Population-based longitudinal and cross-sectional studies of social outcomes of children with epilepsy in different countries are reviewed by researchers at Dalhousie University, Halifax, Nova Scotia, Canada. The Isle of Wight UK study (Rutter et al, 1970) found psychiatric problems in 25% of children with epilepsy compared to 7-9% of normal controls. A Finnish series of children with epilepsy followed to 22 years of age had severe learning disorders in 20% compared to 2% of controls (Kokkonen et al, 1997). At longer follow-up, patients were more likely on disability pension (12% vs 2% controls), twice as likely to be unemployed, and more often unmarried, living alone or with parents (69% vs 40% controls). Cognitive or neurologic disability accounted for the poor social outcome, and seizure control and socioeconomic status were unrelated to the outcome. In Japan (Wakamoto et al, 2000), unlike Finland, normally intelligent young adults with epilepsy had favorable long-term educational and employment outcomes, but the mentally retarded did poorly. In Turku, Finland (Sillanpaa, 1990; Jalava et al, 1997), adults with childhood epilepsy had reduced levels of education, employability, social economic status, and successful marriage (p=0.0001), and 15% were dependent on other caretakers. Those on AEDs were less satisfied with their quality of life than those off medication.

In the Canadian Nova Scotia, population-based epilepsy cohort study (Camfield et al, 1993, 2007; Wirrell et al, 1997), poor social outcome was more common in patients with a learning disorder. Young adults with childhood absence epilepsy had less education, lower working status and higher rates of behavioral and psychiatric difficulty than a chronic disease control group with juvenile rheumatoid arthritis. Children with secondary generalized epilepsy were often mentally handicapped and/or highly dependent with refractory seizures. [1]

COMMENT. Learning disorder and mental handicap are the most significant risk factors for poor social outcome in adults with a history of childhood epilepsy. The effect of epilepsy on social outcome is greater than that of other childhood chronic disease.

Cognitive difficulties in children with idiopathic epilepsy are demonstrated in measures of verbal and visuospatial memory at delays of 30 minutes and 1 week [2]. Poor initial learning efficiency led to an accelerated rate of forgetting auditory-verbal information, with poor recall/recognition scores at 1 week, compared to controls. Impaired initial learning did not affect retrieval at the 30-minute delay.