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Alfonso D, Ailion A, Semaan N, Davalbhakta E, Bearden DJ. Effects of physical activity on cognition and psychosocial functioning in pediatric epilepsy: A systematic review. Epilepsy Behav Rep 2024; 27:100700. [PMID: 39184195 PMCID: PMC11342123 DOI: 10.1016/j.ebr.2024.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Pediatric patients with epilepsy often have psychosocial and cognitive difficulties. Physical activity has emerged as a lifestyle modification that may reduce seizure burden, enhance brain plasticity, and improve cognitive and psychosocial comorbidities. We systematically reviewed published studies examining the effect of physical activity on cognitive and psychosocial function in children and adolescents with epilepsy. Studies were identified with PubMed and Emory Library databases. Eleven studies met inclusion criteria. Six of 10 studies related to psychosocial outcomes showed benefits of physical activity in children and adolescents with epilepsy, including improvements in internalizing symptoms, relationships, self-esteem, and psychological well-being, but four of the 10 studies showed no psychosocial benefits. Of the six studies evaluating cognitive outcomes, all six indicated that physical activity was associated with cognitive improvements in pediatric epilepsy, including areas of attention, processing speed, executive function, and memory. Our review was limited by the paucity of published studies on this topic, and the use of different measurement tools limited our ability to make direct comparisons between studies. Additional studies that compare pediatric epilepsy populations to non-epilepsy control groups are needed to better understand how physical activity affects seizure control and epilepsy-related comorbidities.
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Affiliation(s)
- Demy Alfonso
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Georgia, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia, USA
- Department of Psychology, Northern Illinois University, Illinois, USA
| | - Alyssa Ailion
- Department of Neurology and Psychiatry, Boston Children’s Hospital, MA, USA
- Department of Psychology, Harvard Medical School, Massachusetts, USA
| | - Nicole Semaan
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Georgia, USA
- Department of Neuroscience and Behavioral Biology, Emory University, Georgia, USA
| | | | - Donald J. Bearden
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Georgia, USA
- Department of Pediatrics, Division of Neurology, Emory University School of Medicine, Georgia, USA
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Ibañez-Micó S, Gil-Aparicio R, Gómez-Conesa A. Effect of a physical exercise program supported by wearable technology in children with drug-resistant epilepsy. A randomized controlled trial. Seizure 2024; 121:56-63. [PMID: 39084143 DOI: 10.1016/j.seizure.2024.07.019] [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: 04/26/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE to investigate the effects of a physical exercise (PE) program, supported by wearable technology (WT), in children with drug-resistant epilepsy (DRE). METHODS 29 children with DRE were randomized to experimental (EG) and control (CG) groups. To encourage PE, the EG performed one hour of aerobic activity three days a week for six months, outside the school setting. Compliance was monitored using activity wristbands, with data reported weekly by parents. Health-related quality of life (HRQoL), seizure frequency, physical activity (PA), physical fitness (musculoskeletal, motor, and Cardiorespiratory Fitness), and body composition, were assessed at baseline, at three and six months. RESULTS Seizure frequency in the last six months evolved from 10.5 seizures/week at baseline, to 4.5 at the end of the study in the EG, and from 5.2 seizures/week to one in the CG. Significant differences were found in weekly hours-PE (η2= 0.49); motor fitness (η2= 0.08); Cardiorespiratory Fitness (η2= 0.19); weight (η2= 0.003); Triceps skinfold thickness (η2= 0.05); lower limb muscular strength (η2= 0.03); HRQoL (η2= 0.02); and PA (η2= 0.22). Post-hoc ANOVA revealed that EG improved significantly (p < 0.05) between baseline and six months. Negative correlations were observed between PA and seizure frequency. CONCLUSION Supported by WT, children with DRE increased the weekly hours of PE at three and six months, with no increase in seizure frequency. Our study provides evidence of the effectiveness of PE for improving HRQoL.
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Affiliation(s)
- Salvador Ibañez-Micó
- Pediatric Neurology Unit, Virgen de la Arrixaca University Clinic Hospital, Murcia, Spain
| | | | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, Murcia 30100, Spain.
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Ibañez-Micó S, López-Pina JA, Gómez-Conesa A. Cross-cultural validation and psychometric properties of the Spanish version of the quality of life in Childhood epilepsy Questionnaire (QOLCE-55). Epilepsy Behav 2024; 151:109619. [PMID: 38194772 DOI: 10.1016/j.yebeh.2023.109619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The aims of the present study were to translate and validate the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) into Spanish. METHODS A backtranslation procedure was used to translate the English version of QOLCE-55 to Spanish, and subsequently, parents of 88 children (aged four to 12 years), completed the Spanish version of three self-reported questionnaires: the QOLCE-55, the Pediatric Quality-of-Life Inventory (PedsQLTM 4.0), and the Pediatric Sleep Questionnaire (PSQ). Seven to 10 days later, parents completed the questionnaires again under the same conditions. RESULTS Internal consistency was between 0.669 and 0.968 for the four subscales: cognitive (CF), emotional (EF), social (SF) and physical functioning (PF); and 0.954 for the total score. The test-retest reliability assessed with the intraclass correlation coefficient obtained values from 0.683 for SF to 0.962 for CF. The standard error of measurement for the total score was 5.776, and the minimal detectable change was 16.01. Spearman correlations between the total score of the Spanish version of the QOLCE-55 with the subscales was 0.760 for the CF, 0.776 for the EF, 0.799 for the SF, and 0.682 for the PF (p < 0.001). Convergent validity of QOLCE-55 with the PedsQLTM 4.0 scale was -0.962 (p < 0.001), and the discriminant validity of the QOLCE-55 with PSQ was 0.154 (p = 0.272). This version presented a correlation with maximum lifetime consumption of anti-epileptic drugs (0.500; p < 0.001), and current consumption (0.448; p < 0.001). CONCLUSIONS The Spanish version of the QOLCE-55 has demonstrated adequate psychometric properties, indicating that it can be confidently used to measure the health-related quality-of-life (HRQoL) in children with epilepsy in a Spanish-speaking population. These results corroborate the instrument's cross-cultural validity.
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Affiliation(s)
- Salvador Ibañez-Micó
- Pediatric Neurology Unit, Virgen de la Arrixaca University Clinic Hospital, Murcia, Spain.
| | - José A López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, 30100 Murcia, Spain; Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain.
| | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain.
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Berg AT, Dixon-Salazar T, Meskis MA, Danese SR, Le NMD, Perry MS. Caregiver-reported outcomes with real-world use of cannabidiol in Lennox-Gastaut syndrome and Dravet syndrome from the BECOME survey. Epilepsy Res 2024; 200:107280. [PMID: 38183688 DOI: 10.1016/j.eplepsyres.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Plant-derived highly purified cannabidiol (CBD) reduced the frequency of seizures associated with Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS) and improved the overall condition of patients in placebo-controlled phase 3 clinical trials. Anecdotal reports also suggest a positive effect on nonseizure outcomes. In this study, we aimed to identify, through a caregiver survey which nonseizure outcomes were most likely to change in these patients. METHODS The BEhavior, COgnition, and More with Epidiolex® (BECOME) was a 20-minute, cross-sectional, online survey that was developed with extensive input from caregivers, healthcare professionals, and epilepsy researchers, and was based on questions from validated measures and previously published caregiver reports. US-based caregivers (from Jazz Pharmaceuticals patient/caregiver database) of people with LGS or DS who were treated with CBD (Epidiolex®, 100 mg/mL oral solution) for ≥3 months were asked to compare the past month to the period before CBD initiation and rate their impression of changes using symmetrical Likert scales. RESULTS A total of 498 caregivers (97% parents) of patients with LGS (80%) or DS (20%) completed the survey. Mean (range) age of patients was 16 (1-73) years, and 52% were male. Patients were taking a median CBD dose of 14 mg/kg/d and median 4 concomitant antiseizure medications. A large proportion of respondents reported improvements in ≥1 survey question for all nonseizure-related domains: alertness, cognition, and executive function (85%); emotional functioning (82%); language and communication (79% in nonverbal patients and 74% in verbal); activities of daily living (51%); sleep (51%); and physical functioning (46%). Respondents reported improvements in seizure-related domains, including overall seizure frequency (85%), overall seizure severity (76%), seizure-free days per week for ≥1 seizure type (67%), and seizure freedom during the past month (16%). The majority of respondents who reported reduction in seizure frequency also reported improvements in nonseizure outcomes domains (51-80%). However, improvements in nonseizure outcomes (18-56%) were also reported in patients who either had no change or worsening of seizure frequency. CONCLUSIONS This survey characterized and quantified caregiver impression of changes in the seizure and nonseizure outcomes in patients taking add-on CBD treatment. Overall, 93% of caregivers reported planning to continue CBD treatment, primarily because of reduced seizure burden but also because of improvements in nonseizure-related outcomes. Despite the limitations that are associated with a retrospective survey-based study design, these results support further evaluation of the effect of CBD treatment on nonseizure outcomes among patients with LGS or DS.
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Affiliation(s)
- Anne T Berg
- Northwestern University Feinberg School of Medicine, 420 E Superior St., Chicago, IL, USA.
| | - Tracy Dixon-Salazar
- Lennox-Gastaut Syndrome Foundation, 6030 Santo Road, Suite 1, Unit, 420878, San Diego, CA, USA
| | | | - Sherry R Danese
- Outcomes Insights, 30200 Agoura Road Suite 230, Agoura Hills, CA, USA
| | - Ngoc Minh D Le
- Jazz Pharmaceuticals, Inc., 5750 Fleet Street, Suite 200, Carlsbad, CA, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, 1500 Cooper St 4th Floor, Fort Worth, TX, USA
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Rojulpote KV, 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. Pre-Operative Predictors of Health-Related Quality of Life Two Years After Pediatric Epilepsy Surgery: A Prospective Cohort Study. Seizure 2023; 111:196-202. [PMID: 37683452 DOI: 10.1016/j.seizure.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Seizure freedom is an important predictor of health-related quality of life (HRQOL) after pediatric epilepsy surgery. This study aimed to identify the pre-operative predictors of HRQOL 2 years after epilepsy surgery in children with drug-resistant epilepsy. METHODS This multicenter prospective cohort study assessed pre-operative predictors including child (demographics and clinical variables), caregiver (including caregiver depressive and anxiety symptoms) and family characteristics. HRQOL was assessed using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55 pre-operatively and 2-years after surgery. Univariable linear regression analyses were done to identify significant preoperative predictors of HRQOL 2-years after surgery, followed by multivariable regression. RESULTS Ninety-five children underwent surgery, mean age was 11.4 (SD=4.2) years, and 59 (62%) were male. Mean QOLCE scores were 57.4 (95%CI: 53.8, 61.0) pre-operatively and 65.6 (95%CI: 62.0, 69.1) after surgery. Univariable regression showed fewer anti-seizure medications (ß=-6.1 [95%CI: -11.2, -1.0], p = 0.019), older age at seizure onset (ß=1.6 [95%CI: 0.8, 2.4], p<0.001), higher pre-operative HRQOL (ß=0.7 [95%CI: 0.5, 0.8], p<0.001), higher family resources (ß=0.6 [95%CI: 0.3, 0.9], p<0.001), better family relationships (ß=1.7 [95%CI: 0.3, 3.1], p = 0.017) and lower family demands (ß=-0.9 [95%CI: -1.5, -0.4], p<0.001) were associated with higher HRQOL after surgery. Caregiver characteristics did not predict HRQOL after surgery (p>0.05). Multivariable regression showed older age at seizure onset (ß=4.6 [95%CI: 1.6, 7.6], p = 0.003) and higher pre-operative HRQOL (ß=10.2 [95%CI: 6.8, 13.6], p<0.001) were associated with higher HRQOL after surgery. CONCLUSION This study underscores the importance of optimizing pre-operative HRQOL to maximize HRQOL outcome after pediatric epilepsy surgery.
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Affiliation(s)
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Philippe Major
- Division of Neurology, Department of Neurosciences, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada; Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Andrea Andrade
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, Lurie Children's Hospital, Chicago, IL, USA.
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Perdani RRW, Arozal W, Mangunatmadja I, Kaswandani N, Handryastuti S, Medise BE, Hardi H, Thandavarayan RA, Oswari H. The efficacy and safety of first-line anti-seizure medications as substitution therapy for children with drug-resistant epilepsy: a randomized controlled trial protocol. Front Neurol 2023; 14:1237183. [PMID: 37609651 PMCID: PMC10440385 DOI: 10.3389/fneur.2023.1237183] [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: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
Although many anti-seizure medications (ASMs) are available, treatment failure, known as drug-resistant epilepsy (DRE), still occurs in around 30% of children with epilepsy. Second-line ASMs are usually used as substitution therapy in DRE to control seizures, although international consensus is not available yet. Previous studies focus on comparing the ASMs, whether as add-on or substitution therapy, mainly conducted in newly diagnosed epilepsy. However, the study that investigated first-line ASMs as substitution therapy compared to second-line ones, particularly among DRE children, is still lacking. A randomized controlled trial (RCT) enrolling 102 participants, aged 1-18, at three referral hospitals in Indonesia will be conducted, dividing them into intervention and control groups. The intervention group will be treated with first-line ASMs as the substitution therapy, while the other in the control group will get second-line ASMs. The primary outcome measure is the proportion difference of responders between groups who get first-line and second-line ASMs in 14 weeks of intervention. Clinical trial registration: ClinicalTrials.gov, identifier NCT05697614.
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Affiliation(s)
- Roro Rukmi Windi Perdani
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Child Health, Faculty of Medicine, University of Lampung, Bandar Lampung, Lampung, Indonesia
| | - Wawaimuli Arozal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Irawan Mangunatmadja
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nastiti Kaswandani
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Setyo Handryastuti
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bernie Endyarni Medise
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Harri Hardi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Hanifah Oswari
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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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: 2] [Impact Index Per Article: 2.0] [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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Navik A, Aggarwal A, Singh A, Malhotra RK. Quality of Life of Developmentally Normal Children With Epilepsy and Their Siblings. Cureus 2023; 15:e44067. [PMID: 37753007 PMCID: PMC10518430 DOI: 10.7759/cureus.44067] [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] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Quality of life (QOL) is a fundamental and multidimensional concept that should be considered with health problems, specifically chronic diseases, such as epilepsy. There have been limited studies on how pediatric epilepsy impacts the QOL of siblings of affected individuals. Hence, we studied the impact of epilepsy on the QOL of affected children and their siblings. OBJECTIVE This study aimed to assess the QOL of developmentally normal children with epilepsy and their siblings and the association of QOL scores with the clinicodemographic profile. METHODS This study was conducted at the University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India, a tertiary care hospital. The QOL of children (4-12 years) with epilepsy was assessed using epilepsy-specific questionnaires, i.e., Quality of Life in Childhood Epilepsy Questionnaire-55 (QOLCE-55), which covers the cognitive, emotional, social, and physical domains, and Pediatric Quality of Life Epilepsy Module (Peds QL EM), which covers the impact, cognitive, sleep, executive, and mood/ behavior domains. QOL in siblings was assessed using the Peds QL Inventory, which covers the following domains: physical, emotional, social, and school. The principal investigator administered these questionnaires to parents in Hindi/ English. Scoring was done as per standard instructions of the questionnaire. Clinical and demographic data were recorded in a pro forma. RESULT The median QOLCE-55 score was 81.12, with a range of 74.65-86.34, and the median Peds QL EM score was 89.31, with a range of 75.58-94.48. Overall, Cronbach's alpha of QOLCE-55 and Peds QL EM was >0.8. Breakthrough seizures (≥10) affected the overall QOL (p=0.001) and all domains of QOLCE-55 (except emotional function (p=0.44)) and Peds QL EM (except sleep/fatigue domain (p=0.59)). Age, sex, parental education, socioeconomic status, and type of epilepsy did not affect the overall QOL (p>0.05). The QOL of siblings was not affected as per the Peds QL Inventory score (median score 100) and self-made questionnaire. CONCLUSION Our results suggest that the QOL of children with epilepsy was compromised, whereas the QOL of their siblings was not affected.
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Affiliation(s)
- Abhishek Navik
- Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, IND
| | - Anju Aggarwal
- Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, IND
| | - Aaradhana Singh
- Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, IND
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Marghalani YO, Aljabri A, Kaneetah AH, Alzahrani SG, Hmoud M, Attar A. Quality of Life in Pediatrics With Intractable Epilepsy at King Abdulaziz Medical City, Jeddah, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e42417. [PMID: 37637584 PMCID: PMC10449233 DOI: 10.7759/cureus.42417] [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] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Objective The aim of this study was to assess the cognitive, emotional, social, and physical domains of quality of life (QoL) in pediatric patients with intractable epilepsy with an emphasis on depressed mood and suicidal ideation (SI). Methods This is a cross-sectional study conducted in pediatric neurology outpatient clinics in King Abdulaziz Medical City, Jeddah, Saudi Arabia. The sample consisted of 59 parents whose children aged 4-14 years of either sex had intractable epilepsy. The Quality of Life in Childhood Epilepsy Questionnaire - 55 (QOLCE-55) scale examined four domains of life: cognitive, emotional, social, and physical. Depressed mood and SI were part of the emotional domain. Results The mean ± SD age of children was 8.2 ± 3.25. The mean ± SD of overall QoL was 43.02 ± 15.70, which reflected a poor QoL. Age was not related to the QoL. Female gender was significantly associated with a lower overall QoL (P = 0.0477). Patients with comorbidities had statistically insignificant lower QoL in the cognitive, social, and physical domains in addition to lower overall QoL. Seven of nine participants who reported feeling down reported having SI in the last four weeks (P < 0.001). Conclusions An intractable epilepsy-imposed burden negatively impacts all domains of QoL. Furthermore, females experience lower overall QoL compared to males. Children with comorbidities also tend to have lower QoL scores, although the differences were statistically insignificant. Additionally, a history of feeling down is associated with SI.
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Affiliation(s)
- Yasir O Marghalani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ammar Aljabri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulrahman H Kaneetah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sultan G Alzahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Hmoud
- College of Medicine, University of Bisha, Bisha, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed Attar
- Department of Neuroscience, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Medicine, Hamilton Health Sciences Centre, Jeddah, SAU
- Department of Medicine, McMaster University, Hamilton, CAN
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10
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Chiang JA, Tran T, Swami S, Shin E, Nussbaum N, DeLeon R, Hermann BP, Clarke D, Schraegle WA. Neighborhood disadvantage and health-related quality of life in pediatric epilepsy. Epilepsy Behav 2023; 142:109171. [PMID: 36989568 DOI: 10.1016/j.yebeh.2023.109171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION While several demographic and epilepsy-specific characteristics are associated with diminished HRQoL in children and adolescents with epilepsy, prior investigations have failed to incorporate and address the influence of broader social contextual factors on functional outcomes. To address this gap, the purpose of the current study was to investigate the role of neighborhood disadvantage on HRQoL, including the extent to which familial and seizure-specific risk factors are impacted. METHODS Data included parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 135 children and adolescents with epilepsy, and the Area Deprivation Index (ADI) to measure neighborhood disadvantage. Bivariate correlations were conducted to identify significant associations with neighborhood disadvantage, followed by a three-stage hierarchical multiple regression to predict HRQoL. Follow-up binary logistic regressions were used to determine the risk conferred by neighborhood disadvantage on sociodemographic, seizure-specific, and HRQoL factors. RESULTS Moderate associations between neighborhood disadvantage and familial factors, including parental psychiatric history and Medicaid insurance, were identified, while disadvantage and greater seizure frequency were marginally associated. Neighborhood disadvantage independently predicted HRQoL, and was the sole significant predictor of HRQoL when familial factors were incorporated. Children with epilepsy living in disadvantaged areas were four times more likely to have diminished HRQoL, five times more likely to live with a parent with a significant psychiatric history, and four times more likely to reside with a family receiving Medicaid insurance. CONCLUSIONS These results highlight the importance of identifying high-risk groups, as the cumulative burden of social context, familial factors, and seizure-specific characteristics contribute to lower HRQoL in pediatric epilepsy which disproportionately affects patients from lower-resourced backgrounds. Potentially modifiable factors such as parental psychiatric status exist within the child's environment, emphasizing the importance of a whole-child approach to patient care. Further exploration of disadvantage in this population is needed to better understand these relationships over time.
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Affiliation(s)
- Jenna A Chiang
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Thomas Tran
- Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA
| | - Sonya Swami
- Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA
| | - Elice Shin
- Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA
| | - Nancy Nussbaum
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA
| | - Rosario DeLeon
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, School of Medicine and Public Health, USA
| | - Dave Clarke
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - William A Schraegle
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
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11
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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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12
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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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13
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Almojuela A, Xu Q, O'Carroll A, MacDonald C, Ritchie L, Serletis D. Development of a Pediatric Epilepsy Program: Analysis of Early Multidimensional Outcomes. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1742607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background A Pediatric Epilepsy Program was instituted in Manitoba in 2016. This report seeks to describe changes in the management of pediatric epilepsy patients in Manitoba since the inception of this Program, to provide an early analysis of local outcomes, and to present a framework for further program development.
Methods Data was collected for patients treated both before and after inception of the Program. Caregivers completed questionnaires on quality of life and program satisfaction. An online database was created to capture demographic information, seizure and quality of life outcomes, and caregiver satisfaction ratings. Descriptive statistics were used to summarize the results.
Results Prior to commencement of the Program, 16 patients underwent vagal nerve stimulator (VNS) insertion. At last follow-up, 6.25% of patients achieved Engel class I outcome, 75% achieved class III outcome, and 18.75% were classified as class IV. Following inception of the Program, 11 patients underwent resective procedures and 3 underwent VNS insertions. At last follow-up, 78.6% of patients achieved Engel class I outcome, 14.3% achieved class III outcome, and 7.1% were classified as class IV. Since inception of the Program, the average Quality of Life in Childhood Epilepsy Questionnaire-55 score measuring patient quality of life was (59.7 ± 23.2)/100. The average Care-Related Quality of Life-7D score measuring caregiver quality of life was (78.3 ± 18.6)/100. Caregiver satisfaction had an average rating of (9.4 ± 0.8)/10.
Conclusion Access to epilepsy surgery has significantly improved for children in Manitoba and has led to favorable, early multidimensional outcomes. Structural organization, funding, and multidisciplinary engagement are necessary for program sustainability and growth.
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Affiliation(s)
- Alysa Almojuela
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Aoife O'Carroll
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Carling MacDonald
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley Ritchie
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Demitre Serletis
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States
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14
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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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15
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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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16
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Altwaijri WA, Yahya BJ, Alasmari LB, Alsultan RN, Alsuhaibani SM, Alsemih RM, Moukaddem AK. Quality of life in paediatrics with intractable epilepsy in a large paediatric university hospital in Riyadh, Saudi Arabia. J Family Med Prim Care 2020; 9:5523-5536. [PMID: 33532390 PMCID: PMC7842473 DOI: 10.4103/jfmpc.jfmpc_1172_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/04/2022] Open
Abstract
Context: Epilepsy is said to be intractable when two or more trials of anticonvulsants fail to control the seizures. Literature suggests that intractable epilepsy carries a higher morbidity than controlled epilepsy in children and their caregivers. Aims: The aim of this study is to assess the quality of life (QOL) in children with intractable epilepsy (IE) in KASCH, a tertiary care hospital in Riyadh, Saudi Arabia. Settings and Design: This is a cross-sectional study utilizing a self-administered questionnaire filled by caregivers of epileptic patients visiting the outpatient neurology clinics. Methods and Materials: The quality of life in childhood epilepsy (QOLCE-55) scale examined four domains of life: cognitive, emotional, social, and physical. The sample consisted of 59 parents whose children aged 4-14 of either sex. Statistical Analysis Used: The collected data were analyzed by Statistical Package for the Social Sciences (SPSS) version 22. Results: The mean age of children was 8.9 (SD = 2.9). The mean QOL was 52.8 (SD = 12.9), which reflected a poor QOL. Age was not related to the QOL. Gender was significantly associated with the total and social scores, (P = 0.04) (P = 0.001), respectively. Out of all comorbidities, global developmental delay (GDD) and encephalopathy were significantly associated with the QOL (P < 0.05). Conclusions: Intractable epilepsy impacted all functioning domains of life rendering a poor QOL. Males have reported better QOL and social functioning compared to females. Children with GDD and encephalopathy showed lower well-being.
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Affiliation(s)
- Waleed A Altwaijri
- Department of Pediatric Neurology, King Abdullah International Medical Research Center ( KAIMRC), Riyadh, Saudi Arabia
| | - Buthaina J Yahya
- Department of College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lama B Alasmari
- Department of College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rofan N Alsultan
- Department of College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shoq M Alsuhaibani
- Department of College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rawan M Alsemih
- Department of College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Afaf K Moukaddem
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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17
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Crudgington H, Collingwood A, Bray L, Lyle S, Martin R, Gringras P, Pal DK, Morris C. Mapping epilepsy-specific patient-reported outcome measures for children to a proposed core outcome set for childhood epilepsy. Epilepsy Behav 2020; 112:107372. [PMID: 32906016 PMCID: PMC7689576 DOI: 10.1016/j.yebeh.2020.107372] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objectives of the study were to (1) map questions in epilepsy-specific patient-reported outcome measures (PROMs) of children's health-related quality of life (HRQoL) to a proposed core outcome set (COS) for childhood epilepsy research and (2) gain insight into the acceptability of two leading candidate PROMs. METHOD We identified 11 epilepsy-specific PROMs of children's HRQoL (17 questionnaire versions) in a previous systematic review. Each item from the PROMs was mapped to 38 discrete outcomes across 10 domains of the COS: seizures, sleep, social functioning, mental health, cognition, physical functioning, behavior, adverse events, family life, and global quality of life. We consulted with three children with epilepsy and six parents of children with epilepsy in Patient Public Involvement and Engagement (PPIE) work to gain an understanding of the acceptability of the two leading PROMs from our review of measurement properties: Quality of Life in Childhood Epilepsy (QOLCE-55) and Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL). RESULTS Social Functioning is covered by all PROMs except DISABKIDS and G-QOLCE and Mental Health is covered by all PROMs except G-QOLCE and Hague Restrictions in Childhood Epilepsy Scale (HARCES). Only two PROMs (Epilepsy and Learning Disability Quality of Life (ELDQOL) and Glasgow Epilepsy Outcome Scale (GEOS-YP)) have items that cover the Seizure domain. The QOLCE-55 includes items that cover the domains of Physical Functioning, Social Functioning, Behavior, Mental Health, and Cognition. The CHEQOL parent and child versions cover the same domains as QOLCE-55 except for Physical Functioning and Behavior, and the child version has one item that covers the discrete outcome of Overall Quality of Life and one item that covers the discrete outcome of Relationship with parents and siblings. The QOLCE-55 parent version was acceptable to the parents we consulted with, and CHEQOL parent and child versions were described as acceptable to our child and parent advisory panel members. SIGNIFICANCE Mapping items from existing epilepsy-specific PROMs for children is an important step in operationalizing our COS for childhood epilepsy research, alongside evaluation of their measurement properties. Two leading PROMS, QOLCE-55 and CHEQOL, cover a wide range of domains from our COS and would likely be used in conjunction with assessment tools selected for specific study objectives. The PPIE work provided practical insights into the administration and acceptability of candidate PROMs in appropriate context. We promote our COS as a framework for selecting outcomes and PROMs for future childhood epilepsy evaluative research.
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Affiliation(s)
- Holly Crudgington
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - Amber Collingwood
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - Lucy Bray
- Edge Hill University, Faculty of Health, Social Care and Medicine, UK.
| | - Samantha Lyle
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Rachael Martin
- Edge Hill University, Faculty of Health, Social Care and Medicine, UK.
| | - Paul Gringras
- Evelina London Children's Hospital, UK; King's College London Institute for Women and Children's Health, UK.
| | - Deb K. Pal
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK,Evelina London Children's Hospital, UK,MRC Centre for Neurodevelopmental Disorders, King's College London, UK,King's College Hospital, London, UK
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18
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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: 12] [Impact Index Per Article: 3.0] [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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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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Validation of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55 and QOLCE-16) for use by parents of young adults with childhood-onset epilepsy. Epilepsy Behav 2020; 104:106904. [PMID: 32000098 DOI: 10.1016/j.yebeh.2020.106904] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/05/2020] [Accepted: 01/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to validate the parent-proxy reported Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) in a sample of young adults with a history of childhood-onset epilepsy, allowing for the utilization of a consistent informant (the parent) across the youths' stages of development. The 55-item (QOLCE-55) and 16-item versions (QOLCE-16) were evaluated. METHODS Data came from 134 young adults (aged 18.0 to 28.5 years) with childhood-onset epilepsy, recruited through community and tertiary care centers across Canada. Confirmatory factor analysis (CFA) was used to assess the higher-order factor structure of the QOLCE. Cronbach's alpha was used to evaluate internal consistency. Convergent validity was assessed by intraclass correlation coefficients (ICC) with the youth self-reported Quality of Life in Epilepsy Questionnaire (QOLIE-31-P). RESULTS The higher-order factor structure of the QOLCE-55 and QOLCE-16 demonstrated adequate fit: QOLCE-55 comparative fit index (CFI) = 0.968, Tucker-Lewis index (TLI) = 0.966; and root mean square of approximation (RMSEA) = 0.061; QOLCE-16 CFI = 0.966, TFI = 0.959, RMSEA = 0.141. Higher-order factor loadings were strong, ranging from 0.71 to 0.90. Internal consistency was excellent for the total score (αQOLCE-55 = 0.97; αQOLCE-16 = 0.93) and good-excellent for each subscale (α > 78). Convergent validity was moderate to good for the total score (ICC > 0.72) and each subscale (ICC > 0.51). SIGNIFICANCE These findings provide support for the use of the QOLCE-55 and QOLCE-16 among young adults with a history of childhood-onset epilepsy. Utilizing a consistent measure and informant across the stages of development is essential to reliably evaluate change over time.
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Crudgington H, Rogers M, Morris H, Gringras P, Pal DK, Morris C. Epilepsy-specific patient-reported outcome measures of children's health-related quality of life: A systematic review of measurement properties. Epilepsia 2020; 61:230-248. [PMID: 31953859 PMCID: PMC7065094 DOI: 10.1111/epi.16430] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify and appraise published evidence of the measurement properties for epilepsy-specific patient-reported outcome measures (PROMs) of children's health-related quality of life (HRQoL). METHODS We searched multiple databases for studies evaluating the measurement properties of English-language epilepsy-specific PROMs of children's HRQoL. We assessed the methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. We extracted data about the content validity, construct validity, internal consistency, test-retest reliability, proxy reliability, responsiveness, and precision, and assessed the measurement properties with reference to standardized criteria. RESULTS We identified 27 papers that evaluated 11 PROMs. Methodological quality was variable. Construct validity, test-retest reliability, and internal consistency were more commonly assessed. Quality of Life in Childhood Epilepsy (QoLCE) questionnaires are parent-reported and evaluated more than other PROMs; QoLCE-55 has good and replicated evidence for structural and construct validity and internal consistency. Health-Related Quality of Life Measure for Children with Epilepsy (CHEQoL) has both child and parent-reported versions and good evidence of content, structural, and construct validity. SIGNIFICANCE This review identified two leading candidate epilepsy-specific PROMs for measuring health-related quality of life in children. Establishing evidence of the responsiveness of PROMs is a priority to help the interpretation of meaningful change scores.
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Affiliation(s)
- Holly Crudgington
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Morwenna Rogers
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Hannah Morris
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Paul Gringras
- Evelina London Children's HospitalLondonUK
- KCL Institute for Women and Children's HealthLondonUK
| | - Deb K. Pal
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
- MRC Centre for Neurodevelopmental DisordersKing's College LondonLondonUK
- King's College HospitalLondonUK
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Zhang H, Yu L, Li H, Liu Y. Effect of low glycaemic diet and structured exercise on quality of life and psychosocial functions in children with epilepsy. J Int Med Res 2019; 48:300060519893855. [PMID: 31865832 PMCID: PMC7686625 DOI: 10.1177/0300060519893855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The study aimed to investigate the combined effects of structured exercise
therapy and a low glycaemic diet on quality of life and psychosocial
functions in children with epilepsy. Methods Forty-two subjects aged 11 to 17 years and diagnosed with refractory epilepsy
were recruited. Structured home-based exercise and a low glycaemic diet
designed by exercise and diet specialists were administered for 6 months.
The Children’s Depression Inventory (CDI) and the Quality of Life in
Childhood Epilepsy Questionnaire (QOLCE-55) were administrated to compare
the effects of the combined treatment after 6 months. Results Participants’ mean (±standard deviation) age was 13.1 ± 2.3 years and mean
epilepsy duration was 8.9 ± 4.2 years. The seizure frequency was
approximately two to four/day per week in 28 cases and five per day/week in
8 cases. After the study period, there was a significant improvement in
seizure frequency and in scores on the CDI and QOLCE-55 scales. Conclusion Combined therapy demonstrated a promising improvement in seizure frequency,
depression level and quality of life in children with epilepsy.
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Affiliation(s)
- Hongwei Zhang
- Department of Neurology, Qilu Children's Hospital Of Shandong University, Jinan, Shandong, China
| | - Liqun Yu
- The Second People's Hospital of Dongying, Department of Pediatrics, Dongying, Shandong, China
| | - Hui Li
- Dezhou People's Hospital of Shandong Province, Department of Psychology, DeZhou, Shandong, China
| | - Yong Liu
- Department of Neurology, Qilu Children's Hospital Of Shandong University, Jinan, Shandong, China
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Almanza-Sepulveda ML, Smith ML, Widjaja E. Influence of patient, caregiver, and family factors on unmet healthcare needs in children with drug-resistant epilepsy undergoing epilepsy surgery evaluation. Epilepsy Behav 2019; 99:106502. [PMID: 31493734 DOI: 10.1016/j.yebeh.2019.106502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/03/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether patient, caregiver, and family factors correlate with unmet healthcare needs in children with drug-resistant epilepsy (DRE) who were evaluated for epilepsy surgery. METHODS Caregivers of children with DRE completed questions on unmet healthcare needs, including physical and mental needs. Patient (demographic, seizure severity, and comorbidities), caregiver (sociodemographics, depression, and anxiety), and family (family functioning, resources, and demands) factors were evaluated. A series of bivariable regression was conducted to assess the associations with unmet needs (overall, physical, and mental needs), followed by multivariable regression. RESULTS Of the 86 children with DRE, 32 (37.2%) reported having overall unmet healthcare needs, 21 (24.4%) have unmet physical, and 13 (15.1%) have unmet mental healthcare needs. Multivariable regression showed that the odds of overall unmet needs in children were higher in patients with higher depressive symptoms (odds ratio [OR] = 1.7, p = 0.03), and caregivers who were unemployed (OR = 3.8, p = 0.008). The odds of unmet physical needs in children were higher among patients with higher depressive symptoms (OR = 2.0, p = 0.02), caregivers who were older (OR = 1.1, p = 0.02), and caregivers who were unemployed (OR = 6.5, p = 0.008). There were no significant correlates between patient, caregiver, and family factors with unmet mental needs (all p > 0.05). INTERPRETATION Children with DRE were at risk for not receiving needed healthcare. Patient factors such as patient depressive symptoms, and caregiver factors such as caregivers' age and employment status were associated with unmet needs. Identifying the predictors of unmet healthcare needs is a necessary step in addressing unmet needs in this population with DRE.
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Affiliation(s)
| | - Mary Lou Smith
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto Mississauga, Toronto, Canada
| | - Elysa Widjaja
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Diagnostic Imaging, University of Toronto, Toronto, Canada; Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
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Measurement equivalence of the short-form Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16). Epilepsy Behav 2019; 90:142-147. [PMID: 30530137 DOI: 10.1016/j.yebeh.2018.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess measurement equivalence in the 16-item short-form Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16) across age, sex, and time in a sample of children with newly diagnosed epilepsy. METHODS Data came from 373 children participating in the Health-related Quality of Life in Children with Epilepsy Study (HERQULES), a multicenter prospective cohort study. Measurement equivalence was assessed using multigroup confirmatory factor analysis methods. Comparison groups were stratified by age (4-7 years vs. 8-12 years), sex (male vs. female), and time (at diagnosis vs. 24 months postdiagnosis). RESULTS The QOLCE-16 demonstrated measurement equivalence at the level of strict invariance for each comparison group tested - age: χ2 (3, 274) = 429.6, p < 0.001; comparative fit index (CFI) = 0.985; root mean square error of approximation (RMSEA) = 0.056 (0.046, 0.066); sex: χ2 (3, 271) = 430.5, p < 0.001; CFI = 0.984; RMSEA = 0.057 (0.047, 0.067); and time: χ2 (3, 269) = 566.4, p < 0.001; CFI = 0.985; RMSEA = 0.059 (0.052, 0.066). SIGNIFICANCE The findings provide support for the robust psychometric profile of the QOLCE-16 as a reliable and valid measure of health-related quality of life for children with epilepsy. Demonstrating good properties and a multidimensional structure, the QOLCE-16 is an appropriate short measure for both clinicians and researchers wanting to obtain health-related quality of life information on children with epilepsy.
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Endermann M. Lebensqualität bei Epilepsie: Ein Überblick zum Forschungsstand – Teil 1: Konzeption, Forschungsschwerpunkte, Fragebogenentwicklung. ZEITSCHRIFT FUR EPILEPTOLOGIE 2018. [DOI: 10.1007/s10309-018-0220-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McLaughlin RM, Schraegle WA, Nussbaum NL, Titus JB. Parental coping and its role in predicting health-related quality of life in pediatric epilepsy. Epilepsy Behav 2018; 87:1-6. [PMID: 30145371 DOI: 10.1016/j.yebeh.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Rachael M McLaughlin
- Neuropsychology Laboratory, Dell Children's Medical Center of Central Texas, United States of America; Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, United States of America
| | - William A Schraegle
- Neuropsychology Laboratory, Dell Children's Medical Center of Central Texas, United States of America; Department of Educational Psychology, The University of Texas at Austin, United States of America
| | - Nancy L Nussbaum
- Neuropsychology Laboratory, Dell Children's Medical Center of Central Texas, United States of America; Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, United States of America; Department of Educational Psychology, The University of Texas at Austin, United States of America
| | - Jeffrey B Titus
- Neuropsychology Laboratory, Dell Children's Medical Center of Central Texas, United States of America; Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, United States of America; Department of Neurology, Dell Medical School at The University of Texas at Austin, United States of America.
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Impact of resective epilepsy surgery on health-related quality of life in children with and without low intellectual ability. Epilepsy Behav 2018; 83:131-136. [PMID: 29705622 DOI: 10.1016/j.yebeh.2018.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The current study examined pre- and postoperative health-related quality of life (HRQL) across children with and without low intellectual ability. We also aimed to clarify the literature on postsurgical change by assessing domain-specific HRQL pre- and postoperatively in children with drug-resistant epilepsy. METHOD All patients (n=111) underwent resective epilepsy surgery between 1996 and 2016 at the Hospital for Sick Children in Toronto, comparing baseline and 1-year follow-up HRQL with the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-76). At the group-level, postsurgical change in HRQL was examined through linear mixed-effects modeling. Clinically important change in HRQL at the individual level was quantified using a standard error of measurement (SEM)-based criterion, and estimates were stratified by intellectual ability. RESULTS Children with epilepsy and low intellectual ability had lower overall HRQL compared with those with normal intelligence (b=-10.45, SE=4.89, p=.035). No differences in change in HRQL related to intellectual level were found. In the broader sample, significant postoperative improvements were found for HRQL related to physical activity (b=8.28, SE=1.79, p<.001), social activity (b=15.81, SE=2.76, p<.001), and behavior (b=4.34, SE=1.35, p=.001). Postoperative improvements in physical and social HRQL were associated with better seizure control (p=.011). Conversely, cognitive and emotional domains of HRQL did not improve one year postoperatively, even in the presence of improved seizure control. SIGNIFICANCE Results suggest that children with low intellectual ability can expect to achieve similar improvements in HRQL after epilepsy surgery compared with those with normal intelligence. Further, while overall HRQL is shown to improve in children following epilepsy surgery, domain-specific change is nuanced and has important implications for health practitioners aiming to monitor treatment progress of patients.
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Conway L, Widjaja E, Smith ML. Single-item measure for assessing quality of life in children with drug-resistant epilepsy. Epilepsia Open 2018; 3:46-54. [PMID: 29588987 PMCID: PMC5839315 DOI: 10.1002/epi4.12088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/14/2022] Open
Abstract
Objective The current study investigated the psychometric properties of a single-item quality of life (QOL) measure, the Global Quality of Life in Childhood Epilepsy question (G-QOLCE), in children with drug-resistant epilepsy. Method Data came from the Impact of Pediatric Epilepsy Surgery on Health-Related Quality of Life Study (PESQOL), a multicenter prospective cohort study (n = 118) with observations collected at baseline and at 6 months of follow-up on children aged 4-18 years. QOL was measured with the QOLCE-76 and KIDSCREEN-27. The G-QOLCE was an overall QOL question derived from the QOLCE-76. Construct validity and reliability were assessed with Spearman's correlation and intraclass correlation coefficient (ICC). Responsiveness was examined through distribution-based and anchor-based methods. Results The G-QOLCE showed moderate (r ≥ 0.30) to strong (r ≥ 0.50) correlations with composite scores, and most subscales of the QOLCE-76 and KIDSCREEN-27 at baseline and 6-month follow-up. The G-QOLCE had moderate test-retest reliability (ICC range: 0.49-0.72) and was able to detect clinically important change in patients' QOL (standardized response mean: 0.38; probability of change: 0.65; Guyatt's responsiveness statistics: 0.62 and 0.78). Caregiver anxiety and family functioning contributed most strongly to G-QOLCE scores over time. Significance Results offer promising preliminary evidence regarding the validity, reliability, and responsiveness of the proposed single-item QOL measure. The G-QOLCE is a potentially useful tool that can be feasibly administered in a busy clinical setting to evaluate clinical status and impact of treatment outcomes in pediatric epilepsy.
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Affiliation(s)
- Lauryn Conway
- Department of PsychologyHospital for Sick ChildrenTorontoOntarioCanada
- Department of PsychologyUniversity of Toronto MississaugaMississaugaOntarioCanada
| | - Elysa Widjaja
- Division of NeurologyHospital for Sick ChildrenTorontoOntarioCanada
- Diagnostic ImagingHospital for Sick ChildrenTorontoOntarioCanada
| | - Mary Lou Smith
- Department of PsychologyHospital for Sick ChildrenTorontoOntarioCanada
- Department of PsychologyUniversity of Toronto MississaugaMississaugaOntarioCanada
- Division of NeurologyHospital for Sick ChildrenTorontoOntarioCanada
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Goodwin SW, Ferro MA, Speechley KN. Development and assessment of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16). Epilepsia 2018; 59:668-678. [DOI: 10.1111/epi.14008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Shane W. Goodwin
- School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - Mark A. Ferro
- School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - Kathy N. Speechley
- Departments of Paediatrics and Epidemiology and Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
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Sajobi TT, Wang M, Ferro MA, Brobbey A, Goodwin S, Speechley KN, Wiebe S. Multivariate trajectories across multiple domains of health-related quality of life in children with new-onset epilepsy. Epilepsy Behav 2017; 75:72-78. [PMID: 28830030 DOI: 10.1016/j.yebeh.2017.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
The diagnosis of epilepsy in children is known to impact the trajectory of their health-related quality of life (HRQOL) over time. However, there is limited knowledge about variations in longitudinal trajectories across multiple domains of HRQOL. This study aims to characterize the heterogeneity in HRQOL trajectories across multiple HRQOL domains and to evaluate predictors of differences among the identified trajectory groups in children with new-onset epilepsy. Data were obtained from the Health Related Quality of Life in Children with Epilepsy Study (HERQULES), a prospective multi-center study of 373 children newly diagnosed with new-onset epilepsy who were followed up over 2years. Child HRQOL and family factors were reported by parents, and clinical characteristics were reported by neurologists. Group-based multi-trajectory modeling was adopted to characterize longitudinal trajectories of HRQOL as measured by the individual domains of cognitive, emotional, physical, and social functioning in the 55-item Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Multinomial logistic regression was used to assess potential factors that explain differences among the identified latent trajectory groups. Three distinct HRQOL trajectory subgroups were identified in children with new-onset epilepsy based on HRQOL scores: "High" (44.7%), "Intermediate" (37.0%), and "Low" (18.3%). While most trajectory groups exhibited increasing scores over time on physical and social domains, both flat and declining trajectories were noted on emotional and cognitive domains. Less severe epilepsy, an absence of cognitive and behavioral problems, lower parental depression scores, better family functioning, and fewer family demands were associated with a "Higher" or "Intermediate" HRQOL trajectory. The course of HRQOL over time in children with new-onset epilepsy appears to follow one of three different trajectories. Addressing the clinical and psychosocial determinants identified for each pattern can help clinicians provide more targeted care to these children and their families.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Meng Wang
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Anita Brobbey
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Shane Goodwin
- Department of Epidemiology & Biostatistics, Western University, London, Canada
| | - Kathy N Speechley
- Department of Epidemiology & Biostatistics, Western University, London, Canada; Department of Paediatrics, Western University, London, Ontario, Canada
| | - Samuel Wiebe
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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