Fertility and marital status in adults with childhood onset epilepsy: A population‐based cohort study

Abstract

Objective Our objective was to explore the association of childhood onset epilepsy (COE) and clinical factors on marital status and fertility in adulthood. Methods We identified a population‐based cohort of 307 individuals with COE treated in the Tampere University Hospital district with an inception date of December 31, 1992. A matched reference cohort of 1244 individuals without COE was established as a random sample of the population in the study area through the Population Register Center (PRC). The PRC also provided data on marriages and offspring up to 2018. Fertility and marriage analysis was done by calculating the time until first child and marriage. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with Cox regression for follow‐up spanning up to January 2018. Results Patients with COE had lower fertility rates (32.2% vs 57.3% any offspring, HR = 0.47, 95% CI = 0.38‐0.58) and fewer marriages (28.3% vs 49.7% ever married, HR = 0.49, 95% CI = 0.39‐0.61) than the referents without COE during 25‐year follow‐up. The largest impact was in patients with COE who had any disability (10.1% any offspring, HR = 0.20, 95% CI = 0.10‐0.41; 6.5% ever married, HR = 0.11, 95% CI = 0.06‐0.21), symptomatic etiology of epilepsy (13.1%, HR = 0.18, 95% CI = 0.11‐0.31; 12.1%, HR = 0.21, 95% CI = 0.12‐0.36), onset of epilepsy before 2 years of age (HR = 0.20, 95% CI = 0.12‐0.31; HR = 0.29, 95% CI = 0.18‐0.46), and high seizure frequency after start of treatment (HR = 0.13, 95% CI = 0.06‐0.28; HR = 0.20, 95% CI = 0.10‐0.41). Patients with COE without any disabilities had only slightly lowered fertility (HR = 0.76, 95% CI = 0.61‐0.95) and a nonsignificant reduction in marriages (HR = 0.80, 95% CI = 0.64‐1.02). Significance COE was associated with a lower chance of finding a partner at adulthood and having fewer children. The extent of such effect varied between patient subgroups.

The “maternal effect” on epilepsy risk: Analysis of familial epilepsies and reassessment of prior evidence

“…Women with epilepsy are more likely to marry and to become parents compared to men with epilepsy (Supplementary Table 3). In our cohort, women with epilepsy were 1.4 times more likely than men to have any offspring, consistent with prior evidence. The imbalance in parenthood rates between women and men with epilepsy must be accounted for in any upward‐looking analysis of maternal transmission of epilepsy risk.…”

Long‐term stiripentol administration, an anticonvulsant drug, does not impair sperm parameters in rats

“…Starck et al. (2019) reported decreased fertility in adults with childhood onset of epilepsy, especially if epilepsy starts before 2 years of age. Pathophysiology of fertility disturbances in patients with epilepsy is complex.…”