[A discussion of the curability of childhood epilepsies (author's transl)].

Permanent freedom from fits can be achieved in a large proportion of children with a history of epilepsy through precise individual adjustment and careful maintenance of the therapeutic regimen. A review of the cases treated at the Pediatric Clinic, out-Patient-Department for Epileptics, University of Vienna, reveals that at present about 70% of the patients have a good prognosis (the figures vary from 50 to 85%, depending on the seizure type). An important question which has received only scant attention in the literature arises in the case of patients who have remained free from epileptic fits over a period of many years, namely whether longterm antiepileptic therapy can be terminated and, if so, then when and how. Only very few studies deal specifically with this problem and even these do not provide entirely satisfactory answers to all the posed questions, not only with regard to the optimum time and mode of drug reduction, but also with regard to the principles underlying the choice of apparently suitable candidates for attempted termination of therapy. An attempt is made in this retrospective study comprising 375 patients who have been followed up over a period of at least 5 years, to throw some light on these problems. Indeed, results of statistical significance were obtained by the use of a new mathematical technique, which enables the formulation of new guiding principles in the resolution of all three above-mentioned questions. In consequence, it now appears within the power of the pediatrician to markedly reduce the risk of relapse, which in the case of childhood epilepsies, is about 20%, at present. In general, several basic principles must be adhered to. Total freedom from convulsions over an uninterrupted period of at least 3 years' duration is an absolute prerequisite for consideration of cessation of therapy. Reduction in antiepileptic drug dosage should be carried out as a stepwise procedure over a period of about 2 years. Regular clinical and EEG follow-up examinations should be performed over this period of drug reduction and for 5 years subsequently, in order to recognise and counteract promptly any early signs of possible relapse. The prerequisite convulsionfree period is raised to 4 to 5 years or even longer and the time over which therapy is tailed off increased accordingly in the presence of any of the following criteria: 1. "Endogenous" tendency to relapse, 2. persistence of paroxysmal EEG abnormalities or deterioration of the EEG during the attempt to reduce the dosage of antiepileptic drugs, 3. inveterate epilepsy. The cessation of fits and the termination of medication do not yet signify that all the after-effects of epilepsy are overcome. Social integration must also be achieved before this goal is reached. The psychopathological symptomatology of the patient plays an important role in determining the outcome, whereby the level of intelligence of the patient is the decisive factor...