Long-term medical, educational, and social prognoses of childhood-onset epilepsy: a population-based study in a rural district of Japan

Wakamoto, Hiroyuki; Nagao, Hideo; Hayashi, Masatoshi; Morimoto, Takehiko

doi:10.1016/s0387-7604(00)00121-2

Cited by 133 publications

(127 citation statements)

References 57 publications

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“…On the other hand, several studies have examined social, educational, and employment outcomes in adults who, years previously as children, had epilepsy. [12][13][14]21,22 These studies focused on individuals with intelligence levels comparable to the population norm and either idiopathic or cryptogenic epilepsy. Many were completely seizure-free and off medication.…”

Section: Discussionmentioning

confidence: 99%

“…Because these recent studies have not yet followed participants into adulthood, it is unclear how persistent these early indications of difficulties are, and whether these difficulties identified at initial diagnosis explain the unexpectedly poor outcomes in adults with childhood epilepsy in remission and no longer under treatment. [12][13][14]21,22 For example, one study reported that problems present at initial diagnosis did not persist a year later. 28 Our assessments were performed in the context of a large prospective community-based study.…”

Section: Discussionmentioning

confidence: 99%

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Behavior and social competency in idiopathic and cryptogenic childhood epilepsy

Berg

Vickrey

Testa

et al. 2007

Develop Med Child Neuro

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Behavioral and related disorders are frequently reported in association with childhood epilepsy but the reasons for this are unclear. In a long-term prospective, community-based study of newly-diagnosed childhood epilepsy, behavioral assessments (Child Behavior Checklist) were performed in children 8 to 9 years after the initial diagnosis of epilepsy to determine the impact of remission and medication status on behavioral problems. Children with epilepsy were also compared with sibling controls. A total of 226 children (108 females, 118 males; mean age 13y 1mo [SD 2y 8mo], range 8-17y) with idiopathic or cryptogenic epilepsy were included in the analyses. One hundred and twenty-eight matched pairs were included in analyses of case-sibling differences. Lack of remission and current medication use were associated with worse behavioral problem and competency scores. Lack of remission generally had a greater effect than medication use, except for attention problems; medication status had the more deleterious effect (p<0.001). Children with epilepsy had significantly worse behavioral problems and competency scores relative to sibling controls. Even in pairs in which the patient was seizure-free and off medication, significant case-sibling differences persisted for most scales (p=0.05 to p=0.001). Lack of remission and continued use of antiepileptic drugs have a negative influence on behavioral problems in children with epilepsy but do not fully explain the worse scores relative to siblings. This suggests an independent effect associated with the epilepsy itself.Studies conducted in the 1970s demonstrated high rates of behavioral disturbances associated with symptomatic or severely uncontrolled epilepsy. 1,2 More recent studies of pediatric epilepsy have focused on cryptogenic and idiopathic epilepsy. [3][4][5][6][7][8][9][10][11] These studies have demonstrated an unusually high occurrence of a wide range of social, cognitive, behavioral, and psychiatric difficulties during the active phase of the disorder. It is not fully clear, however, whether adverse associations with epilepsy are seen just in association with ongoing seizures and current use of antiepileptic drugs (AEDs). Some studies found that poorer than expected social and educational outcomes occur even in individuals with excellent seizure control who are no longer on medication. [12][13][14] The independent contributions of seizure control, medication, and epilepsy itself on behavior or related outcomes have not been clearly distinguished. We have addressed this issue in the context of a long-term, prospective, community-based study of children initially recruited when first diagnosed with epilepsy. The focus of the current analyses was to: (1) assess the relative contributions of type of epilepsy, seizure control, and medication status to behavioral problems and to social competencies in children with idiopathic or cryptogenic epilepsy; (2) determine whether children with epilepsy had higher levels of behavioral symptomatology and lower social competenci...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Behavior and social competency in idiopathic and cryptogenic childhood epilepsy

Berg

Vickrey

Testa

et al. 2007

Develop Med Child Neuro

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“…24 Associations between low IQ and poor seizure control have been found in several studies, [25][26][27][28][29] as has motor disability. 2,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] A significant predictor in this study was multiple types of seizure, a relatively unreported finding. 2,38 It is possible that the average delay of 15 months from seizure onset to assessment allowed time for other seizure types to appear.…”

Section: Discussionmentioning

confidence: 99%

Prediction of seizure outcome in childhood epilepsies in countries with limited resources: a prospective study

Banu

Khan

Hossain

et al. 2012

Develop Med Child Neuro

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AIM To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources.METHOD Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children's hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis.RESULTS Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ<70; 58%) and ⁄ or motor (significant limitation of daily living activities; 47%) deficits were common. After 1 year of regular treatment, seizure control was good (seizure freedom) in 53%, and poor (at least one seizure in the last 3mo of follow-up) in 47%. The predictors of poor seizure control were an IQ<70, associated motor disability, multiple seizure types, and a history of cognitive regression (1.9 times more likely to have poor seizure control).INTERPRETATION Seizure control can be predicted using three clinical factors (motor disability, cognitive impairment, and multiple seizure types) at the first clinic visit. Such predictors assist the development of referral plans and management guidelines for childhood epilepsies in resourcepoor countries.The management of childhood epilepsy in countries with limited resources has several specific problems. These include lack of medical resources, misunderstanding of the nature of epilepsy, stigmatization, large treatment gaps (i.e. a high percentage of the target population not receiving medication but often a high level of use of traditional healers), and a lack of understanding of the priorities of the users by those seeking to provide treatment. All of these issues arise in the management of epilepsy in children in Bangladesh. In consultation with parents, we formed the view that the ability to predict seizure control with future treatment can be useful. First, it provides an audit so that if the control is widely discrepant from that predicted, a reason may be sought (e.g. seizures were not epileptic, antiepileptic drugs were not taken). Second, it gives the family and patient an expectation of what antiepileptic drugs can achieve and whether they are essential to management. Third, it allows an approximate cost-benefit analysis to be performed. These may be useful in any setting, but in a country with limited resources (e.g. Bangladesh) this may allow doctors and carers to deploy their resources more effectively. The second broad issue raised was the high rate of additional problems of development and behaviour th...

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“…In a Japanese study of childhoodonset epilepsy [12], 63% were in remission after the mean follow-up of 19 years. Patients with epilepsy tend to achieve seizure freedom over the course of time and the remission rate is subsequently dependent on the duration of follow-up.…”

Section: Seizure Outcomementioning

confidence: 98%

“…Long-term population-based outcome studies in childhoodonset epilepsy commonly report approximately 70% of the patients to be in 5-year remission [12]. In a Japanese study of childhoodonset epilepsy [12], 63% were in remission after the mean follow-up of 19 years.…”

Section: Seizure Outcomementioning

confidence: 99%