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Su L, Chang M, Li Y, Ding H, Zhao X, Li B, Li J. Analysis of factors influencing the efficacy of vagus nerve stimulation for the treatment of drug-resistant epilepsy in children and prediction model for efficacy evaluation. Front Neurol 2024; 15:1321245. [PMID: 38419715 PMCID: PMC10899677 DOI: 10.3389/fneur.2024.1321245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Vagus nerve stimulation (VNS) has been widely used in the treatment of drug-resistant epilepsy (DRE) in children. We aimed to explore the efficacy and safety of VNS, focusing on factors that can influence the efficacy of VNS, and construct a prediction model for the efficacy of VNS in the treatment of DRE children. Methods Retrospectively analyzed 45 DRE children who underwent VNS at Qilu Hospital of Shandong University from June 2016 to November 2022. A ≥50% reduction in seizure frequency was defined as responder, logistic regression analyses were performed to analyze factors affecting the efficacy of VNS, and a predictive model was constructed. The predictive model was evaluated by receiver operating characteristic curve (ROC), calibration curves, and decision curve analyses (DCA). Results A total of 45 DRE children were included in this study, and the frequency of seizures was significantly reduced after VNS treatment, with 25 responders (55.6%), of whom 6 (13.3%) achieved seizure freedom. There was a significant improvement in the Quality of Life in Childhood Epilepsy Questionnaire (15.5%) and Seizure Severity Score (46.2%). 16 potential factors affecting the efficacy of VNS were included, and three statistically significant positive predictors were ultimately screened: shorter seizure duration, focal seizure, and absence of intellectual disability. We developed a nomogram for predicting the efficacy of VNS in the treatment of DRE children. The ROC curve confirmed that the predictive model has good diagnostic performance (AUC = 0.864, P < 0.05), and the nomogram can be further validated by bootstrapping for 1,000 repetitions, with a C-index of 0.837. Besides, this model showed good fitting and calibration and positive net benefits in decision curve analysis. Conclusion VNS is a safe and effective treatment for DRE children. We developed a predictive nomogram for the efficacy of VNS, which provides a basis for more accurate selection of VNS patients.
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Affiliation(s)
- Li Su
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mengmeng Chang
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yumei Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hao Ding
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoyu Zhao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jun Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Smith ML, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Widjaja E. A longitudinal cohort study of mediators of health-related quality of life after pediatric epilepsy surgery or medical treatment. Epilepsia 2023; 64:2162-2171. [PMID: 37212692 DOI: 10.1111/epi.17660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The purpose of this longitudinal cohort study was to examine the variables that influence health-related quality of life (HRQOL) after epilepsy surgery in children. We examined whether treatment type (surgical vs medical therapy) and seizure control are related to other variables that have been shown to influence HRQOL, namely depressive symptoms in children with epilepsy or their parents, and the availability of family resources. METHODS In total, 265 children with drug-resistant epilepsy were recruited from eight epilepsy centers across Canada at the time of their evaluation for candidacy for epilepsy surgery and were assessed at baseline, 6-month, 1-year, and 2-year follow-up. Parents completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) and measures of family resources and depression; children completed depression inventories. Causal mediation analyses using natural effect models were used to evaluate the extent to which the relationship between treatment and HRQOL was explained by seizure control, child and parent depressive symptoms, and family resources. RESULTS Overall, 111 children underwent surgery and 154 were treated with medical therapy only. The HRQOL scores of surgical patients were 3.4 points higher (95% confidence interval [CI]: -0.2, 7.0) relative to medical patients at the 2-year follow-up after adjusting for baseline covariates, with 66% of the effect of surgery attributed to seizure control. Child or parent depressive symptoms and family resources had negligible mediation effects between treatment and HRQOL. The effect of seizure control on HRQOL was not mediated by child or parent depressive symptoms, or by family resources. SIGNIFICANCE The findings demonstrate that seizure control is on the causal pathway between epilepsy surgery and improved HRQOL in children with drug-resistant epilepsy. However, child and parent depressive symptoms and family resources were not significant mediators. The results highlight the importance of achieving seizure control to improve HRQOL.
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Affiliation(s)
- Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Philippe Major
- Division of Neurology, Department of Neurosciences, CHU Ste-Justine Hospital, University of Montreal, Montréal, Quebec, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, Montréal, Quebec, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, Lurie Children's Hospital, Chicago, Illinois, USA
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Widjaja E, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Smith ML. Trajectory of Health-Related Quality of Life After Pediatric Epilepsy Surgery. JAMA Netw Open 2023; 6:e234858. [PMID: 36972050 PMCID: PMC10043749 DOI: 10.1001/jamanetworkopen.2023.4858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Importance Health-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time. Objective To assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy. Design, Setting, and Participants Prospective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021. Exposures Epilepsy surgery or medical therapy. Main Outcomes and Measures HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics. Results There were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patients was 3.0 (95% CI, -0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95% CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72% of surgical patients were seizure-free, compared with 33% of medical patients. Seizure-free patients reported higher HRQOL than those who were not. Conclusions and Relevance This study provided evidence on the association between epilepsy surgery and children's HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.
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Affiliation(s)
- Elysa Widjaja
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, Lurie Children's Hospital, Chicago, Illinois
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Philippe Major
- Division of Neurology, Department of Pediatrics, CHU Ste-Justine Hospital, University of Montreal, Quebec, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, Quebec, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
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Spanish translation, cross-cultural adaptation, and initial assessment of psychometric properties of the Life in Childhood Epilepsy Questionnaire (QOLCE-16). Epilepsy Behav 2022; 134:108838. [PMID: 35839642 DOI: 10.1016/j.yebeh.2022.108838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was the translation and cultural adaptation (TCA) of the Spanish version of the16-item Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16) and an initial assessment of its psychometric properties. METHODS The English version of the QOLCE-16 was cross-culturally adapted into Spanish using a back TCA procedure. Subsequently, for the process of validation of the Spanish version of QOLCE-16, the parents of 75 children with epilepsy (CWE) completed the QOLCE-16 questionnaire, the Pediatric Quality-of-Life Inventory (PedsQL™ 4.0), and the Pediatric Sleep Questionnaire (PSQ) twice in an interval of 7-10 days. The psychometric properties of the four domains of functioning (cognitive, emotional, social, and physical functioning subscales) were analyzed, together with the total QOLCE-16 score using Classical Test Theory. RESULTS The scores of the Spanish version of the QOLCE-16 were obtained (alpha coefficient: 0.882, intraclass coefficient: 0.945). The standard error of measurement for the total score was 4.58, and the minimal detectable change was 13.44. Construct validity was tested using Confirmatory Factor Analysis. The estimates of the loadings for the four factors were higher than 0.35 and significant (α = 0.05). The four-factor model for QOLCE-16 [Chi- squared (p = 0.0540), comparative fit index = 0.985, Tucker-Lewis index = 0.982, root mean square error of approximation = 0.056 (0.000-0.0987), weighted root mean square residual = 0.707] showed good fit to these data. Convergent validity with PedsQL™ 4.0. was 0.791 and the discriminant validity of the QOLCE-16 with PSQ was -0.280. CONCLUSIONS The Spanish version of the QOLCE-16 displays good psychometric properties of validity and reliability. All goodness-of-fit indices represent a good model fit, maintaining the multidimensional Health-related quality-of-life (HRQoL) model of the original English version. The Spanish version of this test can be used reliably to assess HRQoL in CWE in a Spanish-speaking population.
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Nabavi Nouri M, Puka K, Palmar K, Speechley KN. Impact of number of anti-seizure medications on long-term health-related quality of life in children with epilepsy: A prospective cohort study. Seizure 2022; 99:120-126. [PMID: 35636159 DOI: 10.1016/j.seizure.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Health-related quality of life (HRQL) is compromised in children with epilepsy. We aimed to determine whether children diagnosed with epilepsy between ages 4-12 years who are exposed to a higher number of anti-seizure medication (ASM) over the first 2 years, have poorer HRQL 10 years after diagnosis. METHODS Data were obtained from 195 children enrolled in the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES) in Canada. HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) completed by parents at baseline through to 10 years after diagnosis. The total number of ASM were reported by physicians four times in the first two years after diagnosis. Multivariable block-wise linear regression was used to assess the impact of ASM (categorized as none, one, or more than one), as well as clinical and family factors on children's HRQL 10 years after diagnosis. RESULTS Children had a mean age of 7.9 ± 2.3 years at diagnosis and 92 (47%) were female. Mean QOLCE at baseline and 10 years was 72.04±14 and 78.7±16,respectively. Clinically meaningful improvement in HRQL from the 2 to 10-year follow-up was detected in 35% of children, reported similarly across all ASM treatment categories (p = .38). The number of ASM prescribed in the first two years was associated with HRQL at the 10-year follow-up, however this association was not significant when adjusting for clinical characteristics, family factors, and HRQL at the two-year follow-up (p = .75). Our data showed that HRQL at 2 years was the only variable associated with better HRQL scores at 10 years (p = <.001). CONCLUSION In children with new onset epilepsy, exposure to a higher number of ASM, when accounting for clinical and family factors as well as HRQL at 2 years, is not independently associated with lower long-term HRQL. Early HRQL was found to be a good indicator of long-term HRQL, despite the number of ASMs prescribed.
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Affiliation(s)
- Maryam Nabavi Nouri
- Department of Pediatrics, Schulich school of Dentistry and Medicine, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Klajdi Puka
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Katie Palmar
- Department of Clinical Geriatrics, NVS, Karolinska Institute, Stockholm, Sweden
| | - Kathy N Speechley
- Department of Pediatrics, Schulich school of Dentistry and Medicine, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Epidemiology and Biostatistics, Western University, London, ON, Canada
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Khalil M, Almestkawy S, Omar TEI, Ferro MA, Speechley KN. Psychometric properties of an Arabic translation of the quality of life in childhood epilepsy questionnaire (QOLCE-55). Epilepsy Behav 2022; 129:108637. [PMID: 35272207 DOI: 10.1016/j.yebeh.2022.108637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop an Arabic translation of the Quality of Life in Children with Epilepsy-55 questionnaire (QOLCE-55), and to assess its validity and reliability to be readily used in Arabic and Egyptian cultures. SUBJECTS AND METHODS The original English version of the QOLCE-55 was translated into Arabic using a forward-backward translation method, and then a cross-sectional survey was conducted including 100 children with epilepsy aged 4-18 years. Caregivers of children completed the Arabic version of the QOLCE-55. Assessment of psychometric properties of the translated questionnaire was conducted using test-retest reliability, internal consistency, and convergent and divergent validity. RESULTS The translated questionnaire showed excellent test-retest reliability with the intra-class correlation coefficient for all questionnaire domains, as well as the overall questionnaire ranging from 0.91 to 0.98. Cronbach alpha exceeded 0.7 denoting good internal consistency except for the emotional functioning scale. Convergent and divergent validity assessment showed that items of all domains significantly correlated with their scale scores with r > 0.4 and these correlations were much higher than correlations with other scales' scores, consistent with good convergent and divergent validity. The mean total HRQOL score was 65.63 ± 8.79 with the highest score for social functioning domain and lowest score for physical functioning domain. CONCLUSION The Arabic version of the QOLCE-55 can be considered a suitable, reliable, and valid tool to assess the HRQOL of children with epilepsy through their caregivers' reports.
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Affiliation(s)
- Mona Khalil
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt.
| | - Samar Almestkawy
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | - Tarek E I Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Canada
| | - Kathy N Speechley
- Departments of Paediatrics and Epidemiology & Biostatistics, Western University, Canada
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Shah PD, Yun M, Wu A, Arnesen RA, Storey M, Sokoloff M, Shellhaas RA, Turnage C, Axeen EJ, Goodkin HP, Patel AD, Wentzel E, Modi AC, Grinspan ZM. Pediatric Epilepsy Learning Healthcare System Quality of Life (PELHS-QOL-2): A novel health-related quality of life prompt for children with epilepsy. Epilepsia 2021; 63:672-685. [PMID: 34971001 DOI: 10.1111/epi.17156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Pediatric epilepsy is often associated with diminished health-related quality of life (HRQOL). Our aim was to establish the validity of the Pediatric Epilepsy Learning Healthcare System Quality of Life (PELHS-QOL-2) questions, a novel two-item HRQOL prompt for children with epilepsy, primarily for use in clinical care. METHODS We performed a multicenter cross-sectional study to validate the PELHS-QOL-2. Construct validity was established through bivariate comparisons with four comparator measures and known drivers of quality of life in children with epilepsy, as well as by creating an a priori multivariable model to predict the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Validity generalization was established through bivariate comparisons with demographic and clinical information. Content validity and clinical utility were established by assessing how well the PELHS-QOL-2 met eight design criteria for an HRQOL prompt established by a multistakeholder group of experts. RESULTS The final participant sample included 154 English-speaking caregivers of children with epilepsy (mean age = 9.7 years, range = .5-18, 49% female, 70% White). The PELHS-QOL-2 correlated with the four comparator instruments (ρ = .44-.56), was significantly associated with several known drivers of quality of life in children with epilepsy (p < .05), and predicted QOLCE-55 scores in the multivariate model (adjusted R2 = .54). The PELHS-QOL-2 item was not associated with the age, sex, and ethnicity of the children nor with the setting and location of data collection, although PELHS-QOL-Medications was significantly associated with race (worse for White race). Following both quantitative and qualitative analysis, the PELHS-QOL-2 met seven of eight design criteria. SIGNIFICANCE The PELHS-QOL-2 is a valid HRQOL prompt and is well suited for use in clinical care as a mechanism to routinely initiate conversations with caregivers about quality of life in children with epilepsy. The association of PELHS-QOL-Medications with race merits further study.
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Affiliation(s)
- Pooja D Shah
- Weill Cornell Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michelle Yun
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Alan Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Rachel A Arnesen
- Weill Cornell Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Margaret Storey
- College of Liberal Arts and Social Sciences, DePaul University, Chicago, Illinois, USA
| | - Max Sokoloff
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Cassie Turnage
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Erika J Axeen
- Department of Neurology, University of Virginia Children's Hospital, Charlottesville, Virginia, USA
| | - Howard P Goodkin
- Department of Neurology, University of Virginia Children's Hospital, Charlottesville, Virginia, USA
| | - Anup D Patel
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Evelynne Wentzel
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Avani C Modi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zachary M Grinspan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.,Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
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Abstract
BACKGROUND A large number of patients have epilepsy that is intractable and adversely affects a child's lifelong experience with addition societal burden that is disabling and expensive. The last two decades have seen a major explosion of new antiseizure medication options. Despite these advances, children with epilepsy continue to have intractable seizures. An option that has been long available but little used is epilepsy surgery to control intractable epilepsy. METHODS This article is a review of the literature as well as published opinions. RESULTS Epilepsy surgery in pediatrics is an underused modality to effectively treat children with epilepsy. Adverse effects of medication should be weighed against risks of surgery as well as risks of nonefficacy. CONCLUSIONS We discuss an approach to selecting the appropriate pediatric patient for consideration, a detailed evaluation including necessary evaluation, and the creation of an algorithm to approach patients with both generalized and focal epilepsy. We then discuss surgical options available including outcome data. New modalities are also addressed including high-frequency ultrasound and co-registration techniques including magnetic resonance imaging-guided laser therapy.
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Validation of the Health-Related Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) for Brazilian Portuguese. Epilepsy Behav 2021; 120:107969. [PMID: 33964539 DOI: 10.1016/j.yebeh.2021.107969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study aimed to validate the 55-item Health-Related Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) in Brazilian Portuguese and evaluate the relation of its results with clinical data and caregiver burden. METHODS The QOLCE-55 was submitted to translation, back-translation, and cultural adaptation in a pilot sample with 20 subjects. To ensure the psychometric properties of validation, the validation of the QOLCE-55 was carried out in a sample of 45 patients with epilepsy aged between 4 and 18 years and their parents or caregivers and compared with the results of other quality-of-life instruments, namely, the QVCE-50 and QOLIE-AD-48, as well as with the SDQ, abrief behavioral screeningquestionnaire. The WASI and SON-R 2½-7 [a] were used for evaluation of intelligence quotient (IQ) and the Burden Interview for the caregiver burden. RESULTS Internal consistency measured by Cronbach's alpha coefficient was moderate (0.692; p = 0.264), and the test-retest reliability analyzed by the intraclass correlation coefficient was satisfactory when compared with the results by different examiners on the same day (0.951; p = 0.001) and at different times (0.778; p = 0.001). This version of the QOLCE-55 presented a strong correlation with the QVCE-50 (0.904; p < 0.001) and SDQ (-0.428; p = 0.004) but a low correlation with the QOLIE-AD-48 (0.094; p = 0.729). This version also presented a correlation with IQ (R = 0.456, p = 0.003) and an inverse correlation with the Burden Interview (-0.390; p = 0.012). Low quality of life was associated with the presence of tonic-clonic seizures (p = 0.005), polytherapy (p = 0.003), and low socioeconomic conditions (p = 0.005). CONCLUSIONS The Brazilian Portuguese version of the QOLCE-55 was confirmed as a reliable and valid scale to assess quality of life in children and adolescents with epilepsy. Behavioral problems, caregiver burden, tonic-clonic seizures, polytherapy, and socioeconomic precariousness were associated with low quality-of-life values, while IQ was positively correlated with the quality of life in this population.
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Pachange PN, Dixit JV, C AM, Goel AD. Quality of Life among Middle and Secondary School Children with Epilepsy. J Neurosci Rural Pract 2021; 12:490-494. [PMID: 34376960 PMCID: PMC8322960 DOI: 10.1055/s-0041-1725242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives
Epilepsy is a leading cause of disability in school-going children. The objectives of this study were to estimate the prevalence of epilepsy in middle and secondary school children and to assess their quality of life (QOL).
Materials and Methods
This was a cross-sectional study done in schools under the municipal corporation area of Latur Taluka, Maharashtra. At school, children were screened for epilepsy and the positive children were visited at home. Children with confirmed epilepsy were used to calculate prevalence. The QOL of children diagnosed to have epilepsy was assessed using Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) version 1.0.
Statistical Analysis
Mean scores in scales and subscales of QOLCE-55 were calculated. Association between variables was analyzed using unpaired/independent
t
-test and analysis of variance. Statistically significance was fixed for a
p
-value less than 0.05.
Results
Prevalence of epilepsy in middle and secondary school children was found to be 3.20 per 1000. In QOLCE-55, physical functioning was the most compromised, with the lowest mean QOL score (mean = 58.3, standard deviation = 20.66). Present age of the child, age at the first seizure episode, and time interval since last seizure had a statistically significant relation with QOL. The treatment gap was found to be 70.4%.
Conclusions
Assessment of QOL in children with epilepsy is important for effective and comprehensive management of epilepsy.
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Affiliation(s)
| | - J V Dixit
- Department of Community Medicine, Government Medical College, Aurangabad, Maharashtra, India
| | - Arjun M C
- Community Medicine & Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Akhil Dhanesh Goel
- Community Medicine & Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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11
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Anguzu R, Akun P, Katairo T, Abbo C, Ningwa A, Ogwang R, Mwaka AD, Marsh K, Newton CR, Idro R. Household poverty, schooling, stigma and quality of life in adolescents with epilepsy in rural Uganda. Epilepsy Behav 2021; 114:107584. [PMID: 33248944 PMCID: PMC7613327 DOI: 10.1016/j.yebeh.2020.107584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Epilepsy remains a leading chronic neurological disorder in Low- and Middle-Income Countries. In Uganda, the highest burden is among young rural people. We aimed to; (i) describe socio-economic status (including schooling), and household poverty in adolescents living with epilepsy (ALE) compared to unaffected counterparts in the same communities and (ii) determine the factors associated with the overall quality of life (QoL). METHODS This was a cross-sectional survey nested within a larger study of ALE compared to age-matched healthy community children in Uganda. Between Sept 2016 to Sept 2017, 154 ALE and 154 healthy community controls were consecutively recruited. Adolescents recruited were frequency and age-matched based on age categories 10-14 and 15-19 years. Clinical history and standardized assessments were conducted. One control participant had incomplete assessment and was excluded. The primary outcome was overall QoL and key variables assessed were schooling status and household poverty. Descriptive and multivariable linear regression analysis were conducted for independent associations with overall QoL. RESULTS Mean (SD) age at seizure onset was 8.8 (3.9) years and median (IQR) monthly seizure burden was 2 (1-4). Epilepsy was associated with living in homes with high household poverty; 95/154 (61.7%) ALE lived in the poorest homes compared to 68/153 (44.5%) of the healthy adolescents, p = 0.001. Nearly two-thirds of ALE had dropped out of school and only 48/154 (31.2%) were currently attending school compared to 136/153 (88.9%) of healthy controls, p < 0.001. QoL was lowest among ALE who never attended school (p < 0.001), with primary education (p = 0.006) compared to those with at least secondary education. Stigma scores [mean(SD)] were highest among ALE in the poorest [69.1(34.6)], and wealthy [70.2(32.2)] quintiles compared to their counterparts in poorer [61.8(31.7)], medium [68.0(32.7)] and wealthiest [61.5(33.3)] quintiles, though not statistically significant (p = 0.75). After adjusting for covariates, ALE currently attending school had higher overall QoL compared to their counterparts who never attended school (β = 4.20, 95%CI: 0.90,7.49, p = 0.013). QoL scores were higher among ALE with ≥secondary education than those with no or primary education (β = 10.69, 95%CI: 1.65, 19.72). CONCLUSIONS ALE in this rural area are from the poorest households, are more likely to drop out of school and have the lowest QoL. Those with poorer seizure control are most affected. ALE should be included among vulnerable population groups and in addition to schooling, strategies for seizure control and addressing the epilepsy treatment gap in affected homes should be specifically targeted in state poverty eradication programs.
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Affiliation(s)
- Ronald Anguzu
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda,Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pamela Akun
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda
| | - Thomas Katairo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Abbo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Albert Ningwa
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda
| | - Rodney Ogwang
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda,Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
| | | | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Charles R. Newton
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Richard Idro
- Makerere University College of Health Sciences, Kampala, Uganda; Centre for Tropical Neuroscience, Kampala, Uganda; Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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12
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Puka K, Bax K, Andrade A, Devries-Rizzo M, Gangam H, Levin S, Nouri MN, Prasad AN, Secco M, Zou G, Speechley KN. A live-online mindfulness-based intervention for children living with epilepsy and their families: protocol for a randomized controlled trial of Making Mindfulness Matter©. Trials 2020; 21:922. [PMID: 33176853 PMCID: PMC7657360 DOI: 10.1186/s13063-020-04792-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Epilepsy extends far beyond seizures; up to 80% of children with epilepsy (CWE) may have comorbid cognitive or mental health problems, and up to 50% of parents of CWE are at risk for major depression. Past research has also shown that family environment has a greater influence on children's and parents' health-related quality of life (HRQOL) and mental health than epilepsy-related factors. There is a pressing need for low-cost, innovative interventions to improve HRQOL and mental health for CWE and their parents. The aim of this randomized controlled trial (RCT) is to evaluate whether an interactive online mindfulness-based intervention program, Making Mindfulness Matter (M3), can be feasibly implemented and whether it positively affects CWE's and parents' HRQOL and mental health (specifically, stress, behavioral, depressive, and anxiety symptoms). METHODS This parallel RCT was planned to recruit 100 child-parent dyads to be randomized 1:1 to the 8-week intervention or waitlist control and followed over 20 weeks. The intervention, M3, will be delivered online and separately to parents and children (ages 4-10 years) in groups of 4-8 by non-clinician staff of a local community epilepsy agency. The intervention incorporates mindful awareness, social-emotional learning skills, and positive psychology. It is modeled after the validated school-based MindUP program and adapted for provision online and to include a parent component. DISCUSSION This RCT will determine whether this online mindfulness-based intervention is feasible and effective for CWE and their parents. The proposed intervention may be an ideal vector to significantly improve HRQOL and mental health for CWE and their parents given its low cost and implementation by community epilepsy agencies. TRIAL REGISTRATION ClinicalTrials.gov NCT04020484 . Registered on July 16, 2019.
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Affiliation(s)
- Klajdi Puka
- Department of Epidemiology & Biostatistics, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, ON, N6A 5C1, Canada. .,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.
| | - Karen Bax
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,The Mary J. Wright Research and Education Centre, Western University, London, Ontario, Canada
| | - Andrea Andrade
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Margo Devries-Rizzo
- Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.,Health Sciences, Western University, London, Ontario, Canada
| | - Hema Gangam
- Paediatrics, Western University, London, Ontario, Canada
| | - Simon Levin
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Maryam N Nouri
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Asuri N Prasad
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Mary Secco
- Epilepsy Southwestern Ontario, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Robarts Research Institute, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology & Biostatistics, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada
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13
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Puka K, Ferro MA, Camfield CS, Levin SD, Smith ML, Wiebe S, Zou G, Speechley KN. Self-reported quality of life and degree of youth-parent agreement: A long-term follow-up of childhood-onset epilepsy. Epilepsia 2020; 61:2254-2264. [PMID: 32924172 DOI: 10.1111/epi.16665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prospectively delineate self-reported health-related quality of life (HRQOL) of adolescents and young adults (AYAs) 8 and 10 years after an epilepsy diagnosis and evaluate the degree of AYA-parent agreement in ratings of AYA's HRQOL. METHODS Data came from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES), a 10-year longitudinal study of children, aged 4-12 years, with newly diagnosed epilepsy. Epilepsy-specific HRQOL was self-reported by AYA 8 and 10 years after diagnosis and by parents at multiple time points throughout the 10-year follow-up. Measurers of HRQOL over time were analyzed using a linear mixed-effect model approach. AYA-parent agreement was evaluated using intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS A total of 165 AYAs participated at long-term follow-up. There was considerable heterogeneity among AYA's HRQOL, and as a group, there was no significant change in HRQOL from the 8- to 10-year follow-up. Household income at the time of diagnosis, seizure control at follow-up, and a history of emotional problems (anxiety/depression) were independent predictors of HRQOL at follow-up. AYA-parent agreement on AYA's HRQOL was moderate (ICC 0.62, 95% CI 0.51-0.71), although considerable differences were observed at the individual level. AYA-parent agreement varied with AYA's and parent's age, seizure control, and family environment. SIGNIFICANCE In the long-term after a diagnosis of epilepsy, AYAs report stable HRQOL over time at the group level, although notable individual differences exist. Seizure control, anxiety/depression, and family environment meaningfully impact AYA's long-term HRQOL. AYA and parent reports on HRQOL are similar at the group level, although they cannot be used interchangeably, given the large individual differences observed.
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Affiliation(s)
- Klajdi Puka
- Epidemiology & Biostatistics, Western University, London, ON, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Carol S Camfield
- Paediatrics, Child Neurology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Simon D Levin
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Paediatrics, Western University, London, ON, Canada
| | - Mary Lou Smith
- Psychology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samuel Wiebe
- Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
| | - Guangyong Zou
- Epidemiology & Biostatistics, Western University, London, ON, Canada.,Robarts Clinical Trials, Robarts Research Institute, London, ON, Canada
| | - Kathy N Speechley
- Epidemiology & Biostatistics, Western University, London, ON, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Paediatrics, Western University, London, ON, Canada
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14
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Puka K, Speechley KN, Ferro MA. Convulsive status epilepticus in children recently diagnosed with epilepsy and long-term health-related quality of life. Seizure 2020; 80:49-52. [DOI: 10.1016/j.seizure.2020.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022] Open
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15
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Puka K, Ferro MA, Camfield CS, Levin SD, Smith ML, Wiebe S, Zou G, Anderson KK, Speechley KN. Trajectories of quality of life 10 years following a diagnosis of epilepsy in childhood. Epilepsia 2020; 61:1453-1463. [PMID: 32533789 DOI: 10.1111/epi.16579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study estimated trajectories of health-related quality of life (HRQOL) over a 10-year period among children newly diagnosed with epilepsy. We also modeled the characteristics of children, parents, and families associated with each identified trajectory. METHODS Data came from the HERQULES (Health-Related Quality of Life in Children With Epilepsy Study), a Canada-wide prospective cohort study of children (aged 4-12 years) with newly diagnosed epilepsy. Parents reported on their children's HRQOL at diagnosis, and at 0.5-, 1-, 2-, 8-, and 10-year follow-ups using the Quality of Life in Childhood Epilepsy Questionnaire-55. Trajectories of HRQOL were identified using latent class growth models. Characteristics of children, parents, and families at the time of diagnosis that were associated with each trajectory were identified using multinomial logistic regression. RESULTS A total of 367 children were included. Four unique HRQOL trajectories were identified; 11% of the cohort was characterized by low and stable scores, 18% by intermediate and stable scores, 35% by intermediate scores that increased then plateaued, and 43% by high scores that increased then plateaued. Absence of comorbidities, less severe epilepsy, and better family environment (greater satisfaction with family relationships and fewer family demands) at the time of diagnosis were associated with better long-term HRQOL trajectories. Although the analyses used estimates for missing values and accounted for any nonrandom attrition, the proportion of children with poorer HRQOL trajectories may be underestimated. SIGNIFICANCE Children with new onset epilepsy are heterogenous and follow unique HRQOL trajectories over the long term. Overall, HRQOL improves for the majority in the first 2 years after diagnosis, with these improvements sustained over the long term.
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Affiliation(s)
- Klajdi Puka
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Carol S Camfield
- Paediatrics, Child Neurology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon D Levin
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada
| | - Mary Lou Smith
- Psychology, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samuel Wiebe
- Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Guangyong Zou
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | - Kelly K Anderson
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Psychiatry, Western University, London, Ontario, Canada
| | - Kathy N Speechley
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada
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