MRC Centre of Epidemiology for Child Health, Institute of Child Health, University College London, London, United Kingdom.
Epilepsia. 2011 Aug;52(8):1513-21. doi: 10.1111/j.1528-1167.2011.03170.x. Epub 2011 Jul 18.
There is uncertainty about health and socioeconomic outcomes of children with epilepsy, knowledge of adult outcomes, and factors associated with adverse outcomes are essential to guide prognosis, improve management, and determine appropriate allocation of resources.
A subgroup of 101 children with epilepsy (onset ≤ age 16 years) were previously identified and reported from the 1958 National Child Development Study (NCDS), a national United Kingdom birth cohort study. In the current study we examine outcomes of this unique childhood epilepsy subgroup at age 33 compared to unaffected NCDS cohort members in mental and general health, education and employment, marriage, and parenthood. Multivariable regression analyses were used to investigate factors (including etiology, cognitive development, parental interest, and childhood anxiety/depression at age 11 years) associated with adverse outcomes. key findings: Sixty-five (66%) were still participating at 33 years. Median follow-up after epilepsy onset was 28 years (range 17-33 years). Thirty participants [46%, 95% confidence interval (CI) 35-58] had epilepsy onset <5 years, 32 (49%, 95% CI 37-61) had "symptomatic" epilepsy, and 33 (51%, 95% CI 39-63) had idiopathic epilepsy. Thirty-one participants (48%) reported being seen by their doctor for epilepsy in the preceding year, 27 (42%) were registered disabled, 39 (60%) had a drivers license, and 42 (65%) thought their epilepsy made it harder to get/keep a paid job. People who had childhood epilepsy had an increased risk of death [standardized mortality rate (SMR) 3.1, 95% CI 1.1-6.1]. Childhood epilepsy was associated with poor general and mental health at 33 years on univariable analyses, but not after adjusting for childhood cognitive development/comorbidities and anxiety over acceptance by peers/adults at age 11. Childhood epilepsy was an independent risk factor for not being married [odds ratio (OR) 0.45, 95% CI 0.05-0.94] or being a parent (OR 0.67, 95% CI 0.42-0.91). People with childhood epilepsy and poor cognitive development compared to those with poor cognitive development without epilepsy had a greater proportion with subsequent poor mental health (56% vs. 24%, difference in proportion 33%, 95% CI 12-50), and a lesser proportion who married (39% vs. 78%, difference in proportion -39%, 95% CI -56 to -19).
Compared to the unaffected population, children with epilepsy with good cognitive development/without comorbidities have similar adult health, educational, and employment outcomes but have difficulties with establishing and maintaining personal relationships. A combination of having childhood epilepsy plus poor cognitive development is more likely to be associated with adverse outcomes compared to having poor cognitive development without childhood epilepsy. Children with epilepsy have increased risk of death compared to the rest of the population. Pharmacologic management alone is inadequate and long-term psychosocial support is needed.
儿童癫痫患者的健康和社会经济结局以及成人结局的相关知识对于指导预后、改善管理和确定资源的适当分配至关重要。
此前，我们从英国全国出生队列研究（NCDS）中确定并报告了 101 名癫痫发作年龄≤16 岁的儿童（发病年龄≤16 岁）的亚组。在目前的研究中，我们比较了这一独特的儿童癫痫亚组在 33 岁时的精神和一般健康、教育和就业、婚姻和父母身份与未受影响的 NCDS 队列成员的情况。使用多变量回归分析调查了与不良结局相关的因素（包括病因、认知发育、父母关注以及 11 岁时的儿童焦虑/抑郁）。
65 人（66%）在 33 岁时仍在参与研究。癫痫发作后中位随访时间为 28 年（范围为 17-33 年）。30 名参与者（46%，95%置信区间[CI]为 35-58）癫痫发作<5 岁，32 名参与者（49%，95%CI 为 37-61）有“症状性”癫痫，33 名参与者（51%，95%CI 为 39-63）为特发性癫痫。31 名参与者（48%）报告在过去一年中因癫痫就诊，27 名参与者（42%）被登记为残疾，39 名参与者（60%）有驾驶执照，42 名参与者（65%）认为癫痫使他们更难获得/保留一份有薪工作。癫痫儿童的死亡风险增加（标准化死亡率[SMR]为 3.1，95%CI 为 1.1-6.1）。单变量分析显示，癫痫儿童在 33 岁时的一般和心理健康状况较差，但在调整了儿童认知发育/合并症和 11 岁时同龄人和成年人接受程度的焦虑后，这种情况不再存在。癫痫儿童与未婚（比值比[OR]为 0.45，95%CI 为 0.05-0.94）或无子女（OR 为 0.67，95%CI 为 0.42-0.91）的风险独立相关。与认知发育良好且无癫痫的参与者相比，认知发育不良且伴有癫痫的参与者有更大比例的参与者随后出现心理健康不良（56%对 24%，差异比例为 33%，95%CI 为 12-50），以及更小比例的参与者结婚（39%对 78%，差异比例为-39%，95%CI 为-56 至-19）。
与未受影响的人群相比，认知发育良好/无合并症的癫痫儿童在成人健康、教育和就业方面有相似的结局，但在建立和维持人际关系方面存在困难。与认知发育不良但无儿童癫痫相比，同时患有儿童癫痫和认知发育不良的儿童更有可能出现不良结局。与一般人群相比，癫痫儿童的死亡风险增加。单纯的药物治疗是不够的，需要长期的社会心理支持。
