Download PDF
Neuropediatrics 2020; 51(02): 164-169
DOI: 10.1055/s-0039-3399529
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Early Onset, Long Illness Duration, Epilepsy Type, and Polypharmacy Have an Adverse Effect on Psychosocial Outcome in Children with Epilepsy

Valeria Valova
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
,
Aleksandra Kochan
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
,
Bianca Werry
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
,
Rainer John
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
,
Christine Prager
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
,
Joanna Schneider‡   *
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
4   Berlin Institute of Health, Berlin, Germany
,
Angela M. Kaindl   *
1   Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Berlin, Germany
2   Charité – Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany
3   Charité – Universitätsmedizin Berlin, Institute of Cell- and Neurobiology, Berlin, Germany
› Author Affiliations Acknowledgment The authors thank the patients and their parents. The study was funded by the German Research Foundation (DFG, SFB1315, FOR3004) and the Charité - Universitätsmedizin Berlin.
Further Information

Publication History

07 December 2018

29 September 2019

Publication Date:
21 November 2019 (online)

    Permissions and Reprints

Abstract

Epilepsy is often associated with psychosocial comorbidity and this can be more disabling than the seizure activity. Still, these associated conditions are often underdiagnosed and therefore not sufficiently treated. We studied a large pediatric cohort of 371 patients with epilepsy to identify factors associated with negative outcome. We found that patients with early-onset epilepsy, epilepsy of known etiology, and polypharmacy were the most likely to display cognitive impairment. Behavioral problems were particularly prevalent in patients with an epilepsy duration ≥ 5 years. Similarly, early-onset epilepsy, long illness duration, epilepsy of known etiology, and polypharmacy had an adverse effect on school placement and/or social contact. With polypharmacy being the only potentially modifiable factor, it is important to balance between benefits and adverse effects of antiepileptic drugs and consider alternative therapy options in selected patients such as epilepsy surgery, vagal nerve stimulation, and ketogenic diet early-on.

Keywords

pediatric epilepsy - antiepileptic drugs - comorbidity - psychosocial

Competing Interests

The authors declare that they have no competing interests.


Authors' Contributions

AMK and JS were responsible for the project conception. VV, JS, and AMK wrote the manuscript. VV, AK, and BW collected patient data and incorporated them into a database. VV and JS analyzed the data. All authors read, revised, and approved the final manuscript.


* Equal contribution.


 

  • References

  • 1 Elger CE, Helmstaedter C, Kurthen M. Chronic epilepsy and cognition. Lancet Neurol 2004; 3 (11) 663-672
    CrossrefPubMedGoogle Scholar
  • 2 Berg AT, Langfitt JT, Testa FM. , et al. Global cognitive function in children with epilepsy: a community-based study. Epilepsia 2008; 49 (04) 608-614
    CrossrefPubMedGoogle Scholar
  • 3 Witt JA, Elger CE, Helmstaedter C. Adverse cognitive effects of antiepileptic pharmacotherapy: each additional drug matters. Eur Neuropsychopharmacol 2015; 25 (11) 1954-1959
    CrossrefPubMedGoogle Scholar
  • 4 Pastor PN, Reuben CA, Kobau R, Helmers SL, Lukacs S. Functional difficulties and school limitations of children with epilepsy: findings from the 2009-2010 National Survey of Children with Special Health Care Needs. Disabil Health J 2015; 8 (02) 231-239
    CrossrefPubMedGoogle Scholar
  • 5 Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics 2012; 129 (02) 256-264
    CrossrefPubMedGoogle Scholar
  • 6 Vingerhoets G. Cognitive effects of seizures. Seizure 2006; 15 (04) 221-226
    CrossrefPubMedGoogle Scholar
  • 7 Freilinger M, Reisel B, Reiter E, Zelenko M, Hauser E, Seidl R. Behavioral and emotional problems in children with epilepsy. J Child Neurol 2006; 21 (11) 939-945
    CrossrefPubMedGoogle Scholar
  • 8 Kwan P, Brodie MJ. Neuropsychological effects of epilepsy and antiepileptic drugs. Lancet 2001; 357 (9251): 216-222
    CrossrefPubMedGoogle Scholar
  • 9 Datta SS, Premkumar TS, Chandy S. , et al. Behaviour problems in children and adolescents with seizure disorder: associations and risk factors. Seizure 2005; 14 (03) 190-197
    CrossrefPubMedGoogle Scholar
  • 10 Bulteau C, Jambaque I, Viguier D, Kieffer V, Dellatolas G, Dulac O. Epileptic syndromes, cognitive assessment and school placement: a study of 251 children. Dev Med Child Neurol 2000; 42 (05) 319-327
    CrossrefPubMedGoogle Scholar
  • 11 Caplan R. Brain Lang Epilepsy, language, and social skills. Brain Lang 2019; 193: 18-30
    CrossrefPubMedGoogle Scholar
  • 12 Witt JA, Helmstaedter C. How can we overcome neuropsychological adverse effects of antiepileptic drugs?. Expert Opin Pharmacother 2017; 18 (06) 551-554
    CrossrefPubMedGoogle Scholar
  • 13 Boshuisen K, van Schooneveld MM, Uiterwaal CS. , et al; TimeToStop cognitive outcome study group. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Ann Neurol 2015; 78 (01) 104-114
    CrossrefPubMedGoogle Scholar
  • 14 Lamberink HJ, Otte WM, Geerts AT. , et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis. Lancet Neurol 2017; 16 (07) 523-531
    CrossrefPubMedGoogle Scholar
  • 15 Blumcke I, Spreafico R, Haaker G. , et al; EEBB Consortium. Histopathological findings in brain tissue obtained during epilepsy surgery. N Engl J Med 2017; 377 (17) 1648-1656
    CrossrefPubMedGoogle Scholar