Psychosocial and functional outcomes in young adults with childhood‐onset epilepsy: a 10‐year follow‐up

Abstract

Aim To compare long‐term psychosocial and functional outcomes of young adults with uncomplicated childhood‐onset epilepsy (COE) to population norm controls utilizing a controlled prospective cohort study. Method Psychosocial and functional outcomes were assessed at 10‐year follow‐up. Fifty‐three young adults (27 males, 26 females) with COE (n=21 remission; 18y 1mo–30y 9mo; mean age 23y 4mo [SD 3y 4mo]; mean age of epilepsy onset 12y [SD 3y 2mo]) were compared to 55 (23 males, 32 females) first‐degree cousin controls (18y 5mo–29y 8mo; mean age 23y 6mo [SD 3y]). Seizure remission status and baseline comorbidities (attention‐deficit/hyperactivity disorder [ADHD], depressive disorders, anxiety disorders, and academic problems) were examined as possible risk factors for significant differences in functional outcomes. Results Poorer functional outcomes, indicated by patient rated cognition and overall disability, were evident among young adults with epilepsy compared to controls (all p<0.05). These difficulties were due to baseline comorbid ADHD and academic problems. Remission status was not related to measured cognition and overall disability. Interpretation Psychosocial outcomes of young adults with COE were similar to controls. In contrast, functional outcomes were worse in epilepsy across cognition and overall disability. Baseline comorbid ADHD and academic problems were identified as risk factors at 10‐year follow‐up suggesting that these early recognized comorbidities at or near diagnosis have long‐term impacts. What this paper adds Young adults with childhood‐onset epilepsy (COE) and controls have similar psychosocial outcomes 10 years after diagnosis. Young adults with COE report greater limitations in cognition and overall disability than controls. Baseline presence of attention‐deficit/hyperactivity disorder and academic problems significantly affect cognitive and overall disability scores.

Academic attainment following pediatric epilepsy surgery: A systematic review

“…The few studies conducted in this area leave practitioners and parents alike with little information to weigh the costs and benefits of epilepsy surgery on the development the core life skills of literacy and numeracy [84], such as whether surgical outcomes that include better seizure control and reduction of medication afforded children a greater opportunity for ongoing developmental and cognitive progress postsurgically [85]. Considering the positive links between academic attainment and employment outcomes [86], in addition to their cascading effect on quality of life [87], this research is crucial for planning for the future of children with epilepsy.…”

Fostering research pathways to positive long‐term outcomes for childhood‐onset epilepsy

“…1 The QoL achieved appears to be the product of a complex interplay of factors, that extends beyond epilepsyspecific aspects, such as seizure characteristics. 2 The article by Kesselmayer et al 3 reports that while young adults with uncomplicated childhood-onset epilepsy demonstrated comparable long-term psychosocial status (educational attainment, living arrangement, employment status, personal income, marital status, QoL) compared to controls (first-degree cousins), functional outcomes (limitations in cognition and overall disability) were poorer in the epilepsy sample, independent of seizure control. They also report results corroborating previous evidence that baseline comorbidities, such as attention-deficit/hyperactivity disorder and poor academic achievement, are risk factors for long-term functional deficits.…”

“…1 Today, depression screening is foremost in many clinicians' minds. 2,3 Rosic and colleagues do us a great service by taking on this subject, not only in assessing depression, but by doing it repeatedly for 28 months. 4 The sample itself is impressive: 336 children and adolescents completed the study, although the group appeared to be largely heterogeneous.…”

“…Other key methodological advances are also warranted in the effort to foster pathways to positive long‐term outcomes in childhood‐onset epilepsy. Building on Kesselmayer et al’s findings which highlight the pervasive impact that neurobehavioral comorbidities can have on long‐term outcomes, additional baseline factors should be investigated as potential risk or protective factors for outcome trajectories. If observable early indicators near the time of epilepsy diagnosis explain some observed variability in future life outcomes achieved, these baseline characteristics could be used to screen patients for early interventions.…”

“…Filling these knowledge gaps is essential to fuel the process of developing and evaluating interventions that will be appropriately timed and targeted to those most likely to benefit. Kesselemayer et al 3 show some of the key methodological attributes to guide this important line of research: (1) prospectively following children with newly-diagnosed epilepsy over a decade, (2) choice of control group based on strong rationale to limit bias, and (3) baseline measurement of prevalent comorbidities (e.g. psychiatric disorders consistent with DSM-IV criteria via structured interview).…”