Few prospective, population-based, long-term follow-up studies exist on people with
epilepsy. Still fewer reports cover social outcome. Overall mortality is two to three times higher than expected. The contribution of
epilepsy is variable. Importantly, the type of
epilepsy syndrome and gender must be considered in the estimation of mortality rates in
epilepsy. Sudden unexpected death and its mechanisms also need further consideration. Approximately. two thirds of surviving patients will be in terminal remission twenty years after onset of
epilepsy and half of them are seizure-free without medication. The best independent predictors of remission are absence of organic brain damage, low intensity seizure propensity and good early effect of
drug therapy. The long-term outcome is often predictable by observation of the early outcome of
seizures. One third of children with
epilepsy are mentally retarded. Poor social outcome is related to associated neurological disabilities,
drug resistant
seizures and polytherapy. However, even patients with uncomplicated
epilepsy, idiopathic etiology and terminal remission without medication do less favourably than their matched controls in basic and vocational education, and reproductive activity. The employability of this subgroup, however, does not differ significantly from that of controls, compared with approximately 60% of all people with
epilepsy. Further research is needed particularly to enable a better determination of predictors of long-term outcome, recurrence of
seizures after
drug withdrawal and the role of
drug therapy in long-term prognosis.