School Performance and Psychiatric Comorbidity in Childhood Absence Epilepsy: A Danish Cohort Study
Magnus Spangsberg Boesen1, Malene Landbo Børresen2, Soren Christensen2, Amalie Klein-Petersen2, Sahla El Mahdaoui1, Malini Sagar1, Emilie Schou2, Anna Eltvedt2, Melita Cacic Hribljan3, Alfred Peter Born2, Peter Uldall2, Lau Thygesen4, Maria Jose Miranda1
1Herlev Hospital, 2Rigshospitalet, 3Copenhagen University Hospital, Denmark, 4National Institute of Public Health, University of Southern Denmark
Objective:
To determine school performance and psychiatric comorbidity in children with childhood absence epilepsy.
Background:
Childhood absence epilepsy is considered a benign epilepsy but affected children may have unrecognized cognitive and psychiatric problems.
Design/Methods:
We reviewed the medical records in children with ICD-10 codes for idiopathic generalized epilepsy before 18 years of age, and pediatric neurologists confirmed the International League Against Epilepsy criteria for childhood absence epilepsy were met. Control groups were the general pediatric population or children with non-neurological chronic disease. Outcomes were from nationwide and population-based registers on school performance and psychiatric comorbidity. We compared the mean grade point average using linear regression and estimated hazard ratios (HR) using Cox regression for the other outcomes. Analyses were adjusted for the child's sex, and year of birth, and parental highest education, receipt of cash benefits or early disability pension.
Results:
We included 114 children with childhood absence epilepsy with a median age at onset of 5.9 years (interquartile range = 4.5-7.3 years). Compared with both population controls and non-neurological chronically ill children, children with childhood absence epilepsy had increased hazard of special needs education (HR = 2.7, 95% confidence interval (CI) = 1.8-4.1, p < 0.0001), lower grade point average at 9th grade by 1.7 grade points (95% CI = -2.5 to -1.0, p < 0.001), increased ADHD medicine use (HR = 4.4, 95% CI = 2.7-7.2, p < 0.001), increased sleep medicine use (HR = 2.7, 95% CI = 1.7-4.3, p < 0.001), and increased psychiatry visits (HR = 2.1, 95% CI = 1.1-4.0, p = 0.03).
Conclusions:
Children with childhood absence epilepsy have increased psychiatric comorbidity and a considerable proportion of these children receive special needs education in primary/secondary school, albeit insufficient to normalize their considerably lower grade point average in the 9th grade.
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