Neurocognition in childhood epilepsy: Impact on mortality and complete seizure remission 50 years later

Abstract

Objective:To study associations of the severity of impairment in childhood neurocognition (NC) with long-term mortality and complete seizure remission. Methods: A population-based cohort of 245 subjects with childhood onset epilepsy was followed up for 50 years (median = 45, range = 2-50). Childhood NC before age 18 years was assessed as a combination of formal intelligence quotient scores and functional criteria (school achievement, working history, and psychoneurological development). Impaired NC was categorized with respect to definitions of intellectual functioning in International Classification of Diseases, 10th revision (R41.83, F70-F73). The outcome variables, defined as all-cause mortality and 10-year terminal remission with the 5 past years off medication (10YTR), were analyzed with Cox regression models. Results: Of the 245 subjects, 119 (49%) had normal childhood NC, whereas 126 (51%) had various degrees of neurocognitive impairment. During the 50-year observation period, 71 (29%) of the subjects died, 13% of those with normal and 44% of those with impaired NC. The hazard of death increased gradually in line with more impaired cognition, reaching significance in moderate, severe, and profound impairment versus normal NC (hazard ratio [Bonferroni corrected 95% confidence interval] = 3.3 [1.2-9.2], 4.2 [1.2-14.2], and 5.5 [2.4-12.3], respectively). The chance for10YTR was highest among subjects with normal NC (61%), whereas none of those with profound impairment reached 10YTR. In the intermediate categories, the chance was, however, not directly related to the increasing severity of impairment. Significance: The severity of neurocognitive impairment during childhood shows a parallel increase in the risk of death. In comparison with normal NC, subjects with lower childhood NC are less likely to enter seizure remission. However, normal NC does not guarantee complete remission or prevent premature death in some individuals with childhood onset epilepsy. K E Y W O R D Scognitive function, long-term follow-up, mortality in epilepsy, seizure outcome, severity of epilepsy

Epidemiology of Developmental and Epileptic Encephalopathy and of Intellectual Disability and Epilepsy in Children

“…Most children who died had severe or profound ID, as previously reported. 33 Our estimate of mortality before 16 years of age of 13% for DEE was lower than the 21% previously reported. 22 This difference may relate to the previous study having a longer observed period (up to 20 years, median follow-up of 16 years) and their result being an absolute number of deaths in their cohort (12/58, 21%) rather than an estimate of mortality at a set age.…”

Expert opinion on diagnosis and management of epilepsy‐associated comorbidities

“…As listed in Figure 4 , the demographics, disease characteristics (such as early age of epilepsy onset and duration of epilepsy), underlying neuropathologies, as well as static and dynamic variables with potential for cognitive impairment, should be evaluated. 55 , 56 While some factors (eg, location and severity of underlying lesions) are static and cause chronic impairments; other factors (eg, seizure frequency and severity) are dynamic and potentially reversible, and may be manageable with clinical intervention. 53 , 56 , 57 …”

Impacts of COVID-19 Pandemic on Seizure Control in Children with Epilepsy

“…Prolonged bed rest and immobility as widely known problems of children with severe cerebral palsy can greatly weaken their immunity and increase risks of severe illness and hospitalization. Hence, those who have neurological impairment leading to bed ridden state have a likelihood of a developing severe illness or other complications [29]. On the contrary, Balestrini et al have reported that even adult patients with epilepsy and multiple comorbidities show a high percentage of asymptomatic conditions, indicating that comorbidities factors do not necessarily lead to poor outcomes [30].…”