Dataset Information

Early childhood epilepsies: epidemiology, classification, aetiology, and socio-economic determinants

ABSTRACT: Abstract Epilepsies of early childhood are frequently resistant to therapy and often associated with cognitive and behavioural comorbidity. Aetiology focused precision medicine, notably gene-based therapies, may prevent seizures and comorbidities. Epidemiological data utilizing modern diagnostic techniques including whole genome sequencing and neuroimaging can inform diagnostic strategies and therapeutic trials. We present a 3-year, multicentre prospective cohort study, involving all children under 3 years of age in Scotland presenting with epilepsies. We used two independent sources for case identification: clinical reporting and EEG record review. Capture-recapture methodology was then used to improve the accuracy of incidence estimates. Socio-demographic and clinical details were obtained at presentation, and 24 months later. Children were extensively investigated for aetiology. Whole genome sequencing was offered for all patients with drug-resistant epilepsy for whom no aetiology could yet be identified. Multivariate logistic regression modelling was used to determine associations between clinical features, aetiology, and outcome. Three hundred and ninety children were recruited over 3 years. The adjusted incidence of epilepsies presenting in the first 3 years of life was 239 per 100 000 live births [95% confidence interval (CI) 216–263]. There was a socio-economic gradient to incidence, with a significantly higher incidence in the most deprived quintile (301 per 100 000 live births, 95% CI 251–357) compared with the least deprived quintile (182 per 100 000 live births, 95% CI 139–233), χ2 odds ratio = 1.7 (95% CI 1.3–2.2). The relationship between deprivation and incidence was only observed in the group without identified aetiology, suggesting that populations living in higher deprivation areas have greater multifactorial risk for epilepsy. Aetiology was determined in 54% of children, and epilepsy syndrome was classified in 54%. Thirty-one per cent had an identified genetic cause for their epilepsy. We present novel data on the aetiological spectrum of the most commonly presenting epilepsies of early childhood. Twenty-four months after presentation, 36% of children had drug-resistant epilepsy (DRE), and 49% had global developmental delay (GDD). Identification of an aetiology was the strongest determinant of both DRE and GDD. Aetiology was determined in 82% of those with DRE, and 75% of those with GDD. In young children with epilepsy, genetic testing should be prioritized as it has the highest yield of any investigation and is most likely to inform precision therapy and prognosis. Epilepsies in early childhood are 30% more common than previously reported. Epilepsies of undetermined aetiology present more frequently in deprived communities. This likely reflects increased multifactorial risk within these populations. In a prospective study involving all children presenting with epilepsy aged under 3 years in Scotland, Symonds et al. show that epilepsies of undetermined aetiology present more frequently in socially disadvantaged groups. Aetiology is the strongest predictor of outcome, and genetic testing should be prioritized.

SUBMITTER: Symonds J

PROVIDER: S-EPMC8557326 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundEarly childhood is a period when dietary behaviours are established. This study aimed to examine the longitudinal intake of core and discretionary foods and identify early life and socio-economic factors influencing those intakes.MethodsMother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids study, an ongoing birth cohort study, were interviewed. The information on 'weekly frequency of core and discretionary foods intake' using a food frequency questionnaire was collected at 4 months, 8 months, 1 year, 2 years and 3 years age points. Group-based trajectory modelling analyses were performed to identify diet trajectories for 'core' and 'discretionary' foods respectively. A multinomial logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories.ResultsThe intake of core and discretionary foods each showed distinct quadratic (n = 3) trajectories with age. Overall, core foods intake increased rapidly in the first year of life, followed by a decline after age two, whereas discretionary foods intake increased steadily across the five age points. Multiparity (Relative Risk (RR): 0.46, 95%CI: 0.27-0.77), non-English speaking ethnicity of mother (RR: 0.66, 95%CI: 0.47-0.91) and having a single mother (RR: 0.40, 95%CI: 0.18-0.85) were associated with low trajectories of core foods intake whereas older maternal age (RR: 1.05, 95%CI: 1.01-1.08) and longer breastfeeding duration (RR: 1.02, 95%CI: 1.00-1.03) were associated with higher trajectories of core foods intake. Also, multiparity (RR 2.63, 95%CI: 1.47-4.70), low maternal education (RR 3.01, 95%CI: 1.61-5.65), and socio-economic disadvantage (RR 2.69, 95%CI: 1.31-5.55) were associated with high trajectories of discretionary foods intake. Conversely, longer duration of breastfeeding (RR 0.99, 95%CI: 0.97-0.99), and timely introduction of complementary foods (RR 0.30, 95%CI: 0.15-0.61) had a protective effect against high discretionary foods consumption in infancy and early childhood.ConclusionChildren's frequency of discretionary foods intake increases markedly as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socio-demographic factors and infant feeding choices. Hence, there is a need for targeted strategies to improve nutrition in early childhood and ultimately prevent the incidence of chronic diseases in children.

Project description:IntroductionEmpowerment is considered pivotal for how women access and use health care services and experience their sexual and reproductive rights. In Mozambique, women's empowerment requires a better understanding and contextualization, including looking at factors that could drive empowerment in that context. This study aims to identify socioeconomic, demographic, and behavioural determinants of different domains of women's empowerment in Mozambique.MethodsUsing the Demographic and Health Survey (DHS) conducted in 2015 for Mozambique, a sample of 2072 women aged between 15 and 49 years old were included in this study. The DHS's indicators of women's empowerment were used in a principal component analysis and the obtained components were identified as the domains of empowerment. Logistic regressions were run to estimate the association of socioeconomic, demographic, and behavioural characteristics with each domain of empowerment. Crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95% CI) were calculated.ResultsThree domains of women's empowerment were identified, namely (1) Beliefs about violence against women, (2) Decision-making, and (3) Control over sexuality and safe sex. Region, rurality, the experience of intimate partner violence (IPV) and partner's controlling behaviours were associated with Beliefs about violence against women, while Decision-making and Control over sexuality and safe sex were also associated with education, age and wealth. Employment, polygamous marriage and religion was positively associated with Decision-making, and access to media increased the odds of Control over sexuality and safe sex.ConclusionWomen's empowerment seems to be determined by different socio-economic, demographic, and behavioural factors and this seems to be closely related to different domains of empowerment identified. This finding affirms the multi-dimensionality of empowerment as well as the importance of considering the context- and community-specific characteristics.

Dataset Information

Early childhood epilepsies: epidemiology, classification, aetiology, and socio-economic determinants

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets