Abstracts

Rationale: Comorbidities influence prognosis, treatment strategies and everyday life of children with epilepsy. The present study was designed to analyze the presence of comorbidities at the time of seizure onset in a population-based cohort of children with newly diagnosed unprovoked seizures. Methods: From September 1st 2001 a surveillance system has been in use to identify incident cases of first unprovoked seizures (neonatal seizures excluded) and epilepsy among residents of Northern Stockholm, Sweden. Inclusion is based on validation through review of relevant medical records of potential cases. The medical records from the time of the first unprovoked seizure and the following six months of all children (0-18 years) identified as cases through December 31st 2006, n=766, were analysed to identify potential comorbidities (developmental delay, language problems, mental retardation, cerebral palsy, autism spectrum disorders, attention deficit hyperactivity disorder, psychiatric diagnoses) at. We also applied the acronym ESSENCE (Early Symtomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) to describe prevalence of developmental disorders in children younger than 6 years where more specified diagnostic criteria may not have been met yet. Comorbidities were considered to be present when a relevant defined diagnosis appeared in the medical records or when the records included a clear problem description highly suggestive of a comorbidity. Results: As early as at the time of the first recognised seizure or the following six months 32% (n=247) of the children in the cohort had one or more of the defined comorbidities. Out of the cases, 11% (n=87) were diagnosed with, or highly suspected to have, two or more of the diagnoses: mental retardation, cerebral palsy, autism spectrum disorders, attention deficit hyperactivity disorder or psychiatric diagnoses. We found ESSENCE highly suspected or ascertained among 34% (n=105) of the children younger than 6 years (n=315) with a recently diagnosed unprovoked seizure. All studied comorbidities were more frequent in our cohort of children with newly diagnosed unprovoked seizures compared with reported rates in the general population. Mental retardation was found in 16% (n=119) in our seizure cohort vs. 3% in the general pediatric population, cerebral palsy in 9% (n=71) vs. 2.5%, autism spectrum disorders in 7% (n=50) vs. 1%, ADHD in 6% (n=48) vs. 5%. Conclusions: The high prevalence of neurodevelopmental problems in this group of children at onset of unprovoked seizures supports the concept that seizures often appear as part of a broader neurological problem and that in most cases comorbidities should not be considered consequences of the seizure disorder. The observations serve as an important reminder of the needs for a broader approach to the management of children with epilepsy than treatment of their seizures. Sources of funding: Stockholm County Council, AFA