Long-term psychosocial outcome in typical absence epilepsy. Sometimes a wolf in sheeps' clothing
E. C. Wirrell, C. S. Camfield, P. R. Camfield, J. M. Dooley, K. E. Gordon and B. Smith
Department of Pediatrics, Royal University Hospital, Saskatoon, Saskatchewan.
OBJECTIVES: To determine whether young adults in whom typical absence
epilepsy has been diagnosed in childhood have greater psychosocial
difficulties than those with a non-neurologic chronic disease and to decide
which seizure-related factors predict poor psychosocial outcome. DESIGN:
Population-based, inception cohort study. SETTING: The only tertiary care
pediatric hospital in the province of Nova Scotia. PATIENTS: All children
in whom typical absence epilepsy or juvenile rheumatoid arthritis (JRA) was
diagnosed between January 1, 1997, and December 31, 1985, who were aged 18
years or older at follow-up in March 1994 to April 1995. Patients with
typical absence epilepsy were identified from centralized
electroencephalographic records for Nova Scotia, and those with JRA were
identified from discharge diagnoses from the only children's hospital in
Nova Scotia. MAIN OUTCOME MEASURE: Patients participated in a structured
interview that assessed psychosocial function. RESULTS: Fifty-six (86%) of
the 65 patients with absence epilepsy and 61 (80%) of the 76 patients with
JRA participated in the interview. The mean age of the patients at the
interview was 23 years. Terminal remission occurred in 32 (57%) of the
patients with typical absence epilepsy but in only 17 (28%) of the patients
with JRA. Factor analysis identified 5 categories of outcome:
academic-personal, behavioral, employment-financial, family relations, and
social-personal relations. Patients with typical absence epilepsy had
greater difficulties in the academic-personal and in the behavioral
categories (P < .001) than those with JRA. Those with ongoing seizures
had the least favorable outcome. Most seizure-related factors showed
minimal correlation with psychosocial functioning. CONCLUSION: Young adults
with a history of typical absence epilepsy, particularly those without
remission of their seizures, often have poor psychosocial outcomes,
considerably worse than those with JRA.
