Abstracts

Rationale: Neurobehavioural (i.e. cognitive and/or behavioural) impairments are common in childhood epilepsy. Evidence suggests children with early-onset epilepsy (onset <5 years) are particularly at risk yet there is limited population-based data describing the nature and distribution of impairments. This data is required to target appropriate medical/social/educational intervention and resource allocation. NEUROPROFILES, an ongoing population-based, case-control study aims to estimate the incidence of early-onset epilepsy and describe the spectrum of and risk factors for neurobehavioural impairments.Methods: Since May 2013 newly diagnosed preschool children with early-onset epilepsy (CWE) in South East Scotland are being enrolled using active multi-source capture-recapture surveillance. CWE are offered detailed age-appropriate neuropsychological assessment including Bayley-III, Wechsler Preschool and Primary Scales of Intelligence-III, NEPSY-II, ESSENCE-Q, P-BRIEF, Conners Early Childhood, Social Responsiveness Scale-2, ABAS-II, and ITSEA. Matched controls are being recruited through public advertisement. Intergroup differences were examined using binomial tests, chi-square, t-tests or Mann-Whitney U. Incidence ascertained from Scottish 2011 consensus.Results: 60 CWE have been identified (38M:22F p<.05; mean age 22m, 3-54m) – crude incidence 64/100,000 children aged <5yrs/yr (95%CI 49-82). Number of incident cases from areas of low (43%) or high (57%) socioeconomic status were similar to population proportion. 37 CWE (95% CI 49-74, 22 Male) and 38 sex and age matched controls (18 Male) had neuropsychological assessment. Mean time from diagnosis to assessment 2.9months (SD2.02). CWE were more likely to be cognitively impaired (IQ/DQ <1.5SD below the mean) than controls (32% vs 0%, p<.05). Cognitive impairment was more common in those with symptomatic aetiology (p<.05) and on more than one AED (p<.05). Parents of CWE report more multi-domain developmental concerns (p<.001) and poorer adaptive behaviour (p<.01). Parents report more autistic behaviours (p<.01), activity/attention (p<.05) and social functioning (<.05) difficulties in CWE aged >2.5 years old but not in younger children. There were no differences in emotion or conduct scores. Behavioural impairment was not associated with aetiology, seizure focus, or number of AEDs. Collectively, CWE have more neurobehavioural impairments vs controls (49% vs 5%, p<.001). Impairment was not related to socioeconomic status in CWE.Conclusions: Incidence of early-onset epilepsy in South East Scotland is comparable to that reported in other developed regions. CWE are just as likely to reside in areas of low or high socioeconomic status. Data suggest impaired neurodevelopment in CWE is detectable and prominent in the first four years of life. Risk factors for impairments may differ depending on nature (i.e. cognitive or behavioural). Neurobehavioural impairments are present soon after epilepsy onset suggesting factors contributing to the epilepsy itself may also contribute to the formulation and expression of impairments in CWE.