The impact of epilepsy on preschool children and their families

Accessibility to formal education among persons with epilepsy in Mahenge, Tanzania

BACKGROUND

Epilepsy is estimated to affect 50 million people globally, with 80% living in sub-Saharan Africa (SSA). Children with epilepsy (CWE) in SSA are often socially isolated, and many do not get access to school. This study aimed to explore the barriers hindering accessibility to formal education among CWE in Mahenge, Tanzania.

METHODS

The study was conducted in June 2022 in four villages (Mdindo, Msogezi, Mzelezi and Sali) using quantitative and qualitative methods. The quantitative included 203 persons with epilepsy (PWE), while the qualitative involved six focus group discussions and 17 in-depth interviews. Quantitative and qualitative data were analyzed using Stata and Nvivo software, respectively.

RESULTS

Of the 203 PWE, 62 (30.5%) had never enrolled in school, while 77 (54.6%) of those enrolled dropped-out before completing it. The perceived barriers to accessing education were categorized as individual barriers (such as frequent seizures, learning difficulties, anti-seizure medication side effects and perceived stigma), Community barriers (such as stigma and discrimination, negative beliefs and misconceptions, relocation to farms and poor socio-economic status), and Institutional barriers (including lack of knowledge about epilepsy among stake-holders, topography and distance to schools).

CONCLUSION

There is a high rate of dropouts and non-enrolment of CWE in schools within the Mahenge area. Negative beliefs and low awareness of the community about epilepsy and formal education contribute to this issue. This calls for more advocacy to raise community awareness on epilepsy. The government should enforce an inclusive education policy and provide free and uninterrupted anti-seizure medication for seizure control.

Abnormal electroencephalogram (EEG) after drug withdrawal is a risk factor for epilepsy recurrence in children: a systematic review and meta-analysis

BACKGROUND

The relationship between abnormal electroencephalogram (EEG) and epilepsy recurrence after antiepileptic drug (AED) withdrawal has been controversial. We aimed to explore the relationship between abnormal EEG after AED withdrawal and the risk of epilepsy recurrence in children.

METHODS

Literature retrieval was performed using the PubMed, EMBASE, Medline, CENTRAL, and China National Knowledge Infrastructure (CNKI) databases. Included literatures were subjects of pediatric epilepsy patients who discontinued medication. The recurrence rate of epilepsy in patients with normal and abnormal EEG after AED withdrawal was observed. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of literatures. The Chi-square test was used to test heterogeneity. If heterogeneity between the articles existed, a random-effects model was used; otherwise, fixed-effects models were used. Subgroup analysis was used to explore the causes of heterogeneity. The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Mantel-Haenszel statistical method. OR was not adjusted for other factors.

RESULTS

A total of 843 articles were retrieved. Nine studies were included, with a total of 1,663 patients, including 1,299 patients with normal EEG and 364 patients with abnormal EEG. Compared with the normal EEG patients, the OR of recurrence rate after AEDs withdrawal was 3.02 (P=0.0003), with heterogeneity (P<0.0001). The funnel plot indicated that there was no publication bias among the studies. The not partial seizure group analysis showed OR =1.70 (P=0.003) and no heterogeneity (P=0.70) in patients with abnormal EEG compared to those with normal EEG. In the partial seizures subgroup, the OR of the recurrence rate after AED withdrawal was 8.08 (P<0.00001) compared with the normal EEG patients, and there was no heterogeneity (P=0.29). The funnel chart shows that the partial seizures type subgroup analysis revealed positive results, while the not partial seizure group analysis reported negative results, indicating publication bias.

CONCLUSIONS

The risk of epilepsy recurrence is higher in children with abnormal EEG after AED withdrawal, regardless of seizure type. For pediatric epilepsy patients with abnormal EEG after AED withdrawal, a more cautious discontinuation regimen, closer follow-up and monitoring are required.

Family resilience and subjective responses to caregiving for children with epilepsy

OBJECTIVES

This study quantified caregiver burdens and the positive aspects of caregiving for the parents of children with epilepsy, with a focus on the impacts of family resilience as a protective factor for the caring process.

METHODS

This cross-sectional study was conducted among 173 parents of children with epilepsy, all of whom responded to questionnaires containing the shortened Chinese version of the Family Resilience Assessment Scale (FRAS-C), positive aspects of caregiving scale (PAC), and Chinese version of the Zarit Caregiver Burden Interview (CZBI). They also provided relevant sociodemographic data.

RESULTS

The mean CZBI total score was 22.16 (SD, 14.26; range, 0-71), while the mean PAC total score was 40.05 (SD, 11.09; range 11-55). The FRAS-C total score was positively correlated with the PAC total score (r = 0.368, p < 0.001), but negatively correlated with the CZBI total score (r = -0.301, p < 0.001). A multiple linear regression analysis showed that family resilience explained PAC and CZBI at rates of 11.4% and 5.5%, respectively.

CONCLUSIONS

Parents have both positive and negative experiences when caring for children with epilepsy. In this context, family resilience may enhance the positive aspects of caregiving while reducing the frequency of negative feelings, thus highlighting the need for clinicians to focus on adequate interventions aimed at improving family resilience.

Psychometric properties of the Czech versions of the Impact of Pediatric Epilepsy Scale (IPES) and Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48)

OBJECTIVE

In order to introduce a complex system of monitoring and evaluation of the heath-related quality of life (HRQoL) of children and adolescents with epilepsy (CWE) and their families in the Czech Republic, we aimed to validate the Czech versions of two appropriate instruments - the Impact of Pediatric Epilepsy Scale (IPES) and the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48).

METHODS

The verification of the 11-item IPES was carried out in the group of parents of 248 CWE aged 2-18 years. One hundred and thirty-five CWE from the given group aged 11-18 years then completed the 48-item QOLIE-AD-48. Internal consistency, test-retest reliability (with a three-month interval) and the factorial structure of the Czech versions were determined and compared with the original instruments.

RESULTS

We found that the Czech version of the IPES exhibited very good psychometric properties including high internal consistency (Cronbach's alpha, α, of 0.93), high test-retest reliability (intraclass correlation coefficient, ICC, of 0.76) and the same 3-factor structure as the original instrument. The superiority of this 3-factor solution over the alternate 2-factor model proposed for some language versions of the IPES was determined using confirmatory factor analysis. We found 8 items in the Czech version of the QOLIE-AD-48 belonging to original Attitudes towards epilepsy and Social support subscales that do not fit well with the Czech version due to their low correlation with the total score and insufficient test-retest reliability and should be omitted. For the remaining 40 items, we have determined high internal consistency (α = 0.95) and test-retest reliability (ICC = 0.82). Confirmatory factor analysis revealed that the 6-factor solution derived from the original instrument (without two removed subscales) was appropriate for the Czech version. The individual subscales exhibited high internal consistency with α = 0.61-0.91. The external validation of both instruments was confirmed based on a significant correlation between test results and physicians' reports of the characteristics of the child's epilepsy.

CONCLUSIONS

The Czech versions of both instruments studied are reliable and valid, and can be used in the next research focusing on the effect of different treatment approaches on the HRQoL of CWE and their families.

Pediatric epilepsy surgery patients show normal psychosocial development at long-term follow-up despite dissatisfying family dynamics

Drug-resistant pediatric epilepsy involves unpredictable seizures and long-term medical management. Both factors can alter a child's psychosocial development and the dynamics of the family, to the detriment of patient and family wellbeing. While drug-resistant pediatric epilepsy can be successfully treated by neurosurgery in some cases, the outlook for psychosocial and family functioning after surgery remains unclear. A total of 163 participants across four groups took part in the current study: these were (i) individuals who had undergone surgical treatment of drug-resistant focal seizures approximately five years prior as children, and were now largely adolescents or young adults ('Patients'; n = 23), (ii) their caregivers ('Patient Caregivers'; n = 27), (iii) healthy individuals of similar age and gender to the Patients ('Controls'; n = 53), and (iv) their caregivers ('Control Caregivers'; n = 60). Based on similar software validated in adults, we built an interactive computer program, 'Living with Epilepsy', to evaluate the achievement of age-specific developmental tasks in Patients relative to their peers. The Family Adaptability and Cohesion Scale measured family dynamics. The findings showed that in the context of seizure freedom, after pediatric epilepsy surgery, Patients are similar to their healthy peers in terms of attaining developmental tasks, with no differences between the Patient and Control groups (P > .05). Family dynamics, however, seemed resistant to postsurgical adaptation, with Patients reporting lower levels of balanced family dynamics (cohesion, flexibility) and higher rates of unbalanced family dynamics (disengagement, chaos, rigidity, enmeshment) relative to Patient Caregivers (P < .001-0.041), and the Controls (P = .011-0.034). Patients also reported reduced family satisfaction compared with that of Patient Caregivers (P = .002), which was associated with polytherapy prior to surgery; that is, more drug-resistant seizures. These findings suggested that childhood-onset epilepsy has a lasting effect on family functioning, even when the child has an optimal medical and psychosocial outcome. These initial findings have significant implications for the provision of pre- to postoperative family support in pediatric epilepsy cases.

The Impact of Pediatric Epilepsy on Children and Families: A Multicenter Cross-Sectional Study

Background and Objectives:

Epilepsy is considered one of the most prevalent causes of morbidity in children. The aim of this study is to determine how epilepsy impacts the lives of children with epilepsy and their families.

Methods:

A translated version of the “Impact of Pediatric Epilepsy Scale” (IPES) questionnaire was completed by the 80 mothers of children with epilepsy, recruited at three hospitals in Jeddah, Saudi Arabia This is a validated self-administered questionnaire used to assess the impact of epilepsy on the lives of the child and family, as well as the quality of life (QoL) of the child.

Results:

The mean age of children epilepsy was 6.32 years (SD = 3.22). The mean IPES score was 6.28 (SD = 8.42) and the mean child’s QoL was 2.85 (SD= 0.83). 87.5% of the mothers rated their child’s QoL as low. IPES score was significantly associated with cause of seizure (β=0.259; 95%-CI= 0.263 - 10.334; p = 0.039). Child’s QoL was significantly associated with frequency of seizure (β=0.251; 95%-CI= 0.016 - 0.568; p= 0.039) and child’s nationality (β=-0.270; 95%-CI -0.252, -0.013; p= 0.031).

Conclusions:

Pediatric epilepsy may have a greater impact on the lives of the child and the family when it is not comorbid with cerebral palsy. Quality of life tends to be lower for non-Saudi children, and children with more frequent seizures. Therefore, these groups may need more support in managing the impact that epilepsy has on their daily functioning and quality of life.

Parental coping and its role in predicting health-related quality of life in pediatric epilepsy

OBJECTIVE

Psychosocial difficulties are known to greatly impact the health-related quality of life (HRQOL) of a child with epilepsy, and parental coping is a unique aspect that has not been examined in relation to HRQOL in the pediatric population with epilepsy. This study assessed the relationship of parental coping with HRQOL and other clinical and sociodemographic factors.

METHODS

Data included parental ratings on the Illness Cognition Questionnaire-Parent (ICQ-P) and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 108 children and adolescents with epilepsy (mean 11.34 years of age). The ICQ-P examines parental coping through constructs of illness cognitions while QOLCE determines overall functioning as indicated by parents. Bivariate correlations were conducted to identify significant associations with parental coping, followed by a multiple linear regression to determine the relative contribution of parental coping on HRQOL. Sociodemographic factors on parental coping were explored with an analysis of covariance.

RESULTS

Longer duration of epilepsy (r = 0.202) and higher HRQOL (r = 0.208) were significantly associated with parental acceptance on the ICQ-P. Higher parental helplessness was significantly associated with female gender of the child (r = 0.262), diminished HRQOL (r = -0.566), greater seizure frequency (r = 0.255), and higher number of prescribed antiepileptic drugs (AEDs) (r = 0.226). Parent-rated perceived benefits did not have significant association with study variables. Multiple linear regression revealed age of seizure onset (β = 0.19, p = 0.05), seizure frequency (β = -0.22, p = 0.01), and degree of parental helplessness (β = -0.50, p ≤ 0.01) as unique predictors of HRQOL. Two separate ANCOVAs revealed no significant associations between maternal education or insurance type on parental helplessness.

SIGNIFICANCE

Parental coping is significantly related to HRQOL in youth with epilepsy, and elevated feelings of helplessness, along with epilepsy severity, predict lower HRQOL. These findings are the first to demonstrate the unique role of parental coping in HRQOL among youth with epilepsy, and they highlight the importance of providing support to the whole family during pediatric epilepsy treatment.