Early Onset, Long Illness Duration, Epilepsy Type, and Polypharmacy Have an Adverse Effect on Psychosocial Outcome in Children with Epilepsy

Abstract

Epilepsy is often associated with psychosocial comorbidity and this can be more disabling than the seizure activity. Still, these associated conditions are often underdiagnosed and therefore not sufficiently treated. We studied a large pediatric cohort of 371 patients with epilepsy to identify factors associated with negative outcome. We found that patients with early-onset epilepsy, epilepsy of known etiology, and polypharmacy were the most likely to display cognitive impairment. Behavioral problems were particularly prevalent in patients with an epilepsy duration ≥ 5 years. Similarly, early-onset epilepsy, long illness duration, epilepsy of known etiology, and polypharmacy had an adverse effect on school placement and/or social contact. With polypharmacy being the only potentially modifiable factor, it is important to balance between benefits and adverse effects of antiepileptic drugs and consider alternative therapy options in selected patients such as epilepsy surgery, vagal nerve stimulation, and ketogenic diet early-on.

In the eye of the beholder: Using a multiple-informant approach to examine the mediating effect of cognitive functioning on emotional and behavioral problems in children with an active epilepsy

“…In contrast to our hypothesis, significant associations between illness duration and a child's EBPs were not found. Recently, an increase in EBPs was found only among CAWE with an illness duration of above 5 years [13]. As 80 % of our sample had an illness duration below 5-years, the lack of association between illness duration and a child's EBPs might be explained by the relatively short illness durations in our sample.…”

“…The findings from studies exploring relations between EBPs and a variety of child-related factors (e.g., age, gender) are inconsistent, with some studies reporting younger age and female gender to be associated with poorer psychosocial outcomes [7,[9][10][11] while others fail to provide such association [12]. Studies of the associations between epilepsy-related factors and a child's EBPs have indicated that polytherapy is one of the most significant risk factors for poor psychosocial outcome [13]. Early onset of seizures and extended illness duration were also associated with an increased risk for EBPs [13], with each additional year of epilepsy diagnosis, a child was reported to have a 1.35 times greater chance (95 % CI: 1.05-1.73) of having a psychiatric diagnosis [14].…”

“…Studies of the associations between epilepsy-related factors and a child's EBPs have indicated that polytherapy is one of the most significant risk factors for poor psychosocial outcome [13]. Early onset of seizures and extended illness duration were also associated with an increased risk for EBPs [13], with each additional year of epilepsy diagnosis, a child was reported to have a 1.35 times greater chance (95 % CI: 1.05-1.73) of having a psychiatric diagnosis [14]. However, type of seizures (focal vs generalized) or type of epileptic syndrome were less consistent in predicting EBPs [7].…”

“…Furthermore, lower IQ has been associated with increased risk for EBPs in various neurodevelopmental disorders [23,24]. Additionally, specific epilepsy-related factors have been linked with school placement, with polytherapy (ASMs> 3), longer epilepsy duration and early age at onset associated with a child's placement in special education (SE) settings [13]. Considering that children diagnosed with cognitive deficits report more positive social and emotional functioning when in more inclusive educational placements [25,26], it is important to address the role of the school placement on cognitive functioning and EBPs among CAWE.…”

Epilepsy surgery in the first six months of life: A systematic review and meta-analysis

“…Catastrophic epilepsy in the sensitive developmental period of infancy, often associated with polypharmacy, can result in neurological deterioration and severely impaired quality of life [6,7]. Cognitive function decline has been associated with early-onset and long duration of epilepsy, calling for measures to terminate ongoing seizures [8,9].…”