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Social outcomes of young adults with childhood‐onset epilepsy: A case‐sibling‐control study
Author(s) -
Baca Christine B.,
Barry Frances,
Vickrey Barbara G.,
Caplan Rochelle,
Berg Anne T.
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13726
Subject(s) - epilepsy , pediatrics , medicine , sibling , epilepsy syndromes , generalized epilepsy , cohort , odds ratio , cohort study , young adult , prospective cohort study , psychiatry , psychology , developmental psychology
Summary Objective We aimed to compare long‐term social outcomes in young adults with childhood‐onset epilepsy (cases) with neurologically normal sibling controls. Methods Long‐term social outcomes were assessed at the 15‐year follow‐up of the Connecticut Study of Epilepsy, a community‐based prospective cohort study of children with newly diagnosed epilepsy. Young adults with childhood‐onset epilepsy with complicated (abnormal neurologic exam findings, abnormal brain imaging with lesion referable to epilepsy, intellectual disability ( ID ; IQ < 60) or informative history of neurologic insults to which the occurrence of epilepsy might be attributed), and uncomplicated epilepsy presentations were compared to healthy sibling controls. Age, gender, and matched‐pair adjusted generalized linear models stratified by complicated epilepsy and 5‐year seizure‐free status estimated adjusted odds ratios (a OR s) and 95% confidence intervals [CI s] for each outcome. Results The 15‐year follow‐up included 361 individuals with epilepsy (59% of initial cases; N = 291 uncomplicated and N = 70 complicated epilepsy; mean age 22 years [ standard deviation, SD 3.5]; mean epilepsy onset 6.2 years [ SD 3.9]) and 173 controls. Social outcomes for cases with uncomplicated epilepsy with ≥5 years terminal remission were comparable to controls; cases with uncomplicated epilepsy <5 years seizure‐free were more likely to be less productive (school/employment < 20 h/week) (a OR 3.63, 95% CI 1.83–7.20) and not to have a driver's license (a OR 6.25, 95% CI 2.85–13.72). Complicated cases with epilepsy <5 years seizure‐free had worse outcomes across multiple domains; including not graduating high school (a OR 24.97, 95% CI 7.49–83.30), being un‐ or underemployed (<20 h/week) (a OR 11.06, 95% CI 4.44–27.57), being less productively engaged (a OR 15.71, 95% CI 6.88–35.88), and not living independently (a OR 10.24, 95% CI 3.98–26.36). Complicated cases without ID (N = 36) had worse outcomes with respect to productive engagement (a OR 6.02; 95% CI 2.48–14.58) compared to controls. Cases with complicated epilepsy were less likely to be driving compared to controls, irrespective of remission status or ID. Significance In individuals with uncomplicated childhood‐onset epilepsy presentations and 5‐year terminal remission, young adult social outcomes are comparable to those of sibling controls. Complicated epilepsy, notable for intellectual disability, and seizure remission status are important prognostic indicators for long‐term young adult social outcomes in childhood‐onset epilepsy.