ("idiopathic"); 22% had seizures of no known cause and no association with another disorder ("cryptogenic"); and 50% had seizures occurring with a prior brain injury or brain disorder ("remote symptomatic"); this latter group included persons with cerebral palsy or mental retardation.

After 30 years of follow-up, 90% of the studied persons were available for final evaluation. 64% were seizure free for at least 5 years, of whom about 75 % were no longer taking antiepileptic medicines. The most important predictor of being seizure free in all groups was a rapid and good response to medication; this was particularly true in the group with a diagnosis of idiopathic epilepsy.

The author states: "although the majority of patients with epilepsy in childhood are free of seizure activity by the time they are adults, they are at increased risk of social and educational problems irrespective of their being seizure free or their families' socio-economic status. The reason(s) for this can only be presumed".

Persons who continue to have convulsive episodes are at a greater risk of earlier death than are persons who have no further seizures. Persons with epilepsy and cerebral palsy ("remote symptomatic epilepsy") are at greater risk of earlier death than are persons with other forms of epilepsy.

Comment: This excellent, long term follow-up study provides information confirming what has generally been suspected: epilepsy can decrease life expectancy. Whether controlled (seizure free) or uncontrolled, epilepsy too often can have adverse educational and socio-economic consequences. Of the three broad categories of epilepsy, the one associated with other developmental brain disorders such as cerebral palsy or/and mental retardation ("remote symptomatic") is the most serious as measured by life expectancy and quality of life. This is probably true because of the amount of brain injury and degree of brain dysfunction present when both co-exist.

Despite the above, we must remember a very large proportion of epilepsy (85%) irrespective of cause or type is treatable with modem drugs; if not treatable by drugs, treatable by surgery. Most persons with both cerebral palsy and epilepsy can be seizure free; for those who are not seizure free, the number and intensity of seizures can be reduced significantly. Irrespective of the health issues, cultural and social issues are still very important determinants of quality of life of persons with cerebral palsy and epilepsy.

1 Sillanpau, M. et al. Long Term Prognosis of Seizure with Onset in Childhood. NEJM 1998, 338-24, pages 1715-1722.