Unprovoked status epilepticus: the prognosis for otherwise normal children with focal epilepsy.

Objective: To document the effect of unprovoked status epilepticus (SE) on the prognosis for otherwise normal children with focal epilepsy.

Methods: From the Nova Scotia Childhood Epilepsy Study (population-based), we identified patients with focal epilepsy, normal intelligence, and neurologic examination and follow-up ≥ 10 years. We compared those with and without unprovoked SE.

Results: One hundred eighty-eight cases had a mean follow-up of 27 ± 5 years with no deaths from SE. Thirty-nine (20%) had SE, 19 of whom experienced their first seizure. The number of episodes of SE was 1 in 27 patients (69%) and 2 to 10 in 12 patients. At onset 9 of 39 (23%) SE patients and 35 of 149 (23%) no-SE patients had specific learning disorders. At follow-up, 11 (28%) SE and 49 (33%) no-SE patients had learning disorders (P = not statistically different [ns]). Grades repeated, high school graduation, and advanced education did not differ. The number of antiepileptic drug (AED) used throughout the clinical course was the same: 22/39 (56%). SE patients used ≤ 2 AEDs versus 99 of 149 (64%) no-SE patients (P = .2). The distribution of patients using 3 to 11 AEDs was similar. The remission rate (seizure-free without AEDs at the end of follow-up) for SE patients was 24 of 39 (61%) versus 99 of 149 (66%) in no-SE (P = .5). Intractable epilepsy occurred in 15% SE and 11% of no-SE cases.

Conclusions: SE often recurs but apparently has little influence on long-term intellectual and seizure outcome in normally intelligent children with focal epilepsy.