NEUROPROFILES: NEUROdevelopment in PReschool children Of FIfe and Lothian Epilepsy Study
Neurobehavioural problems (i.e. cognitive impairment/behaviour problems) are common in childhood epilepsy. There are very limited data in children with early-onset epilepsy (CWEOE; onset ≤4 years). This study: (1) estimated the incidence of early-onset epilepsy, (2) described the spectrum and prevalence of neurobehavioural problems in CWEOE, and their risk factors, and (3) explored eye-gaze behaviour as a marker of neurobehavioural problems. This two year, prospective, population-based, case-controlled study identified newly diagnosed CWEOE in South East Scotland using active multi-source capture-recapture surveillance. CWEOE and controls completed detailed age-appropriate neuropsychological assessment - including Bayley III/WPPSI III, NEPSY II and social-emotional behaviour questionnaires. Children completed five eye-tracking tasks which assessed memory, attention, and social cognition. 59 CWEOE were identified (36M:23F); ascertainment-adjusted incidence 62/100,000 ≤4yrs/yr (95%CI 40-88). Asian and White-European children were at increased risk of epilepsy. 46 CWEOE (95%CI 62-84, 27M:19F) and 37 sex-age matched controls (18M:19F) underwent neuropsychological assessment. CWEOE had poorer general cognitive ability (p<.001, η²=.24), and increased parent reports of abnormal behaviour – significantly so in adaptive behaviour, ASD behaviours, hyperactivity/inattention, and atypical social behaviour. Overall 63% of CWEOE met criteria for neurobehavioural problems across multiple domains, vs 27% of controls (p<.001). Risk factors varied by domain. Prematurity and symptomatic/cryptogenic aetiology were common risk factors but other seizure-related variables were not. CWEOE with social problems exhibited abnormal eye-gaze behaviour toward social stimuli. Subtle atypicalities in sustained attention were noted in CWEOE, and an unexpected absence of antisaccade production was seen in all children. This is the first population-based study to describe the neurobehavioural profile, and explore eye-gaze behaviour, in CWEOE. Neurobehavioural problems are present, detectable, and highly prevalent in CWEOE, with implications for medical, psychosocial and educational resource provision, and provides an argument for early intervention. Eye-tracking may be a viable marker of neurobehavioural problems, and this study provides impetus for future eye-tracking investigations in CWEOE. Lastly, certain ethnic groups may be at increased risk of early-onset epilepsy in Scotland, providing opportunity for targeted intervention.