Long‐term social outcomes for children with epilepsy

Abstract

SUMMARYChildren with epilepsy often grow into adults with significant social problems including decreased employment, marriage, social relationships, and independent living arrangements. These problems are noted in population-based longitudinal and crosssectional studies from many countries. Learning disorder and mental handicap are the most consistent predictors of poor social outcome. Epilepsy variables, even remission, appear to have little effect. The influence of epilepsy on social outcome is greater than found in other childhood chronic disease control groups. More attention and research is needed to correct these unfortunate outcomes. KEY WORDS: Prognosis, Population-based, Psychosocial, Long-term follow-up.At the time of diagnosis of childhood epilepsy psychosocial problems and comorbidities are common. These include: (1) mental handicap in 21-34% Sillanpaa, 1992); (2) learning disorder in 51-57% (Sillanpaa, 1990(Sillanpaa, , 1992Camfield et al., 1993;Oostrom et al., 2003); (3) mental health problems in 25-34% (Rutter et al., 1970;Oostrom et al., 2003;Austin et al., 2001), and (4) attention deficit disorder in 10% (Austin et al., 2001;Hesdorffer et al., 2004; Dunn & Kronenberger, 2005). These difficulties may reflect an underlying brain abnormality or family dysfunction, and they have important effects on later outcome children with epilepsy. Surprisingly, the continued social problems in normally intelligent children with epilepsy are not clearly related to remission or any other biologic factor except learning disorder. The social outcomes are worse in children with epilepsy than in either community or chronic illness controls.Published studies that address the long-term social outcome of childhood epilepsy are not easily compared because they have used varying definitions for predictor variables (such as mental handicap, neurological deficit and type of syndrome) and varying definitions of what constitutes a satisfactory long-term outcome. INITIAL SUGGESTIONS OF POOR SOCIAL OUTCOME FROM POPULATION-BASED STUDIESTwo excellent British prevalence studies, the Isle of Wight study (Rutter et al., 1970) and the British Child and Adolescent Mental Health Survey (Davies et al., 2003), found that over 25% of children aged 5-14 years with epilepsy had "psychiatric difficulties" as compared with 7-9% of normal controls. The mental health survey also found that only 11% of children with diabetes, a chronic disease control, had behavioral difficulties. In addition, psychiatric difficulties were experienced by 56% of children with epilepsy plus comorbid neurological problems. LARGE POPULATION-BASED LONG-TERM FOLLOW-UP STUDIES FROM MANY REGIONS OF THE WORLD Oulu Finland (Kokkonen et al., 1997)This population-based Finnish series began as a prevalence cohort of all noninstitutionalized children with epilepsy (n = 92) born between 1964-67. When these patients were 22 years of age, they were compared with 211 controls from same birth cohort by interview or questionnaire. Those with childhood onset epilepsy had signifi...

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Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy

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