A national profile of childhood epilepsy and seizure disorder.
To determine sociodemographics, patterns of comorbidity, and function of US children with reported epilepsy/seizure disorder.
Bivariate and multivariable cross-sectional analysis of data from the National Survey of Children’s Health (2007) on 91 605 children ages birth to 17 years, including 977 children reported by their parents to have been diagnosed with epilepsy/seizure disorder.
* Estimated lifetime prevalence of epilepsy/seizure disorder was 10.2/1000 (95% confidence interval [CI]: 8.7-11.8) or 1%,and of
*current reported epilepsy/seizure disorder was 6.3/1000 (95% CI: 4.9-7.8).
*Epilepsy/seizure disorder prevalence was higher in lower-income families and in older, male children.
*Children with current reported epilepsy/seizure disorder were significantly more likely than those never diagnosed to experience
depression (8% vs 2%),
anxiety (17% vs 3%),
attention-deficit/hyperactivity disorder (23% vs 6%),
conduct problems (16% vs 3%),
developmental delay (51% vs 3%),
autism/autism spectrum disorder (16% vs 1%), and
headaches (14% vs 5%) (all P < .05).
They had greater risk of limitation in ability to do things (relative risk: 9.22; 95% CI: 7.56-11.24),
repeating a school grade (relative risk: 2.59; CI: 1.52-4.40),
poorer social competence and greater parent aggravation, and were at increased risk of having unmet medical and mental health needs.
Children with prior but not current seizures largely had intermediate risk.
In a nationally representative sample, children with seizures were at increased risk for mental health, developmental, and physical comorbidities, increasing needs for care coordination and specialized services. Children with reported prior but not current seizures need further study to establish reasons for their higher than expected levels of reported functional limitations.
Further Readings of Interest
Boston’s Children’s Hospital – Vector Blog
Preventing autism after infant seizures
We already know that there’s some kind of connection between epilepsy and autism: Children who have seizures as newborns not uncommonly develop autism, and studies indicate that about 40 percent of patients with autism also have epilepsy. New research at Boston Children’s Hospital finds a reason for the link, and suggests a way to break it — using an existing drug that’s already been given safely to children.
In the online journal PLoS ONE, Frances Jensen, MD, in the Department of Neurology and the F.M. Kirby Neurobiology Center at Boston Children’s, and lab members Delia Talos, PhD, Hongyu Sun, MD, PhD, and Xiangping Zhou, MD, PhD, showed in a rat model that early-life seizures not only lead to epilepsy later in life, but also produce autistic-like behaviors.
Drilling deeper, they showed that early seizures hyper-activate a group of signaling molecules collectively known as the mTOR pathway. This increased signaling – above and beyond the normal surge that happens early in life – disrupts the normal balance of connections (synapses) in the rats’ developing brains. The rats go on to develop epilepsy and altered social behavior, and Jensen believes something parallel happens in humans.
But here’s what’s exciting. They did other experiments where they gave the rats the drug rapamycin, which disables the mTOR pathway, before and after seizures. The mice did not show abnormal synapse or circuit development, and were less likely to have seizures later in life. Autistic-like symptoms appeared less often.
Seizure detection: It’s all in the wrist
When a child loses milestones, consider sleep EEG studies
“Very few physicians have been looking to see what’s happening at night,” Loddenkemper says.
He and research fellow Iván Sánchez Fernández, MD, with other colleagues, decided to look themselves. They reviewed overnight EEG recordings from 147 patients who were seen at Boston Children’s over a 14-year period. They found that 100 of the 147 children indeed had prominent spikes in their EEGs during the night – and about one in five of them did not have known epilepsy.
“Kids can have an almost normal EEG while awake, but show increased spikes during sleep,” says Loddenkemper.
MRI imaging, also done on the children, suggested that the spikes may reflect early, unrecognized strokes or other early injuries to the developing brain. Brain lesions were found in 48 percent of the children with spikes, but in only 19 percent of those without spikes; lesions in the thalamus were especially common. Early stroke was the single most common type of brain injury, found in 14 percent of children with spikes but none of the controls.
“We know that children lose skills and show features of autism when these spikes appear,” he says. “These children lose out on a critical period of brain development and may never fully catch up later in life.”
Loddenkemper is urging his fellow physicians to consider sleep EEG monitoring more often in children not meeting developmental milestones, and to consider giving medications at bedtime if heightened brain electrical activity is found.