Early-onset epilepsy – it’s not all about seizures
By Hannah Gofton
There is a pressing need to investigate the neurodevelopmental consequences of early-onset epilepsy and the risk factors contributing to them. Understanding these neurodevelopmental issues and their associated risks is crucial for improving patients’ quality of life and implementing early interventions to mitigate these adverse effects.
Epilepsy is widely recognised for its adverse effects, in particular seizure frequency and severity. However, less attention is given to other negative consequences, such as its impact on neurodevelopmental outcomes. Individuals diagnosed with epilepsy before the age of five, referred to as having early-onset epilepsy, are particularly susceptible to severe issues, including impaired neurodevelopment.
Neurodevelopmental challenges in individuals with epilepsy often manifest as mental and behavioural disorders. Typically, these include intellectual developmental disorder, autism, Attention Deficit Hyperactivity Disorder (ADHD), depression, and anxiety. These conditions significantly impact the quality of life of epilepsy patients and should be as recognised as a burden comparable to seizures themselves. However, research on the neurodevelopmental consequences of epilepsy remains limited, with an even greater gap in literature regarding early-onset epilepsy.
Beyond the lack of research on neurodevelopmental outcomes in early-onset epilepsy, there is also a scarcity of studies examining the risk factors associated with such outcomes.
Potential risk factors:
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Epilepsy is a heritable condition, meaning families with a history of epilepsy may have a higher prevalence of both epilepsy and its related neurodevelopmental effects.
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Sociodemographic factors, such as living conditions, may influence the likelihood of developing adverse neurodevelopmental outcomes in early-onset epilepsy.
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Neurological abnormalities also play a role. Patients diagnosed with early-onset epilepsy typically undergo neuroimaging, such as Magnetic Resonance Imaging (MRI) or Electroencephalography (EEG), to aid in diagnosis. Abnormalities detected in these scans may indicate an increased risk of neurodevelopmental issues.
Our goal is to explore the neurodevelopmental outcomes of early-onset epilepsies, with a specific focus on adolescence. To address gaps in the current literature, we are conducting a systematic review to assess the prevalence of neurodevelopmental difficulties in individuals with early-onset epilepsy. This review will also examine which risk factors have and haven’t been identified, that could potentially contribute to the neurodevelopmental outcomes seen in this population. The findings from this review will be utilised to conduct a subsequent study with adolescents diagnosed with early-onset epilepsy, aiming to address the identified gaps related to neurodevelopmental outcomes and associated risk factors. This research will enhance our understanding of the range of neurodevelopmental issues linked to early-onset epilepsy and help determine whether certain factors increase the risk of these adverse outcomes. If risk factors are identified, this could lead to the development of preventive interventions, such as therapeutic strategies, to be implemented at the time of diagnosis to prevent neurodevelopmental issues.
Author bio:
Hannah Gofton is a first year PhD student at the Institute for Regenerative and Repair, within The University of Edinburgh. Her research is funded by Epilepsy Research Institute UK to investigate the neurodevelopmental outcomes in adolescents diagnosed with early-onset epilepsies.
Further reading:
We plan to follow up with a cohort of adolescents who were diagnosed with early-onset epilepsy and previously participated in a study around the time of their diagnosis. These experiments consisted of basic cognitive tasks. We aim to reassess these individuals in adolescence to evaluate their outcomes. For more details on this cohort and similar tests that will be conducted, please refer to the papers listed:
Hunter et al. (2019), Neurobehavioral problems in children with early-onset epilepsy
References:
Hunter, M. B., & Chin, R. F. M. (2021). Impaired social attention detected through eye movements in children with early‐onset epilepsy. Epilepsia, 62(8), 1921–1930. https://doi.org/10.1111/epi.16962
Hunter, M. B., Yoong, M., Sumpter, R. E., Verity, K., Shetty, J., McLellan, A., Jones, J., Quigley, A., Tallur, K. K., & Chin, R. F. (2019). Neurobehavioral problems in children with early-onset epilepsy: A population-based study. Epilepsy & Behavior, 93, 87–93. https://doi.org/10.1016/j.yebeh.2019.01.019
Jacoby, A., Snape, D., & Baker, G. A. (2009). Determinants of Quality of Life in People with Epilepsy. Neurologic Clinics, 27(4), 843–863. https://doi.org/10.1016/j.ncl.2009.06.003
Josephson, C. B., Lowerison, M., Vallerand, I., Sajobi, T. T., Patten, S., Jette, N., & Wiebe, S. (2017). Association of depression and treated depression with epilepsy and seizure outcomes. JAMA Neurology, 74(5), 533. https://doi.org/10.1001/jamaneurol.2016.5042
Liu, X., Sun, X., Sun, C., Zou, M., Chen, Y., Huang, J., Wu, L., & Chen, W. (2021). Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis. Autism, 26(1), 33–50. https://doi.org/10.1177/13623613211045029
Pham, T., Sauro, K. M., Patten, S. B., Wiebe, S., Fiest, K. M., Bulloch, A. G. M., & Jetté, N. (2017). The prevalence of anxiety and associated factors in persons with epilepsy. Epilepsia, 58(8). https://doi.org/10.1111/epi.13817
Poke, G., Stanley, J., Scheffer, I. E., & Sadleir, L. G. (2022). Epidemiology of developmental and epileptic encephalopathy and of intellectual disability and epilepsy in children. Neurology, 100(13). https://doi.org/10.1212/wnl.0000000000206758
Wagner, J. L., Mueller, M., Hellier, T. S., Smith, G., & Modi, A. (2021). ADHD and epilepsy-related QoL in youth with epilepsy. Epilepsy & Behavior, 123, 108250. https://doi.org/10.1016/j.yebeh.2021.10825