Social outcome and psychiatric comorbidity of generalized epilepsies – A case‐control study

Abstract

Objective: To investigate social outcome and psychiatric comorbidity of patients with idiopathic/genetic generalized epilepsies (IGEs) and its subtypes (epilepsy with generalized tonic-clonic seizures alone [EGTCS], juvenile absence epilepsy [JAE], and juvenile myoclonic epilepsy [JME]). Methods: A cohort of 402 adult patients with IGE from the Danish island Funen was matched with 4020 randomly selected geography-, age-, and sex-matched controls via the Danish Civil Registration System. Based on register data, we compared social status measured by cohabitant status, educational attainment, income, affiliation to labor market, and psychiatric comorbidity. Results: As compared to controls, patients with IGE had similar cohabitant status but fewer children (no children: 59.0% vs 50.9%), and lower educational level (primary school only: 46.0% vs 37.3%), employment rate (outside of workforce: 56.7% vs 46.5%), and income (low income: 32.6% vs 24.9%) (P < 0.001 for all comparisons). Having IGE was associated with higher a proportion of psychiatric comorbidity (IGE, 22.6%; controls, 13.0%) (P < 0.001). Seizure-free patients did not differ from controls; patients with persistent seizures had lower incomes and employment rates.In the IGE subgroup analyses, JME was associated with worse social status in all parameters studied (eg, 65.9% of JME patients were outside the workforce vs 44.5% of matched controls; P < 0.001), whereas no adverse social status was identified in patients with EGTCS and JAE. Significance: Patients with IGE in general and JME in particular have poorer social status and more psychiatric comorbidity than matched population controls without epilepsy. Poor seizure control was associated with social status and may contribute to negative socioeconomic consequences associated with IGE.

The burden of disease of idiopathic/genetic generalized epilepsy – A nationwide online survey

“…High-burden of disease was also associated with absence and myoclonic seizures indicative for JME. This is in keeping with a recent register-based study from the same cohort reporting a substantially increased risk of psychiatric disease in IGE and particular patients with JME [5,28]. The association of self-reported JME and burden of disease (uncorrected p-value: 0.02, non-significant after correction for multiple testing, Table 2) has to be interpreted with some care given that the self-reported syndrome diagnosis did not show an optimal concordance with the specialist evaluation, likely due to the well-known difficulties associated with the diagnosis of JME [29].…”

“…Previous studies found more psychiatric comorbidities among patients with IGE than among healthy controls [5,34,35]. We found similar results in our psychiatric scores, where BIS-8, SAPAS-AV, and MDI all were higher in our patients compared to those of healthy populations from other studies [23,26,27].…”

“…The questionnaires were sent to two different cohorts. The 'Funen cohort' (named after the Danish island of Funen, where the patients lived at recruitment; n = 476 patients with verified IGE), which was recently characterized in-depth [5] and is considered near population-based, non-biased and representative. In brief, inclusion criteria for the 'Funen cohort' were registered address on Funen at inclusion, age >16, at least one generalized seizure in the patient's history after the age of ten and typical electroencephalographic (EEG) changes.…”

“…IGE is not associated with severe cognitive decline or deficits [2] and the majority of patients achieve seizure control on anti-seizure medication (ASM), although most patients need to try multiple ASMs [3,4]. A minority of patients suffer from drug-resistant epilepsy, which is associated with negative socioeconomic outcome [2] and more psychiatric comorbidities than the background population [5]. However, also patients without recent seizures tend to have fewer children, lower education, employment, and income than healthy controls [5] suggesting that social outcome is not merely determined by seizure control.…”

“…A minority of patients suffer from drug-resistant epilepsy, which is associated with negative socioeconomic outcome [2] and more psychiatric comorbidities than the background population [5]. However, also patients without recent seizures tend to have fewer children, lower education, employment, and income than healthy controls [5] suggesting that social outcome is not merely determined by seizure control.…”