Psychopathology and Quality of Life in Children with Epilepsy: A Cross-Sectional Study

Mediating effects of sleep quality between clinical characteristics and quality of life in children with epilepsy: A cross-sectional study from Southwest China

BACKGROUND

Although sleep quality (SQ) reportedly affects the health-related quality of life (QOL) of patients with epilepsy, little is known about the potential association between SQ and QOL, particularly in children with epilepsy (CWE). Our study aimed to investigate the mediating effect of SQ on the QOL of CWE to obtain more information for the prevention and treatment of epilepsy in children.

METHODS

We collected general demographic and clinical data of 212 CWE and 79 controls (children who visited the Health Examination Department), and their guardians were instructed to answer the Children's Sleep Habits Questionnaire (CSHQ) and the optimized Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). The t-test, analysis of variance, chi-square test, and Fisher's exact test were used for between group comparisons. The Pearson correlation was used to analyze the correlation between variables. The direct, indirect, and total effects of predictors on the QOL of CWE were estimated based on an adjusted mediation model.

RESULTS

CWE had significantly smaller long-term urban residence rates, less educated guardians, higher total CSHQ score, higher incidence of poor SQ, higher bedtime resistance, more sleep anxiety, worse sleep-disordered breathing, increased parasomnia, more daytime sleepiness, more frequent night waking, and greater sleep onset delay than controls (P < 0.05 for all). The univariable analysis showed significant differences in total CSHQ scores between CWE with different seizure frequency in the last month, whether or not drug-resistant epilepsy (DRE), and with different video electroencephalogram (VEEG) findings (P < 0.05 for all). Differences in QOLCE-16 scores between CWE with different guardian's employment status, age at diagnosis, number of anti-seizure medication (ASM) types, seizure frequency in the last month, DRE status, seizure type, VEEG findings, neuropsychological evaluation findings, magnetic resonance imaging (MRI) findings, and etiology were statistically significant (P < 0.05 for all). The correlation study indicated that the total CSHQ score was negatively correlated with the QOLCE-16 score (P < 0.05). The mediation analysis showed that DRE and VEEG abnormalities had a standardized direct effect on the QOL. Seizure frequency in the last month, DRE, and VEEG abnormalities had an indirect effect on the QOL through SQ, and their mediating effect values of SQ were 31.61 %, 13.45 %, and 14.35 %, respectively.

CONCLUSION

Our findings uncovered the relationship of some clinical characteristics with SQ and QOL and characterized the nature of factors affecting the QOL of CWE. SQ could be a key factor in the prognosis of CWE experiencing epileptic seizures, and more attention should be paid on the management of SQ in interventions for epilepsy.

Parent/caregiver reported health-related functioning in Chinese children with epilepsy: A cross-sectional, parents-responded, hospital-based study

Due to epilepsy, children have faced several difficulties and challenges. Epilepsy shows an impact on a person quality of life (QoL) which can be associated with psychological, physical, and social aspects and can have a greater impact on the QoL of the person than that do through another chronic disease(s). Health-related quality of life (HRQoL) is a multidimensional concept that includes emotional, mental, physical, behavioral, and social aspects of the well-being and functioning of the patients. The objective of the study was to assess the level of HRQoL for childhood epilepsy in Chinese children under treatment for epilepsy. Also, to identify factors that can affect QoL. A descriptive, cross-sectional, parents-responded questionnaire-based study was performed on 382, 4 to 18 years old hospitalized and outpatient units' children from various backgrounds, varying socio-economic status, and of varying intellectual capability with the most recent epilepsy. The clinical and socio-demographic parameters were collected from medical records and by an interview with parents of children. The quality of life in the children with epilepsy (QoLCE) questionnaire-91 was used to access HRQoL. The average age of children was 10.4 ± 3.2 years. The duration of epilepsy in children was 3.90 ± 2.80 years. Among the enrolled children, 153 (40%) children were girls, and 229 (60%) individuals were boys. The overall QoLCE questionnaire-91 score was 69.40 ± 16.40 (minimum scores: 27.80, maximum scores: 87.80). A total of 324 (84%), 41 (11%), and 17 (5%) children were from urban, suburban, and rural types, respectively. The generalized seizure (198 (52%)) is the most common type of existing seizure followed by focal seizure (152 (40%)). Male (P = .015), older children (12-14 years, P = .019), those residing in urban areas (P = .021), and those with focal seizures (P = .049) had higher QoL scores. The overall QoL of Chinese CWE is affected by sex, age, urbanization, and seizure type but not with education or economic status of the families. The study provides helpful insight for the clinicians in the management of chronic childhood epileptic conditions (Level of Evidence: II; Technical Efficacy Stage: 5).