Educational and health outcomes of children and adolescents receiving antiepileptic medication: Scotland-wide record linkage study of 766 244 schoolchildren

Abstract

Background Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers. Methods Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions. Results Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes. Conclusions Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.

Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study

“…The increased prevalence of diabetes, asthma, and skin disorders such as psoriasis among children with neurodevelopmental disorders has also been reported elsewhere [ 53 ]. In addition to poorer educational outcomes, including increased additional support needs, among children treated for ADHD and depression, we have also previously reported poorer school outcomes among children treated for diabetes, asthma, and epilepsy [ 54 – 56 ]. Increased additional support needs is not surprising given that these children may require assistance due to wider comorbidities or symptoms directly related to their combination of conditions.…”

Health, educational and employment outcomes among children treated for a skin disorder: Scotland-wide retrospective record linkage cohort study of 766,244 children

“…Our findings of increased special educational need and treatment for asthma, diabetes, epilepsy, depression and ADHD concur partially with previous studies which have reported greater risk of asthma [15,16,18] and ADHD [29][30][31] among children with eczema, increased incidence of diabetes [14,19,21] among children with psoriasis, and more psychiatric disorders and mental health problems among both including specifically depression and anxiety [22][23][24][25][26][27][28]. We have previously reported that children treated for diabetes, asthma, epilepsy, ADHD, and depression have poorer educational and health outcomes, including hospitalisation and mortality, compared to peers, and therefore adjusted for these conditions in our analyses [45][46][47][48][49][50]. However wider comorbidities exist which we could not adjust for.…”

“…We derived sex-, gestation-specific birthweight centiles as a measure of intra-uterine growth. We have previously demonstrated that chronic conditions such as ADHD [45,46], epilepsy [45,47], diabetes [45,48], asthma [45,49], and depression [45,50] are independently associated with poorer educational outcomes and health outcomes. Therefore, to enable adjustment for these comorbid conditions, we used PIS data to identify children dispensed medication for diabetes (insulin), epilepsy (any drug from BNF section 4.8), ADHD (methylphenidate hydrochloride, dexamphetamine sulphate, atomoxetine or lisdexamfetamine dimesylate), or depression (tricyclic antidepressant, selective serotonin reuptake inhibitor, mirtazapine or venlafaxine) on at least one occasion over the school year and those dispensed medication for asthma (inhaled corticosteroid plus beta agonist) twice or more over one year.…”

“…Data (ScotXed). The linkage methodology has been described previously [44][45][46][47][48][49][50]. The Prescribing Information System (PIS) collects information on all prescriptions dispensed to Scottish residents by community pharmacies or primary care.…”

In the eye of the beholder: Using a multiple-informant approach to examine the mediating effect of cognitive functioning on emotional and behavioral problems in children with an active epilepsy

“…The findings from studies exploring relations between EBPs and a variety of child-related factors (e.g., age, gender) are inconsistent, with some studies reporting younger age and female gender to be associated with poorer psychosocial outcomes [7,[9][10][11] while others fail to provide such association [12]. Studies of the associations between epilepsy-related factors and a child's EBPs have indicated that polytherapy is one of the most significant risk factors for poor psychosocial outcome [13].…”