Abstracts

Rationale: Serious chronic diseases in childhood are more frequent and severe if the family is poor. We explored this issue in a population based study of children with epilepsy.Methods: The Nova Scotia population-based childhood epilepsy cohort includes all children in this Canadian province who developed epilepsy between 1977-1985. Comprehensive health care with equal access to all citizens is provided in Nova Scotia. Eligible patients were followed for at least 10 years. Remission was defined as seizure-free without AEDs at the end of follow up. Children with childhood absence epilepsy were excluded. At the end of follow up, a telephone interview was carried out personally by the authors. Total family income at seizure onset was assessed in 1980 Canadian dollars and classified as <$20,000 (“poor” = 1st quintile for family income), $20,000-$50,000 (“adequate” = 2-3 quintile) and >$50,000 (“well off” = 4-5 quintile). We also assessed the family’s level of education (no high school graduation, high school graduation, ≥1 year of post secondary education) and if they owned their own home at the onset of the child’s epilepsy.Results: Of a total of 584 patients, 408 (70%) were eligible for study. Average follow up was 25.5 ± 5.8 years. Overall 133 families (33%) had “poor” income, 153 (38%) had “adequate income” and 122 (30%) were “well off”. Remission of epilepsy occurred in 87/133(65%) of the poor, 93/153(61%) of the adequate and 75/122 (61%) of the well off group = (p=ns). Intractable epilepsy was equally prevalent across groups (poor 18%, adequate 22%, well off 16% p=ns). ≥1 episode of status epilepticus occurred in 20% of the poor, 27% of the adequate and 30% in the well off group (p=ns). The number of generalized tonic-clonic or focal with secondary generalization seizures through the clinical course was the same in all groups. The total number of AEDs used was also the same (1-3 AEDS; poor 79%, adequate 73%, well off 74% p=ns). Owning a home did not predict remission (37% with home ownership had remission vs 35% without home ownership p=ns). Neither paternal nor maternal education was associated with a difference in the rate of remission. Rolandic epilepsy was unexpectedly more common in the well off than poor group (18% vs 2.3%, P<0.0002) while the adequate group fell in between (7.2%). Children from the poor families were more likely to have non syndromic focal epilepsy than the well off (69% vs. 50% p=0.002) again with the adequate group in between (57%). Other syndromes were too infrequent for meaningful statistical analysis but did not appear to differ across income groups.Conclusions: In Nova Scotia with universal health care, significantly more children with Rolandic epilepsy come from rich families and significantly more children with non-syndromic focal epilepsy come from poor families. Nonetheless, across all epilepsy types, coming from a poor or more affluent family does not seem to affect the clinical course or long term seizure outcome of childhood epilepsy.