Asuri N Prasad, MBBS, FRCPC, FRCPE Professor in Pediatrics and Clinical Neurosciences, Schulich Medicine & Dentistry, London, ON.

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1 Asuri N Prasad, MBBS, FRCPC, FRCPE Professor in Pediatrics and Clinical Neurosciences, Schulich Medicine & Dentistry, London, ON.

2 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.

3 Objectives Background Methodology Results Conclusions

4 Neurological disorders in children Acute disorders leading to chronic disorders Epilepsy Cerebral palsy Learning disability Mental handicap Behavioral and psychiatric Acute Encephalitis, Stroke Demyelinating disease, Genetic and metabolic disorders Chronic-

5 Burden of disease Neurological disorders pose high burden Morbidity Mortality Financial cost of care Impact on family Impact on society

6 Prior work

7 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).

8 National Longitudinal Study of Children and Youth The NLSCY began in and collected data from a sample of children, from 0 to 11 years. This group of children were surveyed subsequently every two years, for a total of 8 cycles, terminating in The objective of the NLSCY was to track factors influencing child development in Canada.

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11 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.

12 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.

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14 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.

15 Co-Morbidities of Epilepsy n with Cycle 3 data condit ion n/100 Prevalence per 1000 Number in Canada EPI_MR EPI_CP EPI_LD EPI_EMO Epilepsy Note : Total N = 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.

16 Gender effect

17 School Readiness A total of 33,757 children were included in the analysis and 67 reported epilepsy. Regression was centred around the mean age ( months) and PPVT mean score of ( ). 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).

18 PPVT Scores Test Children with Epilepsy (Mean Scores and Confidence Intervals) Children without Epilepsy (Mean Scores and Confidence Intervals) PPVT-R (25.14;32.55) (36.69; 37.04) Mean PPVT-R scores Without Epilepsy With Epilepsy Without Epilepsy With Epilepsy

19 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.

20 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.