PURPOSE: Seizure outcomes are more complicated in terms of repeated remission and relapse in the course of epilepsy. We aim to investigate the different patterns of evolution in new-onset pediatric epilepsy and the seizure outcome of different types of epilepsy syndromes. METHODS: We examined the evolution pattern of remission and relapse in the course of epilepsy in 326 children who were less than 15 years of age, with new-onset epilepsy. Different remission-relapse patterns were determined in each patient and according to epilepsy syndromes. The probability of repeated remission and relapse were analyzed with Markov process. RESULTS: During follow-up (mean+/-SD: 79+/-25 months) of 326 patients, early remission, defined as remission within the first year of treatment, was seen in 288 patients (88.4%), and late remission was achieved in 21 patients (6.4%). 17 patients (5.2%) never achieved remission. 94.8% of the cohort experienced at least one remission, with first relapse, second relapse, and third relapse occurring in 115 patients (35.3%), 61 patients (18.7%), and 28 patients (8.6%), respectively. At the end of follow-up period, 281 patients (86.2%) were in terminal remission. 194 patients (59.6%) showed a continuous remitting course, and 87 patients (26.7%) showed a remitting-relapse course. 45 patients (13.8%), including worsening courses in 28 patients (8.6%) and drug resistant courses in 17 patients (5.2%), did not show terminal remission. Markov process disclosed that children with epileptic encephalopathy and symptomatic partial epilepsy were less likely to show remission than children with idiopathic partial or generalized epilepsy (P<0.001). CONCLUSION: Only 13.8% of children with new-onset epilepsy have poor seizure outcome in terms of never achieving remission or persistent seizure after achieving at least one remission. The etiology of epilepsy syndrome is an important factor determining seizure outcome.