Abstracts

Rationale: There is general awareness of an increased occurrence of cognitive and behavioral disorders in association with childhood-onset epilepsy. With few exceptions, studies have been clinic based and highly selective. In addition, they have been unable to control for familial factors that may influence the occurrence or detection of these disorders. We examined the frequency of cognitive/behavioral diagnoses in children with epilepsy versus their sibling controls as part of a prospective community-based study. Methods: 613 children with newly diagnosed epilepsy, prospectively identified by pediatric neurologists in Connecticut from 1993 to 1997, were followed. These analyses include 218 cases with idiopathic/cryptogenic epilepsy and 218 sibling controls. Parents completed a questionnaire that included items on developmental, learning, behavioral and psychiatric disorders, and chronic medical conditions. Questionnaires were administered 8-9 years after the diagnosis of epilepsy. Cases and controls were compared using the McNemar’s test, Wilcoxon signed rank test, and conditional logistic regression. Results: The distribution of epilepsy diagnoses in the case group was: idiopathic generalized epilepsy, 27.5%, idiopathic focal epilepsy 14.2%, cryptogenic focal epilepsy, 46.8% cryptogenic epilepsy with focal seizures, unclassified, 11.5% (Table1). Most cases were ≥5 years seizure-free at the time of the parental interview. Cases were more likely than controls to be male and were similar in age. 17.0% of cases were <2 years of age at the onset of epilepsy. Relative to sibling controls, parents were more likely to report that the case had been diagnosed with a learning disorder and aphasic, language, or auditory processing disorder (Table 1). Other self-injurious behavior (not attempted suicide) was more commonly reported in cases. Reports of autistic spectrum disorder, dyslexia, hyperactivity disorder, attention deficit disorder, obsessive compulsive disorder, and attempted suicide were higher in cases than in controls but did not achieve statistical significance. The occurrence of depression and migraine was similar in cases and controls as were teen-age pregnancy and trouble with the law. Smaller proportions of cases had diabetes and asthma compared to controls. Stratification by case’s remission status and age at epilepsy onset did not substantially alter the findings. Conclusions: Cases with childhood-onset epilepsy were significantly more likely to have been diagnosed or described as having a learning or language disorder and more likely to have exhibited self-injurious behavior (not suicide attempt). Parental reports of other psychiatric and somatic disorders were not associated with idiopathic/cryptogenic childhood-onset epilepsy 9 years after diagnosis. Further examination of these findings, using diagnostic interviews designed to make DSM diagnoses is needed to confirm these associations and provide clues into the basis of the increased occurrence seen for some behavioral/cognitive comorbidities.