Comorbidity spectrum in children and youth with epilepsy based on a validated and classified population-based childhood epilepsy cohort.
TL;DR
Most CYE have a wide spectrum of medical, neurological, psychiatric, and neurodevelopmental comorbidities, which need to extend beyond seizures, and their evaluation and management need to extend beyond seizures.
Abstract
Objective
This study was undertaken to describe the occurrence and distribution of medical, neurological, neurodevelopmental, and psychiatric comorbidities in children and youth with epilepsy (CYE) and risk factors of such conditions.
Methods
The study platform is the Norwegian Pediatric Epilepsy Study (NorPec), a nested case-cohort study within the Norwegian Mother, Father, and Child Cohort Study (MoBa). MoBa includes more than 113 000 children with consent for prospective follow-up with questionnaires and registry linkages. NorPec consists of all MoBa children with validated epilepsy diagnoses according to contemporary International League Against Epilepsy definitions and classifications. Information on comorbidities and epilepsy characteristics was based on structured medical record reviews. Differences across categorical variables were tested with chi-squared tests. Risk factors of comorbid categories were assessed using logistic regression models.
Results
Among 1054 CYE, 78% had any comorbid condition. Medical conditions were reported in 62%, neurological conditions in 39%, psychiatric conditions in 32%, and neurodevelopmental impairments in 51%. Most CYE with structural etiologies had medical (78%), neurological (78%), and/or neurodevelopmental (70%) comorbidities. Most CYE with developmental and epileptic encephalopathies (DEEs), genetic etiology, and/or combined epilepsy had not only neurodevelopmental comorbidities (93%-98%) but also neurological (83%-92%) and medical (90%-95%) comorbidities. Neurodevelopmental impairments were still present in self-limited (25%) and genetic generalized epilepsies (33%) and epilepsies of unknown etiologies (42%). Genetic etiology was associated with increased odds of medical comorbidity, structural etiologies with neurological comorbidity, and DEEs with increased odds of neurodevelopmental and neurological comorbidity but reduced odds of reported psychiatric comorbidity. Neurodevelopmental comorbidity was associated with increased odds of medical, neurological, and psychiatric comorbidities overall, but affective conditions were less frequent in DEEs. Heredity, sex, neonatal events, etiology, syndrome category, and having other comorbidities influenced risk of comorbid categories in CYE.
Significance
Most CYE have a wide spectrum of medical, neurological, psychiatric, and neurodevelopmental comorbidities. Thus, their evaluation and management need to extend beyond seizures.