Recent community- and hospital-based studies of epilepsy from its onset suggest a much better prognosis than previously recognized, with about three-quarters of patients entering long-term remission on current medication. The first two years of medication are crucial in determining longer-term prognosis. Early effective therapy may be important in preventing the evolution of chronic epilepsy. Adverse prognostic factors include brain lesions, neuropsychiatric handicaps, and poor compliance.