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Temporal Trends in Incidence of Rolandic Epilepsy, Prevalence Of Original research Arch Dis Child: first published as 10.1136/archdischild-2019-318212 on 14 January 2020. Downloaded from Temporal trends in incidence of Rolandic epilepsy, prevalence of comorbidities and prescribing trends: birth cohort study Jacqueline Stephen,1 Christopher J Weir,1,2 Richard FM Chin 2,3 ► Additional material is ABSTRACT What is already known on this topic? published online only. To view, Objective To examine temporal trends in incidence of please visit the journal online Rolandic epilepsy (RE), prevalence of comorbidities and (http:// dx. doi. org/ 10. 1136/ Annual incidence of Rolandic epilepsy (RE) in antiepileptic drug (AED) prescribing patterns. ► archdischild- 2019- 318212). a Swedish hospital- based study in 1974 was Design Retrospective cohort study. 1Edinburgh Clinical Trials Unit, 21/100 000 and 5/100 000 in an Icelandic Setting The UK. Usher Institute, The University of population- based study in the 1990s. Edinburgh, Edinburgh, UK Patients Children aged 0–16 years born 1994–2012 ► Attention deficit hyperactivity disorder has been 2Muir Maxwell Epilepsy Centre, were followed from birth until September 2017, transfer reported in 31% of children with RE, cognitive Centre for Clinical Brain to another general practitioner practice or death or problems in 22% and behavioural problems Sciences and MRC Centre practice withdrawal from The Health Improvement for Reproductive Health, including pervasive developmental disorder in Network (THIN), whichever occurred first. The University of Edinburgh, 12%. Edinburgh, UK Main outcome measures Incidence of RE, prevalence 3 There is debate whether drug treatment Neurosciences, Royal Hospital of comorbidity and AED prescribing patterns. Read codes ► should be given; in the UK, carbamazepine and for Sick Children, Edinburgh, UK for comorbidities and AEDs were adapted from other UK lamotrigine are recommended first- line, and population-based epilepsy studies. sulthiame or valproate in other countries. Correspondence to Results There were 379 children with first RE event Dr Richard FM Chin, Muir Maxwell Epilepsy Centre, Centre recorded between 2000 and 2014 from active THIN for Clinical Brain Sciences and practices with available mid-year population counts. MRC Centre for Reproductive Crude annual incidence across all years was 5.31/100 What this study adds? Health, The University of 000 (95% CI 4.81 to 5.88). There was no significant Edinburgh, Edinburgh EH8 9YL, UK; r. chin@ ed. ac. uk time trend in adjusted incidence rate ratios (aIRR) (0.99/ ► The incidence of RE in the UK has remained year, 95% CI 0.96 to 1.02). Males had higher aIRR (1.48, virtually unchanged since 2000; crude incidence Received 9 September 2019 95% CI 1.20 to 1.82) as did children aged 6–8 and 9–11 in 2014 was 5/100 000/year and age, gender- Revised 22 November 2019 years compared with 4–5 years (aIRR 2.43, 95% CI 1.73 adjusted incidence was 3.2/100 000/year. Accepted 30 November 2019 to 3.40; aIRR 2.77, 95% CI 1.97 to 3.90, respectively). ► Population- based data confirmation that There was recorded comorbidity in 12% with 6% with a comorbidities occur in a proportion of children recorded diagnosis of pervasive developmental disorder. with RE; 12% were coded with any co- existing http://adc.bmj.com/ Half of children with RE had a record of being prescribed disorder and 6% with pervasive developmental AEDs. disorder. Conclusions UK incidence of RE has remained stable ► Half of children with RE were prescribed with crude incidence of 5/100 000/year. Carers and anti- epileptic drugs with carbamazepine and clinicians need to be aware that comorbidities may valproate remaining the most frequently exist, particularly pervasive developmental disorders. prescribed over the study period. Carbamazepine is consistently the most commonly on September 25, 2021 by guest. Protected copyright. prescribed AED for RE in the UK. studies. There are no contemporary UK studies on incidence of RE. A retrospective, chart review, hospital- based study INTRODUCTION of 196 children with RE found high prevalence of Information on frequency, cause and natural comorbid cognitive and behavioural problems. history of Rolandic epilepsy (RE) is necessary to Attention deficit hyperactivity disorder (ADHD) develop optimal treatment strategies. There are few was found in 31%, 22% had specific cognitive © Author(s) (or their published studies on the incidence of RE.1–4 problems and 11.7% had behavioural problems employer(s)) 2020. Re- use Several factors influence incidence of epilepsy including anxiety, depression and pervasive devel- permitted under CC BY- NC. No including socioeconomic status, gender, ethnicity, opmental disorder (PDD).8 Other hospital- based commercial re- use. See rights and permissions. Published adaptation of regional or international guidelines studies have reported a higher prevalence of cogni- 9 10 by BMJ. in classification and management of epilepsy, avail- tive problems in RE compared with control data. ability of experts in epilepsy.5–7 As the presence A case- control study of 89 children with RE found To cite: Stephen J, Weir CJ, and distribution of such factors can vary between they had higher anxiety and depression scores to Chin RFM. Arch Dis Child 11 Epub ahead of print: [please countries, country- specific data on incidence of controls. Hospital-based studies compared with include Day Month Year]. RE are most appropriate for resource allocation. population- based studies are more likely to produce doi:10.1136/ Furthermore, country-specific incidence would best biassed results. There are no population-based archdischild-2019-318212 inform feasibility of recruitment targets for research studies on comorbidities in RE. Stephen J, et al. Arch Dis Child 2020;0:1–6. doi:10.1136/archdischild-2019-318212 1 Original research Arch Dis Child: first published as 10.1136/archdischild-2019-318212 on 14 January 2020. Downloaded from There has been a long-standing view RE does not need treat- 2000–2017 who were epilepsy-free at entry into the subco- ment with antiepileptic drugs (AEDs).12 13 However, recent hort, to estimate the annual incidence of RE. However, there data suggesting positive treatment effects on cognitive and/ was a substantial increase in withdrawn/merged GP practices or behavioural comorbidities14 15 may influence whether to from 2015 onwards (online supplemental table 1). We therefore treat RE with AEDs. The potential negative cognitive and/or restricted analysis of annual incidence up to December 2014. behavioural effects of AEDs are well recognised, with newer The age range was chosen to cover the lower age RE usually AEDs theoretically having fewer effects.16 In the UK, for chil- starts, and upper age at which most would be seizure free.20 dren who are given treatment, carbamazepine and lamotrigine Codes used for identification of comorbidities and AEDs were are the recommended first- line AEDs. In Germany, Austria and adapted from population- based epilepsy studies2 5 21 22 and are Israel, it is sulthiame and in France it is valproate. The scientific provided as online supplemental material (online supplemental evidence for these recommended AEDs is poor.17 Although there tables 2 and 3). has been a UK survey on current treatment approaches,17 it is unclear whether prescribing patterns of AEDs in RE has changed over time. Given lack of evidence of optimum treatment of RE, StatisticaL ANALYSIS well-designed trials, with realistic recruitment targets based on We summarised over time number of practices contributing contemporary country-specific incidence estimates, are needed. mid- year population counts and returning data satisfying THIN The aims of this study were to investigate temporal trends quality criteria. Mid- year population counts were summarised in incidence of RE, prevalence of comorbidities and AED across practices. prescribing patterns in the UK. For denominators, we examined number of children in every THIN practice irrespective of whether they identified cases of RE (ie, the base population) at the midpoint of each study METHODS year, broken down by: (i) age group in years 4–5; 6–8; 9–11; We carried out a retrospective cohort study using The Health 12–14, 15–16 years; (ii) gender; (iii) GP practice, (iv) quintiles Improvement Network (THIN), a large UK- wide clinical data- of Townsend scores of socioeconomic deprivation. Townsend base that prospectively captures Vision software electronic scores were not updated since 2011, and 7% of contributing health record (EHR) data on prescriptions, diagnoses and symp- practices did not contribute Townsend data. Also, data provided toms in patients presenting to their general practitioner (GP).18 19 at the practice level were a mean of individual participants’ quar- THIN has been used to carry out a number of population-based tile Townsend score which lacks interpretability and is much less studies.5 18 Ninety eight per cent of the UK population are sensitive to differences between practices. Therefore, we were registered with a GP who provides primary care services, refers unable to adjust for socioeconomic status. patients for secondary care and shares care of patients seen in Gender and age at onset of RE were summarised descriptively, secondary care. In THIN, prescription data are automatically as was presence of comorbidities. The proportion and 95% CIs recorded each time a GP issues a prescription and coded using of children with a record of any AED prescription after RE diag- the UK Prescription Pricing Authority and classified according nosis were summarised over time. to the British National Formulary.18 Significant medical events Among the full cohort of children with RE who had at least are recorded by GPs and coded using the Read system. Data 10 years of follow- up from birth, the cumulative distribution of on contact with secondary care are entered from referrals and time to diagnosis of RE was estimated using Kaplan- Meier (KM) discharge letters. Demographic data on age, gender and post- curves.
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