1
|
Zulfiqar Ali Q, Marques P, Patel P, Carrizosa J, Nabbout R, Andrade DM. Transition in epilepsy - A pilot study with patients in and outside of academic centers. Epilepsy Behav 2024; 151:109624. [PMID: 38219605 DOI: 10.1016/j.yebeh.2024.109624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
RATIONALE Epilepsy is a complex condition and seizures are only one part of this disease. The move from pediatric to adult healthcare system proves difficult for many adolescents with epilepsy and their families. The challenges increase when patients have epilepsies associated with intellectual and/or developmental disabilities, autism spectrum disorder, and motor disorders. Knowledge and system gaps may exist between the two systems, adding to the challenges. The main goal of this study is to understand the perception of patients with epilepsy and their families who were preparing to move from pediatric to adult healthcare system or had already moved. METHODS A survey was distributed to patients/caregivers of patients with epilepsy through patient support groups in North America and in-person through the 2019 Epilepsy Awareness Day at Disneyland. Patients were required to be 12 years or older at the time of the survey and were divided into two groups: those between 12 and 17 years and those 18 years or older. Caregivers answered on behalf of patients who were unable to respond (e.g., intellectual disability). Major components of the survey included demographics, epilepsy details, quality and access to care received in pediatric and adult years, and questions regarding transition and readiness. RESULTS Responses were received from 58 patients/caregivers of patients with epilepsy from Canada and the United States. In group A (patients between 12 and 17 years), none of the 17-year-old patients were spoken to about transition. Patients (caregivers) with epilepsy and intellectual and/or developmental disabilities (IDD) had less time to discuss important things during the transition/transfer phase than patients with normal intelligence. Finally, there was a statistically significant difference observed in access to specialty care reported in the adult years, compared to the years in the pediatric system. In the group B (patients 18 years and older) a) 35 % still visit their family doctor for epilepsy related treatment despite the majority being on 2 or more antiseizure medications (ASMs); b) 27 % of patients in this group were still being followed by their pediatric neurologist; c) one patient received care only through visits to the emergency department; d) only 4 % felt that they received clear instructions during transfer of care such as knowing the name of the adult healthcare practitioner and/or the name of the care institution they were being transferred to. CONCLUSIONS This study highlights the lack of appropriate transition to adult healthcare system (AHCS) amongst an unselected group of patients with epilepsy in Canada and United States. An overwhelming majority of patients followed in the community and in academy centers were simply "transferred" to an adult health practitioner, or they remained under the care of pediatricians. Finally, most patients lack access to significant social and medical support after moving to the AHCS.
Collapse
Affiliation(s)
- Quratulain Zulfiqar Ali
- Adult Genetic Epilepsy Program, Toronto Western Hospital, Krembil Brain Institute, Toronto, Canada
| | - Paula Marques
- Adult Genetic Epilepsy Program, Toronto Western Hospital, Krembil Brain Institute, Toronto, Canada; Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Puja Patel
- Isabelle Rapin Division of Child Neurology, The Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Jaime Carrizosa
- Department of Pediatrics, Child Neurology Service, University of Antioquia, Mapeo Genético Research Group, Medellín, Colombia
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Hôpital Universitaire Necker-Enfants Malades, APHP, Member of EPICARE, Institut Imagine, Université Paris Cité, Paris, France
| | - Danielle M Andrade
- Adult Genetic Epilepsy Program, Toronto Western Hospital, Krembil Brain Institute, Toronto, Canada; Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| |
Collapse
|
2
|
Clinical factors predictive of new-onset seizure in patients with AIDS-related brain parenchymal lesion. Seizure 2023; 107:4-12. [PMID: 36931190 DOI: 10.1016/j.seizure.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE This study aimed to determine the clinical characteristics and risk factors of new-onset seizure in patients with AIDS-related brain parenchymal lesion. METHODS A retrospective case-control study from January 2015 to December 2021 was conducted to determine the clinical characteristics and etiology of seizures in patients with AIDS-related brain parenchymal lesion. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with seizures. Receiver operating characteristic (ROC) curve was used to analyze seizure prediction efficiency. RESULTS Among a total of 343 patients with AIDS-related brain lesions, 222 had brain parenchymal lesions. Of the 222 patients in the series (range: 16-81 y), 69 reported an episode of at least one seizure. A logistic regression analysis showed that tuberculoma, cortex involvement, and lesions in parietal lobe were found to have a strong association with higher incidence of seizures, whereas lesions in the periventricular area was less prone to seizure. The area under the ROC curve of these factors was 0.733, indicating these factors could predict seizure effectively. Amongst the 69 patients with seizures in multivariate analysis using logistic regression, multiple lesions significantly associated with focal to bilateral tonic-clonic seizures, and lesions in temporal lobe independently associated with focal impaired awareness seizure. CONCLUSIONS Our study identified the underlying predictors between seizures and the clinical characteristics in a large population of patients with AIDS-related brain parenchymal lesions. These findings would provide further insights into developing effective prevention and treatment strategies aimed at improving the quality of life in the HIV population.
Collapse
|
3
|
Sherlock C, Madigan C, Linehan C, Keenan L, Downes M. Academic attainment following pediatric epilepsy surgery: A systematic review. Epilepsy Behav 2022; 134:108847. [PMID: 35914437 DOI: 10.1016/j.yebeh.2022.108847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
Academic skills, such as reading, spelling and arithmetic, are central to meaningful engagement with society throughout adolescence and into adulthood. The disruption caused by on-going seizure activity places children with drug-resistant epilepsy at a particularly high risk of poor academic attainment. Though epilepsy surgery during childhood has long-been associated with various cognitive changes, less is known of the extent to which pediatric epilepsy surgery impacts academic attainment. The aim of the present systematic review was to identify the nature of the effect of pediatric epilepsy surgery on the core academic skills of reading, writing, and arithmetic. The electronic databases Embase, Medline, PubMed, PsychInfo, OpenAire, and the ISRCTN registry were searched for studies examining academic attainment following epilepsy surgery in childhood, over the last three decades. Two thousand three-hundred and sixty-eight articles were screened for relevance. Thirteen studies met the inclusion criteria. Study quality and reliability were independently assessed by two reviewers. Results indicate that academic attainment primarily stabilizes in the first year following epilepsy surgery. Though changes to learning ability would not be expected in this early recovery phase, this review indicates that children do not, at least, lose the academic skills they have acquired before surgery. Postoperative declines in performance were most notably recorded in assessments of arithmetic, suggesting an area of potential vulnerability in this cohort. These declines were noted in cohorts with the longest periods between seizure onset and surgery. While older age at onset and seizure freedom correlated with improved academic attainment, further research is necessary to fully understand the specific effect of epilepsy surgery on academic attainment. Still, the present review provides valuable information regarding the likely academic outcomes in the early years following surgical treatment for drug-resistant epilepsy.
Collapse
Affiliation(s)
- Clara Sherlock
- University College Dublin, UCD School of Psychology, Dublin, Ireland.
| | - Cathy Madigan
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Christine Linehan
- University College Dublin, UCD School of Psychology, Dublin, Ireland; UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Lisa Keenan
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| | - Michelle Downes
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| |
Collapse
|
4
|
The impact of childhood epilepsy on academic performance: A population-based matched cohort study. Seizure 2022; 99:91-98. [DOI: 10.1016/j.seizure.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
|
5
|
Disrupted alertness and related functional connectivity in patients with focal impaired awareness seizures in temporal lobe epilepsy. Epilepsy Behav 2020; 112:107369. [PMID: 32858367 DOI: 10.1016/j.yebeh.2020.107369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Focal impaired awareness seizures are common in temporal lobe epilepsy (TLE). The cognitive impairment associated with this type of seizure is unclear. Alertness is a fundamental aspect of cognition. The locus coeruleus (LC) is closely related to alertness. We aimed to assess the impairment in alertness and LC-related alertness network in patients with focal impaired awareness seizures. METHODS Patients with unilateral TLE were grouped into the only focal impaired awareness seizure group (focal group, n = 19) and the focal impaired awareness seizure with focal to bilateral tonic-clonic seizure (FBTCS) group (FBTCS group, n = 19) and compared with matched healthy controls (HC, n = 19). Alertness was assessed with the attention network test. Functional magnetic resonance imaging (fMRI) was used to construct an alertness-related LC-based functional connectivity (FC) network. RESULTS The focal group exhibited impaired tonic and phasic alertness and exhibited a decreased trend of LC-based FC to the left superior frontal gyrus (SFG). The FBTCS group exhibited impaired tonic alertness, phasic alertness, and alertness efficiency. No significant difference or trend in LC-based FC was found in the FBTCS group. SIGNIFICANCE This study reveals disrupted alertness and alertness-related LC-based FC in patients with focal impaired awareness seizures. Our results further demonstrate that the patterns of impaired alertness and of changed LC-based FC were not significantly different between focal impaired awareness seizures and FBTCS.
Collapse
|
6
|
Azevedo S, Kothur K, Gupta S, Webster R, Dale RC, Wade F, Gill D, Lah S. Deficits in all aspects of social competence identified in children who have undergone epilepsy surgery. Epilepsy Behav 2020; 112:107388. [PMID: 32882631 DOI: 10.1016/j.yebeh.2020.107388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Abstract
Research on social competence of children who undergo epilepsy surgery is limited. This cross-sectional study aimed to determine the frequency and pattern of impairments in social competence (domains: social skills, social adjustment, and social performance) in a cohort of children who underwent surgery for intractable epilepsy at a single epilepsy surgical center. In addition, we explored the relationships between social competence with epilepsy variables, surgical variables, and seizure outcomes. Fifteen children (5 to 16 years) who underwent focal cortical resection for intractable epilepsy more than 2 years ago (2.58-7.42 years) participated. Parents completed standardized, age-normed questionnaires, assessing three domains of social competence. Demographic and clinical information were obtained from parents and medical records and verified by Pediatric Neurologists and Clinical Nurse Consultant. Individual and group analyses were conducted. Seventy-three percent (n = 11/15) of children were seizure-free. Individual analyses revealed high rates of impairments (scores >1 standard deviation of the mean); 11 out of 15 children (73.3%) obtained a score that fell in the impaired range on at least one domain of social competence, with 5 of these 15 children (30.0%) obtaining impaired scores across domains. Conversely, group analyses of questionnaires completed by parents revealed that compared with norms, children had significant difficulties in all domains of social competence: social skills, social adjustment, and social performance. No significant relationships were found between domains of social competence and epilepsy and surgical variables. In conclusion, children who underwent epilepsy surgery have significantly reduced social competence relative to the norms. Longitudinal studies examining social competence pre- and postsurgery are needed to determine whether surgery improves social competence and whether this is dependent on epilepsy outcomes.
Collapse
Affiliation(s)
- Suzanna Azevedo
- School of Psychology, The University of Sydney, NSW 2006, Australia
| | - Kavitha Kothur
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital Westmead, NSW 2145, Australia; Kids Neuroscience Centre, Children's Hospital at Westmead and The University of Sydney, Australia
| | - Sachin Gupta
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital Westmead, NSW 2145, Australia
| | - Richard Webster
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital Westmead, NSW 2145, Australia
| | - Russell C Dale
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital Westmead, NSW 2145, Australia; Kids Neuroscience Centre, Children's Hospital at Westmead and The University of Sydney, Australia
| | - Fiona Wade
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital Westmead, NSW 2145, Australia
| | - Deepak Gill
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital Westmead, NSW 2145, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, NSW 2006, Australia.
| |
Collapse
|
7
|
Abstract
Epilepsy is considered a disease characterized by an underlying predisposition to seizures as well as neurobiologic, cognitive, psychologic, and social consequences. It is the most frequent chronic neurologic condition of childhood, affecting 0.5%-1% of children worldwide. It comprises a variety of disorders with many different etiologies, consequently affecting management and outcome. Although the great majority of children have epilepsies that are self-limited and have a good prognosis, it is nevertheless very well recognized that epileptic activity (be it seizures or interictal discharges) can be particularly deleterious to the developing brain acting as a disruptor to normal developmental function. Indeed, epilepsy and neurocognitive and behavioral disorders very frequently coexist, and it can be challenging to understand if there is causality or if they are all the reflection of the underlying brain disorder. Hence, accurate phenotypic and etiologic diagnosis is of utmost importance as it will not only guide decision making with regard to choice of treatment but also enable management of expectations concerning outcome. The current chapter aims to provide a general overview of the fast evolving and vast field of childhood epilepsy from its definition and epidemiology, to its diagnostic challenges, management, and outcome.
Collapse
Affiliation(s)
- Filipa Bastos
- University College London National Institute of Health Research Biomedical Research Centre, Great Ormond Street Institute of Child Health, and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Centre Hospitalier Universitaire de Lausanne, Child Neurology and Neurorehabilitation Unit, University of Lausanne, Lausanne, Switzerland
| | - J Helen Cross
- University College London National Institute of Health Research Biomedical Research Centre, Great Ormond Street Institute of Child Health, and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
| |
Collapse
|
8
|
Starck C, Nevalainen O, Auvinen A, Eriksson K. Fertility and marital status in adults with childhood onset epilepsy: A population‐based cohort study. Epilepsia 2019; 60:1438-1444. [DOI: 10.1111/epi.16018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Christian Starck
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Olli Nevalainen
- Hatanpää Health Center City of Tampere Tampere Finland
- Faculty of Social Sciences Unit of Health Sciences Tampere University Tampere Finland
| | - Anssi Auvinen
- Faculty of Social Sciences Unit of Health Sciences Tampere University Tampere Finland
- Child Health Research Center Pirkanmaa Hospital District/TA4 Tampere University Hospital Tampere Finland
| | - Kai Eriksson
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Tampere Center for Child Health Research School of Medicine Tampere University Tampere Finland
- Department of Pediatric Neurology Tampere University HospitalTampere University Hospital Tampere Finland
| |
Collapse
|
9
|
Andrade DM, Bassett AS, Bercovici E, Borlot F, Bui E, Camfield P, Clozza GQ, Cohen E, Gofine T, Graves L, Greenaway J, Guttman B, Guttman-Slater M, Hassan A, Henze M, Kaufman M, Lawless B, Lee H, Lindzon L, Lomax LB, McAndrews MP, Menna-Dack D, Minassian BA, Mulligan J, Nabbout R, Nejm T, Secco M, Sellers L, Shapiro M, Slegr M, Smith R, Szatmari P, Tao L, Vogt A, Whiting S, Carter Snead O. Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force. Epilepsia 2017; 58:1502-1517. [PMID: 28681381 DOI: 10.1111/epi.13832] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 01/13/2023]
Abstract
The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.
Collapse
Affiliation(s)
- Danielle M Andrade
- Division of Neurology, Epilepsy Transition Program and Epilepsy Genetics Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Anne S Bassett
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Eduard Bercovici
- Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Felippe Borlot
- Department of Neurology, Clinical Neurosciences Center University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Esther Bui
- Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Peter Camfield
- Division of Pediatric Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Eyal Cohen
- Division of Pediatric Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Jon Greenaway
- Erin Oak Kids, Centre for Treatment and Development, Toronto, Ontario, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | | | - Ayman Hassan
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Megan Henze
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Miriam Kaufman
- Division of Adolescent Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Hannah Lee
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lezlee Lindzon
- Epilepsy Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lysa Boissé Lomax
- Division of Neurology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Mary Pat McAndrews
- Division of Neuropsychology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dolly Menna-Dack
- LIFEspan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Berge A Minassian
- Pediatric Epileptologist, Division of Pediatric Neurology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatric Neurology, University of Texas Southwestern and Dallas Children's Medical Center, Dallas, Texas, U.S.A
| | | | - Rima Nabbout
- Pediatric Neurologist, Centre of Reference Epilepsies Rares, Hospital Necker-Enfants Malades, Paris, France
| | - Tracy Nejm
- Parent Representative, London, Ontario, Canada
| | - Mary Secco
- Strategic Initiatives, Epilepsy Support Centre, London, Ontario, Canada
| | | | - Michelle Shapiro
- Division of Neurology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | | | - Rosie Smith
- Adult Services, Epilepsy Toronto, Toronto, Ontario, Canada
| | - Peter Szatmari
- Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Leeping Tao
- Surrey Place Centre, Toronto, Ontario, Canada
| | | | - Sharon Whiting
- Division of Pediatric Neurology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - O Carter Snead
- Division of Pediatric Neurology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Baca CB, Barry F, Vickrey BG, Caplan R, Berg AT. Social outcomes of young adults with childhood-onset epilepsy: A case-sibling-control study. Epilepsia 2017; 58:781-791. [PMID: 28378439 DOI: 10.1111/epi.13726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to compare long-term social outcomes in young adults with childhood-onset epilepsy (cases) with neurologically normal sibling controls. METHODS Long-term social outcomes were assessed at the 15-year follow-up of the Connecticut Study of Epilepsy, a community-based prospective cohort study of children with newly diagnosed epilepsy. Young adults with childhood-onset epilepsy with complicated (abnormal neurologic exam findings, abnormal brain imaging with lesion referable to epilepsy, intellectual disability (ID; IQ < 60) or informative history of neurologic insults to which the occurrence of epilepsy might be attributed), and uncomplicated epilepsy presentations were compared to healthy sibling controls. Age, gender, and matched-pair adjusted generalized linear models stratified by complicated epilepsy and 5-year seizure-free status estimated adjusted odds ratios (aORs) and 95% confidence intervals [CIs] for each outcome. RESULTS The 15-year follow-up included 361 individuals with epilepsy (59% of initial cases; N = 291 uncomplicated and N = 70 complicated epilepsy; mean age 22 years [standard deviation, SD 3.5]; mean epilepsy onset 6.2 years [SD 3.9]) and 173 controls. Social outcomes for cases with uncomplicated epilepsy with ≥5 years terminal remission were comparable to controls; cases with uncomplicated epilepsy <5 years seizure-free were more likely to be less productive (school/employment < 20 h/week) (aOR 3.63, 95% CI 1.83-7.20) and not to have a driver's license (aOR 6.25, 95% CI 2.85-13.72). Complicated cases with epilepsy <5 years seizure-free had worse outcomes across multiple domains; including not graduating high school (aOR 24.97, 95% CI 7.49-83.30), being un- or underemployed (<20 h/week) (aOR 11.06, 95% CI 4.44-27.57), being less productively engaged (aOR 15.71, 95% CI 6.88-35.88), and not living independently (aOR 10.24, 95% CI 3.98-26.36). Complicated cases without ID (N = 36) had worse outcomes with respect to productive engagement (aOR 6.02; 95% CI 2.48-14.58) compared to controls. Cases with complicated epilepsy were less likely to be driving compared to controls, irrespective of remission status or ID. SIGNIFICANCE In individuals with uncomplicated childhood-onset epilepsy presentations and 5-year terminal remission, young adult social outcomes are comparable to those of sibling controls. Complicated epilepsy, notable for intellectual disability, and seizure remission status are important prognostic indicators for long-term young adult social outcomes in childhood-onset epilepsy.
Collapse
Affiliation(s)
- Christine B Baca
- Department of Neurology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, U.S.A.,Department of Neurology, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Frances Barry
- Department of Neurology, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Barbara G Vickrey
- Department of Neurology, University of California Los Angeles, Los Angeles, California, U.S.A.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Rochelle Caplan
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Anne T Berg
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern-Feinberg School of Medicine, Chicago, Illinois, U.S.A
| |
Collapse
|
11
|
Chan S, Pressler R, Boyd SG, Baldeweg T, Cross JH. Does sleep benefit memory consolidation in children with focal epilepsy? Epilepsia 2017; 58:456-466. [DOI: 10.1111/epi.13668] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Samantha Chan
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Ronit Pressler
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Stewart G. Boyd
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Torsten Baldeweg
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| |
Collapse
|
12
|
Ashmawi A, Hosny H, Abdelalim A, Bianchi E, Beghi E. The long-term prognosis of newly diagnosed epilepsy in Egypt: A retrospective cohort study from an epilepsy center in Greater Cairo. Seizure 2016; 41:86-95. [DOI: 10.1016/j.seizure.2016.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
|
13
|
Sillanpää M. Natural course of treated epilepsy and medico-social outcomes. Turku studies. Part II. JOURNAL OF EPILEPTOLOGY 2016. [DOI: 10.1515/joepi-2016-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SummaryIntroduction. Population-based data on the prognosis of childhood-onset epilepsy were almost nonexistent in the 1960s. This prompted me to start an epidemiological prospective study on children with epilepsy.Aim. To study the medical and social outcome of children with epilepsy.Methods. The most important personal data on the natural course and outcome were reviewed and compared with the relevant data of other investigators.Results and discussion. The natural course of treated epilepsy is remitting, uninterrupted by relapse (in 48%); a remitting-relapsing course (interrupted by relapses, in terminal remission) (19%); worsening course (early or late remission followed by drug-resistant epilepsy) (14%); and never in ≥5-year remission (drug resistance) (19%) The medical and social outcomes based on my unique, five decades followed cohort show that most subjects are in 10-year remission without medications, which is the definition of resolved epilepsy. Normal or subnormal IQ, non-symptomatic etiology, and low seizure frequency both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy. Subjects with 1-year remission during the first five years form onset of treatment have more than 10-fold chance for entering 5-year terminal remission vs those who have no 1-year remission during the first five years. Even about one fourth of difficult-to-treat subjects become seizure free on medication and more than half of them enter one or more 5-year remissions. Epilepsy has a substantial impact on quality of life even in those who are seizure free off medication for many years and particularly those not in remission or in remission but still on medication.Conclusions. The prognosis is excellent for medical and social outcome. The successful outcome is confirmed by several longitudinal studies from recent decades. Good response to early drug therapy does not necessarily guarantee a favorable seizure outcome, and even a late good response may still predict a successful prognosis. Our life-cycle study is being continued and targets to answer the question whether or not childhood-onset epilepsy is a risk factor for premature and/or increased incidence of mental impairment and dementia.
Collapse
|
14
|
Giussani G, Canelli V, Bianchi E, Erba G, Franchi C, Nobili A, Sander JW, Beghi E. Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study. Eur J Neurol 2016; 23:1218-27. [DOI: 10.1111/ene.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Giussani
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - V. Canelli
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - E. Bianchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - G. Erba
- Department of Neurology; SEC, University of Rochester; Rochester NY USA
| | - C. Franchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - A. Nobili
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - J. W. Sander
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
| | - E. Beghi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | | |
Collapse
|
15
|
Berg AT, Baca CB, Rychlik K, Vickrey BG, Caplan R, Testa FM, Levy SR. Determinants of Social Outcomes in Adults With Childhood-onset Epilepsy. Pediatrics 2016; 137:peds.2015-3944. [PMID: 26983470 PMCID: PMC4811319 DOI: 10.1542/peds.2015-3944] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adults with childhood-onset epilepsy experience poorer adult social outcomes than their peers. The relative roles of seizures over time versus learning and psychiatric problems are unclear. METHODS We examined independent influences of psychiatric and learning disorders and of seizure course in 241 young adults (22-35 years old) with uncomplicated epilepsy in a longitudinal community-based cohort study. Social outcomes were ascertained throughout the study. A history of psychiatric and learning problems was ascertained ∼9 years after study entry. Seizure course was: "Excellent," no seizures after the first year, in complete remission at last contact (N = 95, 39%); "Good," seizures occurred 1 to 5 years after diagnosis, in complete remission at last contact (N = 56, 23%); "Fluctuating," more complicated trajectories, but never pharmacoresistant (N = 70, 29%); "Pharmacoresistant," long-term pharmacoresistant (N = 20, 8%). Multiple logistic regression was used to identify contributors to each social outcome. RESULTS Better seizure course predicted college completion, being either employed or pursuing a degree, and driving, but was not substantially associated with other social outcomes. Poorer seizure course was associated with a greater likelihood of having offspring, particularly in women without partners. Learning problems, psychiatric disorders, or both negatively influenced all but 2 of the social outcomes. CONCLUSIONS In young adults with uncomplicated epilepsy, the course of seizures contributed primarily to education, employment, and driving. A history of learning problems and psychiatric disorders adversely influenced most adult outcomes. These findings identify potential reasons for vocational and social difficulties encountered by young adults with childhood epilepsy and areas to target for counseling and transition planning.
Collapse
Affiliation(s)
- Anne T. Berg
- Epilepsy Center and,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Christine B. Baca
- Department of Neurology and,Department of Neurology, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Karen Rychlik
- Biostatistics Research Core, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Barbara G. Vickrey
- Department of Neurology, Icahn School of Medicine, New York, New York; and
| | - Rochelle Caplan
- David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Francine M. Testa
- Departments of Neurology and,Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Susan R. Levy
- Departments of Neurology and,Pediatrics, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
16
|
Baldin E, Hesdorffer DC, Caplan R, Berg AT. Psychiatric disorders and suicidal behavior in neurotypical young adults with childhood-onset epilepsy. Epilepsia 2015; 56:1623-8. [PMID: 26387857 DOI: 10.1111/epi.13123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We examined the associations of lifetime and current histories of psychiatric disorders and of suicidal thoughts and behaviors with childhood-onset epilepsies in a community-based cohort of young adults. METHODS Cases were neurotypical (normal neurologic, cognitive, and imaging examinations and no evidence of a brain insult responsible for the epilepsy) young adults with childhood-onset epilepsy followed since the onset of their epilepsy approximately 15 years earlier and recruited as part of a community-based study. They were compared to two different control groups: siblings and external controls from the National Comorbidity Survey-Replication (NCS-R). The Diagnostic Interview Survey assessed lifetime and current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnoses of mood disorders and anxiety disorders. Suicidal thoughts and suicide attempt were assessed using the Diagnostic Interview Survey for Children-IV and the Diagnostic Interview Survey (DIS-IV). RESULTS Two hundred fifty-seven cases and 134 sibling controls participated in the DIS-IV portion of the young adult assessment. Comparing cases both to their sibling controls and to the controls drawn from the NCS-R, we did not find any evidence to suggest a higher prevalence of lifetime and current mood or anxiety disorders, suicidal thoughts, and suicide attempt in young adults with childhood-onset epilepsies. SIGNIFICANCE Our findings from a community-based sample of neurotypical young adults do not suggest a substantial or lasting association between childhood epilepsy and psychiatric disorders and suicidal behavior.
Collapse
Affiliation(s)
- Elisa Baldin
- GH Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A
| | - Dale C Hesdorffer
- GH Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A
| | - Rochelle Caplan
- David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, U.S.A
| | - Anne T Berg
- Department of Pediatrics, Epilepsy Center, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois, U.S.A
| |
Collapse
|
17
|
Perucca P, Camfield P, Camfield C. Does gender influence susceptibility and consequences of acquired epilepsies? Neurobiol Dis 2014; 72 Pt B:125-30. [DOI: 10.1016/j.nbd.2014.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022] Open
|
18
|
Beghi E, Camfield PR, Camfield CS. Epidemiologic aspects: lost in transition. Epilepsia 2014; 55 Suppl 3:3-7. [PMID: 25209077 DOI: 10.1111/epi.12703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 11/29/2022]
Abstract
Population-based studies focusing on the long-term prognosis of childhood-onset epilepsy show that despite seizure remission in 70-80% of cases, cognitive, behavioral and psychosocial complications are common and will require management and monitoring in adulthood. This type of study design also demonstrates that death is rare in children who are intellectually and neurologically normal and followed for many years, which is the same for the general population. Only those children with neurologic problems sufficiently severe to interfere with activities of daily living have an increased risk of death in childhood. Investigation of potentially remediable complications is paramount, and the use of antiepileptic medications with potential adverse cognitive and behavioral effects should be identified and eliminated or reduced. In addition, education of the family should be improved. As well, identification and control of social and psychiatric complications is necessary and implies a comprehensive management of the patient before and after the transition from childhood into adulthood.
Collapse
Affiliation(s)
- Ettore Beghi
- Department of Neuroscience, IRCCS Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | | | | |
Collapse
|
19
|
Berg AT, Rychlik K, Levy SR, Testa FM. Complete remission of childhood-onset epilepsy: stability and prediction over two decades. Brain 2014; 137:3213-22. [PMID: 25338950 DOI: 10.1093/brain/awu294] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ultimate seizure outcome of childhood epilepsy is complete resolution of all seizures without further treatment. How often this happens and how well it can be predicted early in the course of epilepsy could be valuable in helping families understand the nature of childhood epilepsy and what to expect over time. In the Connecticut study of epilepsy, a prospective cohort of 613 children with newly-diagnosed epilepsy (onset age 0-15 years), complete remission, ≥5 years both seizure-free and medication-free, was examined as a proxy of complete seizure resolution. Predictors at initial diagnosis were tested. Information about seizure outcomes within 2 years and from 2-5 years after diagnosis was sequentially added in a proportional hazards model. The predictive value of the models was determined with logistic regression. Five hundred and sixteen subjects were followed ≥10 years. Three hundred and twenty-eight (63%) achieved complete remission; 23 relapsed. The relapse rate was 8.2 per 1000 person-years and decreased over time: 10.7, 6.7, and 0 during first 5 years, the next 5 years, and then >10 years after complete remission (P=0.06 for trend). Six participants regained complete remission; 311 (60%) were in complete remission at last contact. Baseline factors predicting against complete remission at last contact included onset age≥10 years (hazard ratio=0.55, P=0.0009) and early school or developmental problems (hazard ratio=0.74, P=0.01). Factors predicting for complete remission were uncomplicated epilepsy presentation (hazard ratio=2.23, P<0.0001), focal self-limited epilepsy syndrome (hazard ratio=2.13, P<0.0001), and uncharacterized epilepsy (hazard ratio=1.61, P=0.04). Remission (hazard ratio=1.95, P<0.0001) and pharmaco-resistance (hazard ratio=0.33, P<0.0001) by 2 years respectfully predicted in favour and against complete remission. From 2 to 5 years after diagnosis, relapse (hazard ratio=0.21, P<0.0001) and late pharmaco-resistance (hazard ratio=0.21, P=0.008) decreased and late remission (hazard ratio=2.40, P<0.0001) increased chances of entering complete remission. The overall accuracy of the models increased from 72% (baseline information only), to 77% and 85% with addition of 2-year and 5-year outcomes. Relapses after complete remission are rare making this an acceptable proxy for complete seizure resolution. Complete remission after nearly 20 years is reasonably well predicted within 5 years of initial diagnosis.
Collapse
Affiliation(s)
- Anne T Berg
- 1 Ann and Robert H. Lurie Children's Hospital of Chicago, Epilepsy Centre, Department of Paediatrics, Chicago, IL, 60611, USA 2 Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Memorial Feinberg School of Medicine, Department of Paediatrics, Chicago, IL, 60611, USA
| | - Karen Rychlik
- 3 Ann and Robert H. Lurie Children's Hospital of Chicago, Biostatistics Research Core, Stanley Manne Children's Research Institute, Chicago, IL, 60611, USA
| | - Susan R Levy
- 4 Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA 5 Department of Paediatrics, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Francine M Testa
- 4 Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA 5 Department of Paediatrics, Yale School of Medicine, New Haven, CT, 06510, USA
| |
Collapse
|
20
|
Chiron C, An I. Pharmacology aspects during transition and at transfer in patients with epilepsy. Epilepsia 2014; 55 Suppl 3:8-11. [DOI: 10.1111/epi.12708] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Catherine Chiron
- Inserm U1129; Paris France
- Reference Center for Rare Epilepsies; Necker Hospital; Paris France
| | - Isabelle An
- Reference Center for Rare Epilepsies; Pitie-Salpetriere Hospital; Paris France
| |
Collapse
|
21
|
Sillanpää M, Saarinen M, Schmidt D. Clinical conditions of long-term cure in childhood-onset epilepsy: a 45-year follow-up study. Epilepsy Behav 2014; 37:49-53. [PMID: 24975821 DOI: 10.1016/j.yebeh.2014.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
Clinical conditions of long-term cure in childhood-onset epilepsy, defined as sustained remission off antiepileptic drug (AED) treatment, are not well known. To address that clinically important question, we determined clinical factors predictive of long-term seizure cure in a population-based cohort of 133 patients followed up since their first seizure before the age of 16 years. At the end of the 45-year follow-up (mean=39.8, median=44, range=11-47), 81 (61%) of the 133 patients had entered at least 5-year remission off AEDs, meeting our definition of cure. The 81 patients were seizure-free off AEDs for a mean of 34.4 (median=38, range=6-46) years and 59 (73%) of the 81 patients following the first standard medication until the end of follow-up (mean=36.5, median=39, range=14-46 years). Four independent factors were found to be associated with cure compared with having seizures while on AEDs: seizure frequency less than weekly during the first 12 months of AED treatment (p=0.002), pretreatment seizure frequency less than weekly (p=0.002), higher IQ (>70; p=0.021), and idiopathic or cryptogenic vs. symptomatic etiology (p=0.042). Patients with seizure frequency of less than once a week during early treatment and idiopathic etiology had a ninefold chance to of being cured since the onset of the first adequate antiepileptic therapy until the end of follow-up compared with patients who a symptomatic etiology had at least weekly seizures while on AEDs (RR=8.7, 95% CI=2.0-37.0; p<0.001). In conclusion, IQ, etiology, and seizure frequencies both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy.
Collapse
Affiliation(s)
- Matti Sillanpää
- Departments of Public Health and Child Neurology, University of Turku, Turku, Finland
| | - Maiju Saarinen
- Departments of Public Health and Child Neurology, University of Turku, Turku, Finland
| | | |
Collapse
|
22
|
Camfield PR, Camfield CS. What happens to children with epilepsy when they become adults? Some facts and opinions. Pediatr Neurol 2014; 51:17-23. [PMID: 24830766 DOI: 10.1016/j.pediatrneurol.2014.02.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The adult outcome after childhood onset epilepsy is a complex subject because seizure types and severity are diverse, comorbidities are common, and additional factors influence social outcome. We review selected data about seizure remission or persistence and social outcome in adulthood. METHODS Information came from published literature, especially population-based studies. RESULTS In general, approximately 50-60% of children with epilepsy eventually have complete seizure remission (i.e., seizure free and off antiepileptic drug treatment): with longer follow-up, the remission rate improves. Predicting remission, persistent or intractable epilepsy is often inaccurate for an individual patient. A tiny proportion of children with epilepsy die as the result of seizures or sudden unexpected death in epilepsy patients; however, an otherwise normal child has the same risk of death as the reference population. When uncontrolled epilepsy persists into adulthood, the rate of sudden unexpected death in epilepsy patients possibly increases. Reports about social outcome in adulthood are increasing. For those with intellectual disability, a lifetime of dependency is to be expected. For those with normal intelligence, adult life is often unsatisfactory with high rates of incomplete education, unemployment, poverty, social isolation, inadvertent pregnancy, and psychiatric disorders. Seizure remission does not ensure good adult social outcome. CONCLUSIONS Although seizure control in childhood is important, anticipating poor social outcome in adulthood may allow earlier interventions. A well-orchestrated transition from pediatric to adult health care may be beneficial for the 40-50% with persistent seizures and for the majority who are at risk for adult social difficulties.
Collapse
Affiliation(s)
- Peter R Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Carol S Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|