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Sometimes a Wolf in Sheeps' Clothing

Elaine C. Wirrell, MD, FRCP; Carol S. Camfield, MD, FRCP; Peter R. Camfield, MD, FRCP; Joseph M. Dooley, MD, FRCP; Kevin E. Gordon, MS, MD, FRCP; Bruce Smith, PhD

Arch Pediatr Adolesc Med. 1997;151(2):152-158.

Abstract
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, 1977, 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.

Arch Pediatr Adolesc Med. 1997;151:152-158

Author Affiliations
From the Department of Pediatrics, Royal University Hospital, Saskatoon, Saskatchewan (Dr Wirrell); the Departments of Pediatrics, Izaak Walton Killam-Grace Health Center (Drs C. S. Camfield, P. R. Camfield, Dooley, and Gordon), and Mathematics, Statistics, and Computing Science (Dr Smith), Dalhousie University Faculty of Medicine, Halifax, Nova Scotia.

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