Increased risk of epilepsy in children with Tourette syndrome: A population-based case-control study

The association between epilepsy and Tourette syndrome has rarely been investigated. In this retrospective cohort study, we analyzed a dataset of 1,000,000 randomly sampled individuals from the Taiwan National Health Insurance Research Database to determine the risk of epilepsy in children with Tourette syndrome. The study cohort consisted of 1062 patients with Tourette syndrome aged ≤18 years, and the control group consisted of three times the number of age- and sex-matched patients without Tourette syndrome, who were insurants, from the same database during the same period. The Tourette syndrome group had an 18.38-fold increased risk of epilepsy than the control group [hazard ratio = 18.38, 95% confidence interval (CI) = 8.26–40.92; P < 0.001]. Even after adjusting for the comorbidities, the risk of epilepsy in the Tourette syndrome group with comorbidities remained high (hazard ratio = 16.27, 95% CI = 6.26–18.46; P < 0.001), indicating that the increased risk was not associated with comorbidities. This population-based retrospective cohort study provides the first and strong evidence that Tourette syndrome is associated with a higher risk of epilepsy. A close follow-up of children with Tourette syndrome for the development of epilepsy is warranted.     

Tryptophan hydroxylase 2 (TPH2) gene polymorphisms and psychiatric comorbidities in temporal lobe epilepsy

Psychiatric comorbidities are frequent in temporal lobe epilepsy (TLE). It is plausible that variance in serotonin-related genes is involved in the susceptibility of these associations. We report here the results on the association of tryptophan hydroxylase 2 (TPH2) gene polymorphisms with psychiatric comorbidities in TLE. A cohort study was conducted on 163 patients with TLE. We assessed the influence of the rs4570625 and rs17110747 polymorphisms in the TPH2 gene on psychiatric comorbidities in TLE. In patients with TLE, the presence of the T allele in the rs4570625 polymorphism was associated with psychotic disorders (OR = 6.28; 95% CI = 1.27–17.54; p = 0.02), while the presence of the A allele in the rs17110747 polymorphism was associated with alcohol abuse (OR = 20.33; 95% CI = 1.60–258.46; p = 0.02). Moreover, we identified male gender (OR = 11.24; 95% CI = 1.68–76.92; p = 0.01) and family history of psychiatric disorder (OR = 15.87; 95% CI = 2.46–100; p = 0.004) as factors also associated with alcohol abuse in TLE. Conversely, a family history of epilepsy was inversely associated with alcohol abuse (OR = 0.03; 95% CI = 0.001–0.60; p = 0.02). Tryptophan hydroxylase 2 gene allele variants might be risk factors for psychiatric conditions in TLE. More specifically, we observed that the T allele in the rs4570625 polymorphism was associated with psychotic disorders, and the A allele in the rs17110747 TPH2 polymorphism was associated with alcohol abuse in patients with TLE. We believe that this study may open new research venues on the influence of the serotonergic system associated with psychiatric comorbidities in epilepsy.     

Psychiatric comorbidity in refractory focal epilepsy: A study of 490 patients

We studied the prevalence and associated factors of psychiatric comorbidities in 490 patients with refractory focal epilepsy. Of these, 198 (40.4%) patients had psychiatric comorbidity. An Axis I diagnosis was made in 154 patients (31.4%) and an Axis II diagnosis (personality disorder) in another 44 (8.97%) patients. After logistic regression, positive family history of psychiatric comorbidities (O.R. = 1.98; 95% CI = 1.10–3.58; p = 0.023), the presence of Axis II psychiatric comorbidities (O.R. = 3.25; 95% CI = 1.70–6.22; p < 0.0001), and the epileptogenic zone located in mesial temporal lobe structures (O.R. = 1.94; 95% CI = 1.25–3.03; p = 0.003) remained associated with Axis I psychiatric comorbidities. We concluded that a combination of clinical variables and selected structural abnormalities of the central nervous system contributes to the development of psychiatric comorbidities in patients with focal epilepsy.     

Sudden unexpected death in epilepsy: Knowledge and experience among U.S. and Canadian neurologists

ImportanceSudden unexpected death in epilepsy (SUDEP) is a common cause of mortality in patients with the disease, but it is unknown how neurologists disclose this risk when counseling patients.ObjectiveThis study aimed at examining SUDEP discussion practices of neurologists in the U.S. and Canada.DesignAn electronic, web-based survey was sent to 17,558 neurologists in the U.S. and Canada. Survey questions included frequency of SUDEP discussion, reasons for discussing/not discussing SUDEP, timing of SUDEP discussions, and perceived patient reactions. We examined factors that influence the frequency of SUDEP discussion and perceived patient response using multivariate logistic regression.ParticipantsThe participants of this study were neurologists who completed postgraduate training and devoted > 5% of their time to patient care.ResultsThere was a response rate of 9.3%; 1200 respondents met eligibility criteria and completed surveys. Only 6.8% of the respondents discussed SUDEP with nearly all (> 90% of the time) of their patients with epilepsy/caregivers, while 11.6% never discussed it. Factors that independently predicted whether SUDEP was discussed nearly all of the time were the following: number of patients with epilepsy seen annually (OR = 2.01, 95% CI = 1.20–3.37, p < 0.01) and if the respondent had a SUDEP case in the past 24 months (OR = 2.27, 95% CI = 1.37–3.66, p < 0.01). A majority of respondents (59.5%) reported that negative reactions were the most common response to a discussion of SUDEP. Having additional epilepsy/neurophysiology training was associated with an increased risk of a perceived negative response (OR = 1.36, 95% CI = 1.02–1.82, p = 0.038), while years in practice (OR = 0.85, 95% CI = 0.77–0.95, p < 0.005) and seeing both adults and children were associated with a decreased likelihood of negative response (OR = 0.15, 95% CI = 0.032–0.74, p = 0.02).ConclusionsU.S. and Canadian neurologists rarely discuss SUDEP with all patients with epilepsy/caregivers though discussions are more likely among neurologists who frequently see patients with epilepsy or had a recent SUDEP in their practice. Perceived negative reactions to SUDEP discussions are common but not universal; more experienced neurologists may be less likely to encounter negative reactions, suggesting that there may be ways to frame the discussion that minimizes patient/caregiver distress.     

Behavioral risk factors among Arizonans with epilepsy: Behavioral Risk Factor Surveillance System 2005/2006

Modifiable risk factors to help improve health outcomes for people with epilepsy in Arizona were identified using the 2005–2006 Arizona Behavioral Risk Factor Surveillance System (BRFSS). Of 9524 adults who participated in this survey, 125 reported ever being diagnosed with epilepsy (lifetime prevalence = 1.3%, 95% CI = 1.1–1.6%). Individuals with active epilepsy (those who had seizures in the prior 3 months and/or were taking anticonvulsants) had an overall lower quality of life. This likely resulted from a large number of medical comorbidities and poor mental and physical health days. Regression models suggested that for individuals with active epilepsy, physical activity was associated with fewer activity-limited days, whereas for individuals with inactive epilepsy, medical comorbidity was positively associated with activity-limited days. Further research is needed to increase the reliability of the findings.     

Health behaviors among people with epilepsy—Results from the 2010 National Health Interview Survey

ObjectivesThis study aimed to estimate and compare the prevalence of selected health behavior—alcohol use, cigarette smoking, physical activity, and sufficient sleep—between people with and without a history of epilepsy in a large, nationally representative sample in the United States.MethodsWe used data from the 2010 cross-sectional National Health Interview Survey (NHIS) to compare the prevalence of each health behavior for people with and without epilepsy while adjusting for sex, age, race/ethnicity, and family income. We also further categorized those with epilepsy into active epilepsy and inactive epilepsy and calculated their corresponding prevalences.ResultsThe percentages of adults with a history of epilepsy (50.1%, 95% CI = 45.1%–55.2%) and with active epilepsy (44.4%, 95% CI = 37.6%–51.5%) who were current alcohol drinkers were significantly lower than that of those without epilepsy (65.1%, 95% CI = 64.2%–66.0%). About 21.8% (95% CI = 18.1%–25.9%) of adults with epilepsy and 19.3% (95% CI = 18.7%–19.9%) of adults without epilepsy were current smokers. Adults with active epilepsy were significantly less likely than adults without epilepsy to report following recommended physical activity guidelines for Americans (35.2%, 95% CI = 28.8%–42.1% vs. 46.3%, 95% CI = 45.4%–47.2%) and to report walking for at least ten minutes during the seven days prior to being surveyed (39.6%, 95% CI = 32.3%–47.4% vs. 50.8%, 95% CI = 49.9%–51.7%). The percentage of individuals with active epilepsy (49.8%, 95% CI = 42.0%–57.7%) who reported sleeping an average of 7 or 8 h a day was significantly lower than that of those without epilepsy (61.9%, 95% CI = 61.2%–62.7%).ConclusionsBecause adults with epilepsy are significantly less likely than adults without epilepsy to engage in recommended levels of physical activity and to get the encouraged amount of sleep for optimal health and well-being, promoting more safe physical activity and improved sleep quality is necessary among adults with epilepsy. Ending tobacco use and maintaining low levels of alcohol consumption would also better the health of adults with epilepsy.     

Suicidal thoughts in epilepsy: A community-based study in Brazil

Epilepsy has been associated with increased risk of suicide; however, few studies have examined the relationship between epilepsy and suicidal behavior. The aims of this study were to evaluate the frequency of suicidal behavior in people with epilepsy and to identify characteristics that are associated with suicidal ideation in epilepsy. Of 171 people with epilepsy identified in a previous survey, 139 were included. A structured interview was conducted, and a second psychiatric evaluation was scheduled for those who agreed. The frequencies of suicidal thoughts, plans, and attempts during lifetime were 36.7, 18.2, and 12.1%, respectively. The following conditions were strongly associated with suicidal thoughts: anxiety (OR = 3.3, 95% CI = 1.4–7.5, P = 0.001), depression (OR = 4.8, 95% CI = 1.9–12.5, P = 0.001), and two or more standardized psychiatric diagnoses (OR = 21.6, 95% CI = 4.4–105.9, P < 0.0001). Although specific characteristics of epilepsy were found to be related to suicidal thoughts, psychiatric diseases also play an essential role.     

Association of alpha subunit of GABAA receptor subtype gene polymorphisms with epilepsy susceptibility and drug resistance in north Indian population

GABA (γ-amino butyric acid) receptors have always been an inviting target in the etiology and treatment of epilepsy because of its role as a major inhibitory neurotransmitter in the brain. The aim of our study was to find out the possible role of single nucleotide polymorphisms (SNPs) present in GABRA1 IVS11 + 15 A > G (rs2279020) and GABRG2 588C > T (rs211037) genes in seizure susceptibility and pharmaco-resistance in northern Indian patients with epilepsy. A total of 395 epilepsy patients and 199 control subjects were enrolled for present study. The genotyping was done by PCR-RFLP methods. The GABRA1 IVS11 + 15 A > G polymorphism conferred high risk for epilepsy susceptibility at genotype ‘AG’ (P = 0.004, OR = 1.77, 95% CI = 1.20–2.63), ‘GG’ (P = 0.01, OR = 1.80, 95% CI = 1.15–2.80) and G allele level (P = 0.001, OR = 1.50, 95% CI = 1.16–1.92). Moreover this polymorphism was also associated with multiple drug resistance in patients with epilepsy for homozygous variant ‘GG’ genotype (P = 0.031, OR = 1.84, 95% CI = 1.05–3.23) and G allele (P = 0.020, OR = 1.43, 95% CI = 1.05–1.95). However GABRG2 588C > T polymorphism was not found to be associated either with epilepsy susceptibility or with drug resistance. Overall results indicate differential role of different subunits of GABA_A receptor subtypes in epilepsy susceptibility and pharmacotherapy.     

Epilepsy may be the major risk factor of mental retardation in children with tuberous sclerosis: A retrospective cohort study

Mental retardation (MR) is one of the most common cognitive comorbidities in children with tuberous sclerosis, and there are enormous studies about its risk factors. The genetic difference and the severity of epilepsy are the two main factors, but their weight in the occurrence of MR is still unclear. Two hundred twenty-three patients with tuberous sclerosis who received intelligence assessment, genetic mutation analysis, and the epilepsy severity assessment were included in our study. Genotype–neurocognitive phenotype correlations and epilepsy–neurocognitive phenotype correlations were analyzed by binary logistic regression analysis. No statistical significant result was found on genotype–neurocognitive phenotype correlations, which contrasted the previous report. The prevalence of MR was 50.0% for the patients with tuberous sclerosis complex-1 (TSC1) mutation, 54.5% for TSC2 (p = 0.561), 54.7% for patients with protein-truncating (PT) and 50.0% for patients with nontruncating (NT) (p = 0.791), and 54.3% for patients with family history and 53.7% for patients without family history (p = 0.748). Statistical significant results were found on epilepsy–neurocognitive phenotype correlations, both on E-chess score (p = 0.01) and the occurrence of infantile spasms (p = 0.014), which was consistent to the previous study. For children with tuberous sclerosis, instead of genetic factors, epilepsy may play the main role for the presence of mental retardation. Patients with mental retardation tend to have earlier seizure attack, take more AEDs, have more seizure types, and have higher seizure frequency. Among the four cognitive functions in Denver II, social ability and language ability are more vulnerable to be influenced than fine and gross motor ability.     

Association between methylenetetrahydrofolate reductase C677T polymorphism and epilepsy susceptibility: A meta-analysis

PurposeMethylenetetrahydrofolate reductase (MTHFR) C677T polymorphism has been implicated as a potential risk factor for epilepsy. To date, many case–control studies have investigated the association between MTHFR C677T polymorphism and epilepsy susceptibility. However, those findings were inconsistent. The objective of this study is to evaluate the precise association between MTHFR C677T polymorphism and epilepsy.MethodsAn electronic search of PubMed, EMBASE for papers on the MTHFR C677T polymorphism and epilepsy susceptibility was performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association.ResultsTen case–control studies containing 1713 cases and 1867 controls regarding MTHFR C677T polymorphism were selected. A significant association between the MTHFR C677T polymorphism and epilepsy susceptibility was revealed in this meta-analysis (for T vs. C: OR = 1.19, 95% CI = 1.08–1.32; for TT + CT vs. CC: OR = 1.20, 95% CI = 1.05–1.38; for TT vs. CC: OR = 1.48, 95% CI = 1.20–1.83; for TT vs. CT + CC: OR = 1.35, 95% CI = 1.12–1.64). In subgroup analysis by ethnicity, the results also indicated the association between the MTHFR C677T polymorphism and epilepsy susceptibility within the Asian populations (for T vs. C: OR = 1.55, 95% CI = 1.15-2.07; for TT + CT vs. CC: OR = 1.67, 95% CI = 1.08-2.59; for TT vs. CC: OR = 2.33, 95% CI = 1.30-4.20; for TT vs. CT + CC: OR = 1.89, 95% CI = 1.12-3.18).ConclusionThe results indicated that MTHFR C677T polymorphism was associated with an increased risk of epilepsy. However, further studies in various regions are needed to confirm the findings from this meta-analysis.     

Socioeconomic deprivation is an independent risk factor for behavioral problems in children with epilepsy

AimThe aim of this study was to examine whether socioeconomic deprivation in children with epilepsy (CWE) increases risk for behavioral problems independent of seizure factors.MethodsA cross-sectional study was done in which parents of children attending a specialist epilepsy clinic were invited to complete a child behavior checklist (CBCL) questionnaire about their child. Medical and sociodemographic data on CWE were obtained through their pediatric neurologists. Home postal code was used to obtain quintiles of Scottish Index of Multiple Deprivation 2012 (SIMD2012) scores for individuals. Lower (1–3) quintiles correspond to higher socioeconomic deprivation. Regression analysis was used to investigate whether a lower quintile was an independent risk factor for scores > 63 (significant behavioral problem).ResultsParents of 87 children (42 male, mean age of 10.5 years) were enrolled. Fifty-nine percent had total scores > 63. A higher proportion of children from quintiles 1–3 compared to those from quintiles 4–5 had externalizing (49% vs. 25%, p = 0.02) and total (54% vs. 30%, p = 0.02) scores > 63. Adjusted OR of quintiles 1–3 vs. 4–5 for scores > 63 = 14.8, 95% CI = 3.0, 68.0. Fewer children with scores > 63 and from quintiles 1–3 were known to the child and adolescent mental health service (CAMHS) compared to those in quintiles 4–5 (p = 0.01).InterpretationSocioeconomic deprivation was an independent risk factor for behavioral problems in CWE. Children with epilepsy and behavioral problems who lived in socioeconomically deprived areas received less help.     

Risk factors for child mental health problems in Lithuania: The role of parental nationality

BackgroundWe compare the mental health status of children who reside in Lithuania with parents who are either Lithuanian nationals or non-Lithuanian nationals.MethodData were drawn from the School Child Mental Health Europe survey (SCMHE), a cross-sectional survey of school children aged 6–11 years. A total of 1152 Lithuanian children participated, among them 11.7% from a non-Lithuanian family. Child mental health was assessed using the Dominique Interactive (DI) and the parent- and teacher Strength and Difficulties Questionnaire (SDQ). Parental attitudes were evaluated, and socio-demographics were collected.ResultsOverall 26.7% of non-Lithuanian versus 17.2% of Lithuanian children reported having an internalizing disorder (p = 0.01) mainly due to separation anxiety (16.4% versus 10.2%, p = 0.04). Odds ratio (OR) for child-reported internalizing disorders was 1.86 (95% CI = 1.17–2.96) once adjusted for other factors including being a girl, to be younger, parental unemployment and low caring and low autonomy parental attitudes which were associated with greater odds of internalizing disorders. In addition, 31.9% of non-Lithuanian reported suicidal thoughts versus 22.0% of Lithuanian children p = .02); OR = 1.60 (95% CI = 1.04–2.46) once adjusted for single parent, parental unemployment, parental alcohol problems and overreactivity attitude.ConclusionsBeing a non-national minority in Lithuania is a risk factor for child mental health. These findings suggest that further studies are needed to inform local policy-makers on targeted prevention and intervention programs in these children.     

Women's posttraumatic stress symptoms and autism spectrum disorder in their children

Maternal posttraumatic stress disorder (PTSD) may be associated with autism spectrum disorder (ASD) in offspring through multiple pathways: maternal stress may affect the fetus; ASD in children may increase risk of PTSD in mothers; and the two disorders may share genetic risk. Understanding whether maternal PTSD is associated with child's ASD is important for clinicians treating children with ASD, as PTSD in parents is associated with poorer family functioning. We examined the association of maternal PTSD with offspring ASD in a large US cohort (N ASD cases = 413, N controls = 42,868). Mother's PTSD symptoms were strongly associated with child's ASD (RR 4–5 PTSD symptoms = 1.98, 95% CI = 1.39, 2.81; RR 6–7 symptoms = 2.89, 95% CI = 2.00, 4.18). Clinicians treating persons with ASD should be aware of elevated risk of PTSD in the mother. Genetic studies should investigate PTSD risk alleles in relation to ASD.     

Active epilepsy prevalence,the treatment gap,and treatment gap risk profile in eastern China: A population-based study

We measured the prevalence of active epilepsy and investigated the treatment gap and treatment gap risk profile in eastern China.This was a cross-sectional population-based survey conducted in Zhejiang, China, from October 2013 to March 2014. A total 54,976 people were selected using multi-stage cluster sampling. A two-stage questionnaire-based process was used to identify patients with active epilepsy and to record their demographic, socioeconomic, and epilepsy-related features. Logistic regression analysis was used to analyze risk factors of the treatment gap in eastern China, as adjusted for age and sex.We interviewed 50,035 people; 118 had active epilepsy (2.4‰), among which the treatment gap was 58.5%. In multivariate analysis, failure to receive appropriate antiepileptic treatment was associated with higher seizure frequency of 12–23 times per year (adjusted odds ratio = 6.874; 95% confidence interval [CI] = 2.372–19.918), > 24 times per year (adjusted odds ratio = 19.623; 95% CI = 4.999–77.024), and a lack of health insurance (adjusted odds ratio = 7.284; 95% CI = 1.321–40.154).Eastern China has relatively lower prevalence of active epilepsy and smaller treatment gap. Interventions aimed at reducing seizure frequency, improving the health insurance system should be investigated as potential targets to further bridge the treatment gap.     

High risk for obesity in children with a subtype of developmental coordination disorder

The purpose of this study was to compare the prevalence of overweight and obesity in typically developing (TD) children, children with developmental coordination disorder (DCD) and balance problems (DCD-BP), and children with DCD without balance problems (DCD-NBP). Two thousand and fifty-seven children (1095 boys, 962 girls) ages 9–12 years were recruited from 18 elementary schools in Taiwan. The Movement Assessment Battery for Children was used to assess motor coordination ability. International cut-off points for body mass index were used to classify participants into the following groups: normal-weight, overweight or obese. Compared with TD children, children in the DCD-BP group were more than twice as likely to be obese (OR = 2.28; 95% CI = 1.41–3.68). DCD-BP children were also more likely to be obese compared to DCD-NBP children (OR = 1.79; 95% CI = 1.02–3.16). Boys in the DCD-BP group were more likely to be obese when compared to DCD-BP girls (OR = 3.12; 95% CI = 1.28–7.57). Similarly, DCD-NBP boys were more likely to be obese when compared to DCD-NBP girls (OR = 2.67; 95% CI = 1.21–5.89). Children with both DCD and BP were significantly more likely to be obese when compared to TD and DCD-NBP children. From an intervention perspective, the inclusion of regular physical activity, including activities that encourage development of both balance and energy expenditure, may be required to prevent obesity in this population.     

Self-esteem in adolescents with epilepsy: Psychosocial and seizure-related correlates

PurposeThis study evaluated self-esteem in adolescents with epilepsy and its association with psychosocial and disease-related variables.MethodsThis was a cross-sectional study with patients enrolled between January and June 2010. Culture-Free Self-Esteem Inventory for Children (CFSEI-2) was administered to 140 children with epilepsy and 50 children with asthma, aged 10–18 years attending mainstream schools.ResultsAdolescents with epilepsy had a significantly lower overall self-esteem score when compared with those with asthma, 17 ± 5.21 versus 19.4 ± 3.83, respectively (P = 0.005). Thirty-one (22.1%) children with epilepsy compared with 4 (8.3%) with asthma had overall self-esteem score below the cutoff (P = 0.034). There was a significant correlation between overall self-esteem score and duration of epilepsy, Hospital Anxiety and Depression Scale (HADS) anxiety score, HADS depression score, and Strengths and Weaknesses of ADHD symptoms and Normal-Behaviors (SWAN) rating combined score. The impact of various correlates on individual domains was not identical. Independent factors associated with low overall self-esteem were HADS depression score (OR: 1.62; 95% CI: 1.2, 2.2; P = 0.002), duration of epilepsy (OR: 1.4; 95% CI: 1.04, 1.88; P = 0.024), and father employment status economically inactive (OR: 11.9; 95% CI: 1.07, 125; P = 0.044). Seizure-free ≥ 12 months was a favorable factor that was less likely to be associated with low self-esteem (OR: 0.14; 95% CI: 0.02, 0.81; P = 0.028).ConclusionSelf-esteem was compromised in adolescents with epilepsy. A significant correlation between self-esteem and psychological comorbidities was demonstrated. Enhancing social support and education programs may improve the self-esteem and, ultimately, the lives of adolescents living with epilepsy.     

Cigarette smoking and associated risk of multiple sclerosis in the Iranian population

Exposure to cigarette smoke is emerging as an environmental risk factor for multiple sclerosis (MS). We investigated the possible association between environmental tobacco smoke, its cumulative exposure, and MS risk. We used data from the Iranian Multiple Sclerosis Registry to identify a case-control of 662 patients who had MS and a comparison group of 394 patients. Information regarding current smoking status, including the number of cigarettes smoked per day, duration, and smoking pack-years indicative of cumulative dose of tobacco smoked was obtained. We analyzed the incidence of MS among ever–smokers who had been smokers during their disease course and prior to disease onset in comparison with never–smokers who had never been exposed by calculating the odds ratio (OR) with a 95% confidence interval (CI) employing logistic regression. Of the 662 MS patients, there were 523 women (79.0%) and 139 men (21.0%), with a mean age of 31 ± 10.0 years at disease onset. The risk for MS was increased among ever–smokers (OR = 1.78, 95% CI = 1.22–2.59, p = 0.03) compared to never–smokers. As compared with never smokers, the OR for patients with 6–10 pack years was 2.91 for men (95% CI = 1.11–9.47, p = 0.03) and 1.69 for women (95% CI = 1.02–6.45, p = 0.04). Our results demonstrate that cigarette smoking is significantly associated with an increased risk for MS. The risk effects of smoking were more noticeable in male patients and at higher tobacco doses.     

Maternal pre-eclampsia is associated with childhood epilepsy in South Carolina children insured by Medicaid

ObjectiveWe examined the association between maternal pre-eclampsia/eclampsia (PE) and childhood epilepsy.MethodsWe conducted a retrospective cohort study using linked maternal–child billing data for Medicaid births in South Carolina from 1996 through 2002, with follow-up billing data for children through December 2008. Women with PE (exposed) and children with epilepsy (outcome) were identified using ICD-9 codes. Non-singleton births, children with documented conditions known to cause abnormal brain development, and children who neither remained in Medicaid until age 6 nor were diagnosed with epilepsy were excluded.ResultsOf 95,450 mother–child pairs in the final cohort, 5460 mothers were diagnosed with PE (5.7%) and 1106 children had the outcome of epilepsy (1.2%). After controlling for potential confounders, PE was significantly associated with risk of epilepsy (OR = 1.46, 95% CI = 1.17–1.82). The increased risk of epilepsy was observed only among full-term infants, and for this subgroup, late PE (first diagnosed after 37 weeks of gestation) was significantly associated with epilepsy (OR = 1.61, 95% CI = 1.21–2.16). The association between PE and epilepsy was particularly strong for children with focal epilepsy.ConclusionPre-eclampsia is associated with childhood epilepsy. Additional research is needed to identify potential mechanisms for the association.     

Why do young adolescents bully? Experience in Malaysian schools

IntroductionTo determine sociodemographic and psychological factors associated with bullying behavior among young adolescents in Malaysia.MethodsThis is a cross-sectional study of four hundred ten 12-year-old adolescents from seven randomly sampled schools in the Federal Territory of Kuala Lumpur, Malaysia. Sociodemographic features of the adolescents and their parents, bullying behavior (Malaysian Bullying Questionnaire), ADHD symptoms (Conners Rating Scales), and internalizing and externalizing behavior (Child Behaviour Checklist) were obtained from adolescents, parents and teachers, respectively.ResultsOnly male gender (OR = 7.071, p = 0.01*, CI = 1.642–30.446) was a significant sociodemographic factor among bullies. Predominantly hyperactive (OR = 2.285, p = 0.00*, CI = 1.507–3.467) and inattentive ADHD symptoms reported by teachers (OR = 1.829, p = 0.03*, CI = 1.060–3.154) and parents (OR = 1.709, p = 0.03*, CI = 1.046–2.793) were significant risk factors for bullying behavior while combined symptoms reported by young adolescents (OR = 0.729, p = 0.01*, CI = 0.580–0.915) and teachers (OR = 0.643, p = 0.02*, CI = 0.440–0.938) were protective against bullying behavior despite the influence of conduct behavior (OR = 3.160, p = 0.00*, CI = 1.600–6.241). Internalizing behavior, that is, withdrawn (OR = 0.653, p = 0.04*, CI = 0.436–0.977) and somatic complaints (OR = 0.619, p = 0.01*, CI = 0.430–0.889) significantly protect against bullying behavior.DiscussionsRecognizing factors associated with bullying behavior, in particular factors distinctive to the local population, facilitates in strategizing effective interventions for school bullying among young adolescents in Malaysian schools.     

Development and validation of an epidemiologic case definition of epilepsy for use with routinely collected Australian health data

ObjectivesWe report the diagnostic validity of a selection algorithm for identifying epilepsy cases.Study design and settingRetrospective validation study of International Classification of Diseases 10th Revision Australian Modification (ICD-10AM)-coded hospital records and pharmaceutical data sampled from 300 consecutive potential epilepsy-coded cases and 300 randomly chosen cases without epilepsy from 3/7/2012 to 10/7/2013. Two epilepsy specialists independently validated the diagnosis of epilepsy. A multivariable logistic regression model was fitted to identify the optimum coding algorithm for epilepsy and was internally validated.ResultsOne hundred fifty-eight out of three hundred (52.6%) epilepsy-coded records and 0/300 (0%) nonepilepsy records were confirmed to have epilepsy. The kappa for interrater agreement was 0.89 (95% CI = 0.81–0.97). The model utilizing epilepsy (G40), status epilepticus (G41) and ≥ 1 antiepileptic drug (AED) conferred the highest positive predictive value of 81.4% (95% CI = 73.1–87.9) and a specificity of 99.9% (95% CI = 99.9–100.0). The area under the receiver operating curve was 0.90 (95% CI = 0.88–0.93).ConclusionWhen combined with pharmaceutical data, the precision of case identification for epilepsy data linkage design was considerably improved and could provide considerable potential for efficient and reasonably accurate case ascertainment in epidemiological studies.