Air pollution and childhood epilepsy diagnosis at a first seizure clinic in The Netherlands: A case-control study

Increasing evidence suggests that exposure to air pollution is linked to neurological disorders, but little is known about the association with epilepsy. This study aimed to quantify the association between exposure to ambient air pollutants and the diagnosis of epilepsy in Dutch children. A population-based case-control study was conducted among children presenting to the first seizure clinic at the Wilhelmina Children's Hospital in Utrecht, the Netherlands, from 1 January 2008 to 31 May 2021. Children were assigned to either cases (i.e., diagnosed with epilepsy, n = 406) or controls (n = 737). Levels of ambient air pollution (nitrogen dioxide [NO₂], ozone [O₃], and particulate matter with aerodynamic diameter < 10 μm [PM₁₀] and < 2.5 μm [PM_2.5]) exposure were assigned for the year of presentation to the residential addresses of study participants using EU-wide air pollution metrics. Logistic regression models, adjusted for common confounders, were applied to calculate odds ratios (ORs) with 95 % confidence intervals (CIs) for the association between air pollution and epilepsy. Overall, no association between ambient air pollution and an epilepsy diagnosis was observed, including NO₂ (OR: 1.01, 95 % CI: 0.98, 1.03), O₃ (OR: 1.01, 95 % CI: 0.98, 1.03), PM_2.5 (OR: 0.99, 95 % CI: 0.94, 1.04), and PM₁₀ (OR: 0.99, 95 % CI: 0.95, 1.02). Subgroup analysis was suggestive but ultimately underpowered to draw any meaningful conclusions. Additional work, including a longitudinal evaluation of air pollutants, a closer examination of epilepsy etiologies, and a wider, community-based approach, is needed to explore these findings further.