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Long-term changes in the incidence of childhood epilepsy. A population study from Finland
Maiju M Saarinen1, Matti Sillanpää2, Dieter Schmidt3
1Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Department of Child Neurology, University of Turku and Turku University Hospital, Turku, Finland; Doctoral Programme of Clinical Investigation, University of Turku, Turku, Finland.
Insights
Childhood epilepsy treatment incidence rose significantly until the 1990s, then slightly declined. This trend in antiepileptic drug use reflects changes in diagnosis and child health over decades.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- The historical trends in childhood epilepsy incidence over recent decades remain unclear.
- Understanding these changes is crucial for public health and clinical practice.
Purpose of the Study:
- To evaluate changes in the incidence of drug-treated childhood epilepsy between 1968 and 2012.
- To analyze trends in the use of antiepileptic drugs (AEDs) for childhood epilepsy.
Main Methods:
- Utilized the Finnish nationwide register of children (aged ≤15 years) prescribed AEDs.
- Defined newly diagnosed epilepsy by the first registered entitlement to fully refundable AEDs.
- Calculated incidence densities per 100,000 person-years annually from 1968 to 2012.
Main Results:
- The incidence density of newly treated childhood epilepsy increased from 35 (1960s) to 87 (1990s) per 100,000 person-years.
- A subsequent decrease was observed, with incidence density falling to 61 per 100,000 person-years.
- Since 1996, incidence density declined 1-2% annually in children under 10, with no significant change in older children.
Conclusions:
- Drug-treated childhood epilepsy incidence distinctly increased from the late 1960s to the early 1990s.
- Potential reasons for the increase include improved diagnosis and wider acceptance of AED treatment.
- A slight decline since the 1990s may reflect recent improvements in child health and safety.
Background:
The incidence of childhood epilepsy has changed during the past decades, but it is unclear whether it increased or decreased.
Methods:
Changes in drug-treated childhood epilepsy between 1968 and 2012 were evaluated using the Finnish nationwide register of all children, aged ≤15years, on antiepileptic drugs (AEDs) prescribed for the treatment of epilepsy. The first registered entitlement to full-refundable AEDs was used as a proxy for newly diagnosed epilepsy. Incidence densities were calculated as ratios of annual new cases per 100,000person-years in each calendar year during 1968 to 2012.
Results:
The annual incidence density of newly treated childhood epilepsy increased from 35 in the 1960s to 87 per 100,000person-years in the 1990s and decreased thereafter to 61 per 100,000person-years. Since 1996, the incidence density decreased 1-2% per year in children aged <1, 1-5, or 6-10years (all 95% confidence intervals within 0.3%-3%), while no substantial change was seen in older children.
Conclusion:
The incidence of drug-treated childhood epilepsy from the late 1960s to the early 1990s distinctly increased. The reasons for the increase are not fully understood but may include increasing ascertainment through improved diagnosis and a wider acceptance of AED treatment. Since the 1990s, a slight decline can be seen, probably reflecting the recent improvement in child health and safety.
