Long-term employment of adults with childhood-onset epilepsy: a prospective population-based study

Our aim was to determine the long-term employment and predictive factors in adults with childhood-onset epilepsy living in the community.

A population-based incidence cohort of 144 children prospectively followed since their first unprovoked seizure before the age of 16 years up to a mean age of 48.

At a mean age of 23 years (range 18-35 years) 85 (71%) of 119 patients living in the community were employed. Predictive of employment at a mean age of 23 were normal intelligence [odds ratio (OR) 14.5, 95% confidence interval (CI) 4.5-46.8, p < 0.01], vocational education (OR 15.2, 95% CI 2.9-79.9, p < 0.01), and age at onset of epilepsy older than 6 years (OR 4.9, 95% CI 1.3-19.2, p = 0.02). At the mean age of 48 years (range 43-59 years), 45 (59%) of 76 patients living in the community were employed, as were 63 (78%) of 81 controls (patients vs. controls, p = 0.01). In 40 (53%) of 76 surviving patients employed between age 23 and 48, four factors were found to predict employment: normal intelligence (OR 15.8; 95% CI 2.4-102.4, p < 0.01), having offspring (OR 6.1; 1.5-25.0, p = 0.01), uninterrupted 5-year terminal remission (5YTR) from age 23 to age 48 (OR 4.8; 1.1-19.9, p = 0.03), and no history of status epilepticus (OR 12.8; 1.8-90.9, p = 0.01).

Normal intelligence, onset of epilepsy at age older than 6, and good vocational education appear to predict employment in early adulthood. Normal intelligence, having offspring, uninterrupted remission, and no history of status epilepticus appear to predict lasting employment into middle age.