Social adjustment and competence 35 years after onset of childhood epilepsy: A prospective controlled study

Purpose: To study the effect of childhood-onset epilepsy without other neurologic deficit on adult social adjustment and competence. Methods: Social competence was studied in a prospective, population-based cohort of childhood-onset epilepsy after a mean follow-up of 35 years. One hundred patients (60% of the total cohort) had no other neurologic problems (''epilepsy only''), and for each patient, two matched controls, a ''random'' control and an ''employee'' control were chosen. Results: Good social outcome was significantly reduced in the ''epilepsy only'' cohort compared with random controls: education [cumulative odds ratio (COR), 2.4; 95% confidence interval (CI), 1.4-4.1]; employability (COR, 7.3; 95% CI, 2.7-20.0); and marriage rate (COR, 3.7; 95% CI, 1.9-7.3). The patients with epilepsy rated their own ability to control their lives as ''poor or missing'' four times more frequently than the employee controls. Patients receiving antiepileptic polytherapy, but not monotherapy, were significantly less satisfied with their present life (OR, 6.7; 95% CI, 1.9-24.1) and felt their general health was significantly poorer (OR, 5.1; 95% CI, 1.2-21.3) than did the employee controls. Furthermore, patients with continuing seizures were significantly less satisfied with their present life (OR, 4.1; 95% CI, 1.1-15.1) than were employee controls. Conclusions: Many patients with ''epilepsy only'' beginning in childhood have persistent and significant social-adjustment and competence problems in adulthood.