Original articleLong-term medical, educational, and social prognoses of childhood-onset epilepsy: a population-based study in a rural district of Japan
Introduction
Since epilepsy usually begins during childhood and may subsequently affect the patient's normal course of development [1], [2], numerous studies have been performed on the prognosis of epilepsy in terms of various aspects, including seizure control, mortality, academic achievement, educational background, employment, marriage, and licensed driving [3–59]. However, the majority of prior research results were based on the outcomes in mixed populations of children and adults [5], [6], [8], [12], [14], [18], [19], [22], [23], [35], [38], [39], [44], [45], and were biased by patients with refractory epilepsy who were treated at university hospitals [6], [7], [9], [10], [15], [17], [18], [30], [32], [33], [36], [42] or specialized epilepsy centers [12], [14], [26], [27], [28], [29], [31], [34], [40], [41], [43], [44], [47], [48]. Due to methodological problems, there have only been a few reports of population-based studies addressing all these prognostic issues simultaneously based on longitudinal follow-up observation of only epileptic children [3], [16], [25].
In a recent population-based study in Finland, Sillanpää et al. [25] found a long-term negative impact of childhood-onset seizures on the patients’ levels of education, and the likelihood of their employment and marriage, and the authors also found these adverse effects even in patients with idiopathic epilepsy in remission without medication, a group that would be expected to have the most favorable outcome. As a result, Sillanpää et al. concluded that even the mildest form of childhood-onset epilepsy may have a lifelong effect on the patients’ educational and social prognoses. However, more similar studies remain to be conducted before such a pessimistic conclusion can be generally accepted.
The purpose of this study was to present and evaluate our data on the long-term medical, educational, and social outcomes in a cohort of children with epilepsy who had been followed until they became adults in a defined rural area of Japan. Furthermore, we conducted a survey of the patients’ recognition of epilepsy as well as the parents’ current concerns about the prognosis of epilepsy, which had been neglected in prior prognostic studies [60], [61].
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Subjects and methods
The sample of this study included all individuals who had been given a diagnosis of epilepsy under 16 years of age between April 1961 and April 1992 at the Department of Pediatrics of Uwajima City Hospital and who were 20 years of age or older at the final follow-up in 1998. The hospital is the center of medical institutions in Uwajima City, which is located in the Southern part of Ehime Prefecture in Japan, and surrounding districts, which comprises of three counties (Higashiuwa, Kitauwa and
Results
We identified 167 patients (87 men and 80 women) who met the inclusion criteria for this study. Among them, ten patients were lost to follow-up, and the parents of two others refused participation. The remaining 155 patients were eligible for this study and their parents were interviewed by telephone. Accordingly, the follow-up rate was 92.8%. The demographic and clinical characteristics of the 155 patients are shown in Table 1. The epilepsy was classified as idiopathic in 62 patients (40.0%),
Discussion
The present study comprised of long-term follow-up evaluation of the medical, educational, and social outcomes in 155 patients (including seven dead ones) with a history of childhood-onset epilepsy aged 20 years or older. Due to the high follow-up rate as well as the subjects’ highly representative nature as to the population of epileptic children in this defined area, our study nearly completely avoided the selection bias pertinent to retrospective studies in which there was considerable loss
Conclusion
Overall, the results of the present study are consistent with those of prior population-based studies by Sillanpää [3], [16] and Sillanpää et al. [25] showing that the long-term prognosis of childhood-onset epilepsy is favorable in terms of seizure remission and psychiatric complications, whereas it is unfavorable in terms of mortality rate, levels of school education and educational background, and rates of employment, marriage and licensed driving. However, with regard to the long-term
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