Educational and health outcomes of children and adolescents receiving antiepileptic medication: Scotland-wide record linkage study of 766 244 schoolchildren

Abstract

Background: Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers.

Methods: Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions.

Results: Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes.

Conclusions: Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.

Keywords: Educational outcomes; Epilepsy; Health; Population cohort; Prescribing; Record linkage.

Fig. 1

Number of Pupils Included and Excluded at Each Stage of Data Cleaning

Fig. 2

Association between Treatment with Antiepileptic Medication and all-cause Hospitalisation. a By Time from Commencement of Medication. b By Age at Admission. Adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex- gestation-specific birthweight centile, 5-minute Apgar score and comorbid conditions (diabetes, asthma, attention deficit hyperactivity disorder and depression)

Fig. 3

Association between Treatment with Antiepileptic Medication and Hospitalisation for Injury/Poisoning/ Trauma. a By Time from Commencement of Medication. b By Age at Admission. Adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex- gestation-specific birthweight centile, 5-minute Apgar score and comorbid conditions (diabetes, asthma, attention deficit hyperactivity disorder and depression)

Fig. 4

Association between Treatment with Antiepileptic Medication and all-cause Mortality. a By Time from Commencement of Medication. b By Age at Admission. Adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex- gestation-specific birthweight centile, 5-minute Apgar score and comorbid conditions (diabetes, asthma, attention deficit hyperactivity disorder and depression)