Asuri N Prasad, MBBS, FRCPC, FRCPE Professor in Pediatrics ... · Asuri N Prasad, MBBS, FRCPC,...
Transcript of Asuri N Prasad, MBBS, FRCPC, FRCPE Professor in Pediatrics ... · Asuri N Prasad, MBBS, FRCPC,...
Asuri N Prasad, MBBS, FRCPC, FRCPE
Professor in Pediatrics and Clinical
Neurosciences, Schulich Medicine &
Dentistry, London, ON.
Acknowledgements
My Collaborators Bradley Corbett PhD, Jorge G Burneo, MD,
MSPH
Epilepsy Program, London Health Sciences Centre & Children’s
Hospital of Western Ontario, Ivey Business School at Western
University, London, Ontario, Canada, N6A5C2.
Research Data Centre at Western
Ontario Brain Institute for Funding the Research through the
Eplink Team Grant.
Objectives
Background
Methodology
Results
Conclusions
Neurological disorders in
children
Chronic-
• Epilepsy
• Cerebral palsy
• Learning disability
• Mental handicap
• Behavioral and psychiatric
Acute
• Encephalitis, Stroke Demyelinating disease,
• Genetic and metabolic disorders
Acute disorders leading to chronic
disorders
Burden of disease
Neurological disorders pose high burden
Morbidity
Mortality
Financial cost of care
Impact on family
Impact on society
Prior work
Findings from previous
study
The data suggest an over-representation of seizure disorders in children born to parents of lower socioeconomic status.
Preschool children in the lowest income quintile were twice as likely as their counterparts in the highest income quintile to have seizure disorders.
higher prevalence of seizure disorders among school-age children living in low-income neighborhoods may be the consequence of environmental factors, such as higher exposure rates to antecedent illnesses (infections) or risk factors for seizures (head trauma from injury).
National Longitudinal Study
of Children and Youth
The NLSCY began in 1994-1995 and collected data from a sample of 25000 children, from 0 to 11 years.
This group of children were surveyed subsequently every two years, for a total of 8 cycles, terminating in 2008-2009.
The objective of the NLSCY was to track factors influencing child development in Canada.
Methods
Question HLT-Q45 in the survey asked the PMK “Does the child have any of the following long-term conditions that have lasted or are expected to last six months or more and have been diagnosed by a health professional”.
“Epilepsy, Cerebral palsy, Learning disability, Mental Handicap, Emotional Nervous difficulties”
Question (HLT-Q51D) identified whether the condition was treated by means of a specific anticonvulsant or antiepileptic medication.
Methods
Descriptive statistics (cross sectional cycles 1-4)
Cross sectional weights were applied (Boot strapping)
Prevalence estimates n/1000 generated
Using data from Cycles 1 to 8 of the NLSCY, standard scores on the Peabody Picture Vocabulary Test-Revised (PPVT-R) were employed in a regression analysis to compare standardized scores on the PPVT-R in children with and without epilepsy.
Current Study
Extend our probe of the dataset to answer following
questions
Primary:
To determine how many children with epilepsy also
have co-morbidities of epilepsy.
To determine how children with epilepsy compare
with their peers on important developmental
outcomes.
Co-Morbidities of Epilepsy
Children with epilepsy alone accounted for 56.87%, while
10.07% had at least 1 co-morbid condition, 23.57% had at
least 2 co-morbid conditions while 9.53% had three or
more conditions.
Cycle 3 data
n with
condit
ion n/100
Prevalence
per 1000 Number in Canada
EPI_MR 38 0.12 1.17 7581
EPI_CP 36 0.11 1.1 6949
EPI_LD 50 0.16 1.16 10107
EPI_EMO 26 0.083 0.83 5243
Epilepsy 161 0.53 5.3 32045
Note : Total N = 31963
Gender effect
School Readiness
A total of 33,757 children were included in the analysis and 67 reported epilepsy.
Regression was centred around the mean age (61.069 months) and PPVT mean score of (100.6811).
Children with epilepsy underperformed on the school readiness test (PPVT-R) in comparison to the rest of their cohort (β=-0.05, se=0.01, p=0.000).
Male cohort also underperformed in comparison to females (β =0.033, se=0.001, p=0.000).
PPVT Scores
Test Children with Epilepsy (Mean Scores and Confidence Intervals)
Children without Epilepsy (Mean Scores and Confidence Intervals)
PPVT-R 28.85 (25.14;32.55) 36.86 (36.69; 37.04)
0
5
10
15
20
25
30
35
40
WithoutEpilepsy
WithEpilepsy
Mean PPVT-R scores
WithoutEpilepsy
WithEpilepsy
Conclusions
Epilepsy prevalence estimates from the NLSCY are comparable
to the results of other studies (US, Finland).
Nearly half of the population of children with epilepsy carry a
high likelihood of an associated neurological developmental
disability (CP, ID, LD, EMO-Nerv).
Children with epilepsy underperform on standardized tests of
school readiness (PPVT).
Therefore, this is a population with a chronic disorder at
significant risk for academic underachievement.
Early screening for co-morbid conditions in children with
epilepsy should be considered in educational system and early
intervention programs targeted.
Future
The extension of this work will seek to answer the following questions using the
NLSCY data which includes both cross sectional and longitudinal surveys;
To determine how the prevalence of epilepsy changes with age and what
proportion of people with epilepsy experience a ‘disappearance of symptoms’.
To determine the length or duration of epilepsy in this population of individuals?
Using data on behavioural scales collected in the survey, we will determine how
children with epilepsy fare on measures of behaviour (anxiety, emotional disorder,
conduct disorder, hyperactivity and inattention) in comparison to children without
epilepsy and other comorbid conditions.
Using data from the depression and family functioning scales administered to
parents or caregivers of children with epilepsy, we can begin to understand the
impact of epilepsy on the caregivers and family functioning.