Seizure 2022, Vol 99, Editor’s Choice: The impact of childhood epilepsy on academic performance: A population-based matched cohort study
It is now widely recognised that the disability related to epilepsy is not simply the sum total of all epileptic seizures a person has experienced. Of course, most seizures are disabling, but they are merely one – albeit important – manifestation of epilepsy (1). The disability related to seizures is often complicated by immediately pre- and postictal symptoms, by their more persistent effects on physical and mental health, and by responses to the seizures – at personal, family and societal level. While this seems complex enough, the disability experienced by people with epilepsy is also influenced by the underlying cause of their disorder and how this changes over time. In children, there is the additional dimension of the effects of epilepsy on education. The suboptimal treatment of epilepsy in childhood and adolescence will not only cause disability and disadvantage at this particular time of a person’s life. The suboptimal use of educational opportunities is likely to have permanent effects on the life chances of those affected.
My Editor’s Choice from the current volume of Seizure summarises the findings of an original research study by Reidar P. Lystad et al. which characterises how profoundly epilepsy affects formal education in childhood and adolescence (2). This population-based study compares educational performance in children hospitalised with epilepsy in New South Wales, Australia, with that of children not hospitalised with this disorder (hospitalisation statistics provide the most reliable statistical data about epilepsy in childhood and adolescence in Australia, authors estimate that 80% of young people with epilepsy in this country are hospitalised after their initial presentation with seizures. This patient group is therefore considered fairly representative of all children and adolescents with epilepsy. The up to 20% of cases who are not hospitalised typically have uncomplicated absence epilepsies).
Young people hospitalised with epilepsy were found to be three times more likely than matched controls not admitted to hospital not to have achieved the national minimum standard for numeracy (ARR: 3.40; 95%CI 2.76?4.18) and reading (ARR: 3.15; 95%CI 2.60?3.82), compared to peers matched for age, sex and socioeconomic status. Young people hospitalised with epilepsy had a 78% higher risk of not completing year 10 (ARR: 1.78; 95%CI 1.14?2.79), 18% higher risk of not completing year 11 (ARR: 1.18; 95%CI 0.97?1.45), and 38% higher risk of not completing year 12 (ARR: 1.38; 95%CI 1.14?1.67), compared to non-hospitalised controls.
While this population-based study cannot tell us about the specific reasons for the poor educational achievements of young people with epilepsy are – i.e. to what extent seizures, medication, stigma, comorbid disorders or underlying pathology causing epilepsy are to blame, its stark findings draw attention to the potentially avoidable damage done to the life chances of young people with epilepsy and call for further research exploring causation and testing interventions.
(1) Olusanya BO, Wright SM, Nair MKC, et al. Global burden of childhood epilepsy, intellectual disability, and sensory impairments. Pediatrics. 2020;146(1):e20192623
(2) Lystad RP, McMaugh A, Herkes G, Badgery-Parker T, Cameron CM, Mitchell RJ. The impact of childhood epilepsy on academic performance a population-based matched cohort study. Seizure 2022; 99:91-98.