Cognitive disorders in childhood epilepsy: a comparative longitudinal study using administrative healthcare data

Abstract

Objective The study aimed to assess the risk of cognitive impairment in patients with epilepsy, the impact of age of epilepsy onset on cognition and the temporal relationship of epilepsy onset and intellectual impairment. Methods This longitudinal study analyzed birth cohorts and followed-up children born 2005–2007 up to the age of ten using administrative healthcare data of about 8.9 million members insured by the statutory health insurance “BARMER” in Germany. We compared prevalence of cognitive impairment (ICD-code F7*) in children with epilepsy (ICD-code G40) to controls, and calculated relative risks by age groups at onset of epilepsy and assessed differences in relation to the temporal sequence of the diagnoses. Results Of the 142,563 pre-pubertal children included in the analysis, 2728 (1.9%) had an epilepsy diagnosis within the first 10 years of life. 17.4% (475/2728) of children with epilepsy had a diagnosis of cognitive impairment compared to 1.7% (2309/139835) in controls. The relative risk for cognitive impairment compared to age-matched controls was 10.5 (95% CI 9.6, 11.6) and was highest in epilepsy cases with seizure manifestation within the first 2 years of life compared to older children. The prevalence of cognitive impairment before epilepsy diagnosis was slightly increased compared to controls, while it was increased by a factor of nine in children diagnosed with cognitive impairment in the year of onset of epilepsy or afterwards. Conclusions Pre-pubertal children with epilepsy have a ten-fold higher risk for intellectual impairment compared to age-matched controls. This risk inversely correlates with the age of epilepsy manifestation. Cognitive impairment was diagnosed after epilepsy manifestation in the majority of patients.

IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis

“…Developmental delay, cognitive deficits, and psychosocial comorbidities represent major challenges for children with epilepsy, resulting in a substantial impairment of quality of life (QoL) besides seizure activity [ 1 ]. Cognitive impairment in children with epilepsy occurs in up to 17% of cases compared to 1.7% in the general population and may rise to 70% in children with intractable epilepsy [ 2 , 3 ]. A worse cognitive status is also strongly associated with lower psychosocial outcomes in adulthood [ 4 ].…”

A Compared Study of Eicosapentaenoic Acid and Docosahexaenoic Acid in Improving Seizure-Induced Cognitive Deficiency in a Pentylenetetrazol-Kindling Young Mice Model

“…Research has shown that epilepsy increases the risk of cognitive disorder in children [ 23 ]. Similarly, in the present investigation, PTZ kindling led to a decline in cognitive function, as evidenced by impaired performance on the MWM test.…”

Kognition bei Epilepsien im Kindes- und Jugendalter

“…Die Angaben zur Inzidenz von Epilepsien im Kindes- und Jugendalter variieren zwischen 41 und 191 Fällen pro 100 000 Kinder 9 , 10 . Die Prävalenz von kognitiven Einschränkungen bei Kindern und Jugendlichen wird mit bis zu 25 % angegeben und variiert in Abhängigkeit von der Altersstruktur der untersuchten Kohorten sowie der Art und des Zeitpunkts der Testung 11 .…”

“…Dabei deuten die Ergebnisse auch darauf hin, dass das Risiko für kognitive Einschränkung größer war, je früher sich die Epilepsie manifestierte ( Abb. 1 ) 10 .…”