Purpose: Our aim was to determine the long-term

employment and predictive factors in adults with childhood-

onset epilepsy living in the community.

Methods: A population-based incidence cohort of 144 children

prospectively followed since their first unprovoked

seizure before the age of 16 years up to a mean age of 48.

Results: At a mean age of 23 years (range 18–35 years) 85

(71%) of 119 patients living in the community were

employed. Predictive of employment at a mean age of 23

were normal intelligence [odds ratio (OR) 14.5, 95% confidence

interval (CI) 4.5–46.8, p < 0.01], vocational education(

OR15.2,95%CI2.9–79.9,p < 0.01),andageat onset of

epilepsy older than 6 years (OR 4.9, 95% CI 1.3–19.2,

p = 0.02). At the mean age of 48 years (range 43–59 years),

45 (59%) of 76 patients living in the community were

employed, as were 63 (78%) of 81 controls (patients vs. controls,

p = 0.01). In 40 (53%) of 76 surviving patients

employed between age 23 and 48, four factors were found

to predict employment: normal intelligence (OR 15.8; 95%

CI 2.4–102.4, p < 0.01), having offspring (OR 6.1; 1.5–25.0,

p = 0.01), uninterrupted 5-year terminal remission(5YTR)

from age 23 to age 48 (OR 4.8; 1.1–19.9, p = 0.03), and no

history of status epilepticus (OR 12.8; 1.8–90.9, p = 0.01).

Conclusions: Normal intelligence, onset of epilepsy at age

older than 6, and good vocational education appear to

predict employment in early adulthood. Normal intelligence,

having offspring, uninterrupted remission, and no

history of status epilepticus appear to predict lasting

employment into middle age.