Can Long-Term Employment Outcome of Adults with Childhood-Onset Epilepsy be Predicted? Insights and Issues

Abstract

Once children with epilepsy become adults, they often have substantial, and sometimes devastating, social problems including unemployment (Kokkonen et al. 1997; Camfield and Camfield 2007). However, it is uncertain, which features, if any, apart from overt learning disability and mental handicap, allows to predict long-term employment in patients with new-onset childhood epilepsy (Sillanpaa 1990; Jalava et al. 1997; Wakamoto et al. 2000). Even without intellectual handicap, long-term employment outcome appears unsatisfactory in as many as 50% of children with epilepsy (Jalava et al. 1997; Camfield and Camfield 2003). One populationbased study from Nova Scotia concluded that for the most children with partial epilepsy and normal intelligence, social outcome can hardly be predicted on the basis of biological factors like medical features and clinical course of epilepsy (Camfield et al. 1993). Furthermore, a number of authors suggested that features of seizures and their control appeared to have little relationship with later social success (Camfield and Camfield 1993; Wirrell et al. 1997; Shinnar and Pellock 2002). In contrast, a population-based study from Japan found that factors that determine the social prognosis including employment were almost identical to those for remission of seizures (Okuma and Kumashiro 1981). In a population-based questionnaire survey in Finnish patients with childhood-onset epilepsy, seizure-free patients were significantly more often unemployed than those seizurefree for over 1 year (Koponen et al. 2007). In conclusion, it is unclear which factors, if any, enable the prediction of longterm employment outcome in childhood-onset epilepsy apart and above the well-known risk attributable to mental handicap (Sillanpaa 1990; Jalava et al. 1997). It is clinically important to be able to predict the likely social course of childhood-onset epilepsy during adulthood, particularly in terms of employment. In addition to counseling parents, this could allow for preventive measures and comprehensive psychosocial support during childhood to obtain the optimal social outcome possible (Camfield and Camfield 2007). A number of recent results and open questions are discussed briefly (and not