Childhood epilepsy linked to increased comorbidity

1. In a Norwegian nationwide registry study, children with epilepsy were compared to the general population. Over three-quarters of children with epilepsy had at least 1 comorbid neurologic, medical, or psychologic disorder compared to less than a third in the general population.

2. Children with more complicated epilepsies had even higher rates of comorbidity compared to children with uncomplicated epilepsy and those without epilepsy.

Evidence Rating Level: 2 (Good)

Study Rundown: Childhood epilepsy is a disorder with multiple associated neurocognitive comorbidities. These comorbid conditions often share risk factors with epilepsy and may even be associated as causes. Few studies have comprehensively assessed both the medical and neurocognitive comorbidities of epilepsy. This is one of few studies to use a comprehensive, national registry to explore the burden of disease in children with epilepsy. Study authors categorized children with epilepsy (CWE) into those with complicated epilepsy (additional neurological/cognitive disorders) and uncomplicated epilepsy, and compared them to matched controls. Over three quarters of CWE had at least 1 comorbid medical/neurological or psychiatric disorder compared with less than a third of children without epilepsy. All medical conditions had higher prevalence among CWE. Almost half of CWE children had developmental or psychiatric disorders, compared to less than 10% in the general population. Generally, all medical and psychiatric conditions were more frequent among children with complicated epilepsy (CWE+) compared to those with uncomplicated epilepsy (CWE-). While this study effectively outlines the increased burden of disease among CWE, it is limited by potential systematic inconsistencies in the registry. Nonetheless, these findings may help clinicians have a better understanding of the increased burden of disease among this population.

Click to read the study published today in Pediatrics

Relevant Reading: The psychosocial impact of epilepsy in childhood

Study Author, Dr. Kari Modalsli Aaberg, MD, talks to 2 Minute Medicine: Norwegian Institute of Public Health, Department of Child Health, and National Center for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.

“We think this is an important topic because epilepsy is one of the most frequent chronic neurological conditions in children. As we describe in our article, children with epilepsy often have other medical, neurological, developmental and psychiatric conditions. The management of childhood epilepsy should not only focus on the epileptic seizures, but also include thorough assessments of all aspects of health, including development, psychiatric symptoms, nutrition, growth and sleep.”

In-Depth [cross-sectional study]: This study included 1 125 161 children from the Norwegian Patient Registry. Of this sample, 0.6% of children (6635) had a diagnosis of epilepsy. Comorbid disorders were divided into 3 categories: medical, neurologic and psychiatric/developmental. Among CWE, 78.3% had at least 1 comorbid disorder compared to 30.3% among children without epilepsy. All medical conditions had increased frequency among CWE. The highest odds ratios for CWE in this category were visual impairments (OR = 30.6), chromosomal abnormalities (OR = 19.6), and malnutrition/eating difficulties (OR = 16.1). The most frequent neurologic disorders among CWE were cerebral palsy (13.9%), headache conditions (6.6%), and congenital neurologic malformations (6.5%). Compared to the general population, the risk of having a comorbid neurological disorder was at least 25 times higher in the CWE group . Among CWE, 42.9% had a developmental/psychiatric disorder, compared to 6.6% in the general population. The highest relative risk among CWE was intellectual disability (OR = 41.0). Of CWE, 58.5% were classified as CWE+ and had more frequent medical, neurologic, and psychiatric conditions compared to CWE-. Compared to CWE-, the CWE+ group had increased risk of comorbid medical conditions, most significantly visual impairments (OR = 14.3), malnutrition/eating difficulties (OR 13.7) and chromosomal abnormalities (OR = 9.8).

Image: PD

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