Asuri N Prasad, MBBS, FRCPC, FRCPE

Professor in Pediatrics and Clinical

Neurosciences, Schulich Medicine &

Dentistry, London, ON.

Acknowledgements

My Collaborators Bradley Corbett PhD, Jorge G Burneo, MD,

MSPH

Epilepsy Program, London Health Sciences Centre & Children’s

Hospital of Western Ontario, Ivey Business School at Western

University, London, Ontario, Canada, N6A5C2.

Research Data Centre at Western

Ontario Brain Institute for Funding the Research through the

Eplink Team Grant.

Objectives

Background

Methodology

Results

Conclusions

Neurological disorders in

children

Chronic-

• Epilepsy

• Cerebral palsy

• Learning disability

• Mental handicap

• Behavioral and psychiatric

Acute

• Encephalitis, Stroke Demyelinating disease,

• Genetic and metabolic disorders

Acute disorders leading to chronic

disorders

Burden of disease

Neurological disorders pose high burden

Morbidity

Mortality

Financial cost of care

Impact on family

Impact on society

Prior work

Findings from previous

study

The data suggest an over-representation of seizure disorders in children born to parents of lower socioeconomic status.

Preschool children in the lowest income quintile were twice as likely as their counterparts in the highest income quintile to have seizure disorders.

higher prevalence of seizure disorders among school-age children living in low-income neighborhoods may be the consequence of environmental factors, such as higher exposure rates to antecedent illnesses (infections) or risk factors for seizures (head trauma from injury).

National Longitudinal Study

of Children and Youth

The NLSCY began in 1994-1995 and collected data from a sample of 25000 children, from 0 to 11 years.

This group of children were surveyed subsequently every two years, for a total of 8 cycles, terminating in 2008-2009.

The objective of the NLSCY was to track factors influencing child development in Canada.

Methods

Question HLT-Q45 in the survey asked the PMK “Does the child have any of the following long-term conditions that have lasted or are expected to last six months or more and have been diagnosed by a health professional”.

“Epilepsy, Cerebral palsy, Learning disability, Mental Handicap, Emotional Nervous difficulties”

Question (HLT-Q51D) identified whether the condition was treated by means of a specific anticonvulsant or antiepileptic medication.

Methods

Descriptive statistics (cross sectional cycles 1-4)

Cross sectional weights were applied (Boot strapping)

Prevalence estimates n/1000 generated

Using data from Cycles 1 to 8 of the NLSCY, standard scores on the Peabody Picture Vocabulary Test-Revised (PPVT-R) were employed in a regression analysis to compare standardized scores on the PPVT-R in children with and without epilepsy.

Current Study

Extend our probe of the dataset to answer following

questions

Primary:

To determine how many children with epilepsy also

have co-morbidities of epilepsy.

To determine how children with epilepsy compare

with their peers on important developmental

outcomes.

Co-Morbidities of Epilepsy

Children with epilepsy alone accounted for 56.87%, while

10.07% had at least 1 co-morbid condition, 23.57% had at

least 2 co-morbid conditions while 9.53% had three or

more conditions.

Cycle 3 data

n with

condit

ion n/100

Prevalence

per 1000 Number in Canada

EPI_MR 38 0.12 1.17 7581

EPI_CP 36 0.11 1.1 6949

EPI_LD 50 0.16 1.16 10107

EPI_EMO 26 0.083 0.83 5243

Epilepsy 161 0.53 5.3 32045

Note : Total N = 31963

Gender effect

School Readiness

A total of 33,757 children were included in the analysis and 67 reported epilepsy.

Regression was centred around the mean age (61.069 months) and PPVT mean score of (100.6811).

Children with epilepsy underperformed on the school readiness test (PPVT-R) in comparison to the rest of their cohort (β=-0.05, se=0.01, p=0.000).

Male cohort also underperformed in comparison to females (β =0.033, se=0.001, p=0.000).

PPVT Scores

Test Children with Epilepsy (Mean Scores and Confidence Intervals)

Children without Epilepsy (Mean Scores and Confidence Intervals)

PPVT-R 28.85 (25.14;32.55) 36.86 (36.69; 37.04)

0

5

10

15

20

25

30

35

40

WithoutEpilepsy

WithEpilepsy

Mean PPVT-R scores

WithoutEpilepsy

WithEpilepsy

Conclusions

Epilepsy prevalence estimates from the NLSCY are comparable

to the results of other studies (US, Finland).

Nearly half of the population of children with epilepsy carry a

high likelihood of an associated neurological developmental

disability (CP, ID, LD, EMO-Nerv).

Children with epilepsy underperform on standardized tests of

school readiness (PPVT).

Therefore, this is a population with a chronic disorder at

significant risk for academic underachievement.

Early screening for co-morbid conditions in children with

epilepsy should be considered in educational system and early

intervention programs targeted.

Future

The extension of this work will seek to answer the following questions using the

NLSCY data which includes both cross sectional and longitudinal surveys;

To determine how the prevalence of epilepsy changes with age and what

proportion of people with epilepsy experience a ‘disappearance of symptoms’.

To determine the length or duration of epilepsy in this population of individuals?

Using data on behavioural scales collected in the survey, we will determine how

children with epilepsy fare on measures of behaviour (anxiety, emotional disorder,

conduct disorder, hyperactivity and inattention) in comparison to children without

epilepsy and other comorbid conditions.

Using data from the depression and family functioning scales administered to

parents or caregivers of children with epilepsy, we can begin to understand the

impact of epilepsy on the caregivers and family functioning.